Small N designs for rehabilitation research. Water-based exercise for cardiovascular fitness in people with chronic stroke: a randomized controlled trial. A Comparison of 12 Weeks of Pilates and Aquatic Training on the Dynamic Balance of Women with Mulitple Sclerosis The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Evaluation of an aquatics programme on fitness parameters of individuals with a brain injury Aquatic therapy versus conventional land-based therapy for Parkinson's disease: an open-label pilot study. Feasibility of 2 different water-based exercise training programs in patients with Parkinson's disease: a pilot study. The effect of aquatic therapy on postural balance and muscle strength in stroke survivors — a randomized controlled pilot trial
Rehabilitation research presents unique and challenging problems to investigators during both the design and analysis periods . Statistical issues regarding sample size requirements for an adequately powered study may be in direct conflict with realistic recruitment and subject retention goals . Issues of underpowered studies , sample size requirements , and recruitment goals plague rehabilitation research . R and omized clinical trials ( RCTs ) are typically narrow in scope and thus lack generalizability to everyday , yet specific , clinical problems ; they are also costly and time-consuming and require large numbers of participants for r and omization to have optimal , desired effects . Further , the RCT design may not be applicable to assistive technologies and environmental modifications-vital components of disability and rehabilitation research -nor is it appropriate in situations in which theoretical models of change are lacking or premature . Single-case design s are better suited for studies in which underst and ing and changing patient behavior and functional status are primary goals and the targeted sample sizes are less than 30 and frequently less than 10 . Theoretical , method ological , and clinical reasons for using experimental and quasi-experimental single-case design s are presented . Recommendations for design ing and conducting single-case studies that contribute to the evidence base are also discussed OBJECTIVE To evaluate the effect of an 8-week , water-based exercise program ( experimental group ) with that of an upper-extremity function program ( control group ) to increase cardiovascular fitness within a community setting for people with stroke . DESIGN Single-blind r and omized controlled trial . SETTING Public community center . PARTICIPANTS A volunteer sample of 12 community-dwelling people with stroke with mild to moderate residual motor deficits . INTERVENTION Study subjects participated in group exercise programs for 1 hour , 3 times a week for 8 weeks . The experimental group exercised in chest-deep water at targeted heart rates . The control group performed arm and h and exercises while sitting . Main outcome measures The primary outcome measure was cardiovascular fitness ( V(O2)max ) . Secondary measures were maximal workload , muscle strength , gait speed , and the Berg Balance Scale score . RESULTS The experimental group attained significant improvements over the control group in cardiovascular fitness , maximal workload , gait speed , and paretic lower-extremity muscle strength . The relatively short program ( 8 wk ) of water-based exercise result ed in a 22 % improvement in cardiovascular fitness in a small group of people with stroke who had relatively high function . CONCLUSIONS A water-based exercise program undertaken as a group program may be an effective way to promote fitness in people with stroke Background : Multiple Sclerosis ( MS ) is a disabling chronic disease of the nervous system in which the myelin system of the central nervous system is deteriorated . The objective of this study is to underst and the effect of Pilates exercises and aquatic training for a 12 week period on the dynamic balance of MS patients . Methods : The research method is semi-experimental . As a result , among the female patients visiting the MS clinic of Kashani hospital in Esfahan , 57 patients with disease intensity levels between 0 and 4.5 were taken as sample s. The average length of the disease was 8 ± 2 years , 20;40 years old , and they were r and omly divided into three groups of Pilates exercise group , aquatic training group , and the control group . The exercise schedule for the experiment groups consisted of 12 weeks , three sessions per week , and 1 hour for each session . The dynamic balance of the patients , before and after the exercises was measured by Six Spot Step Test . Results : The adjusted mean differences of Timed Up and Go Test ( TUGT ) scores of the experimental groups are significantly different ( P<0.05 ) . Therefore , it can be said that Pilates exercise interventions and aquatic training can significantly increase the dynamic balance of the examinees in the post-experiment stage . Conclusions : Performing the Pilate exercises and aquatic training  increases dynamic balance of the MS patients . Considering the role of dynamic balance on physical fitness and enabling the person in doing is daily chores and routines , and its direct effect on the quality of life , it leads the specialists in applying these exercises as a supplementary treatment along with the medicinal treatments for MS patients OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity The primary objective was to determine the effect of an aquatic exercise programme on the physical fitness of people with a brain injury . A pre-test – post-test r and omized-groups design was conducted . Sixteen out patients with a brain injury were included in the study . Eight participants were assigned to an aquatic exercise group and eight to a control group . The components of physical fitness measured included cardiovascular endurance , body composition , muscular strength and endurance and flexibility . Measurements were taken pre- and post-programme . Results indicated an increase in components of physical fitness for the experimental group but not the control group . Increases in fitness were reported as having a positive impact on the functional capacity of individuals in the exercise group as well as enhancing the individual 's ability to complete activities of daily living successfully . Results indicate that aquatic exercise may positively impact the primary and secondary physical injuries caused by a brain injury OBJECTIVES To assess and compare 2 different protocol s of physiotherapy ( l and or water therapy ) for people with Parkinson 's disease ( PD ) focused on postural stability and self-movement , and to provide method ological information regarding progression within the program for a future larger trial . DESIGN R and omized , controlled , open-label pilot trial . SETTING Out patients , Parkinson 's disease Center of Ferrol-Galicia ( Spain ) . PARTICIPANTS Individuals ( N=11 ) with idiopathic PD in stages 2 or 3 according to the Hoehn and Yahr Scale completed the investigation ( intervention period plus follow-up ) . INTERVENTIONS After baseline evaluations , participants were r and omly assigned to a l and -based therapy ( active control group ) or a water-based therapy ( experimental group ) . Participants underwent individual sessions for 4 weeks , twice a week , for 45 minutes per session . Both interventions were matched in terms of exercise features , which were structured in stages with clear objectives and progression criteria to pass to the next phase . MAIN OUTCOME MEASURES Participants underwent a first baseline assessment , a posttest immediately after 4 weeks of intervention , and a follow-up assessment after 17 days . Evaluations were performed OFF-dose after withholding medication for 12 hours . Functional assessment s included the Functional Reach Test ( FRT ) , the Berg Balance Scale ( BBS ) , the UPDRS , the 5-m walk test , and the Timed Up and Go test . RESULTS A main effect of both therapies was seen for the FRT . Only the aquatic therapy group improved in the BBS and the UPDRS . CONCLUSIONS In this pilot study , physiotherapy protocol s produced improvement in postural stability in PD that was significantly larger after aquatic therapy . The intervention protocol s are shown to be feasible and seem to be of value in amelioration of postural stability-related impairments in PD . Some of the method ological aspects detailed here can be used to design larger controlled trials OBJECTIVE To compare the effects of 2 different water-based exercise training programs on functional mobility , motor symptoms , and quality of life ( QOL ) on patients with mild to moderate Parkinson 's disease ( PD ) . DESIGN Matched , controlled , pilot study . SETTING Outpatient Parkinson 's disease center . PARTICIPANTS Patients ( N=21 ) with PD ( Hoehn and Yahr stage range , 1 - 3 ) . INTERVENTIONS Participants were assigned to a low-intensity water exercise program ( group 1 ) or a muscular resistance water exercise intervention ( group 2 ) . Group sessions were held for 12 weeks , twice a week for 60 minutes per session . MAIN OUTCOME MEASURES Functional mobility was measured by means of the Five Times Sit-to-St and Test , while the motor part of the Unified Parkinson 's Disease Rating Scale was used to assess motor impairment . Patients ' QOL was rated by means of the 39-item Parkinson 's Disease Question naire . RESULTS Once the intervention ended , the participants ' QOL improved significantly , regardless of the program undertaken ( P=.02 for group 1 ; P=.005 for group 2 ) . Only participants in group 2 showed a significant change in functional mobility ( P=.001 ) and Parkinsonian motor symptoms ( P=.012 ) . CONCLUSIONS Water-based exercise training programs are a helpful therapy in PD . Muscular resistance programs of this kind seem to be of value in improving functional mobility , motor symptoms , and QOL in patients with PD . Some of the method ologic aspects detailed here can be used to design larger controlled trials Objective : To evaluate the effect of an aquatic therapy programme design ed to increase balance in stroke survivors . Design : A r and omized , controlled pilot trial . Setting : Rehabilitation department of a university hospital . Subjects : Ambulatory chronic stroke patients ( n = 25):13 in an aquatic therapy group and 12 in a conventional therapy group .  Interventions : The aquatic therapy group participated in a programme consisting of Ai Chi and Halliwick methods , which focused on balance and weight-bearing exercises . The conventional therapy group performed gym exercises . In both groups , the interventions occurred for 1 hour , three times per week , for eight weeks . Main measures : The primary outcome measures were Berg Balance Scale score and weight-bearing ability , as measured by vertical ground reaction force during four st and ing tasks ( rising from a chair and weight-shifting forward , backward and laterally ) . Secondary measures were muscle strength and gait . Results : Compared with the conventional therapy group , the aquatic therapy group attained significant improvements in Berg Balance Scale scores , forward and backward weight-bearing abilities of the affected limbs , and knee flexor strength ( P<0.05 ) , with effect sizes of 1.03 , 1.14 , 0.72 and 1.13 st and ard deviation units and powers of 75 , 81 , 70 and 26 % , respectively . There were no significant changes in the other measures between the two groups . Conclusions : Postural balance and knee flexor strength were improved after aquatic therapy based on the Halliwick and Ai Chi methods in stroke survivors . Because of limited power and a small population base , further studies with larger sample sizes are required
Objective : To summarize evidence on the effects of aquatic therapy on mobility in individuals with neurological diseases .