Discussion
pain, disability, LM muscle thickness, lumbopelvic, trunk muscle function
To the best of our knowledge, this is the first study to investigate the effects of an early aquatic rehabilitation program on pain, disability, and trunk muscle function following lumbar spine fusion. Our data supported most of the hypotheses, with the 6-week aquatic rehabilitation program significantly improving trunk muscle strength, lumbopelvic stability, and LM muscle thickness, and reducing pain and disability in patients after lumbar fusion compared with the home exercise program.Significant improvement in pain score was observed only in the experimental group. Although no research has been performed on the effects of aquatic exercise for lumbar fusion, similar pain relief effects of aquatic exercise intervention were observed in patients after total knee and hip replacementIn this study, both the aquatic rehabilitation program and home exercise program significantly improved the disability score, although better results were observed with aquatic exercise than with home exercise. We observed a 37.82% decrease in ODI in the experimental group, which was better than the previously reported data (18% and 36%)The TUGT is an assessment tool that reflects the lower extremity function and the static and dynamic balance of patients who undergo lumbar fusion. This assessment also evaluates movements necessary for ambulation in daily lifeThe experimental group exhibited significantly improved trunk extensor strength. After surgery, the trunk extensor muscle is damaged, and the patient is typically afraid to do land exercises. However, the buoyancy of water can reduce the body’s weight and load on the muscle. This can help overcome the sense of fear and pain experienced by patients that typically lead to reduced movement, thereby enhancing their willingness to move in the water. In addition, an aquatic environment may allow patients to perform exercises to reestablish motor control without exacerbating their symptomsThe lumbopelvic stability test revealed a significant intervention effect between patients in the experimental and control groups. Studies have shown that strengthening the lumbar stabilizer muscles such as transverse abdominis and multifidus can improve trunk control abilityA recent study, conducted in 2021, reported that hip abductor strengthening exercises can increase the size of LM musclesSeveral limitations of this study may partially interfere with the results. First, as the study lacked a long-term follow-up, it is unclear whether the observed improvements could be maintained for a longer period of time. Second, the study was not blinded, and thus, the outcome could not entirely exclude bias in the measurement of results. Finally, although the exercise frequency of the participants in the control group was recorded, no therapist supervised their exercises, whereas the participants in the experimental group were supervised twice while they received their aquatic exercise training. Hence, it is unclear whether the positive effects are attributable to hydrotherapy or supervision.