World Confederation for Physical Therapy edition:16 location:Amsterdam, The Netherlands date:20-23 June 2011
Introduction: The most frequent complications after burn injuries are deconditioning, muscle weakness, contractures, hypertrophic scarring, pain, itching, psychological and social impairments.
Exercising is a well-known intervention for these complications and it is evidence-based practice in children. In adults however few RCTs are available.
Aquatic exercise provides several therapeutic benefits. Buoyancy and hydrostatic pressure counteract gravity and create an environment with low joint loading and muscle resistance during movements. This might provide a more effective and attractive medium to develop physical fitness.
The study here is a pilot of a larger project to assess the influence of aquatic exercise and balneotherapy on scar maturation, physical fitness and quality of life.
Participants: Twenty-two adults between 19 and 67 years old with total body surface area (TBSA) of burns between 5% and 60% agreed to participate.
Informed consent was obtained from all patients and they were stratified into two groups. Ethical approval was obtained by the University Hospital of Leuven.
The intervention group (n=8) performed aquatic exercise during a 3-week period with 3 sessions a week (of 1 hour). Sessions consisted of light warming-up exercises, aerobic training, strength exercises and cooling down.
Methodology: The control group (n=14) received no extra treatment, however, both groups continued their conventional treatment program of physical therapy and scar care (hydration, silicone and pressure therapy).
Hand strength (hand grip strength, key and tip pinch strength), exercise capacity (distance and heart rate during 6-minutes walking test), pulmonary function (forced expiratory volume in 1 second and forced expiratory vital capacity) were assessed. All outcome measures were made at baseline, at end of intervention and at 3-month follow-up.
A paired Wilcoxon test was used to analyze the change observed at follow-up compared to baseline. A Mann Whitney U test was used to compare changes over time between the aquatic exercise group and control group. P-value, <0.05 was considered significant.
Results: No clinically relevant effects on hand strength and pulmonary function were found. The 6-minutes walking distance increased similarly in both groups, although only significant (p=0.013) for the control group probably because of the larger patient sample. This coincides the expected learning effect of approximately 10%. Nevertheless in the intervention group the walking distance after 3 weeks of therapy increased remarkably.
Mann Whitney U tests indicated no statistically significant differences between groups at baseline and at follow-up after 3 months.
Discussion: No significant relevant effects on physical parameters were found. This could be due to a limited patient population, the short training period and specificity of assessment tools in relation to the training program.
Although contradictory results were obtained, the pilot project highlights the need for a more extensive study that will assess activity of daily life and quality of life of burn patients following an aquatic exercise program for a longer period of time in a larger patient population.
Acknowledgements: The pilot project was accomplished thanks to a grant of the Belgian Burn Foundation.