Evidenced-based aquatic therapy guidelines for Parkinson's disease

BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative  disorder characterised by motor and non-motor symptoms, affecting movement, function, mental status, and social engagement. Aquatic therapy is gaining popularity as a form of structured physical activity. Implementing aquatic research evidence into  clinical practice can be challenging due to a lack of patient and practice-based evidence  and pragmatic aquatic therapy-specific guidelines.  

AIMS: Firstly, to synthesise the literature on the effectiveness of aquatic therapy for PD  and examine the optimum aquatic therapy prescription. Subsequently, to explore the  values and preferences of people with PD. Finally, to establish international evidence-based aquatic therapy guidelines for people with PD.  

METHODS: A systematic review and meta-analysis was conducted to establish the  research evidence base. Focus groups and interviews were conducted with people with  PD in Ireland and Australia to identify factors influencing access to, participation in,  and long-term adherence to community aquatic therapy. Information from both studies  was used, along with stakeholder engagement, to obtain consensus using a 3-step modified Delphi process with over 45 international practice experts. 

RESULTS: Aquatic therapy can have positive outcomes that are comparable to land?based interventions for improving mobility, balance, gait, disability, and quality of life.  Patient-centred evidence highlighted the importance of access to community-based,  individually tailored programs, group camaraderie, and socialisation, with aquatic  therapy considered beneficial for health and wellbeing. The guidelines provide  preliminary evidence for the optimal dosage, content, safety, and delivery of aquatic programs for people with mild to advanced PD. 

DISCUSSION: The aquatic therapy guidelines presented in this thesis can be used to  guide clinical decision-making and to help standardise aquatic therapy practice, increase  safety and optimise outcomes for people with PD. It is anticipated that the guideline  infographic will be shared widely to enhance the impact of this research.