Effects of Combined Aquatic Exercise and Occupational Therapy in Stroke Patients: A Retrospective Study

Abstract

Cerebrovascular accident (CVA), or stroke, is the leading cause of global mortality. National occurrence rate is ∼730,000 cases/year, while ∼4,000,000 stroke survivors must be cared for annually (estimated cost ∼$40 billion). PURPOSE: To determine if aquatic exercise (AE), concurrent with occupational therapy (OT), yielded greater functional gains in stroke patients versus OT treatment alone. METHODS: Retrospective chart review evaluating subjective CVA data from a local inpatient rehabilitation hospital. We examined 37 charts of stroke survivors (27 men, 10 women; mean age = 67y ± 11) treated at this facility, who received OT with (n = 24) or without (n = 13) concurrent AE. Functional Independence Measure (FIM) scores were examined in stroke patients who received: (1) OT treatment plus AE, or; (2) OT treatment alone. Independent t-tests were used to determine outcome differences between the two patient groups. The Pearson product moment correlation was used to determine relationships between demographic and performance variables. Linear regression was used to predict the effect of AE on length of rehab stay and FIM outcomes. RESULTS: There was a positive correlation between gender and length of stay (r=0.41, p=0.01), demonstrating that females stayed longer than males, and; BMI and length of stay (r=0.37, p=0.03), with individuals having higher BMIs staying longer. Discharge bed/chair transfer (p<0.05), locomotion (p<0.01), and stair (p<0.05) scores were higher for patients receiving AE versus those who did not. Linear regression indicated that AE predicted the following discharge FIM scores: bed/chair transfer (r2=0.14, p=0.02); locomotion (walking) (r2=0.25, p=0.002), and; stairs (r2=0.12, p=0.04). AE also predicted change in bed/chair transfer FIM score (r2=0.15, p=0.02). CONCLUSIONS: The findings indicate that AE, combined with OT, improved discharge functional outcomes (e.g. bed/chair transfer FIM score, locomotion (walking) FIM score, stairs FIM score) in stroke patients. Furthermore, combined OT and AE successfully predicted several discharge FIM outcomes indicative of independent living capability. Future research should examine a larger patient population, from multiple facilities, to determine similarities and differences in combined applications of OT and AE.