A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis: a pilot trial

BACKGROUND： An increasingly aging population implies an increasing prevalence of osteoarthritis （OA） of hip or knee. It has been ascertained that unspecific hydrotherapy of OA according to Sebastian Kneipp not only improves the range of mobility but also reduces pain significantly and increases the quality of life of the patients affected. OBJECTIVE： The main aim of this pilot study was to determine the effects of hydrotherapy in comparison to conventional physiotherapy, and to analyze the feasibility of the study design under clinical circumstances. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： The study design is a prospective randomized controlled three-arm clinical pilot trial, carried out at a specialist clinic for integrative medicine. Thirty patients diagnosed with symptomatic OA of hip or knee and radiologic findings were randomly assigned to one of two intervention groups and a control group： hydrotherapy （group 1）, physiotherapy （group 2）, and both physiotherapy and hydrotherapy （group 3, control group） of the affected joint. MAIN OUTCOME MEASURES： Primary outcome： pain intensity of the affected joint in the course of inpatient treatment; secondary outcome： health-related quality of life, joint-specific pain and mobility in the course of the study. RESULTS： Concerning the main outcome, intervention group 1 showed most beneficial effects in the course of inpatient treatment, followed by groups 3 and 2, and also the indirect flexion ability of hip or knee together with the general patient mobility through the ＂timed up and go＂ test were mainly improved within group 1 followed by groups 3 and 2. CONCLUSION： The results of this pilot study demonstrate beneficial effects of hydrotherapy. The study design is feasible. For statistically significant evidence and a robust conclusion of efficacy of Kneipp＇s hydrotherapy, a larger sample size is necessary. TRIAL REGISTRATION NUMBER： NCT 00950326.

Effect of hydrotherapy on sleep deficiency among older people in integrated community health services in Pandak Ⅰ Bantul

Objective: Relaxation technique is a nonpharmacological treatment applied to increase sleep efficiency and the quality of sleep.Hydrotherapy is one of the relaxation techniques and uses warm water to decrease stress and muscle stiffness, as well as to warm the body. The incidence of sleep deficiency among older people in Integrated Community Health Services, Pandak I Bantul, has slightly increased year by year. This research aims to evaluate the effect of hydrotherapy on sleep deprivation among older people.Methods: The research was a quasi-experimental study with a pre-post test design. Purposive sampling was used to enroll 66 older people from the Integrated Community Health Services, Pandak I Bantul, Yogyakarta, Indonesia, as a sample, and we divided them into two groups: 33 people formed the intervention group, and 33 people comprised the control group. The intervention group did hydrotherapy once a day for a total of 7 days. First, they soaked their feet in warm water for 10 minutes. The water temperature was adjusted according to the body temperature, to approximately 40.0℃-43.0℃. Then, the intervention group took a bath using warm water. The level of sleep quality was measured using the Pittsburgh Sleep Quality Index(PSQI) questionnaire. Data analysis was done using the Wilcoxon test.Results: The mean score for sleep quality in the pretest in the intervention group was 9.04(standard deviation [SD]: 2.57) and the score on the posttest was 42(SD: 1.43). The mean score for sleep quality in the intervention group was 4.67, with P=0.05.Meanwhile, the research found that the difference between the pretest and posttest scores for quality of sleep in the control group was 0.42, with P=0.059. Wilcoxon analysis found that in the intervention group, there was a significant difference after intervention using hydrotherapy, with P<0.05. In the control group, there was no significance difference between the pretest and posttest scores,with P> 0.05.Conclusions: According to the results of the present study, it appears that the practice of hydrotherapy is effective in reducing sleep deficiency and hence can be considered an effective method of intervention.

The Effectiveness of 6 Months Hydrotherapy Program Based on Halliwick Concept on the Respiratory System of Down Syndrome Children

The aim of the study was to investigate the effect of a hydrotherapy program on FVC, FEV, PEF, RR and SaO2 on children with Down syndrome over six months and to compare it with a conventional respiratory physiotherapy program. Eighteen children, with Down Syndrome, aged 6 - 11 years (9.53 ± 0.454), divided into two groups of nine, the intervention group (IG), that participated in the hydrotherapy program and the control group (CG) participated in the classical physiotherapy program. We calculated mean values of FVC, FEV, PEF, RR and SaO2 before and after six months intervention for both groups. There was a statistically significant improvement in all factors for both groups. However, were statistically more significant for the intervention group (IG). Based on a specific protocol of intervention in the water and at the same time with a group of children who participated in a similar program of classical respiratory physiotherapy, it was found to be statistically more important than the second group in improving respiratory function. We recommend the use of hydrotherapy as a complementary therapy that should be part of the weekly program of these children in addition to the existing treatments they attend.

Regulative effect for natural killer cell by hot spring hydrotherapy—Quantitative and qualitative discussion

Along with maintaining immune competent cells, one of the purposes of cancer patient is regulating the first line of defense for survival. Moreover, the factors that influence the acquired immune activity are systemic metabolic disorder in diabetes, malnutrition, extreme exhaustion, stresses, aging and medical side effect such as chemotherapy. So we have to select appropriate menu to regulate immune function through leukocyte storage. Especially, NK cell is first line of defense against virus infected cell and/or tumor cell. In order to recommend the effect of hot spring hydrotherapy on the peripheral white blood cells as a parameter for complementary and alternative medicine (CAM) within a short period, the granulocytes, lymphocytes, lymphocyte subsets in their peripheral blood were monitored. In the young group (35 or less), the number of granulocytes clearly decreased after hydrotherapy. In the older group (over 35 years old), the total number of leukocytes and lymphocytes significantly increased after the therapy. Using a FACScan, we investigated CD2, CD4, CD8, CD16, CD19 and CD56 positive cell as well as the cytokine containing cell, as direct assessment for immunological preparation (IFN-γ, IL-4 and IL-1β). After hydrotherapy, the CD16+ cells also increased outstandingly. However, the CD19+ cells clearly decreased. Moreover, there was a decrease in the cytokine-producing cell count of subjects whose blood cells had a higher number of the cell level before. All of the results indicated that hot spring hydrotherapy could regulate the immune system even in normal human. Like this, blood hormonal level was measured in order to know the mechanism of the quantitative and qualitative, adjustment of the leucocytes becomes possible within a short term. As a result of measuring, 7 kinds of hormone including mainly adrenocortical hormones, adrenalin level reduced in constitution dependent manner. From these results, it was suggested that the quantitative and qualitative fluctuation of the leukocyte by the hydrotherapy is closely related to dynamics of blood hormonal level.

Hydrotherapy treatment for patients with psoriatic arthritis—A qualitative study

Purpose: To describe how patients living with psoriatic arthritis experience long-term hydrotherapy group treatment. Studies for this group of patients are lacking. Method: Qualitative in terviews were conducted with ten informants after hydrotherapy treatment. The treatment included exercises for increased mobility, coordination, endurance, aerobic fitness, stretching and relaxation. The interviews were analysed with content analysis. Results: A theme “hydrotherapy—a multidimensional experience” and two categories emerged: situational factors and effects of hydrotherapy. The category “situ- ational factors” comprised the subcategories: warm water, training factors and a competent instructor, and the category “effects of hydro- therapy” comprised the subcategories: psy- chological effects, improved physical capacity, social effects, changed pain experience and changes in work and participation in daily life. Conclusion: Positive effects of regular hydro- therapy in a group setting were shown in physical ability, energy, sleep, cognitive function, work and participation in daily life. The instruc- tors had an important coaching role, which needs to be promoted.

A New Activated Water Charged by Electrophoresis, Effect on the Experimentally Immuno-Suppressed Animal and Their Anti-Oxidative Activity

Every individuals expose to the lisk of conventional immunodeficiency in daily life with both internal and externals. In a series of investigation, we have been assessed the various health promoting menu such as hot spring hydrotherapy, acupuncture & moxibution, light excurse, evidenced Control water western medicine technique. In this report, we try to investigate the regulatory effect of hydrotherapy by activated water molecule as our representative menu under the influence of hypothalamus system. We set up both animal and human model for assessment of hydrotherapy. Before starting experimental assessment, six males and females seven-week-old ddY mice, are used for the acute oral toxicity study. There is no sign for toxicity as judged by body weight, organ inspection by veterinary doctor. Next, young ddY mice are experimentally induced diabetes and immune-deficient status by administrating cancer chemotherapeutic agent, Streptzotosin. Charged Water was evident to control the blood sugar level compared to the Control Water group together with conventional control group. Both experimental group of mice wear statistically significant for recovery from blood sugar level and antibody secreting cell both IgM and IgG plaque-forming cell. We confirm also activated water group delivered the granulocyte that slow down the oxidative stress by super oxide.

Hot Spring Hydro Therapy Regulates Peripheral Leukocyte Together with Emotional Hormone and Receptor Positive Lymphocytes According to Each Constitution/Condition

Two primary defense systems develop in vertebrates, innate and adaptive. Despite those defense systems, the overwhelming problems of possessing this dual system, the innate or adoptive do not seem to guard or even prevent the development of one internal threat to survival, moreover sometimes direct to autoimmunity accompanying hypersensitivity. Further, every individual exposes to the risk of immunodeficiency in daily life with both internal and external stimuli. In this report, we tried to report the suitable menu for regulating the immune system modulate and discuss how we can compare and select each menu by evidence-based manner more than VAS. In a series of investigation, we have assessed the various health promoting menus such as hot spring hydrotherapy, acupuncture & moxibustion, light walking, independent to the western medicine. In this report, we try to summarize the regulatory effect of hot spring hydrotherapy as our representative menu under the influence of hypothalamus system. Their effects of elements were evaluated by the total number of peripheral leukocyte, its subsets, granulocyte and lymphocyte ratio, emotional hormones, receptor positive lymphoid cells. The regulative effects were confirmed also by other menu than hydrotherapy, acupuncture, walking etc. However, just by the simple comparison between the group before and after the hydrotherapy, we cannot exhibit the real regulatory effect by each menu. So we tried to show the effect by trying to indicate the constitution/condition dependent manner. Because the effect was not uniformly to each individual but it was dependent on each condition/constitution before the start of the menu. This is the one of the main proposes of this report for summaries that it is important to regulate the number and levels of each factor as ideal value. In other words, the regulation of each factor affected under the hypothalamus system is regulated with each constitution, under the influence of daily circumstances. The mode of regulation was the same in each menu, indicating that the higher leveler was down regulated and lower leveler was up regulated. Moreover, each vector of change was reversely correlated to the value of the day before. The other purpose of this study was designed to establish the regulatory effect of this hydrotherapy being not limited in the number of leukocyte in peripheral but in the emotional hormones. They were adrenaline and dopamine but not found another hormone for healthy individuals. Hot spring hydrotherapy for a short duration was expected to influence the immune system combining with hormone levels in the blood quantitatively. These hormones were evidenced by adrenalin and dopamine as well as adrenergic receptor positive lymphocytes. The final subject was to confirm and compare the effect of hot spring hydrotherapy and other menu. The reproducible effects were expressed by the linear slant and could compare each other with the value of slope. We tried to discuss the advantage and demerit, how we can compare each medicine with the peripheral leukocyte in number and function.

Aquatic physical therapy for Parkinson’s disease

One of the predominant effects of PD is alteration of motor skills, which leads to compromised posture and physical balance. Aquatic physical therapy, performed in a heated pool, can serve as one of intervention alternatives for PD carriers. Aim: To analyze the effects of the Halliwick Concept hydrotherapy in acquisition of motor skills in Parkinson’s disease (PD) patients. Methods: A clinical, qualitative method was used to evaluate 7 volunteers (59.85 ± 7.92 years of age, both male and female), who were in II and III stages of PD according to the Hoehn & Yar Scale. The participants were evaluated in the start and end of the interventions phase, and then the evaluation was conducted interventions in a heated pool (32?C - 34?C) twice a week, each session lasting approximately 30 minutes, totaling 10 sessions. The Halliwick Principles’ 3-phase 10-point methods were used for acquisition of aquatic motor skills. Results: They indicate an improvement in their ability to float in prone and supine positions (P = 0.04*) and longitudinal rotation in the bipedal position. Conclusion: The activation of motor control improved the motor skills of the participants.

Aquatic Physiotherapy and Parkinson’s Disease: Effects on Functional Motor Skills

Parkinson’s Disease (PD) is a progressive disease with motor impairment, and as such requires a multidisciplinary team that includes physiotherapy. Physiotherapy can stimulate learning ability, motor recovery, neuroplasticity and neuroprotection. The aquatic physiotherapy (AP) for PD enables movements to be progressively and safely executed, reducing the risk of falls. Hence, the objective of this study is to analyze the effects of an AP program on the functional motor skills of people with PD. This is a controlled quasi-experimental clinical trial, with blind assessor. The participants were male and female, diagnosed with PD, Hoehn and Yahr stages 1 to 4 and medical certificate for AP. The exclusion criteria were: not presenting independent walking;sensorial deficit;contraindications for attending a heated pool;alterations in levodopa ingestion. The functional assessments conducted on land were: walking speed test;Five Times Sit to Stand Test;Mini BESTest, Unified Parkinson’s Disease Rating Scale (UPDRS) for activities of daily living (ADL);and motor skill parts, evaluated before, after and 4 months after AP. The aquatic assessment was conducted through the Aquatic Functional Assessment Scale (AFAS). The participants were allocated in two groups: Control Group (CG), which did not take part in the pool activities, and Experimental Group (EG), which was submitted to AP, throughout 32 twice-a-week, 50-minute-long appointments. Functional exercises were proposed to respect the principles of specificity and progression regarding complexity in the aquatic activities through aquatic motor skills learning phases. Groups and times were compared statistically. At the end of the study, the EG was composed of 11 participants and the CG 7. There were no differences between the groups at the beginning of the study. A difference was observed between groups for gait speed in evaluation 2;difference between assessment 1 and 2 for GE in the ADL and motor, as well as between assessment 2 and 3 for GE in the motor assessment. CG presented a decline from assessment 1 and 3. In the aquatic assessment, the EG had a statistical difference after the intervention. It was observed that the AP program can modify the aquatic motor skills and the land motor skills of walking speed, the UPDRS ADL and the UPDRS motor.

Greek Translation, Content Validity, Test-Retest and Inter-Rater Reliability of Swimming with Independent Measure (SWIM) Assessment Test for People with Disabilities Based on Halliwick Concept

Objectives: Halliwick-based hydrotherapy has become one of the most widespread approaches in the water environment for people with disabilities. The Swimming with Independent Measure (SWIM) test was developed by Peackok (1993) based on the need to create specific aquatic assessment tests for people with disabilities. The purpose of our study was its translation into Greek language and the investigation of its metric properties. Methods: A total of 40 children with cerebral palsy aged on average 7.36 years participated in the study: 20 children with GMFCS 1 - 5 and cognitive limitations, and 20 children with GMFCS 1 - 4 without cognitive limitations. Two physiotherapists with extensive experience in hydrotherapy and Halliwick philosophy participated in the test-retest and inter-rater reliability and validity assessment. Results: The test-retest and inter-rater reliability for the overall score was found to be high (ICC = 0.99). In terms of validity, a positive correlation was found between SWIM and GMFM (r = 0.59). Conclusions: The Greek translation of the SWIM test was found to be highly reliable for assessing mental adaptation and functionality in the aquatic environment for children with disabilities, so it is recommended to professionals.

Immediate effect of fomentation on pulmonary function in patient with bronchial asthma:a case series

Background:Asthma is a major non-communicable disease affecting both children and adult populations,characterized by inflammation and narrowing of airways.Hydrotherapy is a naturopathy treatment modality effectively used to manage bronchial asthma.This case series presents the immediate effect of one such hydrotherapy treatment hot fomentation on pulmonary function in bronchial asthma.Case presentation:Three women who had chief complaints of wheezing,sneeze and breathlessness due to chronic bronchial asthma.Hot fomentation over the inter-scapular region was given to the patient for a duration of 20 minutes.Pulmonary function test was performed using Recorders&Medicine Systems Pvt Ltd.Helios 401 before and immediately after the intervention to assess the efficacy of hot fomentation.Result:When compared to baseline,the pulmonary function’s parameters,such as forced vital capacity,forced expiratory volume in the first second,forced expiratory volume in the first second/forced vital capacity ratio,forced expiratory flow(25–75%)and peak expiratory flow showed significant improvement immediately after the fomentation.Conclusion:After 20 minutes of hot fomentation,significant improvement in pulmonary function was observed.Hot fomentation over the interscapular region,could thus be used to improve clinical outcomes in the management of bronchial asthma by improving pulmonary function and relieving acute symptoms.

Effects of ice massage of the head and spine on heart rate variability in healthy volunteers

OBJECTIVE： Ice massage （IM） is one of the treatment procedures used in hydrotherapy. Though its various physiological/therapeutic effects have been reported, effects of IM of the head and spine on heart rate variability （HRV） have not been studied. Thus, this study evaluated the effects of IM of the head and spine on HRV in healthy volunteers.METHODS： Thirty subjects were randomly divided into 3 sessions： （1） IM, （2） tap water massage （TWM） and （3） prone rest （PR）. Heart rate （HR） and HRV were assessed before and after each intervention session.RESULTS： A significant increase in the mean of the intervals between adjacent QRS complexes or the instantaneous HR （RRI）, square root of mean of sum of squares of differences between adjacent normal to normal （NN） intervals （RMSSD）, number of interval differences of successive NN intervals greater than 50 milliseconds （NN50）, proportion derived by dividing NN50 by total number of NN intervals along with significant reduction in HR after IM session; significant increase in RRI along with significant reduction in HR after TWM, and a significant increase only in RMSSD after PR were observed. However, there was no significant difference between the sessions.CONCLUSION： Results of this study suggest that 20 min of IM of the head and spine is effective in reducing HR and improving HRV through vagal dominance in healthy volunteers.

Role of jet force technology in wound management

Aim:The aim was to study the role of jet force technology(JFT)in wound management.Methods:This is a retrospective analysis of 18 cases of chronic nonhealing wounds in which JFT was used.Chronic wounds which had already undergone surgical debridement but which were not ready for reconstruction(skin graft/flap)secondary to a persistent bacterial load or infection(tissue culture positive)were included in the study.Patients were divided into two groups.Group 1 included those patients who were poor candidates for anesthesia or who refused for reconstruction and were managed with JFT only.Group 2 included those patients who were cleared for anesthesia and who were and who were managed with JFT and skin graft or flap coverage.The time to negative wound cultures after JFT and the total duration of healing were noted.Results:In both the groups,all tissue culture positive chronic wounds became negative after 2±1 weeks and were ready for reconstruction.In Group 1(6 patients),the wounds completely healed in 5-6 weeks with JFT only.In Group 2(12 patients),the wounds completely healed in 3-4 weeks with JFT and skin graft/flap.Conclusion:Hydrotherapy with JFT helps in the removal of contaminants,debris,and microbial colonization of the wound leading to spontaneous wound healing and facilitating wound bed preparation for wound coverage by a skin graft or flap.