1. Effect of hydrotherapy in the rehabilitative treatment of Multiple Sclerosis (MS) Volanti P, Scialabba G, De Cicco D. Neurorehabilitation Unit Fondazione Salvatore Maugeri, IRCCS P.O. “SS. Salvatore” – Mistretta (ME) May 25, 2010

2. Background  Despite major advances in MS care and disease modifying therapies, no longer term benefit on disability has yet been demonstrated  The supportive and symptomatic management provided by multidisciplinary rehabilitation programmes remain the mainstay of treatment

3. Aim of the study  To evaluate and compare the efficacy of conventional physiotherapy and hydrotherapy on impairment, disability, and quality of life of MS patients

4. Materials and Methods-1  Sixty patients affected by secondary progressive MS with mild to moderate disability (Expanded Disability Status Scale–EDSS scores≤6.5), referred to our Neurorehabilitation Unit, were randomly assigned to two groups, and matched for age, gender, EDSS and Functional Indipendence Mesaure (FIM) scores

5. Materials and Methods-2  The Control Group (n=28) received conventional physiotherapy twice a day, five times per week, for 2 consecutive months  The Hydrotherapy Group (n=32) also received conventional physiotherapy, as well as 45 min of water exercises (at 32 C) 3 times per week, for 2 consecutive months

6. Materials and Methods-3 Primary outcomes  Impairment and disability (EDSS and FIM scores)  Quality of life (McGill Qol-SIS) Secondary outcomes  Spasticity (Ashwort scale)  Pain (Visual Analogue Scale, VAS)  Fatigue (Fatigue Severity Scale, FSS)  10-mt walking time (sec)  Muscle strength (manual muscular test, MMT)  Respiratory function (spirometric parameters) At baseline, and at the end of the rehabilitative treatment, were evaluated:

7. Table 1. Demographic and clinical characteristics of groups at baseline Control Group (n=28)Hydrotherapy Group (n=32)p Age (years) 41,5 ± 8,7 45 ± 6,6ns Sex (M/F)15/1316/16ns EDSS (0-10) 6,3 ± 0,26,2 ± 0,2 ns FIM  Total score (18-128)  Motor score 83,4 ± 12,5 55,4 ± 13,9 85,7 ± 9,4 56,6 ± 9,8 ns Ashwort score (ASH, 0-4)1,7 ± 1,11,8 ± 1,2ns Pain (VAS, 0-10)4.8 ± 15 ± 0,9ns Fatigue (FSS,1-7)5,1 ± 0,6 5,2 ± 0,7 ns 10-mt walking time (sec)17,3 ± 5,119,2 ± 7,9ns Muscle Strenght (MMT)  AASS (0-70)  AAII (0-70) 66,7 ± 5,3 56,5 ± 11,5 66,3 ± 4,8 58,7 ± 10,1 ns FVC (%)97 ± 6,9101 ± 13,2ns Quality of life (McGill QoL-SIS)5,7 ± 1,15,4 ± 1,4ns

8. Results-1 FIM scores FIM scores before treatment FIM scores after treatment p Control Group 83,4 ± 12,593,6 ± 15,4<0,001 Hydrotherapy Group 85,7 ± 9,499,8 ± 10,8<0,001 pns<0,05 At the end of the 2 months of rehabilitative treatment, the Hydrotherapy Group improved significantly in disability, as assessed by the Functional Independence Measure (FIM) scores, compared to the Control Group FIM scores p=ns p<0,05

9. Results-2 EDSS scores  At the end of the two months of treatment, no significantly changes in EDSS scores were reported in the two groups p=ns EDSS

10. Results-3 Quality of life (McGill Qol-SIS) MQoL-SIS before treatment MQol-SIS after treatment p Control Group5,7 ± 1,16,1 ± 1,4ns Hydrotherapy Group 5,4 ± 1,46,8 ± 1,5p<0.05  At the end of the two months of treatment, only the Hydrotherapy Group improved significantly in quality of life MQOL-SIS

11. Results-4 Secondary outcomes  At the end of the two months of treatment, the Hydrotherapy Group also showed a larger improvement on spasticity (Ashwort score) and pain (VAS), compared to the Control Group.  No statistical differences were reported in other secondary outcomes (fatigue, muscle strength, 10-mt walking time, respiratory function), for both control and hydrotherapy group Ashwort score before and after treatment VAS scores for pain before and after treatment p=ns p<0.05

12. Conclusions  Adding hydrotherapy to the conventional physiotherapy program improve function and quality of life, and reduce spasticity and pain, in patients affected by secondary progressive multiple sclerosis with mild to moderate disability