Evidence-Based Aquatic Therapy Guidelines for Parkinson’s Disease: An International Consensus Study

Article type: Research Article

Authors: Carroll, Louise M.^a | Morris, Meg. E.^{b; c} | O’Connor, William T.^d | Volpe, Daniele^e | Salsberg, Jon^{d; f} | Clifford, Amanda M.^{a; *}

Affiliations: [a] School of Allied Health, Faculty of Education and Health Sciences, Aging Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland | [b] Victorian Rehabilitation Centre, Healthscope; ARCH, College Science, Health and Engineering, La Trobe University, Bundoora, Australia | [c] College of Healthcare Sciences, James Cook University, Queensland, Australia | [d] University of Limerick School of Medicine, Faculty of Education and Health Sciences, Limerick, Ireland | [e] Fresco Parkinson Institute Centre of Excellence, “Villa Margherita”, Vicenza, Italy | [f] Health Research Institute, University of Limerick, Limerick, Ireland

Correspondence: [*] Correspondence to: Amanda M. Clifford, PhD, School of Allied Health, Faculty of Education and Health Sciences, Aging Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland. Tel.: +353 061 234118; E-mail: Amanda.Clifford@ul.ie.

Abstract: Background:Aquatic therapy is one therapy option for people living with Parkinson’s disease (PD). However, the optimal prescription, dosage, and delivery remain unclear. Objective:i) To generate consensus statements, ii) to establish evidence-based clinical practice aquatic therapy guidelines for PD. Methods:Seventy-three international experts were invited to participate in a 3-step modified Delphi study. Gaps in the aquatic therapy evidence, patient preferences, and stakeholder engagement were considered when developing the initial list of 43-statements identified by the research development group. Practice experts rated each statement on an 11-point Likert scale. Consensus for inclusion was set at a priori of ≥70% of respondents scoring an item ≥7. Two rounds of Delphi questionnaires were completed online, and the expert comments were analyzed using content analysis. An online consensus meeting with an expert subgroup (n = 10) then advised on the guideline’s acceptability and debated items until consensus for inclusion was reached. Results:Fifty experts participated in the Delphi round one (83% response rate) and 45 in round two (90% response rate), representing 15 countries. In round one, 35 statements met the criteria for consensus. Content analysis informed the revised statements in round two, where 12 of the remaining 16 statements met consensus. The final agreed aquatic therapy guidelines include key information about dosage, content, safety, contraindications, and the optimal aquatic therapy delivery throughout the disease course. Conclusion:Stakeholders, including international practice experts, informed a rigorous evidence-based approach to integrate the best available evidence, patient preferences, and practice expertise to inform these guidelines.

Keywords: Aquatic therapy, guidelines, hydrotherapy, Parkinson’s disease, physical therapy, rehabilitation

DOI: 10.3233/JPD-212881

Journal: Journal of Parkinson's Disease, vol. 12, no. 2, pp. 621-637, 2022