Effects of water-based exercise on functioning and quality of life in people with Parkinson's disease: a systematic review and meta-analysis.

AIM: To investigate the effects of the water-based exercise on balance, mobility, mobility and functional independence, functional performance, fear of falling and quality of life in people with Parkinson's disease. METHODS: We searched pubmed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base and SciELO to June 2020 for randomised controlled trials that investigated the effects of water-based exercise in people with Parkinson's disease. Two comparisons were made: water-based exercise versus usual care and water-based exercise versus land-exercise. The main outcomes were Balance, Confidence, Mobility, Unified Parkinson's Disease Rating Scale and quality of life. Mean differences (MD) with 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the I2 test. RESULTS: Fifteen randomised controlled trials were found (435 people). Compared to usual care, water-based exercise resulted in improvement in balance MD (9.1, 95% CI: 6.5, 11.8, N = 45). Water-based exercise resulted in improvement in balance MD (3.1, 95% CI: 1.2, 5.0, N = 179), mobility MD (-2.2, 95% CI: -3.3, -1.0, N = 197) and quality of life MD (-5.5, 95% CI: -11, -0.07, N = 98) compared to land-based exercise, but without significant difference in functional performance MD (0.01, 95% CI: -2.6 to 2.7, N = 69). Land-based exercise resulted in improvement in fear of falling MD (-3.5, 95% CI: -5.6, -1.3, N = 58) compared to water-based exercise. CONCLUSION: Water-based exercise was more efficient than land-based exercise and/or usual care in improving balance, mobility and quality of life in people with Parkinson's disease.

Addition of an educational programme for primary caregivers to rehabilitation improves self-care and mobility in children with cerebral palsy: a randomized controlled trial.

OBJECTIVE: To assess whether the addition of an education programme for primary caregivers to rehabilitation improves daily functioning in children with cerebral palsy. DESIGN: A randomized, single-blind, controlled study. SETTING: This study was conducted in a rehabilitation centre in Salvador, Brazil. PARTICIPANTS: A total of 63 boys and girls with cerebral palsy, at 1-12 years of age, with Gross Motor Function Classification Systems I-V, were randomly assigned to two groups: educational programme for primary caregivers and conventional rehabilitation ( n = 29) or conventional rehabilitation alone ( n = 31). INTERVENTION: Each group received 12 sessions of 30 minutes of conventional rehabilitation and 12 sessions of 45 minutes to intervention group. MEASUREMENTS: Gross Motor Function Classification System, Gross Motor Function Measure and daily functioning with the Pediatric Evaluation of Disability Inventory were assessed by a blinded assessor. The clinical outcomes were obtained at the completion of treatment (12 weeks). RESULTS: Of the 63 patients included, 60 (mean ± SD age: 4.6 ± 2.74 years) completed the protocol. The combined education and rehabilitation, as compared with conventional rehabilitation alone, yielded significantly greater benefit in the self-care domain of the Functional Skills Scale (mean change 1.74 versus 5; P = 0.001), self-care (mean change 5.52 versus 13.99; P = 0.017) and the mobility domain of the Caregiver Assistance Scale of Pediatric Evaluation of Disability Inventory (mean change 0.87 versus 17.88; P = 0.002). CONCLUSION: Self-care and mobility improved in children with cerebral palsy with the addition to conventional rehabilitation of an educational programme for primary caregivers.