Literature review

HYDROTHERAPY
Review on the effectiveness of it's application in physiotherapy and occupational therapy.

by Dr. Craig W.Martin, Senior Medical Advisor Kukuh Noertjojo, Health Care Analyst.
(May 2004)

I came across this review online and I was intrigued to find out what the benefits were for patients in this rehabilitation process. My new job role is in Orthopaedics and hydrotherapy, so more knowledge into this role will be extremely valuable to me.

The beginning of the review states that many practitioners believe that water has many curative properties that are not harmful or toxic. Current rehabilitation professionals define hydrotherapy as a pool therapy program specifically designed for an individual in an attempt to improve neuromuscular and skeletal function.

The therapy is conducted and supervised by appropriately qualified personnel ( physiotherapists and therapy assistants), ideally in a purpose-built hydrotherapy pool. The use of hydrotherapy as a rehabilitation tool was first described by Hippocrates (c.450-375 BC) and is now commonly used by physiotherapists and occupational therapists.

It lists how hydrotherapy is applied in numerous rehabilitation programs for:

• Improving muscular and cardiopulmonary endurance in the elderly
• Pulmonary rehabilitation in patients with severe asthma
• Ventilated patients with Guillan-Barre Syndrome
• Sports injuries
• Osteoarthritis and rheumatoid arthritis
• Various dermatological conditions
• Rett syndrome
• Chronic heart failure
• Reducing spasticity in severe traumatic brain injury patients
• Burns and wound healing
• Ankylosing spondylitis
• Fibromyalgia
• Lower back pain
• Rehabilitation post anterior cruciate ligament surgery
• Colles' fracture and total femur replacement
• Pressure ulcer
• Children with complex regional pain syndrome
• Rehabilitation of patients with supraspinatus muscle tears
• Rehabilitation of patients with spinal muscular atrophy
• Rehabilitation of ankle sprains grade 1 and 2
• Improving functional mobility in patients with incomplete c-6 spinal cord lesion
• Venous stasis/insufficiency, including haemorrhoids
• Common colds
• Urolithiasis
• Various psychiatric conditions, including hysteria.

(It is also common to occasionally be used during labour and birth).

By looking at the list of different rehabilitation programmes, I can see that hydrotherapy can cater to many different health problems, and also orthopaedic injuries such as knee and ankle which are common in dancers.

The review then addresses previous literature results that have shown the high level evidence on the effectiveness of hydrotherapy.
One example is: "Hydrotherapy and rehabilitation of patients with anterior cruciate ligament disruption."
Thomson et al conducted a Cochrane systematic review on the effectiveness of physiotherapist-led programs and interventions for rehabilitation of anterior cruciate ligament (ACL), medial collateral ligament (MCL) and meniscal injuries (M) of the knee in adults.
The authors found 31 previous trials, and only 2 of these 31 trials involved the application of hydrotherapy vs land-based rehabilitation program among patients.

The trial consisted of McClintock et al randomizing 20 post ACL reconstructive surgery patients into 2 rehabilitation programs: 10 days 'standard' home program followed by 7 hydrotherapy sessions and 10 days 'standard' home program followed by 7 land based therapy sessions. The hydrotherapy based and land-based programs were not similar or equivalent. Both rehabilitation programs took 28 days. The knee was measured pre operation, 10 days post operation and pre and post therapy sessions ( 7 measurements in all up to 28 days follow-up).
However, the authors did report that patients in the hydrotherapy program demonstrated significantly greater pain in mean flexion and range of motion at four weeks. The authors also reported that hydrotherapy based patients showed a significantly faster rate of return to pre-operative values of knee extension. In summary of this trail, there was evidence that post op hydrotherapy may be more effective than a land-based rehabilitation program for those patients undergoing ACL reconstructive surgery.

The final summary of this review stated that:

1. The application of water to treat disease has been used throughout history. It is known that Hippocates (460-375 BC) used hot and cold water in the treatment of multiple disease states. At present, hydrotherapy is applied to treat a myriad of diseases, including musculoskeletal problems. The majority of the evidence on the effectiveness of hydrotherapy to treat the described disease states and 'conditions' comes from small case series/reports and subsequent low level evidence (level 4).
2. The higher level evidence that was reviewed does not suggest hydrotherapy is effective in treating osteoarthritis, rheumatoid arthritis, chronic low back pain, fibromyalgia or pressure ulcers. There were 2 papers that did suggest that post ACL reconstructive surgery patients may have better outcomes than those undertaking land based exercises alone.
3. The application of hydrotherapy is not always without risk. There are reports in the literature regarding legionella infections, burn, folliculitis and hypersensitivity pneumonitis which were directly related to the hydrotherapy.

In conclusion, the summary of this review is a good example of when I carry out my inquiry in module 3. I cannot be biased, only stating my opinion that supports the argument- I have to acknowledge there may be risks too, and I should be prepared to list the positive and negatives to ultimately deliver a fair and true report of my inquiry.








  


























































 

Special Interest Group

So I have finally created a new SIG group; The importance of rehabilitation.
I hope this link works! Please take a look at the link below and feel free to comment and share any
ideas or opinions you have on this topic! Past experiences maybe?

Thanks,

Katrina x

https://plus.google.com/u/0/communities/102632499025856245557

New ideas emerging

I've been jotting down ideas in my journal lately when I've had light bulb moments whilst researching
for my inquiry, and I've found that this has really helped mark down any ideas which I can then use later on with my research.
Over the past week I have been brainstorming ideas, flicking through webpages and supporting information  for my inquiry- and there seems to be an underlying idea that keeps popping up or even a topic of interest. There seems to be a correlation between dance and science.
Science appears to be the supporting evidence in the dance world, and health and dance are also interlinked.

I have also just discovered that Dr Roger Wolman, a consultant at the Royal National Orthopaedic Hospital has a Dance Medicine Clinic on the NHS. This is very exciting as it appears there are some links between my new professional practice of orthopaedic therapy and that of the dance world. (I will continue with this idea in upcoming blogs!)
I hope I can bring my knowledge of the body into my new job and absorb as much information as I can by learning about the science and therapeutic side of the role.

Also, after reading a few other blogs this week I saw that the word 'Ethics' emerges numerous times. This is something I will have to handle with great care if I am to incorporate my inquiry into my current practice. Obviously I will have to inform my work colleagues of my intentions and I will have to be extremely vigilant whilst carrying out my research in my place of work.



 

Phone call with Paula: New direction for my inquiry

After a phone call with Paula Nottingham this afternoon, I have gained insight into what my potential line of inquiry could be. We talked about the topic I was interested in and what I had been looking into since my deferral of module 2 in november. As I was still working in retail at the time, I wanted to research the need for professional nutritionists and psychologists in vocational dance schools as I feel strongly (from my experience) that young dancers are not nurtured as well as they should to develop into mature adults. However, Paula noted that this could be difficult to develop into a line of inquiry as it is not relevant to my current practice.

Recently, I have been offered a new job role of a therapy assistant with the NHS; a role which consists of assisting a physiotherapist in the care of orthopaedic patients.
This new development in my career is a huge turning point in my life and has made me think, could I use my potential inquiry in conjunction with my professional practice?

Paula thought this would be a good idea and a good plan of action for me. From my experience of dance training and my knowledge of the body, I could potentially incorporate this with my new professional practice. There are several ideas going through my head already and I can't wait to get started in my new job as a therapy assistant.
Are there any similarities between dance therapy and physiotherapy? I shall soon find out!
Dance movement therapy is something I might go into in the future, and by completing my inquiry within my new practice, it could be an invaluable stepping stone into the industry.

I will keep you all updated once I start my new job, but in the meantime the mammoth amount of research begins!

Katrina

x

New job!

I am very proud and happy to say that I have been offered a new job this week; as a therapy assistant working with the NHS. It is a massive deal for me as I have wanted to escape from the retail environment for a while now, and I really feel that this new opportunity I am embarking on will be incredibly beneficial to me and is something I can relate to. Finally no weekends or late nights!! I am hoping the more structured shift patterns will allow me more breathing time whilst working through module 2. My past dancing career and my new job role are all interlinked and I am so happy I've got to this point as it's been a long time coming.

:)

Katrina x

New year new start

Ahhhhh so now it is time to get my thinking cap back on again! I hope everyone had a lovely Christmas break?! I had a peaceful and quiet Christmas and had a lot of time on my hands to reflect and really think about what I would like to talk about in my professional inquiry. I was so snowed under in November and I felt ridiculously under pressure to pull something out of the bag for module 2, so I decided to defer the module until the new year, and I'm so glad I did. I have delved into a completely new topic but a topic I feel I can relate to and it could expand into something really interesting and relevant to my future practice.
If there are any other BAPP's that have deferred module 2 please comment on my blog! It would be great to hear from you :)

Here's to a happy and successful new year!

x
 

Task 5c: Thoughts on Reader 5; Professional ethics in relation to my inquiry

ETHIC
Noun. Plural noun: Ethics.

A set of moral principles, especially ones relating to or affirming a specified group, field, or form of conduct.

I have always been brought up on strong ethical morals and values and I have inevitably taken these into my personal and professional life. However, I found reader 5 very compelling to read as it unveiled several new aspects of ethics that I have never considered before.
For example, I discovered that there are contrasting theories to ethics that sway the outcome of a situation.

Consequentialism means that where an act is morally right, and only if, that act maximizes the good. With regards to whether an action is morally right depends on the outcomes ( consequences).
JS Mill(1861) developed this theory of moral obligation to produce the greatest good for the greatest number (reader 5 page 9).
This theory can be deemed as imperative in large organisations as they strive to create the greatest outcome. However, it can be portrayed as unethical if your intentions are morally wrong.
 A good example of this is the case study in reader 5 of the 'Ethics in Photography',(reader 5 page 11) the story of photographer Kevin Carter. It states that his lack of intervention on the girl's behalf was justified ( he and the other photographers were instructed not to touch anyone for fear of epidemics), but I believe ethical morals should over ride rules in this situation. He didn't help the little girl to find water, he followed 'the rules', and maximised his outcome by then winning a prize for the photograph. In a professional workplace such as teaching, the students are your number one priority. Consequences occur that may question rules and regulations but I believe that if the outcome is of a greater good then it should over ride the deontology ethical rule.

Deontology is where Immanuel Kant (1779) believed that moral rules are absolute and argued that only absolutely good thing is a good will. He stated that you should help people no matter what your desires are. For Kant, lying is always wrong no matter what the circumstances are.
Of course rules and regulations should be abided by in your professional workplace and community as it keeps the system working efficiently and smoothly. However in reference to the case study of the photographer in reader 5, the motives of his actions were morally wrong even though he was abiding by the rules. I believe in following deontology in the workplace to a certain extent, but if the rules question your ethical morals I would certainly go against them to ensure the outcome would always be morally right and that of a greater good.

Virtue ethics is a theory that focuses on the moral behaviour and character of a person rather than the importance of the action. But if the consequences and rules of the action are thrown out the window, how does that determine if it is morally right or wrong based on the person's character? In my opinion, if someone's actions are ethically unjust then that relates to that person's character. Your actions reflect on your personality, undoubtedly.

To pursue my professional inquiry there are many factors I must consider to ensure all information and research I convey is true and unbiased. Ultimately I want to establish that the people I am interviewing feel comfortable and safe with the questions I put forward to them. I intend to interview professionals in the field of Dance Movement Psychotherapy, so all interviewees will be over the age of 18 and will not need consent from a parent or guardian.
However, if I were to interview participant's of a dance movement therapy session who suffers with for instance, Parkinson's, would I need consent from a spouse or family member as well as themselves?
I will definitely use The British Educational Research Association (BERA) to conduct my ethics checklist when composing my inquiry plan.

https://www.bera.ac.uk/wp-content/uploads/2014/02/Ethics-and-Educational-Research.pdf?noredirect=1

"As a researcher - as a professor who teaches research ethics - I am obligated to ensure accuracy, to uphold confidentiality, to secure informed consent...and to promote beneficence." (Tillman 2010 p.1).

 It has occurred to me that I will likely interview an elderly person at some stage in the inquiry process and I have to acknowledge what impact this will have on them, and I will be compelled to ensure that the interview is beneficial to them, and not just for me.
Ethical laws in professional practice need to be contemplated when piecing together my plan for my professional inquiry. Some of these are:

Data Protection Act http://www.legislation.gov.uk/ukpga/1998/29/contents
Human Rights Act http://www.legislation.gov.uk/ukpga/1998/42/contents
Equality Act http://equalities.gov.uk/equality_act_2010.aspx

I intend to scour these sources and determine that my findings in my research comply with these laws respectively.

References

Mill, JS (1987) Utilitarianism and Other Essays. London: Penguin.
Kant, I (2007) Critique of Pure Reason. London: Penguin Classics.
Tillman, L.M. (2010) Deadline: Ethics and the Ethnographic Divorce, Qualitative Inquiry, 10 (10) p1-3.