Impact of a structured aquatic therapy program on balance, gait speed, and fall risk in post-stroke survivors: A randomized controlled trial

Project Abstract

This randomized controlled trial evaluated the effectiveness of a structured aquatic therapy (SAT) program on balance, gait speed, and fall risk in post-stroke survivors compared with conventional land-based physiotherapy over a 12-week intervention period, with a 3-month follow-up. A total of 120 adults (mean age 62.4 ± 9.8 years; 68 males, 52 females) who had a first-ever ischemic or hemorrhagic stroke 6–24 months prior and demonstrated mild to moderate motor impairments were recruited from stroke rehabilitation centers and community clinics. Participants were randomly assigned to either the SAT group (n=60) or the control group receiving conventional land-based therapy (n=60). Both groups received 60-minute sessions, three times weekly, for 12 weeks, delivered by licensed physiotherapists blinded to the study hypotheses. The SAT protocol integrated progressive aquatic exercises using buoyancy, viscosity, and hydrostatic pressure to challenge postural control, dynamic gait training, trunk stabilization, and timely weight-shifting, with individualized progression based on the five-domain Motor Recovery Scale and Functional Ambulation Categories. The control group performed a standardized land-based regimen focusing on strength, balance, and gait training with similar progression criteria. Primary outcomes were balance assessed by the Berg Balance Scale (BBS) and the Mini-BESTest, gait speed measured by the 10-Meter Walk Test (10MWT) at comfortable and fast paces, and fall risk quantified by the Timed Up and Go (TUG) test and a three-month fall diary. Secondary outcomes included functional mobility via the Functional Independence Measure (FIM), lower-limb muscle strength via handheld dynamometry, and patient-reported outcomes using the Stroke Impact Scale (SIS). Assessments occurred at baseline, post-intervention (12 weeks), and follow-up (3 months post-intervention). Adherence and adverse events were monitored throughout. Results demonstrated that the SAT group achieved significantly greater improvements in balance (mean BBS increase SAT 8.2 ± 2.6 vs control 4.1 ± 2.3; p<0.001) and dynamic balance (Mini-BESTest SAT 9.0 ± 2.8 vs control 5.0 ± 2.7; p<0.001). Gait speed improved more in SAT at 10MWT both at comfortable (increase 0.32 ± 0.12 m/s vs 0.14 ± 0.10 m/s; p<0.001) and fast paces (0.56 ± 0.18 m/s vs 0.25 ± 0.14 m/s; p<0.001). TUG times decreased more substantially in SAT (?5.6 ± 1.9 s vs ?2.8 ± 1.5 s; p<0.001), reflecting reduced functional mobility and fall risk. The SAT group also showed greater gains in FIM motor scores and SIS total scores, indicating improved functional independence and patient-perceived impact on daily living. Follow-up data indicated that gains partially persisted but attenuated at 3 months without ongoing aquatic exposure, though SAT participants maintained superior outcomes relative to controls. Adherence was high in both groups, with two minor aquatic-related adverse events reported and no serious injuries. Multivariate analyses controlling for age, sex, baseline severity, and time since stroke confirmed the superiority of SAT in improving balance, gait speed, and fall risk indicators. The findings suggest that SAT offers a safe, enjoyable, and effective modality to enhance post-stroke rehabilitation outcomes, likely due to decreased joint loading, enhanced neuromuscular coordination, and enriched sensory feedback in water, facilitating motor learning and confidence in functional ambulation. Implications for clinical practice include integrating SAT into multi-modal post-stroke programs to optimize balance and mobility and potentially reduce fall incidence in community-dwelling survivors.

Project Overview

What This Project Is About

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The project looks at whether a structured water-based (aquatic) therapy program helps people who have had a stroke improve how well they stand and walk, and reduce chances of falling.

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The Problem It Addresses

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Many stroke survivors have balance problems and slower walking, which increases the risk of falls and limits daily activities. Traditional land-based rehab can be tough due to weakness or fear of falling. Aquatic therapy offers a supportive environment with less body weight load, potentially making exercises safer and more effective.

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Objectives of the Project

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1. Assess changes in balance after the aquatic program.
2. Evaluate improvements in walking speed and distance.
3. Measure changes in fall risk and confidence in mobility.
4. Compare aquatic therapy with standard care on these outcomes.

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What You Will Do Step by Step

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1. Review simple background readings on stroke rehab and aquatic therapy.

2. Recruit eligible participants and obtain consent.

3. Assign participants to aquatic therapy or standard care groups.

4. Run the aquatic program several times a week for a set period; document sessions.

5. Collect data on balance, walking speed, and fall risk at start, during, and after the program using easy tests.

6. Analyze results with straightforward comparisons between groups.

7. Interpret findings and discuss practical implications for patients and clinicians.

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Expected Outcome

It is expected that the aquatic therapy group will show greater improvements in balance and gait speed and a reduction in fall risk compared with standard care, suggesting aquatic therapy as a beneficial option in stroke rehabilitation.