Health-related quality of life and musculoskeletal function in patients with musculoskeletal disorders: after compared to before short-term group-based aqua-exercises

Figures & data

Figure 1. Inclusion of patients in the aqua-exercising intervention and data collection procedures. EQ-5D: EuroQol 5 Dimensions.

Table 1. Characteristics of the patients.

	Study patients	Patients not included^a
Variable	(n = 39)	(n = 54)	p
Gender			0.250
Female	34 (87.2)	42 (77.8)
Male	5 (12.8)	12 (22.2)
Age (years)
Mean ± SD	55 ± 12	51 ± 14	0.212
20–30	2 (5.1)	3 (5.6)
31–40	2 (5.1)	12 (22.2)
41–50	11 (28.2)	9 (16.7)
51–60	11 (28.2)	16 (29.6)
61–70	9 (23.1)	6 (11.1)
71–80	4 (10.3)	7 (13)
81–90	0 (0)	1 (1.9)
Location of musculoskeletal disorder			0.784
Low or middle back	11 (28.2)	15 (28.3)
Neck	5 (12.8)	11 (20.8)
General myalgia	11 (28.2)	9 (16.7)
Lower extremities	5 (12.8)	3 (5.7)
Shoulder	3 (7.7)	3 (5.7)
Unspecific location	0 (0)	4 (7.4)
Multiple locations	4 (10.3)	9 (16.7)
Parallel physiotherapy during the intervention period		(n = 49)^e	0.860
No	21 (53.8)	27 (55.1)
Home-based exercising programme	12 (30.8)	11 (22.4)
Individual physiotherapy	4 (10.3)	8 (16.3)
Pain relief	2 (5.1)	3 (6.1)
Events during the intervention period^b			0.841
Events supposed to affect health positively	4 (10.3)	5 (9.3)
No known changes	20 (51.3)	29 (53.7)
Events supposed to affect health negatively	15 (38.5)	20 (37.0)
Compliance rate	(n = 1)^f	(n = 50)^f	0.009^g
Median (25th–75th percentile)	13 (12–14)	11 (7–14)
1–4 sessions	0 (0)	8 (16.0)
5–8 session	4 (10.5)	9 (18.0)
9–12 sessions	6 (15.4)	12 (24.0)
13–16 sessions	28 (71.8)	21 (4.02)
Cancelled^c during the intervention period	1 (2.6)	11 (20.4)	0.012^g
Other diagnoses according to the ICD-10^d			0.541
Yes	33 (84.6)	43 (79.6)
No	6 (15.4)	11 (20.4)

Data are shown as numbers (n) and proportions (%) of patients, unless otherwise indicated.

^aPatients participating in aqua-exercising who complied with the study criteria, except for not providing both pre- and post-EQ-5D. ^bRegistered in the medical record. Changes in personal or working situation, in the patient’s mood and medical complications, for example death of a next of kin, were categorized as negative changes.

^cReasons were: increased pain or other symptoms (n = 4), cold/cough (n = 1), abdominal pain (n = 1), minor stroke (n = 1), gynaecological symptoms (n = 2), socio-economic reason (n = 1) and gave no reason (n = 2).

^dWithin the past 5 years, irrespective of which healthcare profession registered the diagnosis.

^eFive patients could not be asked whether they had received physiotherapy anywhere else, since they did not participate in the evaluation post-aqua-exercising.

^fIn five patients who cancelled aqua-exercising (one of the study patients and four not included patients), the physiotherapist did not register the number of sessions.

ICD-10: International Classification of Diseases, 10th revision.

^gStatistically significant difference (p < 0.05).

Table 2. EuroQol 5 Dimensions (EQ-5D) measured before and after aqua-exercising.

EQ-5D dimension	Answering alternative	Pre-aqua-exercising	Post-aqua-exercising	p
Mobility	No problems	13 (39.4)	14 (42.4)	1.0
	Some problems	20 (60.6)	19 (48.7)
	Extreme problems	0 (0)	0 (0)
Self-care	No problems	28 (84.8)	30 (90.9)	0.688
	Some problems	4 (10.3)	2 (6.1)
	Extreme problems	1 (2.6)	1 (3)
Usual activities	No problems	9 (23.1)	12 (36.4)	0.063
	Some problems	17 (51.5)	16 (48.5)
	Extreme problems	7 (21.2)	5 (15.2)
Pain	No problems	1 (3)	1 (3)	0.453
	Some problems	21 (63.6)	24 (72.7)
	Extreme problems	11 (33.3)	8 (24.2)
Anxiety/depression	No problems	9 (27.3)	15 (45.5)	0.021^a
	Some problems	19 (57.6)	14 (42.4)
	Extreme problems	5 (15.2)	4 (12.1)

Data are shown as numbers (n) and proportions (%) of patients. n = 33 out of 39 participating patients, since six patients (a different six patients between the different dimensions) did not deliver data on the dimensions at both time-points.

^aStatistically significant improvement (p < 0.05).

Table 3. Description of the studied standard aqua-exercise programme.

Exercise component	Frequency	Intensity (% of VO2max/% of 1 RM); HR^a; BPM, range	Time (min)	Type, examples of motions and examples of “instructions to patients”
Total	2 times a week;16 sessions	Moderate	30	Group-based aqua-exercise
Warm-up		40–65, increasing 104;120–140	6	Jogging: “jog close to the bottom of the pool”
Mobility		40; 85; 50	3	Rotation in the hip in the horizontal plane: “paint number eight with your flexed knee”
Dynamic endurance strength upper extremity^b and isometric strength trunk		65; 100; 60	3	Shoulder abduction/adduction in the horizontal plane: “open up your chest and close it again”
Aerobic training that also included dynamic endurance strength trunk		65; 117; 135–160	6	Flexion of hips and knees bilaterally unilaterally in the sagittal plane: “jump like a frog”
Dynamic endurance strength lower extremity^b and isometric strength trunk		65; 100; 60	3	Hip extension unilaterally in the sagittal plane: “kick a ball behind your hip”
Aerobic training that also included dynamic endurance strength trunk		65; 119; 135–160	3	Running in circles: “Change direction when you have run to the end of the pool”
Mobility trunk and upper and lower extremity		40; 86; not relevant^c	3	Rotation column in the horizontal plane
Isometric stretching, relaxation including deep breathing		40; 72; not relevant^c	3	Lateral flexion of the cervical column in the vertical plane: “lay your ear on your shoulder”

Description according to the frequency, intensity, time, type (FITT) model (22).

^aHeart rate per minute. For pedagogical reasons, we show how HR varied (mean values during each section) for an example patient with a maximum pulse of 180 bpm (not included in the study sample) during a training session in the standard aqua-exercise programme, using a digital pulse monitor.

^bFor variation, these sections could be switched with each other.

^cMusic was played but exercises did not follow the music rhythm.

RM: repetition maximum; VO_2max: maximal oxygen consumption; BPM: beats per minute of the music rhythm.

Figure 2. Health-related quality of life measured before and after aqua-exercising: median EuroQol 5 Dimensions (EQ-5D) total score and barometer score. 25th–75th percentiles: ^a0.09–0.69, ^b0.09–0.73, ^c35–70, ^d40–75.

Table 4. Health-related quality of life (HRQoL) and musculoskeletal function after compared to before aqua-exercising.

		Change in EQ-5D total score			Total n
		Worse	Similar	Better
Change in musculoskeletalfunction assessed byphysiotherapist	Worse	0	1	0	1
	Similar	4	6	10	20
	Better	2	3	6	11
Total n		6	10	16	32^a

Data are shown as numbers (n) of patients with improved, stable or worsened HRQoL and musculoskeletal function, categorized according to Goal Attainment Scaling.

^a n = 32 since either pre- or post-physiotherapy assessment was missing in seven patients.

EQ-5D: EuroQol 5 Dimensions.

O’Riordan C, Clifford A, Van De Ven P, et al. Chronic neck pain and exercise interventions: frequency, intensity, time, and type principle. Arch Phys Med Rehabil. 2014;95:770–783.

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