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Guideline Summary
Guideline Title
Best evidence statement (BESt). Aquatic physical therapy combined with land-based physical therapy to improve functional independence.
Bibliographic Source(s)
Cincinnati Children's Hospital Medical Center. Best evidence statement. Aquatic physical therapy combined with land-based physical therapy to improve functional independence. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2011 Jan 4. 6 p. [17 references]
Guideline Status

This is the current release of the guideline.

Scope

Disease/Condition(s)

Acquired neurological impairments, including:

  • Traumatic brain injury
  • Spinal cord injury
  • Brain tumor
  • Meningitis
  • Encephalitis
  • Transverse myelitis
  • Cerebrovascular accident (CVA)
  • Guillain-Barre
Guideline Category
Rehabilitation
Clinical Specialty
Family Practice
Internal Medicine
Neurology
Pediatrics
Physical Medicine and Rehabilitation
Intended Users
Advanced Practice Nurses
Nurses
Occupational Therapists
Physical Therapists
Physician Assistants
Physicians
Guideline Objective(s)

To evaluate if aquatic physical therapy combined with land-based physical therapy versus physical therapy alone improves functional independence among children ages 0-21 years diagnosed with acquired neurological impairments

Target Population

Inclusion: Children with acquired neurological impairments (ages 0 to 21) which includes diagnoses such as traumatic brain injury, spinal cord injury, brain tumor, meningitis, encephalitis, transverse myelitis, cerebrovascular accident (CVA), and Guillain-Barre

Exclusion: Patients with neurological impairments that are hereditary, present at or around the time of birth, or degenerative including, but not limited to cerebral palsy, muscular dystrophy, and spina bifida

Interventions and Practices Considered
  1. Aquatic therapy combined with land-based physical therapy
  2. Land-based physical therapy alone
Major Outcomes Considered

Level of functional independence

Methodology

Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

Search Strategy

  • Date Range: 1950 to October 2010
  • Keywords: Aquatic therapy, aquatic exercises, hydrotherapy, aquatics, pool therapy, swimming, pediatrics, child, brain tumor, brain injury, encephalitis, spinal cord injury, meningitis, transverse myelitis, Guillain-Barre, stroke, CVA, functional independence
  • Databases: CINAHL, Medline, Pubmed, PEDro, Cochrane Library, Scopus, ACP Journal Club, Hooked on Evidence, PsycINFO, ERIC
Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence

Table of Evidence Levels

Quality Level Definition
1a† or 1b† Systematic review, meta-analysis, or meta-synthesis of multiple studies
2a or 2b Best study design for domain
3a or 3b Fair study design for domain
4a or 4b Weak study design for domain
5 Other: General review, expert opinion, case report, consensus report, or guideline

†a = good quality study; b = lesser quality study

Methods Used to Analyze the Evidence
Systematic Review
Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

Not stated

Rating Scheme for the Strength of the Recommendations

Table of Recommendation Strength

Strength Definition
"Strongly recommended" There is consensus that benefits clearly outweigh risks and burdens (or vice-versa for negative recommendations).
"Recommended" There is consensus that benefits are closely balanced with risks and burdens.
No recommendation made There is lack of consensus to direct development of a recommendation.
Dimensions: In determining the strength of a recommendation, the development group makes a considered judgment in a consensus process that incorporates critically appraised evidence, clinical experience, and other dimensions as listed below.
  1. Grade of the Body of Evidence (see note above)
  2. Safety/Harm
  3. Health benefit to the patients (direct benefit)
  4. Burden to patient of adherence to recommendation (cost, hassle, discomfort, pain, motivation, ability to adhere, time)
  5. Cost-effectiveness to healthcare system (balance of cost/savings of resources, staff time, and supplies based on published studies or onsite analysis)
  6. Directness (the extent to which the body of evidence directly answers the clinical question [population/problem, intervention, comparison, outcome])
  7. Impact on morbidity/mortality or quality of life
Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation

This guideline has been reviewed against quality criteria by 2 independent reviewers form the Cincinnati Children's Hospital Medical Center (CCHMC) Evidence Collaboration.

Recommendations

Major Recommendations

There is insufficient evidence and a lack of consensus to make a recommendation on the effectiveness of aquatic physical therapy combined with land physical therapy versus land physical therapy alone in children with acquired neurological impairments.

Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

Current evidence was found to be mostly expert opinion or descriptive studies, which was considered insufficient to make a recommendation.

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

Appropriate use of aquatic physical therapy combined with land based physical therapy in children with acquired neurological impairments

Potential Harms

Not stated

Qualifying Statements

Qualifying Statements

This Best Evidence Statement addresses only key points of care for the target population; it is not intended to be a comprehensive practice guideline. These recommendations result from review of literature and practices current at the time of their formulation. This Best Evidence Statement does not preclude using care modalities proven efficacious in studies published subsequent to the current revision of this document. This document is not intended to impose standards of care preventing selective variances from the recommendations to meet the specific and unique requirements of individual patients. Adherence to this Statement is voluntary. The clinician in light of the individual circumstances presented by the patient must make the ultimate judgment regarding the priority of any specific procedure.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Getting Better
IOM Domain
Effectiveness

Identifying Information and Availability

Bibliographic Source(s)
Cincinnati Children's Hospital Medical Center. Best evidence statement. Aquatic physical therapy combined with land-based physical therapy to improve functional independence. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2011 Jan 4. 6 p. [17 references]
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2011 Jan 4
Guideline Developer(s)
Cincinnati Children's Hospital Medical Center - Hospital/Medical Center
Source(s) of Funding

Cincinnati Children's Hospital Medical Center

Guideline Committee

Not stated

Composition of Group That Authored the Guideline

Group/Team Members

Group/Team Leader: Heather Blackburn, PT, MPT, CBIS, Division of Occupational Therapy, Physical Therapy, and Therapeutic Recreation

Support Personnel: Barbara Giambra, MS, RN, CPNP Evidence-Based Practice Mentor, Center for Professional Excellence/Research and Evidence-Based Practice

Financial Disclosures/Conflicts of Interest

Not stated

Guideline Status

This is the current release of the guideline.

Guideline Availability

Electronic copies: Available from the Cincinnati Children's Hospital Medical Center External Web Site Policy.

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

Availability of Companion Documents

The following are available:

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI Institute on August 25, 2011.

Copyright Statement

This NGC summary is based on the original full-text guideline, which is subject to the following copyright restrictions:

Copies of this Cincinnati Children's Hospital Medical Center (CCHMC) External Web Site Policy Best Evidence Statement (BESt) are available online and may be distributed by any organization for the global purpose of improving child health outcomes. Examples of approved uses of the BESt include the following:

  • Copies may be provided to anyone involved in the organization's process for developing and implementing evidence based care
  • Hyperlinks to the CCHMC website may be placed on the organization's website
  • The BESt may be adopted or adapted for use within the organization, provided that CCHMC receives appropriate attribution on all written or electronic documents
  • Copies may be provided to patients and the clinicians who manage their care

Notification of CCHMC at EBDMInfo@cchmc.org for any BESt adopted, adapted, implemented or hyperlinked by the organization is appreciated.

Disclaimer

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The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

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