Just a quickie post this morning, but one that I couldn’t resist.
You know how nice it is to be soaking in a hot bath or hot pools after doing some great energetic thing (vacuuming the house? gardening?) – and how many people with chronic pain tell us that a soak in a bath or a hot shower is just great? Well, this study uses a randomised trial looking at traditional exercise or exercise in 33 degree water – and guess what? The exercise in water worked best.
Not too fast there OK, the research design for this study does NOT compare apples with apples. Let’s take a look at some of the problems that I see with the methodology (and why you need to read the research not just cut to the conclusions).
There are a couple of things that help with ‘motivation’ or adherence to treatment – the first is contact with a person who will encourage you, the second is ongoing monitoring, and the third is to have something ‘special’ happening or a ‘special’ place to go to do the treatment. And this study, unfortunately, suffers for not controlling for these variables between the two groups.
The hydrotherapy group got to come in for therapy five times a week, for four weeks, under the supervision of a physiotherapist. And the other group? Given a sheet of exercises, told what to do by the physiotherapist, then left to it. Four weeks later, the results were assessed.
Given our chronic pain population who are often reluctant to move, need a lot of encouragement and supervision, and are probably going to experience an increase in pain especially after the first few exercise sessions, which group do you think did better? Which group do you think actually did the exercise?! I’m prepared to lay money on the group that had supervision, lovely warm water, and had to come in on a regular basis…
A couple of other thoughts occur to me also – when do you think the best time for measuring an outcome might be? Immediately at the conclusion of a treatment or sometime later when the expectancy effects have settled, and the reality of ‘life’ intervenes and the residual effects are what remains? This study measured outcome immediately at the conclusion of the treatment period, so didn’t control for these very influential factors.
I’ll bet that over the next couple of months, there will be a rise in the prescription of hydrotherapy under supervision by a physiotherapist, with this study being cited as a good reason for doing so. I mean, this is a study published in a well-established peer-reviewed and very influential journal. But hold on folks – how good is this study really? Would you want to draw conclusions from this?
Dundar U, Solak O, Yigit I, Evcik D, Kavuncu V. (2009). Clinical effectiveness of aquatic exercise to treat chronic low back pain: a randomized controlled trial. Spine, 34 (14), 1436-1440