EFFECTIVENESS OF AQUATIC THERAPY INTERVENTION IN A CHILD WITH LEGG-CALVE-PERTHES DISEASE: A CASE REPORT

D. Vora¹, A. Bhaskar², B. Merchant¹, D. Vishvakarma¹, M. Gajjar¹

Background: Hip disorders such as Legg-Calve-Perthes (LCP) disease adversely affects a child’s mobility level, resulting in restricted participation at school and in the community. In India, the incidence of the disease ranges from 0.4-4.4 per 100,000 children. It affects children 3 to 12 years of age and males are affected 3 to 5 times more than females. Current research regarding the conservative management of LCP disease is limited. The study by Brech et al. clinically evaluated the effectiveness of physical therapy for individuals with LCP disease. They concluded that individuals who received physical therapy intervention showed improved range of motion and strength in the affected hip. However, there is little to no evidence on the effectiveness of aquatic therapy in this condition. In 2011, the Cincinnati Children’s Hospital Medical Center published a guide entitled Evidence-Based Care Guideline for Conservative Management of Legg-Calve-Perthes Disease. This guideline and its associated outcome measure, the Classification Instrument in Perthes (CLIPer), served as the primary resource for this case report.

Purpose: To explore the effectiveness of aquatic therapy interventions in a 4 year old boy diagnosed with LCP disease, using the CLIPer score and 5 times sit to stand test (5 STS) as outcome measures.

Methods: The child participated in an 8 week program where he was treated using aquatic therapy interventions on the treating orthopedic surgeon's advice. Sessions of 60 minutes duration were conducted 2 times per week. At baseline, the child showed decreased left hip range of motion, strength, impaired balance and pain. His CLIPer score was 16, indicative of severe involvement of the left hip. Aquatic therapy interventions were carried out in an indoor temperature controlled pool, consisting of strategies using principles of Water Specific Therapy which focussed on mobility, functional strengthening and balance training.

Results: Outcomes were measured at 4 week intervals and showed progressive improvements. At the end of 8 weeks, the CLIPer score reduced from 16 to 5 indicative of mild involvement and 5 STS time reduced from 21 seconds to 16 seconds.  

Conclusion(s): Aquatic therapy may be a useful rehabilitation tool to improve outcomes in children presenting with LCP disease.

Implications: Aquatic Therapy may be a valuable tool especially in early phases of rehabilitation in LCP disease. Buoyancy of water reduces weight bearing stresses on the joint. This promotes joint off loading which allows for early mobilisation and strengthening even before land physical therapy may be indicated. Immersion in warm water also promotes relaxation of muscle spasm which may reduce the dependence on analgesics needed for pain relief. Future research is needed to determine the combined effect of aquatic therapy and land physical therapy interventions for patients with LCP including treatment frequency and duration. Randomized clinical trials with a larger sample size should be done to confirm the findings.

Funding, acknowledgements: N/A

Keywords: Aquatic Therapy, Legg-Calve-Perthes Disease, Physical Therapy

Topic: Paediatrics

Did this work require ethics approval? No

Institution: N/A

Committee: N/A

Reason: It’s a retrospective case report of child referred for aquatic therapy, informed parental consent taken before therapy and abstract submission.