Nível de evidencia da fisioterapia aquática em pessoas com Doença de Parkinson: revisão sistemática

Abstract

Introduction: Parkinson's disease (PD) is the second most common neurodegenerative disease in the elderly. The main characteristic of PD is the change in the control of automatic movements, with the four cardinal signs of the disease: tremor, bradykinesia, muscle rigidity and balance difficulties. The main treatments used in PD are medications and surgical procedures, however, physical therapy has shown positive effects in minimizing or delaying the evolution of symptoms, in addition to promoting greater functionality and quality of life for people with PD. Aquatic physiotherapy through immersion of the body in water helps to promote rehabilitation in the entire biopsychosocial context of the person with PD. Due to the enormous benefits of Aquatic Physiotherapy there is a large amount of reported evidence. However, little is known about the classification of the level of evidence of aquatic physical therapy in people with PD, which method of aquatic physical therapy would be the most efficient and which domains of the International Classification of Functioning (ICF) model would benefit the most. Objectives: To determine the level of evidence of aquatic physical therapy in Parkinson's disease, identify which are the most effective methods and classify their effects in the domains of the ICF. Method: The present study is a systematic review prepared in accordance with the guidelines for systematic reviews and meta-analysis (PRISMA) and GRADE. Searches were carried out in the Scielo, Pubmed, Lilacs, PEDro and Medline databases, including studies of the clinical trial type performed in humans, with a diagnosis of PD and that evaluate the effects of aquatic physical therapy in this population. Single case studies, integrative and scoping reviews were excluded. Results: After eliminating studies that did not meet the inclusion criteria, 25 studies were selected for this review. System Traffic Lights was used to synthesize the methodological quality found with GRADE. Ai Chi and Traditional Aquatic Therapy (TAT) showed good evidence for the domains of body function, participation, environmental and personal factors, and a moderate level of evidence for activity, in gait, mobility and balance outcomes. The TAT was classified as yellow in the Traffic Light System in the body function domain in the flexibility and risk of falling outcomes, and the Halliwick and Ai Chi in the red color for the domain of activity and body structure, respectively. Conclusion: It was possible to observe strong evidence for the use of aquatic physical therapy in the domains of body function, personal and environmental factors of the ICF. For domains of activity and body function, aquatic physical therapy showed a moderate level of evidence, and for domain of body structure, the level was considered low. Through this present study, it is possible to conclude that there is a need for other studies to better investigate the effectiveness of aquatic physiotherapy in PD, encompassing the ICF domains.