ࡱ> &(%q bjbjt+t+ AAr ]HHHHHHH\\\\8  \"LNNNNNN$=1^rHrrHHrrr@HHL\\HHHHLrrLHHL \\XLINTRODUCTION Exercise therapy is now routinely recommended for individuals with osteoarthritis, rheumatoid arthritis and ankylosing spondylitis (7). Several recent reviews have summarised the effectiveness of exercise therapy programs for this population.(7) However, most of the research has examined land exercise, with relatively few studies investigating the effectiveness of aquatic therapy programs applied to patients with rheumatic disorders. These aquatic therapy programs, taught and practised in physiotherapy departments, are often based on tradition, personal opinions, empirical experience and subjective patient response (14). The literature existing today provides knowledge about general indications, contraindications, components and procedures for developing aquatic exercise programs. However, there seems to be a deficit of research that reports quantitative evidence-based measures of the effectiveness of aquatic therapy for rheumatic patients (2,14). The authors of this project have fulfilled a clinical affiliation period at Reumasol Centre in Spain. Reumasol Centre, run by the Norwegian Rheumatics Association (NRF), is using aquatic therapy programs as one of its main therapeutic means for rheumatic patients. As was the case at Reumasol Centre, the use of aquatic therapy programs were based on tradition, personal opinions, empirical experience, and subjective patient response. With this background the authors wanted to investigate what available research states about the effectiveness of aquatic therapy. Pain, ADL-functioning and Quality of Life are often identified as the most important outcome measures for chronic rheumatic patients (28). Therefore the emphasis in this project will be put on these three outcomes. Focusing on rheumatic diseases with a high prevalence (osteoarthritis, rheumatoid arthritis and ankylosing spondylitis) was a rational approach to find studies on the subject, as aquatic therapy in water is often proposed to this population. The main question of this report was: What are the documented effects of aquatic therapy for patients with rheumatoid arthritis, osteoarthrtitis and ankylosing spondylitis on pain, ADL-functioning and Health-Related Quality of Life (HRQL)? In order to answer the main question a literature review seemed rational. The Cochrane Collaboration has provided a comprehensive handbook with guidelines to performing reviews in a systematic way. By consistently following these guidelines to reduce chance effects and limit systematic errors, more reliable results upon which conclusions and decisions regarding different forms can be made (39). The first section of this report will describe the theoretical framework of this project. The next section will describe the methodological approach to this systematic review. The results regarding the effectiveness of exercise therapy in water will be described in the third section. These results will be interpreted and discussed in the fourth section. This section will also discuss limitations of this project, and implications for future practice and research. Any other relevant information will be presented in appendices. PAGE  PAGE 1   prsyz{}~0JmH0J j0JUB*CJCJ5CJ,  [\opqr{|}h&`#$$&d  [\opqrsy{}. A!"#$% [$@$NormalmH 4@4 Heading 2 $,@&CJ <A@<Default Paragraph Font*B@* Body TextCJ, @,Footer  p#&)@& Page Number      !!Zi r z } )5r z } A:\IntroductionFINAL.docICTheekA:\IntroductionFINAL.docRCzalen&C:\WIN95\Desktop\IntroductionFINAL.doc@F~ @GTimes New Roman5Symbol3& Arial"0eeefC 0  IntroductionRCzalenRCzalenOh+'0  4 @ L Xdlt| IntroductionontrRCzalenCzaCzaNormalRCzalen2zaMicrosoft Word 8.0@@t^M@lς@lςC ՜.+,D՜.+,H hp  Fontys Hogescholenn 1  Introduction Title 6> _PID_GUIDAN{A1BADCA4-72EA-11D6-87F1-0002A576D0EA}  !"#$'Root Entry F (ś)1Table WordDocumentSummaryInformation(DocumentSummaryInformation8CompObjjObjectPoolśś  FMicrosoft Word Document MSWordDocWord.Document.89q