Effects of Aquatic Therapy on Post-Stroke Motor Recovery Experience

Thesis Abstract

Stroke remains a leading cause of long-term disability worldwide, with motor deficits significantly impairing survivors' functional independence and quality of life. Despite advancements in conventional physiotherapy, many post-stroke individuals continue to experience suboptimal motor recovery, prompting interest in complementary and alternative rehabilitation modalities. Aquatic therapy, characterized by its buoyant environment and supportive properties, has emerged as a promising intervention to enhance motor function; however, empirical evidence regarding its effectiveness and influence on patient recovery experience remains limited and scattered. This study aims to systematically evaluate the effects of aquatic therapy on motor recovery and the psychological and experiential aspects of post-stroke rehabilitation. The primary objective is to assess whether integrating aquatic therapy into standard physiotherapy protocols leads to statistically significant improvements in motor performance among post-stroke patients. Specific objectives include (1) quantifying changes in motor function using the Fugl-Meyer Assessment (FMA); (2) examining patients' subjective recovery experience via the Stroke Impact Scale (SIS) and qualitative interviews; (3) comparing recovery trajectories between patients receiving aquatic therapy versus conventional land-based therapy; and (4) exploring the mediating role of motivation and psychological well-being in motor recovery outcomes. Employing a mixed-methods research design, the quantitative component adopts a randomized controlled trial (RCT) format with a sample of 80 post-stroke patients recruited from a physiotherapy outpatient clinic. Participants are randomly assigned to either an experimental group receiving aquatic therapy sessions thrice weekly alongside routine therapy or a control group receiving standard land-based physiotherapy alone for twelve weeks. Quantitative data are collected at baseline, six weeks, and twelve weeks using the Fugl-Meyer Assessment for motor function, the Stroke Impact Scale for patient-perceived recovery, and the Hospital Anxiety and Depression Scale (HADS) for psychological status. Data analysis involves repeated-measures ANOVA to evaluate within- and between-group differences over time, supplemented by multiple regression to identify predictors of motor improvement. The qualitative component comprises semi-structured interviews with a purposive subsample of 20 participants from the experimental group to explore their subjective recovery experience. Thematic analysis is employed to identify key themes related to motivation, self-efficacy, and perceived barriers or facilitators of recovery in aquatic settings. Integration of quantitative and qualitative findings aims to provide a comprehensive understanding of the multifaceted effects of aquatic therapy. Expected findings include significant gains in motor function in the aquatic therapy group relative to controls, accompanied by enhanced patient-reported outcomes related to confidence, motivation, and overall quality of life. Qualitative insights are anticipated to reveal that aquatic therapy fosters a more positive recovery experience, reducing fear of falling and increasing engagement in rehabilitation. Subgroup analyses may indicate that psychological factors such as motivation mediate the relationship between therapy modality and motor outcomes. This study contributes novel empirical evidence to the body of knowledge on aquatic therapy in stroke rehabilitation, extending current understanding to include experiential and psychosocial dimensions. It applies the Biopsychosocial Model and Self-Determination Theory as theoretical frameworks to interpret the complex interactions between physical recovery and psychological factors. The findings are expected to inform clinical practice guidelines by endorsing aquatic therapy as an effective adjunct to traditional physiotherapy, emphasizing its role in enhancing both motor and experiential recovery. Concluding, the research underscores the potential of aquatic therapy to improve post-stroke motor recovery and enrich the rehabilitation experience. Recommendations include integrating aquatic therapy into standard stroke rehabilitation programs, tailored to individual patient needs and motivations. Further research is suggested to explore long-term effects, cost-effectiveness, and scalability across different healthcare settings. Ultimately, this study aims to influence policy, optimize rehabilitation strategies, and improve outcomes for post-stroke individuals through evidence-based, holistic approaches.