Effects of the Bad Ragaz Ring Method on muscle activation of the lower limbs and balance ability in chronic stroke: A randomised controlled trial.
Hyun-Gyu Cha, Young-Jun Shin, Myoung-Kwon Kim
PMID 30931045WHAT IT FOUND
Adding Bad Ragaz Ring water therapy to conventional rehabilitation improved lower-leg muscle activation and balance compared with conventional rehabilitation alone.
Because the water group also received a different amount of conventional rehabilitation, the separate contribution of water therapy cannot be isolated.
Key findings
01The group receiving Bad Ragaz Ring water therapy plus conventional rehabilitation improved lower-limb muscle activation and balance index after 6 weeks, while the conventional rehabilitation only group improved on Timed Up and Go only.
02Significant between-group differences in posttraining gains were reported for tibialis anterior activation, gastrocnemius activation, and balance index, with larger gains in the water therapy plus conventional rehabilitation group.
03In the experimental group, tibialis anterior activation increased from 58.91 to 80.82 microvolts, gastrocnemius activation increased from 75.55 to 96.73 microvolts, and balance index decreased from 6.45 to 2.64, where a lower balance index means better balance.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study had only 22 participants, so the findings are uncertain and may not apply to other stroke populations. Participants had to be able to walk more than 10 m without aids and have mild spasticity, so it says little about more impaired patients. The experimental group received 30 minutes of conventional rehabilitation, while the control group received 60 minutes, so the effect of water therapy cannot be separated from the different conventional therapy dose. There was no follow-up after intervention, so it is unknown whether the improvements lasted. Only 22 of 50 screened patients met criteria, which may limit generalisability.
Declared interests
The authors declared no conflicts of interest and received no financial or material support.
The easy way to misread this
Do not conclude that Bad Ragaz Ring water therapy alone caused the improvement. The water group also received conventional rehabilitation, and the conventional rehabilitation dose differed between groups, so the contribution of water therapy alone cannot be isolated.