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Meta-Analysis
. 2016 Mar 23;3(3):CD005523.
doi: 10.1002/14651858.CD005523.pub3.

Aquatic exercise for the treatment of knee and hip osteoarthritis

Else Marie Bartels  1 , Carsten B Juhl, Robin Christensen, Kåre Birger Hagen, Bente Danneskiold-Samsøe, Hanne Dagfinrud, Hans Lund
Affiliations
Meta-Analysis

Aquatic exercise for the treatment of knee and hip osteoarthritis

Else Marie Bartels et al. Cochrane Database Syst Rev. .

Abstract

Background: Osteoarthritis is a chronic disease characterized by joint pain, tenderness, and limitation of movement. At present, no cure is available. Thus only treatment of the person's symptoms and treatment to prevent further development of the disease are possible. Clinical trials indicate that aquatic exercise may have advantages for people with osteoarthritis. This is an update of a published Cochrane review.

Objectives: To evaluate the effects of aquatic exercise for people with knee or hip osteoarthritis, or both, compared to no intervention.

Search methods: We searched the following databases up to 28 April 2015: the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library Issue 1, 2014), MEDLINE (from 1949), EMBASE (from 1980), CINAHL (from 1982), PEDro (Physiotherapy Evidence Database), and Web of Science (from 1945). There was no language restriction.

Selection criteria: Randomized controlled clinical trials of aquatic exercise compared to a control group (e.g. usual care, education, social attention, telephone call, waiting list for surgery) of participants with knee or hip osteoarthritis.

Data collection and analysis: Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias of the included trials. We analysed the pooled results using standardized mean difference (SMD) values.

Main results: Nine new trials met the inclusion criteria and we excluded two earlier included trials. Thus the number of participants increased from 800 to 1190 and the number of included trials increased from six to 13. Most participants were female (75%), with an average age of 68 years and a body mass index (BMI) of 29.4. Osteoarthritis duration was 6.7 years, with a great variation of the included participants. The mean aquatic exercise duration was 12 weeks. We found 12 trials at low to unclear risk of bias for all domains except blinding of participants and personnel. They showed that aquatic exercise caused a small short term improvement compared to control in pain (SMD -0.31, 95% CI -0.47 to -0.15; 12 trials, 1076 participants) and disability (SMD -0.32, 95% CI -0.47 to -0.17; 12 trials, 1059 participants). Ten trials showed a small effect on quality of life (QoL) (SMD -0.25, 95% CI -0.49 to -0.01; 10 trials, 971 participants). These effects on pain and disability correspond to a five point lower (95% CI three to eight points lower) score on mean pain and mean disability compared to the control group (scale 0 to 100), and a seven point higher (95% CI 0 to 13 points higher) score on mean QoL compared with control group (scale 0 to 100). No included trials performed a radiographic evaluation. No serious adverse events were reported in the included trials with relation to aquatic exercise.

Authors' conclusions: There is moderate quality evidence that aquatic exercise may have small, short-term, and clinically relevant effects on patient-reported pain, disability, and QoL in people with knee and hip OA. The conclusions of this review update does not change those of the previous published version of this Cochrane review.

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Conflict of interest statement

Christensen R, Danneskiold‐Samsøe B, and Lund H were co‐authors of the Lund 2008 trial. Otherwise none known. EM Bartels has no known conflicts of interests. CB Juhl has no known conflicts of interests, R Christensen has no known conflicts of interests, H Dagfinrud has no known conflicts of interests, KB Hagen has no known conflicts of interests, B Danneskiold‐Samsøe has no known conflicts of interests, and H Lund has no known conflicts of interests.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included trial.
3
3
'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included trials.
4
4
Forest plot of comparison: 1 Aquatic exercise vs control immediately after treatment ‐ knee & hip OA, outcome: 1.1 Pain.
5
5
Forest plot of comparison: 1 Aquatic exercise vs control immediately after treatment ‐ knee & hip OA, outcome: 1.2 Disability.
6
6
Forest plot of comparison: 1 Aquatic exercise vs control immediately after treatment: knee & hip OA, outcome: 1.3 QoL.
1.1
1.1. Analysis
Comparison 1 Aquatic exercise vs control immediately after treatment: knee and hip OA, Outcome 1 Pain.
1.2
1.2. Analysis
Comparison 1 Aquatic exercise vs control immediately after treatment: knee and hip OA, Outcome 2 Disability.
1.3
1.3. Analysis
Comparison 1 Aquatic exercise vs control immediately after treatment: knee and hip OA, Outcome 3 Quality of life.
2.1
2.1. Analysis
Comparison 2 Aquatic exercise vs control immediately after treatment: knee OA, Outcome 1 Pain.
2.2
2.2. Analysis
Comparison 2 Aquatic exercise vs control immediately after treatment: knee OA, Outcome 2 Disability.
2.3
2.3. Analysis
Comparison 2 Aquatic exercise vs control immediately after treatment: knee OA, Outcome 3 Quality of life.
3.1
3.1. Analysis
Comparison 3 Aquatic exercise vs control immediately after treatment: hip OA, Outcome 1 Pain.
3.2
3.2. Analysis
Comparison 3 Aquatic exercise vs control immediately after treatment: hip OA, Outcome 2 Disability.
3.3
3.3. Analysis
Comparison 3 Aquatic exercise vs control immediately after treatment: hip OA, Outcome 3 Quality of life.
4.1
4.1. Analysis
Comparison 4 Aquatic exercise vs control at follow‐up: knee and hip OA, Outcome 1 Pain.
4.2
4.2. Analysis
Comparison 4 Aquatic exercise vs control at follow‐up: knee and hip OA, Outcome 2 Disability.
4.3
4.3. Analysis
Comparison 4 Aquatic exercise vs control at follow‐up: knee and hip OA, Outcome 3 Quality of life.
5.1
5.1. Analysis
Comparison 5 Aquatic exercise vs control at follow‐up: knee OA, Outcome 1 Pain.
5.2
5.2. Analysis
Comparison 5 Aquatic exercise vs control at follow‐up: knee OA, Outcome 2 Disability.
5.3
5.3. Analysis
Comparison 5 Aquatic exercise vs control at follow‐up: knee OA, Outcome 3 Quality of life.
6.1
6.1. Analysis
Comparison 6 Aquatic exercise vs control at follow‐up: hip OA, Outcome 1 Pain.
6.2
6.2. Analysis
Comparison 6 Aquatic exercise vs control at follow‐up: hip OA, Outcome 2 Disability.
6.3
6.3. Analysis
Comparison 6 Aquatic exercise vs control at follow‐up: hip OA, Outcome 3 Quality of life.
7.1
7.1. Analysis
Comparison 7 Adverse events, Outcome 1 Adverse events.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to ongoing studies

Faulkner 2006 {published data only}
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Sct. George Hospital {published data only}
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Taglietti 2014 {published data only}
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Yazigi 2013 {published data only}
    1. Ongoing study Starting date of trial not provided. Contact author for more information.

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