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Efficacy of Aquatic Therapy in Improving Balance in Patients With Stroke: A Systematic Review and Meta-Analysis
Laura Gento-Andrés1, Ismael Sanz-Esteban1, Isabel Rodríguez-Costa1
1Universidad Europea de Madrid, Faculty of Medicine, Health and Sports, Department of Physiotherapy, 28670 Villaviciosa de Odón, Madrid, Spain.
Objective:
To evaluate the efficacy of aquatic therapy in improving balance, gait speed, and fall risk in patients with stroke.
Data Sources:
MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, Web of Science, and Physiotherapy Evidence Database were searched for studies published from 2013 to October 2024.
Study Selection:
Experimental studies comparing aquatic therapy with conventional rehabilitation, land-based interventions, or no intervention. The primary outcome was balance, assessed using the Berg Balance Scale. Secondary outcomes included gait speed and fall risk.
Data Extraction:
Study design characteristics, number of participants, interventions characteristics, and outcomes were extracted.
Data Synthesis:
Twenty-seven interventional studies with 1134 participants (236 women and 225 men approximately) were included in the systematic review, among which 19 contributed to the meta-analysis. Ages ranged from 49.5 to 69.1 years. The time since injury varied from approximately 30 days to 5.4 years. Risk of bias of included studies was assessed using Cochrane Risk of Bias tool 2. Aquatic therapy significantly improved balance (Berg Balance Scale: MD, -5.10; 95% CI, -8.85 to -1.36; P=.008), gait speed (MD, -5.10; 95% CI, -8.85 to -1.36; P=.008), and reduced fall risk (MD, -4.38; 95% CI, -7.17 to -1.59; P=.002). Subgroup analyses based on session frequency (>20 sessions vs 10-20 sessions) showed similar effects.
Conclusions:
This meta-analysis suggests that aquatic therapy may be effective in enhancing balance and gait speed and in reducing fall risk among individuals with stroke; however, these findings should be interpreted with caution because of the high heterogeneity observed across studies.
