Efficacy of aquatic therapy in people with spinal cord injury: a systematic review and meta-analysis.

Aquatic therapy, or hydrotherapy, is often used in neurological rehabilitation because water can support movement, ease resistance training, and allow cardiovascular exercise in ways that may be harder on land. This systematic review and meta-analysis asked whether hydrotherapy helps people with spinal cord injury (SCI), searching five databases for randomized controlled trials. Of 11 RCTs initially identified, only 3 studies with a combined 71 participants had usable data for analysis, and ages and injury levels varied across them. Using the Cochrane Risk of Bias tool, only one of the three studies was rated high quality, while the other two were rated low quality.

Outcomes measured included functional independence, muscle spasticity (Ashworth scale), and cardiovascular measures. Given the small number of studies, small participant numbers, and mostly low quality of evidence, the findings offer only limited and uncertain support for hydrotherapy's role in SCI rehabilitation.

If you or someone you know has a spinal cord injury, you may have heard that exercising in water, sometimes called hydrotherapy or aquatic therapy, can be a helpful part of rehabilitation. This study looked at the existing scientific evidence to see how well it actually works.

Researchers searched multiple databases and found 11 relevant trials, but only 3 of them, involving a total of 71 people, had enough usable data to be analyzed together. The people in these studies varied quite a bit in age and in how severe or where their spinal cord injury was located. When the researchers checked the quality of these three studies, only one was rated as high quality, while the other two were rated low quality.

The studies measured things like independence in daily activities, muscle stiffness, and heart and lung fitness. Because there were so few high quality studies and so few participants overall, the review cannot say with confidence how well aquatic therapy works for spinal cord injury. The evidence available so far is limited and uncertain rather than a clear demonstration of benefit.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis set out to evaluate hydrotherapy's efficacy in spinal cord injury (SCI) rehabilitation, searching CINAHL, PubMed, Scopus, Web of Science, and PEDro for RCTs. Of 11 RCTs initially identified, only 3 trials totaling 71 participants provided data suitable for analysis, a substantial attrition that limits the scope of any pooled conclusions. Risk of bias assessment via the Cochrane tool found only one study to be high quality, with the remaining two rated low quality.

Outcome measures across studies included the Functional Independence Measure, the Ashworth scale for spasticity, and cardiovascular parameters via CardioTouch 3000 and Quark CPET, reflecting heterogeneity in both instruments and constructs assessed. Age and injury level also varied across the sample. Given the small number of included trials, small sample sizes, and predominance of low quality studies, the evidence base for hydrotherapy in SCI remains sparse and of uncertain reliability.

The abstract does not report pooled effect estimates or specify whether meta-analytic synthesis was statistically significant, and no adverse events were mentioned. These gaps mean the current literature cannot yet support firm conclusions about hydrotherapy's efficacy for this population.