A systematic review of nonrandomized controlled trials on the curative effects of aquatic exercise

Abstract

Background:

The objectives of this review were to integrate the evidence of curative effects through aquatic exercise and assess the quality of studies based on a review of nonrandomized controlled trials (nRCTs).

Methods:

Study design was a systematic review of nonrandomized controlled trials. Trials were eligible if they were nonrandomized clinical trials. Studies included one treatment group in which aquatic exercise was applied. We searched the following databases from 2000 up to July 20, 2009: MEDLINE via PubMed, CINAHL, and Ichushi-Web.

Results:

Twenty-one trials met all inclusion criteria. Languages included were English (N = 9), Japanese (N = 11), and Korean (N = 1). Target diseases were knee and/or hip osteoarthritis, poliomyelitis, chronic kidney disease, discomforts of pregnancy, cardiovascular diseases, and rotator cuff tears. Many studies on nonspecific disease (healthy participants) were included. All studies reported significant effectiveness in at least one or more outcomes. However results of evaluations with the TREND and CLEAR-NPT checklists generally showed a remarkable lack of description in the studies. Furthermore, there was the problem of heterogeneity, and we were therefore not able to perform a meta-analysis.

Conclusion:

Because there was insufficient evidence on aquatic exercise due to poor methodological and reporting quality and heterogeneity of nRCTs, we were unable to offer any conclusions about the effects of this intervention. However, we were able to identify problems with current nRCTs of aquatic exercise, and propose a strategy of strengthening study quality, stressing the importance of study feasibility as a future research agenda objective.

Keywords:

• aquatic exercise
• systematic review
• nonrandomized controlled trials

Acknowledgements

This study was supported by the Health and Labour Sciences Research Grants (Research on Health Security Control: ID No. H20-007) from the Japanese Ministry of Health, Labour and Welfare in 2009. We would like to express our appreciation to Ms Rie Higashino, Ms Mari Makishi, and Ms Yukiko Yamada for their assistance in this study.

Disclosure

The authors report no conflicts of interest in this work.