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Aquatic Therapy for improving Lower Limbs Function in Post-stroke Survivors: A Systematic Review with Meta-Analysis

Ghayour Najafabadi, Mahboubeh; Shariat, Ardalan; Dommerholt, Jan; Hakakzadeh, Azadeh; Nakhostin-Ansari, Amin; Selk-Ghaffari, Maryam; Ingle, Lee; Cleland, Joshua A.


Mahboubeh Ghayour Najafabadi

Ardalan Shariat

Jan Dommerholt

Azadeh Hakakzadeh

Amin Nakhostin-Ansari

Maryam Selk-Ghaffari

Joshua A. Cleland


Background: Lower limb disability is common in chronic stroke patients, and aquatic therapy is one of the modalities used for the rehabilitation of these patients. Objectives: To summarize the evidence of the effects of aquatic therapy on lower limb disability compared to land-based exercises in post-stroke patients. Methods: MEDLINE, PsycInfo, CENTRAL, SPORTDiscus, PEDro, PsycBITE, and OT Seeker were searched from inception to January 2019. The search included only randomized clinical trials. Two reviewers independently examined the full text and conducted study selection, data extraction, and quality assessment. Data synthesis was applied to summarize information from the included studies. The quantitative analysis incorporated fixed-effect models. Results: Of the 150 studies identified in the initial search, 17 trials (629 participants) satisfied the eligibility criteria. Aquatic therapy improved balance based on the Berg Balance Scale (BBS) (standardized mean difference [SMD], 0.72; 95% confidence interval [CI], 0.50–0.94; I2=67%) compared with land-based exercises (control). Also, aquatic therapy had a small positive effect on walking speed (SMD, −0.45; 95% CI {-0.71–(−0.19)}; I2=57%), based on the results of the 10-m walking test, compared to controls. Aquatic therapy had a small positive effect on mobility (based on Timed Up and Go), (SMD, −0.43; 95% CI {-0.7-(- 0.17)}; I2=71%) compared to land-based exercise (control). Conclusions: Aquatic therapy had a more positive effect on walking speed, balance, and mobility than land-based exercises. Further research is needed to confirm the clinical utility of aquatic therapy for patients following stroke in the long term.


Ghayour Najafabadi, M., Shariat, A., Dommerholt, J., Hakakzadeh, A., Nakhostin-Ansari, A., Selk-Ghaffari, M., …Cleland, J. A. (in press). Aquatic Therapy for improving Lower Limbs Function in Post-stroke Survivors: A Systematic Review with Meta-Analysis. Topics in Stroke Rehabilitation, 1-17.

Journal Article Type Article
Acceptance Date May 8, 2021
Online Publication Date Jun 19, 2021
Deposit Date Jun 21, 2021
Journal Topics in Stroke Rehabilitation
Print ISSN 1074-9357
Electronic ISSN 1945-5119
Publisher Thomas Land Publishers
Peer Reviewed Peer Reviewed
Pages 1-17
Keywords Hydrotherapy; Gait; Stroke; Lower limb function; Postural balance
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