Purpose/Hypothesis: This study is a systematic review of randomized controlled trials (RCTs) evaluating the benefits of aquatic therapy for people with multiple sclerosis (MS). Multiple sclerosis is an inflammatory, demyelinating condition that affects the central nervous system. In the United States alone, multiple sclerosis affects an estimated 350,000 to 400,000 individuals. Aquatic therapy is a recommended intervention for these individuals; therefore, it would be prudent to investigate the current research evidence to support this claim.
Number of Subjects: 305 individuals diagnosed with MS from eight RCTs are included in this systematic review.
Materials and Methods: Databases used in this study were Academic Search Premier, Academic Search Elite, CINAHL Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, MEDLINE, MEDLINE with Full Text, SPORTDiscus with Full Text, and Cochrane Clinical Answer. The search terms included: “‘multiple sclerosis' or ‘ms' or ‘demyelinating disease’ or ‘relapsing remitting’, AND aquatic therapy or hydrotherapy or aquatic exercise or water exercise or pool therapy or water therapy, AND fatigue or exhaustion or tiredness or lethargy or endurance or benefits.” The search was further limited to: Scholarly Journals, Randomized Control Trials, English language and dated 2010 to present. The original search resulted in 1523 articles, of which 522 were duplicates and removed. An additional 18 articles were found on the PEDro database to total 1019. Further screening of the titles and abstracts removed 1005 articles due to not including the core criteria of multiple sclerosis, aquatic therapy, and benefits from aquatic therapy. Additionally, six articles were removed during the full-text review due to not being RCTs. RCTs included in this systematic review were analyzed using the PEDro analysis scale.
Results: Eight RCTs were included in the systematic review. No articles were excluded based on the PEDro scale. The average PEDro score was 5.875 with a range of 4 (fair) - 7 (good). Of the eight articles, three articles scored 7 (good), two articles scored 6 (good), two articles scored 5 (fair), and one article scored 4 (fair).
Conclusions: Research supports the use of aquatic therapy as a means to slow the progression and decrease symptoms associated with this disease. The results show an array of benefits for individuals with MS participating in aquatic therapy. The eight RCTs indicated significant improvement in the following areas: fatigue, depression, quality of life, balance, walking ability, function capacity based on 6-meter walk test, thermoregulation, cardiorespiratory function, paraesthesia, and pain.
Clinical Relevance: There are a multitude of benefits of aquatic therapy for individuals with MS. The recommended dosage based on these studies include incorporating aquatic therapy at a light to moderate intensity for 45-minute sessions, 3 times a week, for at least 8 weeks in order to achieve significant benefits. The subjects included in these studies ranged in age from 18 to 75 years old with an Expanded Disability Status Scale score from 1 to 7.5 out of 10. Therefore, aquatic therapy has shown significant improvements across a wide range in age and disability. Unless contraindicated, physical therapists should encourage and implement aquatic therapy intervention into the plan of care for individuals with MS.