Exercise in the Aquatic Environment for People With Primary Hip Osteoarthritis: A Systematic Review and Meta-analyses

Abstract

Background and Purpose: More than 31 million Americans experience activity limitations related to hip osteoarthritis (OA), and aquatic exercise is one management option. To guide aquatic-based exercise practice, the available evidence-based data (quantity and quality) of aquatic environment exercise for people with primary hip OA was evaluated. Methods: A systematic search was conducted from 2004 to 2020 using 8 databases: PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library, EMBASE, Allied and Complementary Medicine Database (AMED), Science Citation Index Expanded, ISI Proceedings (Web of Science), and REHABDATA. The extracted data included information related to authors, study design, participant characteristics (demographics, time since diagnosis, comorbidity), intervention details (setting, type, water temperature and depth, and dosage parameters such as frequency, intensity, duration and length), outcome measures, and adverse events. Results: There were 196 studies identified, with 136 studies screened at the abstract level with 48 resultant studies, reviewed at the full-text level with 9 resultant publications included in this quantitative analyses (7 randomized controlled trials [RCTs] and 2 non-RCTs). Individuals with hip OA who participated in prescribed aquatic exercise experienced improved overall lower extremity function including range of motion, strength, balance, gait, function performance (p = .00; standardized mean difference [SMD] = 0.30; SE = 0.07; I 2 = 0), and pain (p = .00; SMD = 0.34; SE = 0.12; I 2 = 45) but no change in quality of life (p = .07; SMD = 0.15; SE = 0.08; I 2 = 0). Discussion and Conclusion: For individuals with primary hip OA, prescribed exercise in an aquatic environment improved lower extremity function, balance, and pain outcomes. To improve consistent, evidence-driven aquatic intervention for individuals experiencing limitations secondary to hip OA, these researchers recommend that schedule individual or staff time to review these systematic review results, establish a user-friendly dosage rubric including these minimum intensity and aquatic environment parameters, and discuss the evidence-driven suggested outcomes and include other specific standardized outcomes for their facility, as well as a means to efficiently document these outcomes.