Effectiveness of aquatic therapy on physical functional impairment in knee osteoarthritis: a meta-analysis study

Authors

  • Bambang Trisnowiyanto Department of Physiotherapy, Health Polytechnic of Surakarta, Indonesia
  • Isna Andriani Kusuma Husada University of Surakarta
  • Hendrik Hendrik Department of Physiotherapy, Health Polytechnic of Makassar, Indonesia

DOI:

https://doi.org/10.47197/retos.v77.117461

Keywords:

Aquatic therapy, hydrotherapy, joint pain, joint stiffness, osteoarthritis

Abstract

Introduction: Pain, reduced range of motion, and limited physical function are clinical signs of osteoarthritis (OA), a consequence of joint cartilage damage. OA is one of the main causes of disorders in older people. OA becomes more common with increasing age and a sedentary lifestyle. Aquatic therapy utilizes the physical properties of water.

Objective: This study compared the effects of aquatic therapy and land-based physiotherapy activities on osteoarthritis patients' pain, joint stiffness, range of motion, and reduced physical function.

Methodology: The study employed a meta-analysis, organized according to the PICO model framework. Articles were obtained from ScienceDirect and PubMed databases using keywords such as "aquatic therapy" OR "water exercises" OR "hydrotherapy" AND 'osteoarthritis' AND "randomized controlled trial". The data was examined using Review Manager 5.3.

Results: This meta-analysis study comprised eight articles and 423 samples from various countries. In individuals with osteoarthritis, aquatic therapy was found to significantly improve joint stiffness (SMD = -0.39; 95% CI = -0.77 to -0.01; p=0.05) and pain levels (SMD = -0.61; 95% CI = -0.85 to -0.36; p<0.001). Joint range of motion can also be increased by aquatic therapy (SMD = 0.26; 95% CI = -0.19 to -0.72; p=0.25), and physical function in patients with osteoarthritis (SMD = -0.23; 95% CI = -0.78 to -0.33; p=0.42).

Discussion: This meta-analysis is consistent with previous research, where water therapy has an improving effect on impaired physical function.

Conclusion: Compared with land-based physiotherapy exercises, aquatic therapy helps osteoarthritis patients overcome impaired physical function.

References

Alonso-Rodríguez, A. M., Sánchez-Herrero, H., Nunes-Hernández, S., Criado-Fernández, B., González-López, S., & Solís-Muñoz, M. (2021). Efficacy of hydrotherapy versus gym treatment in primary total knee prosthesis due to osteoarthritis: A randomized controlled trial. Anales Del Sistema Sanitario de Navarra, 44(2), 225–241. https://doi.org/10.23938/ASSN.0963

Arfianti, L., Pawana, I. P. A., Wardani, N. K., Hayyan, A. J. A., Rizqi, F. A., Prabawa, I. M. Y., Nugroho, A. B., & Handarini, L. P. S. (2025). A comparison between extracorporeal shockwave therapy and dex-trose prolotherapy on quadriceps muscle performance in knee osteoarthritis. Retos, 68, 224-233. https://doi.org/10.47197/retos.v68.113579

Assar, S., Gandomi, F., Mozafari, M., & Sohaili, F. (2020a). The effect of Total resistance exercise vs. aquatic training on self-reported knee instability, pain, and stiffness in women with knee osteoarthritis: A randomized controlled trial. BMC Sports Science, Medicine and Rehabilitation, 12(1), 1–13. https://doi.org/10.1186/s13102-020-00175-y

Assar, S., Gandomi, F., Mozafari, M., & Sohaili, F. (2020b). The Effect of TRX vs. Aquatic Exercises on Self-Reported Knee Instability, Balance, Knee Stiffness, Pain, Quadriceps Strength, and Knee Flexion ROM in Women with Knee Osteoarthritis: A Randomized Controlled Trial. BMC Sports Science, Medicine and Rehabilitation, 12, 1–13. https://doi.org/10.21203/rs.2.13552/v2

Augusto Teixeira, C., Haas, L., Frata, B., Fiori Bortoli, A., Scalco Acco, F., de Castro, G., & Cechetti, F. (2024a). Effects of a low, medium, and high-intensity aquatic physiotherapy protocol on functional and biochemical parameters in individuals with knee osteoarthritis: protocol for a crossover randomized controlled trial. F1000Research, 12, 1–25. https://doi.org/10.12688/f1000research.140342.4

Awal, M., Erawan, Tiar, H., Durahim, D., & Kemenkes Makassar, P. (2023). The effect of Shortwave Diathermy and Isometric Quadriceps Femoris Contraction Exercise on Increasing Walking Patterns in Osteoarthtritis : A Literature Review. Media Fisioterapi Poltekkes Makassar, 15(2), 1–7. https://doi.org/10.32382/fis.v15i2.378

Azizi, S., Dadarkhah, A., Rezasoltani, Z., Raeissadat, S. A., Mofrad, R. K., & Najafi, S. (2020). Randomized controlled trial of aquatic exercise for treatment of knee osteoarthritis in elderly people. Interventional Medicine and Applied Science, 11(3), 161–167. https://doi.org/10.1556/1646.11.2019.19

Beverly, M; Murray, D. W. (2023). Walking on water: subchondral vascular physiology explains how joints work and why they become osteoarthritic Michael Beverly. EFORT Open Reviews, 8(6), 436–442. https://doi.org/10.1530/EOR-23-0002

Dias, J. M., Cisneros, L., Dias, R., Fritsch, C., Gomes, W., Pereira, L., Santos, M. L., & Ferreira, P. H. (2017). Hydrotherapy improves pain and function in older women with knee osteoarthritis: a randomized controlled trial. Brazilian Journal of Physical Therapy, 21(6), 449–456. https://doi.org/10.1016/j.bjpt.2017.06.012

Ferreira, R. M., Martins, P. N., & Gonçalves, R. S. (2024). Non-pharmacological and non-surgical interventions to manage patients with knee osteoarthritis: An umbrella review 5-year update. Osteoarthritis and Cartilage Open, 6(3), 100497. https://doi.org/10.1016/j.ocarto.2024.100497

Garzón Mosquera, J. C., & Aragón Vargas, L. F. (2021). Sedentary lifestyle, physical activity and health: a narrative review. Retos, 42, 478–499. https://doi.org/10.47197/retos.v42i0.82644

Isfawati, M. S. G. F. R. N. (2025). Combination of Tibial Positional Correction and Close Chain Stabilizing Exercises in Improving Stair Climbing Ability in Patients with Knee Osteoarthritis. Concept and Communication, 17(1), 15–23. https://doi.org/10.32382/fis.v17i1.1495

Khruakhorn, S., & Chiwarakranon, S. (2021). Effects of hydrotherapy and land-based exercise on mobility and quality of life in patients with knee osteoarthritis: a randomized control trial. Journal of Physical Therapy Science, 33(4), 375–383. https://doi.org/10.1589/jpts.33.375

Kim, I. S., Chung, S. H., Park, Y. J., & Kang, H. Y. (2012). The effectiveness of an aquarobic exercise program for patients with osteoarthritis. Applied Nursing Research, 25(3), 181–189. https://doi.org/10.1016/j.apnr.2010.10.001

Kunduracilar, Z., Guvenir Sahin, H., Sonmezer, E., & Sozay, S. (2018). The effects of two different water exercise trainings on pain, functional status and balance in patients with knee osteoarthritis. Complementary Therapies in Clinical Practice, 31, 374–378. https://doi.org/10.1016/j.ctcp.2018.01.004

Lee, C. H., & Kim, I. H. (2021). Aquatic exercise and land exercise treatments after total knee replacement arthroplasty in elderly women: A comparative study. Medicina (Lithuania), 57(6). https://doi.org/10.3390/medicina57060589

Ma, J., Chen, X., Xin, J., Niu, X., Liu, Z., & Zhao, Q. (2022). Overall treatment effects of aquatic physical therapy in knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 17(1), 1–15. https://doi.org/10.1186/s13018-022-03069-6

Masyitah, D., Mashudi, Tumanggor, B. E., & Fadriyanti, Y. (2024). The effect of osteoarthritis exercise on pain and joint range of motion in osteoarthritis patients. Retos, 52, 432–437. https://doi.org/10.47197/retos.V52.101853

Montoya Gonzalez, S., Tobon Olaya, D., Lopez Muñoz, A. Y., Garzón García, J. S., Jimeno Lopez, M. I., & Marín Henao, E. (2022). Efectos de la hidroterapia sobre el dolor en osteoartritis y fibromialgia: Una revisión narrativa. Revista de La Sociedad Española Del Dolor, 29(2), 78–87. https://doi.org/10.20986/resed.2022.3955/2021

Munukka, M., Waller, B., Häkkinen, A., Nieminen, M. T., Lammentausta, E., Kujala, U. M., Paloneva, J., Kautiainen, H., Kiviranta, I., & Heinonen, A. (2020a). Effects of progressive aquatic resistance training on symptoms and quality of life in women with knee osteoarthritis: A secondary analysis. Scandinavian Journal of Medicine and Science in Sports, 30(6), 1064–1072. https://doi.org/10.1111/sms.13630

Munukka, M., Waller, B., Häkkinen, A., Nieminen, M. T., Lammentausta, E., Kujala, U. M., Paloneva, J., Kautiainen, H., Kiviranta, I., & Heinonen, A. (2020b). Effects of progressive aquatic resistance training on symptoms and quality of life in women with knee osteoarthritis: A secondary analysis. Scandinavian Journal of Medicine and Science in Sports, 30(6), 1064–1072. https://doi.org/10.1111/sms.13630

Roper, J. A., Bressel, E., & Tillman, M. D. (2013). Acute aquatic treadmill exercise improves gait and pain in people with knee osteoarthritis. Archives of Physical Medicine and Rehabilitation, 94(3), 419–425. https://doi.org/10.1016/j.apmr.2012.10.027

Schencking, M., Wilm, S., & Redaelli, M. (2013). A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis: A pilot trial. Journal of Integrative Medicine, 11(1), 17–25. https://doi.org/10.3736/jintegrmed2013004

Slouma, M., Abbes, M., Kharrat, L., Dhahri, R., Maaoui, R., Mouhli, N., Hfaidh, M., Zrida, S., Ksibi, I., Rahali, H., Hedia, B., & Gharsallah, I. (2024). Aquatic versus Land-Based Exercise for Knee Osteoarthritis: A Randomized Controlled Trial. Korean Journal of Family Medicine, 0–6. https://doi.org/10.4082/kjfm.23.0102

Tedeschi, R., Giorgi, F., & Donati, D. (2024). Harnessing the Power of Water: A Scoping Review of Hydrokinesiotherapy as a Game-Changer in Knee Osteoarthritis Management. Journal of Clinical Medicine, 13(19). https://doi.org/10.3390/jcm13195811

Downloads

Published

01-04-2026

Issue

Section

Theoretical systematic reviews and/or meta-analysis

How to Cite

Trisnowiyanto, B., Andriani, I., & Hendrik, H. (2026). Effectiveness of aquatic therapy on physical functional impairment in knee osteoarthritis: a meta-analysis study. Retos, 77, 315-323. https://doi.org/10.47197/retos.v77.117461