Effectiveness of aquatic exercise for treatment of knee osteoarthritis

Systematic review and meta-analysis

Wirksamkeit von Wassergymnastik bei Kniegelenksarthrose

Systematische Übersicht und Metaanalyse

Abstract

Objective

This paper presents a systematic review and meta-analysis of the effectiveness of aquatic exercise for treatment of knee osteoarthritis (OA).

Methods

PubMed, the Cochrane Library, Embase, CAMbase, and the Web of Science were screened through to June 2014. Only randomized controlled trials (RCTs) comparing aquatic exercise with control conditions were included. Two authors independently selected trials for inclusion, assessed the included trials, and extracted data. Outcome measures included pain, physical function, joint stiffness, quality of life (QOL), and safety. Pooled outcomes were analyzed using standardized mean difference (SMD).

Results

There is a lack of high quality studies in this area. Six RCTs (398 participants) were included. There was moderate evidence for a moderate effect on physical function in favor of aquatic exercise immediately after the intervention, but no evidence for pain or QOL when comparing aquatic exercise with nonexercise. Only one trial reported 3 months of follow-up measurements, which demonstrated limited evidence for pain improvement with aquatic exercise and no evidence for QOL or physical function when comparing aquatic exercise with nonexercise. There was limited evidence for pain improvement with land-based exercise and no evidence for QOL or physical function, when comparing aquatic exercise with land-based exercise according to follow-up measurements. No evidence was found for pain, physical function, stiffness, QOL, or mental health with aquatic exercise immediately after the intervention when comparing aquatic exercise with land-based exercise. Two studies reported aquatic exercise was not associated with serious adverse events.

Conclusion

Aquatic exercise appears to have considerable short-term benefits compared with land-based exercise and nonexercise in patients with knee OA. Based on these results, aquatic exercise is effective and safe and can be considered as an adjuvant treatment for patients with knee OA. Studies in this area are still too scarce and too short-term to provide further recommendations on how to apply this therapy.

Zusammenfassung

Ziele

In der vorliegenden systematischen Übersicht und Metaanalyse wurde die Wirksamkeit von Wassergymnastik in der Behandlung der Kniegelenksarthrose untersucht.

Methoden

PubMed, die Cochrane Library, Embase, CAMbase und das Web of Science wurden bis Juni 2014 durchsucht. Eingeschlossen wurden nur randomisierte, kontrollierte Studien (RCT), in denen Wassergymnastik mit Kontrollbedingungen verglichen wurde. Zwei Autoren schlossen unabhängig Studien ein, prüften diese und extrahierten Daten. Zu den Studienendpunkten gehörten Schmerz, körperliche Funktionsfähigkeit, Gelenksteifigkeit, Lebensqualität und Sicherheit. Die gepoolten Ergebnisse wurden anhand standardisierter Mittelwertdifferenzen (SMD) analysiert.

Ergebnisse

Es mangelt an qualitativ hochwertigen Studien zur beschriebenen Thematik. Sechs RCT mit 398 Teilnehmern wurden eingeschlossen. Die Analyse ergab eine mäßige Evidenz dafür, dass Wassergymnastik verglichen mit dem Verzicht auf Bewegungsübungen einen moderaten Effekt auf die körperliche Funktionsfähigkeit unmittelbar nach der Anwendung hat; in Bezug auf Schmerz oder Lebensqualität ließ sich dagegen keine Wirkung belegen. Nur in einer Studie wurden für 3 Monate Follow-up-Messungen durchgeführt. Diese ergaben eine begrenzte Evidenz für eine Schmerzbesserung bei Wassergymnastik und keinen Beleg für einen Effekt auf die Lebensqualität oder körperliche Funktionsfähigkeit, wenn Wassergymnastik mit dem Verzicht auf Bewegungsübungen verglichen wurde. Gemäß den Follow-up-Messungen gab es eine eingeschränkte Evidenz für eine Schmerzbesserung bei Trockengymnastik im Vergleich zu Wassergymnastik, hinsichtlich der Lebensqualität und körperlichen Funktionsfähigkeit fand sich keine Evidenz. In Bezug auf Schmerz, die körperliche Funktionsfähigkeit, Steifigkeit, Lebensqualität und psychische Verfassung fand sich kein Effekt der Wassergymnastik direkt nach Anwendung im Vergleich zu Trockengymnastik. In zwei Studien war angegeben, dass Wassergymnastik nicht mit schweren unerwünschten Ereignissen verbunden war.

Schlussfolgerungen

Verglichen mit Trockengymnastik und dem Verzicht auf Bewegungsübungen scheint Wassergymnastik kurzzeitig von beträchtlichem Nutzen für Patienten mit Kniegelenksarthrose zu sein. Auf der Grundlage dieser Ergebnisse ist die Methode wirksam und sicher. Sie kann als unterstützende Maßnahme bei Kniegelenksarthrose angesehen werden. Da es in diesem Themenbereich noch immer zu wenige Studien gibt und die Studiendauer zu knapp bemessen ist, sind weitergehende Empfehlungen zur Anwendung der Wassergymnastik nicht möglich.

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Compliance with ethical guidelines

Conflict of interest. Meili Lu, Youxin Su, Yingjie Zhang, Ziyi Zhang, Wenting Wang, Zhen He, Feiwen Liu, Yanan Li, Changyan Liu, Yiru Wang, Lu Sheng, Zhengxuan Zhan, Xu Wang, and Naixi Zheng state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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Correspondence to Prof. Youxin Su.

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The authors are grateful to the State Administration of Traditional Chinese Medicine for funding this study (No. 201307004).

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Lu, M., Su, Y., Zhang, Y. et al. Effectiveness of aquatic exercise for treatment of knee osteoarthritis. Z Rheumatol 74, 543–552 (2015). https://doi.org/10.1007/s00393-014-1559-9

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Keywords

  • Randomized controlled trial
  • Balneology
  • Pain
  • Physical function
  • Quality of life

Schlüsselwörter

  • Randomisierte, kontrollierte Studie
  • Balneologie
  • Schmerz
  • Körperliche Funktionsfähigkeit
  • Lebensqualität