Aquatic exercise for the treatment of knee and hip osteoarthritis

Else Marie Bartels; Hans Lund; Kåre Birger Hagen; Hanne Dagfinrud; Robin Christensen; Bente Danneskiold‐Samsøe

doi:10.1002/14651858.CD005523.pub2

Ejercicio acuático para el tratamiento de la osteoartritis de rodilla y cadera

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Referencias

Referencias de los estudios incluidos en esta revisión

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Cochrane T, Davey RC, Matthes Edwards SM. Randomised controlled trial of the cost‐effectiveness of water‐based therapy for lower limb osteoarthritis. Health Technology Assessment 2005;9(31):iii‐xi, 1.

Foley A, Halbert J, Hewitt T, Crotty M. Does hydrotherapy improve strength and physical function in patients with osteoarthritis‐‐a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. Annals of the Rheumatic Diseases 2003;62(12):1162‐7.

Patrick DL, Ramsey SD, Spencer AC, Kinne S, Belza B, Topolski TD. Economic evaluation of aquatic exercise for persons with osteoarthritis. Medical Care 2001;39(5):413‐24.

Stener‐Victorin E, Kruse‐Smidje C, Jung K. Comparison between electro‐acupuncture and hydrotherapy, both in combination with patient education and patient education alone, on the symptomatic treatment of osteoarthritis of the hip. Clinical Journal of Pain 2004;20(3):179‐85.

Wang TT. Aquatic exercise improves flexibility, strength, and walk time in osteoarthritis. PhD Thesis 2004.

Google Scholar

Wyatt FB, Milam S, Manske RC, Deere R. The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. Journal of Strength and Conditioning Research 2001;15(3):337‐40.

Referencias de los estudios excluidos de esta revisión

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Ahern M, Nicholls E, Simionato E, Clark M, Bond M. Clinical and psychological effects of hydrotherapy in rheumatic diseases. Clinical Rehabilitation 1995;9:204‐12.

Alexander MJL, Butcher JE, MacDonald PB. Effects of a water exercise program on walking gait, flexibility, strength, self‐reported disability and other psycho‐social measures of older individuals with arthritis. Physiotherapy Canada 2001;203‐11.

Google Scholar

Belza B, Topolski T, Kinne S, Patrick DL, Ramsey SD. Does adherence make a difference? Results from a community‐based aquatic exercise program. Nursing Research 2002;51(5):285‐91.

Borchers M, Schwarzkopf S, Stucki G. A multidisciplinary, multimodal daycare concept for patients with osteoarthritis ‐ First results [Tageskliniken für funktionsstörungen bei muskuloskelettalen erkrankungen ‐ pilotergebnisse aus dem schwerpunkt osteoarthrose (OA)]. Aktuelle Rheumatologie 2003;28:43‐8.

Cusack T. Abstracts from the Irish Society of Chartered Physiotherapists Annual Conference held in Dublin on 31st October and 1st November 2003. Physiotherapy‐Ireland (PHYSIOTHER‐IRELAND) 2003;24(2):37‐50.

Google Scholar

D'Lima DD, Colwell CW, Jr, Morris BA, Hardwick ME, Kozin F. The effect of preoperative exercise on total knee replacement outcomes. Clinical Orthopaedics 1996, (326):174‐82.

Elkayam O, Wigler I, Tishler M, Rosenblum I, Caspi D, Segal R, et al. Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis [see comments]. Journal of Rheumatology 1991;18(12):1799‐803.

Green J, McKenna F, Redfern EJ, Chamberlain MA. Home exercises are as effective as outpatient hydrotherapy for osteoarthritis of the hip. British Journal of Rheumatology 1993;32(9):812‐5.

Guillemin F, Virion JM, Escudier P, De Talance N, Weryha G. Effect on osteoarthritis of spa therapy at Bourbonne‐les‐Bains. Joint, bone, spine : revue du rhumatisme. 2001;68(6):499‐503.

Gyurcsik NC, Estabrooks PA, Frahm‐Templar MJ. Exercise‐related goals and self‐efficacy as correlates of aquatic exercise in individuals with arthritis. Arthritis and Rheumatism 2003;49(3):306‐13.

Hill S, Eckett MJH, Paterson C, Harkness EF. A pilot study to evaluate the effects of floatation spa treatment on patients with osteoarthritis. Complementary Therapies in Medicine 1999;7:235‐8.

Kostopoulos D. Comparative effects of aquatic recreational and aquatic exercise programs on mobility, pain perception and treatment satisfaction among elderly persons with osteoarthritis of the knee. PhD Thesis 2000.

Google Scholar

Kovacs I, Bender T. The therapeutic effects of Cserkeszolo thermal water in osteoarthritis of the knee: a double blind, controlled, follow‐up study. Rheumatology International 2002;21(6):218‐21.

Lin SY, Davey RC, Cochrane T. Community rehabilitation for older adults with osteoarthritis of the lower limb: a controlled clinical trial. Clinical Rehabilitation 2004;18(1):92‐101.

Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis and Rheumatism 1989;32(11):1396‐405.

Nguyen M, Revel M, Dougados M. Prolonged effects of 3 week therapy in a spa resort on lumbar spine, knee and hip osteoarthritis: follow‐up after 6 months. A randomized controlled trial. British Journal of Rheumatology 1997;36(1):77‐81.

Norton CO, Hoobler K, Welding AB, Jensen GM. Effectiveness of aquatic exercise in the treatment of women with osteoarthritis. The Journal of Aquatic Physical Therapy 1999;5(3):8‐15.

Google Scholar

Silva LE, Pessanha AC, Oliveira LM, Myamoto S, Valim V, Jones A, et al. Efficacy of water exercise in the treatment of patients with knee osteoarthritis: A randomized, single‐blind, controlled clinical trial. Annals of the Rheumatic Diseases 2005;64:556.

Suomi R, Lindauer S. Effectiveness of arthritis foundation aquatic program on strength and range of motion in women with arthritis. Journal of Aging & Physical Activity 1997;5:341‐51.

Suomi R, Koceja DM. Postural sway characteristics in women with lower extremity arthritis before and after an aquatic exercise intervention. Archives of Physical Medicine and Rehabilitation 2000;81(6):780‐5.

Suomi R, Collier D. Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis. Archives of Physical Medicine and Rehabilitation 2003;84(11):1589‐94.

Tishler M, Rosenberg O, Levy O, Elias I, Amit‐Vazina M. The effect of balneotherapy on osteoarthritis. Is an intermittent regimen effective?. European Journal of Internal Medicine 2004;15(2):93‐6.

Referencias adicionales

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Altman R, Asch E, Bloch D, Bole G, Bortenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis ‐ Classification of osteoarthritis of the knee. Arthritis and Rheumatism 1986;29(8):1039‐1049.

Badley EM, Rasooly I, Webster GK. Relative importance of musculoskeletal disorders as a cause of chronic health problems, disability, and health care utilization: findings from the 1990 Ontario Health Survey. Journal of Rheumatology 1994;21(3):505‐514.

Bellamy N, Kirwan J, Boers M, Brooks P, Strand V, Tugwell P, et al. Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis. Consensus development at OMERACT III. Journal of Rheumatology 1997;24(4):799‐802.

Brandt KD, Mankin H, Shulman LE. Workshop on etiopathogenesis of osteoarthritis. Journal of Rheumatology 1986;13:1126‐1160.

Google Scholar

Ethgen M, Boutron I, Baron G, Giraudeau B, Sibilia J, Ravaud P. Reporting of harm in randomized, controlled trials of nonpharmacologic treatment for rheumatic disease. Annals of Internal Medicine 2005 Jul 5;143(1):20‐5.

Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis and Rheumatism 1998;41(8):1343‐1355.

Felson DT. Epidemiology of osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS, editors. Osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS editor(s). Osteoarthritis. 2. Oxford: Oxford University Press, 2003:9‐16.

Google Scholar

Flores RH, Hochberg MC. Definition and classification of osteoarthritis.. In: Brandt KD, Doherty M, Lohmander LS editor(s). Osteoarthritis. 2. Oxford: Oxford University Press, 2003:1‐8.

Google Scholar

Guccione AA. Arthritis and the process of disablement. Physical Therapy 1994;74(5):408‐414.

Gur H, Cakin N, Akova B, Okay E, Kucukoglu S. Concentric versus combined concentric‐eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee. Archives of Physical Medicine and Rehabilitation 2002;83(3):308‐316.

Guyatt GH, Sackett DL, Cook DJ. Users' guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence‐Based Medicine Working Group. The Journal of the American Medical Association 1993;270(21):2598‐2601.

Higgins JPT, Green S, editors. Assessment of Study Quality. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005]; Section 6.. The Cochrane Library. Chichester, UK: John Wiley & Sons, Ltd., 2005.

Google Scholar

Hurley MV. Muscle dysfunction and effective rehabilitation of knee osteoarthritis: what we know and what we need to find out. Arthritis and Rheumatism 2003;49(3):444‐452.

Ioannidis JP, Lau J. Completeness of safety reporting in randomized trials: an evaluation of 7 medical areas. JAMA 2001;285(4):437‐43.

Oliveria SA, Felson DT, Reed JI, Cirillo PA, Walker AM. Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis and Rheumatism 1995;38(8):1134‐1141.

Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Annals of Rheumatic Diseases 2001;60(2):91‐97.

Rogind H, Bibow‐Nielsen B, Jensen B, Moller HC, Frimodt‐Miller H, Bliddal H. The effects of a physical training program on patients with osteoarthritis of the knees. Archives of Physical Medicine and Rehabilitation 1998;79(11):1421‐7.

Rothfuss J, Mau W, Zeidler H, Brenner MH. Socioeconomic evaluation of rheumatoid arthritis and osteoarthritis: a literature review. Seminars in arthritis and rheumatism 1997;26(5):771‐9.

Sharma L, Dunlop DD, Cahue S, Song J, Hayes KW. Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Annals of Internal Medicine 2003;138(8):613‐9.

Sowers M, Lachance L, Hochberg M, Jamadar D. Radiographically defined osteoarthritis of the hand and knee in young and middle‐aged African American and Caucasian women. Osteoarthritis and Cartilage 2000;8(2):69‐77.

Tugwell P, Shea B, Boers M, Brooks P, Simon L, Strand V, et al. Evidence Based Rheumatology. BMJ Books, 2004.

Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Knipschild PG. Balneotherapy for rheumatoid arthritis and osteoarthritis. Cochrane Database of Systematic Reviews 2000, (2):CD000518.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Cochrane 2005

Methods	Intention to treat Blinded assessor Losses to follow up 25‐27% Concealment of allocation
Participants	312 volunteers randomised into Aquatic: 153, Control: 159 63% female Mean age 70 All with pain and stiffness in the knee or hip were included, the ACR criteria was not followed.
Interventions	Aquatic exercise: stretching, strengthening and aerobic exercises, primarily low to moderate intensity. 3 months supervised, 9 months unsupervised. Sessions of 1 hour, twice a week. Total: 84 sessions. Control: Telephone interview quarterly monitoring changes in exercise behaviour and other treatment
Outcomes	Pain (WOMAC), stiffness (WOMAC) and function (WOMAC). Quality of life (SF‐36 & EuroQol). Walk ability (8 foot walk)
Notes	GOLD
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Foley 2003

Methods	Intention to treat Blinded assessor Losses to follow up 20% (aquatic) 26% (land‐based) Concealment of allocation
Participants	105 volunteers randomised into Aquatic: 35 Land‐based: 35 Control: 35 Mean age 71 49.5 % female Radiological diagnosis of hip or knee OA
Interventions	Aquatic exercise: Stretching and strengthening exercise. Land‐based: Strengthening exercise Both exercise groups: 30 min each session, 3 times per week for 6 weeks. Control: 3 telephone calls to record any changes in condition and treatment
Outcomes	Pain (WOMAC), stiffness (WOMAC), function (WOMAC), Quality of life (SF‐12)
Notes	GOLD
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Patrick 2001

Methods	Intention to treat Blinding of assessor unclear Losses to follow up 19% Concealment of allocation unclear
Participants	249 volunteers randomised into Aquatic: 125 Control: 124 Mean age 66 86 % female Clinically confirmed diagnosis of OA
Interventions	Aquatic: Joint range‐of‐motion, maintenance of muscle strength Control: Follow used activities, abstain from new exercise programs
Outcomes	Pain (HAQ), function (HAQ), quality of life (QOL), quality of well being (QWB)
Notes	GOLD
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Stener‐Victorin 2004

Methods	Intention to treat Patient, therapist and assessor was not blinded Losses to follow up 31% Unclear concealment of allocation
Participants	45 volunteers randomised into Electro‐acupuncture: 15 Aquatic: 15 Patient education: 15
Interventions	Patient education + electro‐acupuncture Patient education + hydrotherapy Patient education alone
Outcomes	Disability rating index (DRI) Global self rating index (GSI)
Notes	SILVER
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Wang 2004

Methods	Intention to Treat Patient, therapist and assessor was not blinded Losses to follow up 18.3 % Concealment of allocation
Participants	43 volunteers randomised into aquatic exercise: 21 control: 22
Interventions	Aquatic exercise with focus on strengthening exercise
Outcomes	Pain in joint Six‐minute walk Functional status Psychological distress
Notes	GOLD
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Wyatt 2001

Methods	No intention to treat analysis Blinded assessor Losses to follow up not reported Unclear concealment of allocation
Participants	46 volunteers randomised into a land‐based and aquatic exercise program. Number of participants in each group not reported
Interventions	Aquatic and Land‐based exercise was the same: resistance exercise over knee, straight leg raises, mini‐squat and walking
Outcomes	VAS pain 1 mile walk time Stiffness
Notes	SILVER
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D ‐ Not used

See grading system in text for definition of Gold and Silver.
ACR criteria for the hip joint: age greater than 40 years, weight‐bearing pain, pain relieved by sitting, antalgic gait, decreased painful range of motion, a normal erythrocyte sedimentation rate (ESR) and a negative rheumatoid factor test.
ACR criteria for the knee joint: age greater than 50 years, knee pain, stiffness < 30 min, crepitus, bony tenderness, bony enlargement, no palpable warmth, a normal erythrocyte sedimentation rate (ESR) and a negative rheumatoid factor test.
EUROQOL: The EuroQol is a multidimensional health profile developed by the EuroQol Group in 1990 and revised in 1993.
HAQ: Health Assessment Questionnaire.
PQOL: The Perceived Quality of Life Scale is a generic instrument for assessing perceived quality of life among adults.
VAS: Visual analogue scale
WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index

Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Ahern 1995	Poor randomization procedure. No follow up. But the immediate effect is described for pain, stiffness, depression, self‐efficacy.
Alexander 2001	Not randomized. Mix of different patient categories (OA, 27; RA 3; FMS 1; Psoriasis 1).
Belza 2002	OA in different joints not hip and/or knee alone.
Borchers 2003	No aquatic exercise, not possible to assess the effect of water treatment alone,
Cusack 2003	Abstract only
D'Lima 1996	Aquatic exercise is combined with land exercise. Mix of both OA and RA.
Elkayam 1991	No exercise, only water immersion.
Green 1993	Only data on surrogate outcomes
Guillemin 2001	No exercise (only SPA therapy). No randomization.
Gyurcsik 2003	Not possible to evaluate the effect on KNEE OA (Mix of OA, RA and FMS). No randomization.
Hill 1999	No exercise, only water immersion.
Kostopoulos 2000	Only comparing two different types of aquatic exercises
Kovacs 2002	No exercise, only immersion.
Lin 2004	Not randomised
Minor 1989	When it is possible to distinguish between OA and RA, it is not possible to distinguish between aquatic and non‐aquatic exercise / control.
Nguyen 1997	Mix of hip, knee and lumbar OA. No exercise, a mixed modality of spa and balneotherapy.
Norton 1999	Only effect sizes reported, and no SD was given, thus it was impossible to include the results in the meta‐analysis
Silva 2005	No exercise
Suomi 1997	Mix of RA and OA.
Suomi 2000	Mix of RA and OA.
Suomi 2003	Mix of RA and OA.
Tishler 2004	No exercise, only water immersion.

OA: Osteoarthritis
RA: Rheumatoid arthritis
FMS: Fibromyalgia syndrome
SPA therapy: treatment including water, but not including exercise
SD: Standard deviation

Data and analyses

Open in table viewer

Comparison 1. Aquatic exercise versus control after treatment ‐ knee&hip mixed

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	4	638	Std. Mean Difference (IV, Random, 95% CI)	0.19 [0.04, 0.35]
Open in figure viewer Analysis 1.1 Comparison 1 Aquatic exercise versus control after treatment ‐ knee&hip mixed, Outcome 1 Pain.
1.1 WOMAC pain	2	380	Std. Mean Difference (IV, Random, 95% CI)	0.20 [‐0.00, 0.40]
1.2 Visual Analogue Pain	1	43	Std. Mean Difference (IV, Random, 95% CI)	0.50 [‐0.10, 1.11]
1.3 HAQ pain	1	215	Std. Mean Difference (IV, Random, 95% CI)	0.12 [‐0.15, 0.39]
2 Function Show forest plot	4	648	Std. Mean Difference (IV, Random, 95% CI)	0.26 [0.11, 0.42]
Open in figure viewer Analysis 1.2 Comparison 1 Aquatic exercise versus control after treatment ‐ knee&hip mixed, Outcome 2 Function.
2.1 WOMAC function	2	375	Std. Mean Difference (IV, Random, 95% CI)	0.23 [0.03, 0.44]
2.2 HAQ function	2	273	Std. Mean Difference (IV, Random, 95% CI)	0.31 [0.07, 0.55]
3 Walking ability Show forest plot	2	355	Std. Mean Difference (IV, Random, 95% CI)	0.18 [‐0.03, 0.39]
Open in figure viewer Analysis 1.3 Comparison 1 Aquatic exercise versus control after treatment ‐ knee&hip mixed, Outcome 3 Walking ability.
3.1 Six‐minute walk	1	43	Std. Mean Difference (IV, Random, 95% CI)	‐0.03 [‐0.63, 0.57]
3.2 8‐foot walk time	1	312	Std. Mean Difference (IV, Random, 95% CI)	0.21 [‐0.01, 0.43]
4 Stiffness Show forest plot	2	380	Std. Mean Difference (IV, Random, 95% CI)	0.14 [‐0.06, 0.34]
Open in figure viewer Analysis 1.4 Comparison 1 Aquatic exercise versus control after treatment ‐ knee&hip mixed, Outcome 4 Stiffness.
4.1 WOMAC stiffness	2	380	Std. Mean Difference (IV, Random, 95% CI)	0.14 [‐0.06, 0.34]
5 Quality of life Show forest plot	3	599	Std. Mean Difference (IV, Random, 95% CI)	0.32 [0.03, 0.61]
Open in figure viewer Analysis 1.5 Comparison 1 Aquatic exercise versus control after treatment ‐ knee&hip mixed, Outcome 5 Quality of life.
5.1 SF‐12 physical	1	70	Std. Mean Difference (IV, Random, 95% CI)	0.69 [0.21, 1.17]
5.2 PQOL ‐ perceived quality of life	1	222	Std. Mean Difference (IV, Random, 95% CI)	0.35 [0.09, 0.62]
5.3 EURO‐QOL	1	307	Std. Mean Difference (IV, Random, 95% CI)	0.10 [‐0.12, 0.33]
6 Mental health Show forest plot	4	642	Std. Mean Difference (IV, Random, 95% CI)	0.16 [0.01, 0.32]
Open in figure viewer Analysis 1.6 Comparison 1 Aquatic exercise versus control after treatment ‐ knee&hip mixed, Outcome 6 Mental health.
6.1 SF‐36 mental	1	307	Std. Mean Difference (IV, Random, 95% CI)	0.15 [‐0.08, 0.37]
6.2 SF‐12 mental	1	70	Std. Mean Difference (IV, Random, 95% CI)	0.19 [‐0.28, 0.66]
6.3 Psychological Distress	1	43	Std. Mean Difference (IV, Random, 95% CI)	0.37 [‐0.24, 0.97]
6.4 QWB ‐ quality of well being	1	222	Std. Mean Difference (IV, Random, 95% CI)	0.13 [‐0.13, 0.40]

Open in table viewer

Comparison 2. Aquatic exercise versus control after treatment ‐hip

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Function Show forest plot	1	28	Std. Mean Difference (IV, Random, 95% CI)	0.76 [‐0.02, 1.53]
Open in figure viewer Analysis 2.1 Comparison 2 Aquatic exercise versus control after treatment ‐hip, Outcome 1 Function.
1.1 DRI‐disability rating index	1	28	Std. Mean Difference (IV, Random, 95% CI)	0.76 [‐0.02, 1.53]
2 Quality of life Show forest plot	1	28	Std. Mean Difference (IV, Random, 95% CI)	0.76 [‐0.02, 1.53]
Open in figure viewer Analysis 2.2 Comparison 2 Aquatic exercise versus control after treatment ‐hip, Outcome 2 Quality of life.
2.1 GSI ‐ global self rating index	1	28	Std. Mean Difference (IV, Random, 95% CI)	0.76 [‐0.02, 1.53]

Open in table viewer

Comparison 3. Aquatic exercise versus land after treatment ‐ knee

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	1	46	Std. Mean Difference (IV, Random, 95% CI)	0.86 [0.25, 1.47]
Open in figure viewer Analysis 3.1 Comparison 3 Aquatic exercise versus land after treatment ‐ knee, Outcome 1 Pain.
1.1 VAS pain	1	46	Std. Mean Difference (IV, Random, 95% CI)	0.86 [0.25, 1.47]
2 Walking ability Show forest plot	1	46	Std. Mean Difference (IV, Random, 95% CI)	0.43 [‐0.16, 1.01]
Open in figure viewer Analysis 3.2 Comparison 3 Aquatic exercise versus land after treatment ‐ knee, Outcome 2 Walking ability.
2.1 1 MILE walk time	1	46	Std. Mean Difference (IV, Random, 95% CI)	0.43 [‐0.16, 1.01]
3 Stiffness Show forest plot	1	46	Std. Mean Difference (IV, Random, 95% CI)	‐0.26 [‐0.84, 0.32]
Open in figure viewer Analysis 3.3 Comparison 3 Aquatic exercise versus land after treatment ‐ knee, Outcome 3 Stiffness.

Open in table viewer

Comparison 4. Aquatic exercise versus control at follow up ‐ knee&hip mixed

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	1	310	Std. Mean Difference (IV, Random, 95% CI)	0.11 [‐0.12, 0.33]
Open in figure viewer Analysis 4.1 Comparison 4 Aquatic exercise versus control at follow up ‐ knee&hip mixed, Outcome 1 Pain.
1.1 WOMAC pain	1	310	Std. Mean Difference (IV, Random, 95% CI)	0.11 [‐0.12, 0.33]
2 Function Show forest plot	1	306	Std. Mean Difference (IV, Random, 95% CI)	0.10 [‐0.12, 0.33]
Open in figure viewer Analysis 4.2 Comparison 4 Aquatic exercise versus control at follow up ‐ knee&hip mixed, Outcome 2 Function.
2.1 WOMAC function	1	306	Std. Mean Difference (IV, Random, 95% CI)	0.10 [‐0.12, 0.33]
3 Stiffness Show forest plot	1	310	Std. Mean Difference (IV, Random, 95% CI)	0.13 [‐0.09, 0.36]
Open in figure viewer Analysis 4.3 Comparison 4 Aquatic exercise versus control at follow up ‐ knee&hip mixed, Outcome 3 Stiffness.
3.1 WOMAC stiffness	1	310	Std. Mean Difference (IV, Random, 95% CI)	0.13 [‐0.09, 0.36]
4 Mental health Show forest plot	1	309	Std. Mean Difference (IV, Random, 95% CI)	0.05 [‐0.17, 0.27]
Open in figure viewer Analysis 4.4 Comparison 4 Aquatic exercise versus control at follow up ‐ knee&hip mixed, Outcome 4 Mental health.
4.1 SF‐36 mental	1	309	Std. Mean Difference (IV, Random, 95% CI)	0.05 [‐0.17, 0.27]

Open in table viewer

Comparison 5. Aquatic exercise versus control at follow up ‐ hip

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.00 [‐0.04, 2.04]
Open in figure viewer Analysis 5.1 Comparison 5 Aquatic exercise versus control at follow up ‐ hip, Outcome 1 Pain.
1.1 VAS pain	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.00 [‐0.04, 2.04]
2 Function Show forest plot	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.00 [‐0.04, 2.04]
Open in figure viewer Analysis 5.2 Comparison 5 Aquatic exercise versus control at follow up ‐ hip, Outcome 2 Function.
2.1 DRI‐disability rating index	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.00 [‐0.04, 2.04]
3 Quality of life Show forest plot	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.00 [‐0.04, 2.04]
Open in figure viewer Analysis 5.3 Comparison 5 Aquatic exercise versus control at follow up ‐ hip, Outcome 3 Quality of life.
3.1 GSI ‐ global self rating index	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.00 [‐0.04, 2.04]

Analysis 1.1

Comparison 1 Aquatic exercise versus control after treatment ‐ knee&hip mixed, Outcome 1 Pain.

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Analysis 1.2

Comparison 1 Aquatic exercise versus control after treatment ‐ knee&hip mixed, Outcome 2 Function.

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Analysis 1.3

Comparison 1 Aquatic exercise versus control after treatment ‐ knee&hip mixed, Outcome 3 Walking ability.

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Analysis 1.4

Comparison 1 Aquatic exercise versus control after treatment ‐ knee&hip mixed, Outcome 4 Stiffness.

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Analysis 1.5

Comparison 1 Aquatic exercise versus control after treatment ‐ knee&hip mixed, Outcome 5 Quality of life.

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Analysis 1.6

Comparison 1 Aquatic exercise versus control after treatment ‐ knee&hip mixed, Outcome 6 Mental health.

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Analysis 2.1

Comparison 2 Aquatic exercise versus control after treatment ‐hip, Outcome 1 Function.

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Analysis 2.2

Comparison 2 Aquatic exercise versus control after treatment ‐hip, Outcome 2 Quality of life.

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Analysis 3.1

Comparison 3 Aquatic exercise versus land after treatment ‐ knee, Outcome 1 Pain.

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Analysis 3.2

Comparison 3 Aquatic exercise versus land after treatment ‐ knee, Outcome 2 Walking ability.

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Analysis 3.3

Comparison 3 Aquatic exercise versus land after treatment ‐ knee, Outcome 3 Stiffness.

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Analysis 4.1

Comparison 4 Aquatic exercise versus control at follow up ‐ knee&hip mixed, Outcome 1 Pain.

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Analysis 4.2

Comparison 4 Aquatic exercise versus control at follow up ‐ knee&hip mixed, Outcome 2 Function.

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Analysis 4.3

Comparison 4 Aquatic exercise versus control at follow up ‐ knee&hip mixed, Outcome 3 Stiffness.

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Analysis 4.4

Comparison 4 Aquatic exercise versus control at follow up ‐ knee&hip mixed, Outcome 4 Mental health.

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Analysis 5.1

Comparison 5 Aquatic exercise versus control at follow up ‐ hip, Outcome 1 Pain.

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Analysis 5.2

Comparison 5 Aquatic exercise versus control at follow up ‐ hip, Outcome 2 Function.

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Analysis 5.3

Comparison 5 Aquatic exercise versus control at follow up ‐ hip, Outcome 3 Quality of life.

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Table 1. Clinical relevance table ‐ Knee and hip mixed OA

Study	Outcome (scale)	# patients (# trials	Ctl baseline mean,SD	Wt absolute change	Relative % change	Statistical Sig.	Quality of evidence
Cochrane (2005) ; Foley (2003)	WOMAC (Western Ontario McMaster Osteoarthritis Index) (pain) (0‐20)	380 (2)	9.10 (3.14)	3.0% (0.6 fewer points on a scale 0 to 20 scale)	6.6% (I)	statistically significant but not clinically significant	GOLD
Wang (2004)	VAS (Visual Analogue Scale) pain (0‐100)	43 (1)	55.3 (24.6)	12% (12.3 fewer points on a 0‐100 scale)	0.2% (I)	not significant	GOLD
Patrick (2001)	HAQ (Health Assessment Questionnaire) pain (0‐3)	249 (1)	1.05 (0.61)	2% (0.07 fewer points on a 0‐3 scale)	7% (I)	not significant	GOLD
Cochrane (2005); Foley (2003)	WOMAC function (0‐68)	380 (2)	31.05 (11.24)	4.3% (2.9 points on scale of 0 to 68)	9.4% (1)	statistically significant but not clinically significant	GOLD
Patrick (2001); Wang (2004)	HAQ function (0‐3)	292 (2)	0.95 (0.5)	5.2% (0.16 fewer points on a 0‐3 scale)	16.3% (I)	statistically significant	GOLD
Cochrane (2005)	WOMAC pain (0‐20)	310 (1)	9.10 (3.14)	0.3% (0.35 points fewer on a 0‐20 scale)	4% (I)	not significant	GOLD
Cochrane (2005)	WOMAC function (0‐68)	310 (1)	31.05 (11.24)	0.1% (0.11 fewer points on a 0‐68 scale)	0.4% (I)	not significant	GOLD
Legend: ctl=control group; SD=standard deviation; wt=weighted; I=improvement; sig=significance;

Table 1. Clinical relevance table ‐ Knee and hip mixed OA

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Table 2. Clinical relevance table ‐ Hip OA

Study	Outcome (scale)	#patients #(trials)	Ctl baseline mean,SD	Absolute change	Relative % change	Statistical sig.	Quality of evidence
Stener‐Victorin (2004)	VAS (Visual Analog Scale) pain (0‐100)	28 (1)	56.0 (21.89)	22% (21.9 fewer points on a 0‐100 scale)	40% (I)	not statistically significant	SILVER
Legend: ctl=control group, SD=standard deviation, sig=significance, I=improvement

Table 2. Clinical relevance table ‐ Hip OA

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Table 3. Clinical relevance table ‐ Knee OA

Study	Outcome (scale)	#patients (# trials)	Ctl baseline mean,SD	Absolute change	Relative % change	Statisitical sig.	Quality of evidence
Wyatt (2001)	VAS (Visual Analog Scale) pain (0‐10)	46 (1)	5.6 (1.4)	12% (1.2 fewer points on a 0‐10 scale)	22% (I)	statistically significant	SILVER
Legend: ctl=control group; sig=significance; I=improvement

Table 3. Clinical relevance table ‐ Knee OA

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Comparison 1. Aquatic exercise versus control after treatment ‐ knee&hip mixed

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	4	638	Std. Mean Difference (IV, Random, 95% CI)	0.19 [0.04, 0.35]

1.1 WOMAC pain	2	380	Std. Mean Difference (IV, Random, 95% CI)	0.20 [‐0.00, 0.40]
1.2 Visual Analogue Pain	1	43	Std. Mean Difference (IV, Random, 95% CI)	0.50 [‐0.10, 1.11]
1.3 HAQ pain	1	215	Std. Mean Difference (IV, Random, 95% CI)	0.12 [‐0.15, 0.39]
2 Function Show forest plot	4	648	Std. Mean Difference (IV, Random, 95% CI)	0.26 [0.11, 0.42]

2.1 WOMAC function	2	375	Std. Mean Difference (IV, Random, 95% CI)	0.23 [0.03, 0.44]
2.2 HAQ function	2	273	Std. Mean Difference (IV, Random, 95% CI)	0.31 [0.07, 0.55]
3 Walking ability Show forest plot	2	355	Std. Mean Difference (IV, Random, 95% CI)	0.18 [‐0.03, 0.39]

3.1 Six‐minute walk	1	43	Std. Mean Difference (IV, Random, 95% CI)	‐0.03 [‐0.63, 0.57]
3.2 8‐foot walk time	1	312	Std. Mean Difference (IV, Random, 95% CI)	0.21 [‐0.01, 0.43]
4 Stiffness Show forest plot	2	380	Std. Mean Difference (IV, Random, 95% CI)	0.14 [‐0.06, 0.34]

4.1 WOMAC stiffness	2	380	Std. Mean Difference (IV, Random, 95% CI)	0.14 [‐0.06, 0.34]
5 Quality of life Show forest plot	3	599	Std. Mean Difference (IV, Random, 95% CI)	0.32 [0.03, 0.61]

5.1 SF‐12 physical	1	70	Std. Mean Difference (IV, Random, 95% CI)	0.69 [0.21, 1.17]
5.2 PQOL ‐ perceived quality of life	1	222	Std. Mean Difference (IV, Random, 95% CI)	0.35 [0.09, 0.62]
5.3 EURO‐QOL	1	307	Std. Mean Difference (IV, Random, 95% CI)	0.10 [‐0.12, 0.33]
6 Mental health Show forest plot	4	642	Std. Mean Difference (IV, Random, 95% CI)	0.16 [0.01, 0.32]

6.1 SF‐36 mental	1	307	Std. Mean Difference (IV, Random, 95% CI)	0.15 [‐0.08, 0.37]
6.2 SF‐12 mental	1	70	Std. Mean Difference (IV, Random, 95% CI)	0.19 [‐0.28, 0.66]
6.3 Psychological Distress	1	43	Std. Mean Difference (IV, Random, 95% CI)	0.37 [‐0.24, 0.97]
6.4 QWB ‐ quality of well being	1	222	Std. Mean Difference (IV, Random, 95% CI)	0.13 [‐0.13, 0.40]

Comparison 1. Aquatic exercise versus control after treatment ‐ knee&hip mixed

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Comparison 2. Aquatic exercise versus control after treatment ‐hip

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Function Show forest plot	1	28	Std. Mean Difference (IV, Random, 95% CI)	0.76 [‐0.02, 1.53]

1.1 DRI‐disability rating index	1	28	Std. Mean Difference (IV, Random, 95% CI)	0.76 [‐0.02, 1.53]
2 Quality of life Show forest plot	1	28	Std. Mean Difference (IV, Random, 95% CI)	0.76 [‐0.02, 1.53]

2.1 GSI ‐ global self rating index	1	28	Std. Mean Difference (IV, Random, 95% CI)	0.76 [‐0.02, 1.53]

Comparison 2. Aquatic exercise versus control after treatment ‐hip

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Comparison 3. Aquatic exercise versus land after treatment ‐ knee

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	1	46	Std. Mean Difference (IV, Random, 95% CI)	0.86 [0.25, 1.47]

1.1 VAS pain	1	46	Std. Mean Difference (IV, Random, 95% CI)	0.86 [0.25, 1.47]
2 Walking ability Show forest plot	1	46	Std. Mean Difference (IV, Random, 95% CI)	0.43 [‐0.16, 1.01]

2.1 1 MILE walk time	1	46	Std. Mean Difference (IV, Random, 95% CI)	0.43 [‐0.16, 1.01]
3 Stiffness Show forest plot	1	46	Std. Mean Difference (IV, Random, 95% CI)	‐0.26 [‐0.84, 0.32]

Comparison 3. Aquatic exercise versus land after treatment ‐ knee

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Comparison 4. Aquatic exercise versus control at follow up ‐ knee&hip mixed

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	1	310	Std. Mean Difference (IV, Random, 95% CI)	0.11 [‐0.12, 0.33]

1.1 WOMAC pain	1	310	Std. Mean Difference (IV, Random, 95% CI)	0.11 [‐0.12, 0.33]
2 Function Show forest plot	1	306	Std. Mean Difference (IV, Random, 95% CI)	0.10 [‐0.12, 0.33]

2.1 WOMAC function	1	306	Std. Mean Difference (IV, Random, 95% CI)	0.10 [‐0.12, 0.33]
3 Stiffness Show forest plot	1	310	Std. Mean Difference (IV, Random, 95% CI)	0.13 [‐0.09, 0.36]

3.1 WOMAC stiffness	1	310	Std. Mean Difference (IV, Random, 95% CI)	0.13 [‐0.09, 0.36]
4 Mental health Show forest plot	1	309	Std. Mean Difference (IV, Random, 95% CI)	0.05 [‐0.17, 0.27]

4.1 SF‐36 mental	1	309	Std. Mean Difference (IV, Random, 95% CI)	0.05 [‐0.17, 0.27]

Comparison 4. Aquatic exercise versus control at follow up ‐ knee&hip mixed

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Comparison 5. Aquatic exercise versus control at follow up ‐ hip

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.00 [‐0.04, 2.04]

1.1 VAS pain	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.00 [‐0.04, 2.04]
2 Function Show forest plot	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.00 [‐0.04, 2.04]

2.1 DRI‐disability rating index	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.00 [‐0.04, 2.04]
3 Quality of life Show forest plot	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.00 [‐0.04, 2.04]

3.1 GSI ‐ global self rating index	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.00 [‐0.04, 2.04]

Comparison 5. Aquatic exercise versus control at follow up ‐ hip

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Referencias

Referencias de los estudios incluidos en esta revisión

Cochrane 2005 {published data only}

Foley 2003 {published data only}

Patrick 2001 {published data only}

Stener‐Victorin 2004 {published data only}

Wang 2004 {published data only}

Wyatt 2001 {published data only}

Referencias de los estudios excluidos de esta revisión

Ahern 1995 {published data only}

Alexander 2001 {published data only}

Belza 2002 {published data only}

Borchers 2003 {published data only}

Cusack 2003 {published data only}

D'Lima 1996 {published data only}

Elkayam 1991 {published data only}

Green 1993 {published data only}

Guillemin 2001 {published data only}

Gyurcsik 2003 {published data only}

Hill 1999 {published data only}

Kostopoulos 2000 {published data only}

Kovacs 2002 {published data only}

Lin 2004 {published data only}

Minor 1989 {published data only}

Nguyen 1997 {published data only}

Norton 1999 {published data only}

Silva 2005 {published data only}

Suomi 1997 {published data only}

Suomi 2000 {published data only}

Suomi 2003 {published data only}

Tishler 2004 {published data only}

Referencias adicionales

Altman 1986

Badley 1994

Bellamy 1997

Brandt 1986

Ethgen 2005

Felson 1998

Felson 2003

Flores 2003

Guccione 1994

Gur 2002

Guyatt 1993

Higgins 2005

Hurley 2003

Ioannidis 2001

Oliveria 1995

Peat 2001

Rogind 1998

Rothfuss 1997

Sharma 2003

Sowers 2000

Tugwell 2004

Verhagen 2000

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

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