Is hydrotherapy effective to improve balance, functional mobility, motor status, and quality of life in subjects with Parkinson’s disease? A systematic review and meta-analysis

Abstract Background Individuals with Parkinson disease (PD) present with balance and functional mobility disabilities that negatively affect the quality of life (QOL). Objective To systematically review the effects of hydrotherapy on balance, functional mobility, QOL, and motor status in subjects with PD. Design Systematic review and meta-analysis. Participants A total of 484 participants were included. The mean age of participants ranged from 54 to 78 years. The average duration of PD ranged from 3 to 10 years. Methods MEDLINE (Pubmed), Embase, Cochrane CENTRAL, SCOPUS, Scielo, Physiotherapy Evidence Database (PEDro), and Google Scholar were searched from inception to December 2017. Randomized controlled trials (RCT), non-RCT, and pre-post studies were included. Main outcome measurements Berg Balance Scale; Timed Up and Go test; Parkinson’s disease quality of life and Short Form-36 Health Survey (SF-36); Unified Parkinson Disease Rating Scale-Part III. Results Nineteen studies were identified, including 8 RCTs, 3 non-RCTs, and 8 pre-post studies. Our meta-analysis showed a moderate-quality of evidence for positive effects of hydrotherapy combined or not with land-based therapy on balance (133 subjects; MD = 2.00 [95% CI, 0.56 to 3.43; I 2 0%, p=.01]) and functional mobility (133 subjects; MD = -1.08 [95% CI, -1.99 to -0.18; I 2 8%, p=.02]). We found a low quality of evidence for no effects of hydrotherapy combined or not with land-based therapy on QOL (76 subjects; MD = -6.35 [95% CI, -13.04 to 0.33; I 2 7%, p=.06]) and on motor status (140 subjects; MD = -1.11 [95% CI, -3.27 to 1.04; I 2 0%, p=.31). The risk of bias across the included RCTs was low. Conclusions Hydrotherapy combined or not with other therapies may improve balance and functional mobility in subjects with PD when compared to land-based therapy alone or usual care. Level of evidence Level I