• Benjamin Waller, Anna Ogonowska-Slodownik, Manuel Vitor, Johan Lambeck, Daniel Daly, Urho M Kujala, and Ari Heinonen.
• B. Waller, PT, MSc, Department of Health Sciences, University of Jyvaskyla, PO Box 35, FI-40014, Jyvaskyla, Finland. ben.waller@jyu.fi.
• Phys Ther. 2014 Oct 1; 94 (10): 1383-95.

BackgroundCurrent management of osteoarthritis (OA) focuses on pain control and maintaining physical function through pharmacological, nonpharmacological, and surgical treatments. Exercise, including therapeutic aquatic exercise (TAE), is considered one of the most important management options. Nevertheless, there is no up-to-date systematic review describing the effect of TAE on symptoms and function associated with lower limb OA.PurposeThe purpose of this study was to conduct a systematic review with meta-analysis to determine the effect of TAE on symptoms and function associated with lower limb OA.Data SourcesThe data sources used in this study were: MEDLINE, PubMed, EMBASE, CINAHL, PEDro, and SPORTDiscus.Study SelectionAll studies selected for review were randomized controlled trials with an aquatic exercise group and a nontreatment control group. In total, 11 studies fulfilled the inclusion criteria and were included in the synthesis and meta-analysis.Data ExtractionData were extracted and checked for accuracy by 3 independent reviewers.Data SynthesisStandardized mean difference (SMD) with 95% confidence interval (95% CI) was calculated for all outcomes. The meta-analysis showed a significant TAE effect on pain (SMD=0.26 [95% CI=0.11, 0.41]), self-reported function (SMD=0.30 [95% CI=0.18, 0.43]), and physical functioning (SMD=0.22 [95% CI=0.07, 0.38]). Additionally, a significant effect was seen on stiffness (SMD=0.20 [95% CI=0.03, 0.36]) and quality of life (SMD=0.24 [95% CI=0.04, 0.45]).LimitationsHeterogeneity of outcome measures and small sample sizes for many of the included trials imply that conclusions based on these results should be made with caution.ConclusionsThe results indicate that TAE is effective in managing symptoms associated with lower limb OA.© 2014 American Physical Therapy Association.

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