The Effects of Hydrotherapy on Balance, Functional Mobility, Motor Status, and Quality of Life in Patients with Parkinson Disease: A Systematic Review and Meta-analysis.

BACKGROUND

Individuals with Parkinson disease (PD) present 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 patients 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; Unified Parkinson Disease Rating Scale-Part III.

RESULTS

A total of 19 studies were identified, including eight RCTs, three non-RCTs, and eight 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 patients; MD = 2.00 [95% CI, 0.56 to 3.43; I 0%, P = .01]) and functional mobility (133 patients; MD = -1.08 [95% CI, -1.99 to -0.18; I 8%, P = .02]). However, hydrotherapy combined or not with land-based therapy did not improve QOL (76 patients; MD = -6.35 [95% CI, -13.04 to 0.33; I 7%, P = .06]) and motor status (140 patients; MD = -1.11 [95% CI, -3.27 to 1.04; I 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 of patients with PD when compared to land-based therapy alone or usual care.

LEVEL OF EVIDENCE

Level I.