Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain: A Randomized Clinical Trial | Physical Activity | JAMA Network Open | JAMA Network
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    1 Comment for this article
    Apples and Oranges
    Jeff Harband, MSPT | Owner, Director, OASIS PT & Aquatics
    As the owner of an Aquatic Therapy / Physical Therapy practice, I was excited to see another article about the wonders of Aquatic Therapy. However, I am concerned by the comparison with infrared ray thermal therapy, which seems to be falling out of favor for lack of efficacy. Perhaps a comparison between PT where the same activities were performed on land and in water would be much more convincing.

    Jeff Harband, PT
    Owner, Director
    OASIS PT & Aquatics
    Views 9,253
    Citations 0
    Original Investigation
    Physical Medicine and Rehabilitation
    January 7, 2022

    Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain: A Randomized Clinical Trial

    Author Affiliations
    • 1Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
    • 2Department of Rehabilitation Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
    • 3Department of Rehabilitation Medicine, Qingtian People’s Hospital, Lishui, China
    • 4Department of Rehabilitation Medicine, Changzhou Seventh People’s Hospital, Jiangsu Changzhou, China
    • 5The Second School of Clinical Medicine, Xuzhou Medical University, Xuzhou, China
    • 6Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
    JAMA Netw Open. 2022;5(1):e2142069. doi:10.1001/jamanetworkopen.2021.42069
    Key Points

    Question  Is therapeutic aquatic exercise as effective as physical therapy modalities in the management of adults with chronic low back pain?

    Findings  In this randomized clinical trial of 113 individuals with chronic low back pain, therapeutic aquatic exercise had a greater influence on pain, function, quality of life, sleep quality, and mental state than physical therapy modalities after a 3-month intervention, and the effect was present up to the 12-month follow-up. The recommendation rate of therapeutic aquatic exercise was significantly higher than that of physical therapy modalities.

    Meaning  The findings of this trial suggest that therapeutic aquatic exercise is an effective treatment for adults with chronic low back pain.


    Importance  Therapeutic aquatic exercise is frequently offered to patients with chronic low back pain, but its long-term benefits are unclear.

    Objective  To assess the long-term effects of therapeutic aquatic exercise on people with chronic low back pain.

    Design, Setting, and Participants  This 3-month, single-blind randomized clinical trial with a 12-month follow-up period was performed from September 10, 2018, to March 12, 2019, and the trial follow-up was completed March 17, 2020. A total of 113 people with chronic low back pain were included in the experiment.

    Interventions  Participants were randomized to either the therapeutic aquatic exercise or the physical therapy modalities group. The therapeutic aquatic exercise group received aquatic exercise, whereas the physical therapy modalities group received transcutaneous electrical nerve stimulation and infrared ray thermal therapy. Both interventions were performed for 60 minutes twice a week for 3 months.

    Main Outcomes and Measures  The primary outcome was disability level, which was measured using the Roland-Morris Disability Questionnaire; scores range from 0 to 24, with higher scores indicating more severe disability. Secondary outcomes included pain intensity, quality of life, sleep quality, recommendation of intervention, and minimal clinically important difference. Intention-to-treat and per-protocol analyses were performed.

    Results  Of the 113 participants, 59 were women (52.2%) (mean [SD] age, 31.0 [11.5] years). Participants were randomly allocated into the therapeutic aquatic exercise group (n = 56) or the physical therapy modalities group (n = 57), and 98 patients (86.7%) completed the 12-month follow-up. Compared with the physical therapy modalities group, the therapeutic aquatic exercise group showed greater alleviation of disability, with adjusted mean group differences of −1.77 (95% CI, −3.02 to −0.51; P = .006) after the 3-month intervention, −2.42 (95% CI, −4.13 to −0.70; P = .006) at the 6-month follow-up, and −3.61 (95% CI, −5.63 to −1.58; P = .001) at the 12-month follow-up (P < .001 for overall group × time interaction). At the 12-month follow-up point, improvements were significantly greater in the therapeutic aquatic exercise group vs the physical therapy modalities group in the number of participants who met the minimal clinically important difference in pain (at least a 2-point improvement on the numeric rating scale) (most severe pain, 30 [53.57%] vs 12 [21.05%]; average pain, 14 [25%] vs 11 [19.30%]; and current pain, 22 [39.29%] vs 10 [17.54%]) and disability (at least a 5-point improvement on the Roland-Morris Disability Questionnaire) (26 [46.43%] vs 4 [7.02%]). One of the 56 participants (1.8%) in the therapeutic aquatic exercise group vs 2 of the 57 participants (3.5%) in the physical therapy modalities group experienced low back pain and other pains related to the intervention.

    Conclusions and Relevance  The therapeutic aquatic exercise program led to greater alleviation in patients with chronic low back pain than physical therapy modalities and had a long-term effect up to 12 months. This finding may prompt clinicians to recommend therapeutic aquatic exercise to patients with chronic low back pain as part of treatment to improve their health through active exercise rather than relying on passive relaxation.

    Trial Registration  Chinese Clinical Trial Registry: ChiCTR1800016396