Water-based exercises for improving activities of daily living after stroke.
BACKGROUND
Water-based exercises are used in rehabilitation and might help to reduce disability after stroke.


OBJECTIVE
To investigate the effect of water-based exercises for reducing disability after stroke.


METHODS
We searched the Cochrane Stroke Group Trials Register (last searched August 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to April 2010), EMBASE (1980 to April 2010), CINAHL (1982 to April 2010), AMED (1985 to April 2010), SPORTDiscus (1949 to April 2010), the Physiotherapy Evidence Database (PEDro, April 2010) and OT Seeker (1969 to April 2010). In an effort to identify further published, unpublished and ongoing trials we handsearched relevant journals and conference proceedings, searched trials and research registers, checked reference lists and contacted authors.


METHODS
We included studies using random assignment.


METHODS
Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. The primary outcome was activities of daily living.


RESULTS
We included four trials involving 94 participants in this review. There was a significant improvement in activity of daily living (mean difference (MD) 13.20 points on the 'Capacidad funcional' (functional capacity) subscale of the Brazilian-Portuguese version of the SF-36; 95% confidence interval (CI) 8.36 to 18.04; P < 0.00001) and on muscle strength (MD 1.01 Nm/kg; 95% CI 0.19 to 1.83; P = 0.02) but these results should be interpreted with caution because population numbers were small and the results are based on single studies. There was no significant improvement in ability to walk (MD 0.14 m/s; 95% CI -0.32 to 0.606; P = 0.55), postural balance (MD 3.05 points; 95% CI -3.41 to 9.52; P = 0.35) or fitness (MD 3.6 (VO(2max); 95% CI -0.53 to 7.73; P = 0.09) after water-based exercises treatment compared to control. Adverse effects were not reported.


CONCLUSIONS
The evidence from randomised controlled trials so far does not confirm or refute that water-based exercises after stroke might help to reduce disability after stroke. There is a lack of hard evidence for water-based exercises after stroke. Better and larger studies are therefore required.
(a) Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, Kreischa, Germany, (b) Sektion Therapiewissenschaften, SRH Fachhochschule für Gesundheit Gera gGmbH, Gera, Thueringen, Germany, 07548.
Jan
J
Mehrholz
Joachim
J
Kugler
Marcus
M
Pohl
D000203:Activities of Daily Living; D006801:Humans; D006875:Hydrotherapy / Q000379:methods*; D053580:Muscle Strength; D004856:Postural Balance; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D000071939:Stroke Rehabilitation; D016138:Walking
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