title: A systematic review of nonrandomized controlled trials on the curative effects of aquatic exercise.
abstract: BACKGROUND
  The objectives of this review were to integrate the evidence of curative effects through aquatic exercise and assess the quality of studies based on a review of nonrandomized controlled trials (nRCTs).
  
  
  METHODS
  Study design was a systematic review of nonrandomized controlled trials. Trials were eligible if they were nonrandomized clinical trials. Studies included one treatment group in which aquatic exercise was applied. We searched the following databases from 2000 up to July 20, 2009: MEDLINE via PubMed, CINAHL, and Ichushi-Web.
  
  
  RESULTS
  Twenty-one trials met all inclusion criteria. Languages included were English (N = 9), Japanese (N = 11), and Korean (N = 1). Target diseases were knee and/or hip osteoarthritis, poliomyelitis, chronic kidney disease, discomforts of pregnancy, cardiovascular diseases, and rotator cuff tears. Many studies on nonspecific disease (healthy participants) were included. All studies reported significant effectiveness in at least one or more outcomes. However results of evaluations with the TREND and CLEAR-NPT checklists generally showed a remarkable lack of description in the studies. Furthermore, there was the problem of heterogeneity, and we were therefore not able to perform a meta-analysis.
  
  
  CONCLUSIONS
  Because there was insufficient evidence on aquatic exercise due to poor methodological and reporting quality and heterogeneity of nRCTs, we were unable to offer any conclusions about the effects of this intervention. However, we were able to identify problems with current nRCTs of aquatic exercise, and propose a strategy of strengthening study quality, stressing the importance of study feasibility as a future research agenda objective.
authors.affiliation: Faculty of Regional Environment Science, Tokyo University of Agriculture, Tokyo, Japan;
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Kamioka
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Tsutani
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Mutoh
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Okuizum
authors.forename: Miho
authors.initials: M
authors.lastname: Ohta
authors.forename: Shuichi
authors.initials: S
authors.lastname: Handa
authors.forename: Shinpei
authors.initials: S
authors.lastname: Okada
authors.forename: Jun
authors.initials: J
authors.lastname: Kitayuguchi
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Kamada
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Shiozawa
authors.forename: Sang-Jun
authors.initials: SJ
authors.lastname: Park
authors.forename: Takuya
authors.initials: T
authors.lastname: Honda
authors.forename: Shoko
authors.initials: S
authors.lastname: Moriyama