title: Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis.
abstract: BACKGROUND
  Current 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.
  
  
  OBJECTIVE
  The 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.
  
  
  METHODS
  The data sources used in this study were: MEDLINE, PubMed, EMBASE, CINAHL, PEDro, and SPORTDiscus.
  
  
  METHODS
  All 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.
  
  
  METHODS
  Data were extracted and checked for accuracy by 3 independent reviewers.
  
  
  RESULTS
  Standardized 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]).
  
  
  CONCLUSIONS
  Heterogeneity 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.
  
  
  CONCLUSIONS
  The results indicate that TAE is effective in managing symptoms associated with lower limb OA.
authors.affiliation: B. Waller, PT, MSc, Department of Health Sciences, University of Jyvaskyla, PO Box 35, FI-40014, Jyvaskyla, Finland. ben.waller@jyu.fi.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Waller
authors.affiliation: A. Ogonowska-Slodownik, MSc, Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education, Warsaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Ogonowska-Slodownik
authors.affiliation: M. Vitor, MSc, Faculty of Sport, University of Porto, Porto, Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: Vitor
authors.affiliation: J. Lambeck, PT, BHS, KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Lambeck
authors.affiliation: D. Daly, PhD, KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences.
authors.forename: Daniel
authors.initials: D
authors.lastname: Daly
authors.affiliation: U.M. Kujala, MD, PhD, Department of Health Sciences, University of Jyvaskyla.
authors.forename: Urho M
authors.initials: UM
authors.lastname: Kujala
authors.affiliation: A. Heinonen, PhD, Department of Health Sciences, University of Jyvaskyla.
authors.forename: Ari
authors.initials: A
authors.lastname: Heinonen
mesh_terms: D016001:Confidence Intervals; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D059352:Musculoskeletal Pain / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation*; D016017:Odds Ratio; D015207:Osteoarthritis, Hip / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D020370:Osteoarthritis, Knee / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D010147:Pain Measurement; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013550:Swimming / Q000502:physiology*