Samenvatting

MAIN QUESTIONS: What are the effects of aquatic therapy for people with rheumatoid arthritis, osteoarthritis and ankylosing spondylitis on pain, ADL-functioning and health Related Quality of Life (HRQL)?

BACKGROUND: An interest in investigating the effects of aquatic therapy emerged from a clinical affiliation period the authors of this project had at Reumasol Centre. Many patients report great subjective benefit from aquatic therapy. The Authors of this review wanted to investigate objective effectiveness of this intervention.

OBJECTIVE: A report on the effects of aquatic therapy for people with rheumatoid arthritis, osteoarthritis and ankylosing spondylitis on pain, ADL-functioning and Health Related Quality of Life.

SEARCH STRATEGY: Medline, PEDro, Cinahl, and Cochrane collaborations databases were searched using Robinson and Dickersin's "Revised Strategy Translated into PubMed Format" from "Development of an optimal search strategy for the retrieval of controlled trials using PubMed". The strategy was modified to facilitate searches on the different databases. Reference checking was conducted. Personal communication was obtained with experts in the field of research: Prof. Jefferson Cardoso, Dr. Arianne Verhagen and Dr. Maria Judd.

ELIGIBILITY CRITERIA: Trials were eligible if they were controlled trials that compared effects of aquatic therapy with any other, or no intervention. The participants in the trial had to be diagnosed with either rheumatoid arthritis (RA), osteoarthritis (OA) or ankylosing spondylitis (AS) by internationally accepted criteria (e.g. NY criteria for RA 1968, Modified N.Y. criteria for AS, The revised ARA criteria of 1987). At least one of the following had to be key outcome measures: Pain, ADL-functioning and/or Health Related Quality of Life.

MAIN RESULTS: 12 trials with 785 participants were included in this review. Methodological quality of the trials were assessed by use of the PEDro scale, and subsequently compared with the Delphi List. 10 of the included trials were randomised, two were controlled clinical trials. The quality and design of the included studies differed widely.

CONCLUSION: Research on aquatic therapy is scarce and heterogeneous in quality and design. Most authors provide results that indicate some justification for continued use of this treatment form for people with chronic rheumatic disorders. There is a discrepancy between the lack of objective improvements, and the fact that most participants report great subjective benefits from aquatic therapy.