PTOTSystematic ReviewClinical rehabilitation2025

Aquatic exercise interventions in the treatment of musculoskeletal upper extremity disorders: A scoping review.

Lynn Murray, Michelle Kennedy, Michael Malone and 2 others

PMID 39895004

WHAT IT FOUND

Aquatic exercise for upper limb issues is almost exclusively studied in shoulder conditions, especially after rotator cuff repair.

It is rarely delivered alone, usually mixed with land-based therapy, manual work, or injections. We cannot tell if the water itself adds benefit, and reporting is too poor to guide practice.

Key findings

01Shoulder problems were the most frequently treated condition, with rotator cuff repair being the most evaluated, while no studies focused on elbow conditions.

02Aquatic therapy was often part of a wider care package including land-based exercises, manual therapy, and injections, making it impossible to separate the water's specific contribution.

03Intervention reporting was poor, with less than 50% compliance with standard description guidelines, limiting the ability to replicate what was actually done.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTs

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What it does not show

No critical appraisal of methodological quality was performed, so the validity of the included studies is unknown. Intervention reporting was poor, with less than 50% compliance with standard guidelines, making it difficult to know exactly what was delivered. The review found no homogeneous randomized controlled trials suitable for meta-analysis, limiting conclusions about efficacy. Elbow and wrist/hand conditions were severely underrepresented in experimental studies. Patient experience data was limited to only two studies.

Declared interests

No specific funding or conflict of interest declarations were provided in the supplied text.

The easy way to misread this

Do not interpret the prevalence of aquatic therapy in shoulder rehab as proof of its specific efficacy. Most studies combined it with land-based exercises, manual therapy, or injections, and reporting was too poor to separate the water's contribution from the overall care package.

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