Effects of hydrokinesitherapy on balance and walking ability for stroke survivors: update of a systematic review and meta-analysis of randomized controlled studies.

The trials were mostly of poor quality: many did not describe how participants were allocated, only 7 of 29 made their protocol publicly available in advance, and 5 had more than 5% dropout without an intention-to-treat analysis. Every included trial was single-centre with a small sample (12 to 160 participants), so the pooled results lean on small studies. The water programmes differed widely in type, intensity and length (2 to 12 weeks), so the review cannot say which protocol or dose works best. Most of the differences in results between trials remained unexplained after analysis (66.8% of the variance was left over), so the pooled balance estimate carries real uncertainty. The walking ability result reversed direction when one 2016 trial was removed, so it is not a stable finding. Some outcomes rested on very few participants (Functional Reach 107 people across 4 trials; Five Times Sit-to-Stand 65 people), so those estimates are imprecise. Sixteen of the 29 trials were run in Asia and most participants were inpatients, which may limit how far these results transfer to other settings and to community-dwelling patients.

The authors declare no conflict of interest with any financial organisation regarding the material discussed. The work was funded by four Chinese provincial programmes in Yunnan Province, all linked to traditional Chinese medicine personnel training and to acupuncture and Tuina research teams for brain disease. The authors state the funders had no role in study design, data collection, analysis or interpretation, or in writing the report.

Do not assume that better balance on the Berg Balance Scale means better walking or daily living. The review found not enough evidence for either, and its walking result flipped direction when one trial was removed from the analysis.