The Effect of Water-Based Therapy Compared to Land-Based Therapy on Balance and Gait Parameters of Patients with Stroke: A Systematic Review

Nour Zughbor, Aisha Alwahshi, Rahaf Abdelrahman, Zeina Elnekiti, Hoda Elkareish, Marian Grace Gabor, Senthilnathan Ramakrishnan

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Abstract

Introduction: Stroke is defined as the lack of blood supply to the brain, leading to rapid loss of brain function presenting with impairments such as muscle weakness, spasticity, lack of coordination, and proprioception loss. Both hydrotherapy and land-based therapy aim to target these aspects in the process of rehabilitation. The study aims to determine the effectiveness of water-based therapy on balance and gait of patients with stroke compared to land-based therapy. Methods: Data for this review were extracted from databases such as CINAHL, OTseeker, Ovid, PEDro, and PubMed (MEDLINE) and other sources such as Google Scholar. PRISMA guidelines were followed to exclude irrelevant studies. Only randomized controlled trials (RCTs) were included, and methodological quality was assessed using the PEDro scale. A meta-analysis of extracted data was conducted. Results: A total of 16 relevant RCTs were included for the review (n = 412 participants). All RCTs investigated the effect of water-based therapy compared to land-based therapy on balance and gait of patients with stroke. Meta-analysis of studies that used the Berg Balance Scale (BBS) as a primary outcome measure favored land-based therapy. Studies that used the Good Balance System (GBS) and the Biodex Balance System (BioBS) to measure the changes in anteroposterior sway and mediolateral sway favored water-based therapy. The overall pooled effect favored land-based therapy in improving gait parameters. Conclusion: Findings from meta-analysis support the effectiveness of land-based therapy in the improvement of balance and gait parameters of patients with stroke. However, the evidence for water-based therapy continues to be limited, and higher quality studies are required to determine the effectiveness of water-based therapy on patients with stroke, particularly on balance and gait.
Original languageEnglish
Pages (from-to)409-417
Number of pages9
JournalEuropean Neurology
Volume84
Issue number6
Early online date16 Jul 2021
DOIs
Publication statusE-pub ahead of print - 16 Jul 2021

Bibliographical note

This is the accepted manuscript version of an article published by S. Karger AG in European Neurology, 2021, (In-press) https://dx.doi.org/10.1159/000517377

Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders.

Keywords

  • Balance
  • Gait
  • Hydrotherapy
  • Land-based therapy
  • Stroke

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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