The Effect of Hydrotherapy on Balance and Mobility in Post Stroke: Meta Analysis
DOI:
https://doi.org/10.23917/fisiomu.v7i2.17175Keywords:
hydrotherapy, aquatic therapy, water exercises, balance, mobility, post-strokeAbstract
Introduction: Stroke is one of the leading causes of disability, affecting balance and mobility. Physical therapy rehabilitation efforts continue to be developed to optimize the recovery of motor function. Hydrotherapy, with the unique properties of the aquatic environment, is believed to offer therapeutic benefits in improving physical function and quality of life for post-stroke patients. This study aims to systematically and quantitatively evaluate the effectiveness of hydrotherapy in improving balance and mobility in post-stroke patients using a meta-analysis approach. Methods: The study was conducted by reviewing the literature from the PubMed and ScienceDirect databases from 2016 to 2025. Inclusion criteria included randomized controlled trials (RCTs) evaluating hydrotherapy interventions in post-stroke patients with outcomes related to balance and mobility. Data analysis was performed using a random-effects model with calculation of the standardized mean difference (SMD) and a heterogeneity test (I²). Results: A total of 6 studies met the inclusion criteria. The results of the meta-analysis showed that hydrotherapy was effective in improving balance (SMD = 0.84; 95% CI: 0.09 to 1.59; p=0.03; I² = 90%) and mobility (SMD = -0.28; 95% CI: -1.37–0.80; p=0.61; I² = 95%) compared to conventional land-based physical therapy interventions. Conclusion: In post stroke patients, hydrotherapy significantly improves balance, while its effect on mobility remains inconclusive. This intervention is worth considering as part of a physical therapy rehabilitation program. However, further research with more consistent methodological designs is still needed to strengthen the scientific evidence.
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Bei, N., Long, D., Bei, Z., Chen, Y., Chen, Z., & Xing, Z. (2023). Effect of Water Exercise Therapy on Lower Limb Function Rehabilitation in Hemiplegic Patients with the First Stroke. Alternative Therapies in Health and Medicine, 29(7), 429–433.
Carroll, J., Manzano, C. L., Tomlinson, E., Sadek, A., Cooper, C., Jones, H. E., Rowsell, L., Knight, J., Mumford, A., Palmer, R., Hollingworth, W., Welton, N. J., & Whiting, P. (2024). Clinical and cost-effectiveness of clopidogrel resistance genotype testing after ischaemic stroke or transient ischaemic attack : a systematic review and economic model. NIHR Journals, 28(57). https://doi.org/10.3310/PWCB4016
Cha, H. G., Shin, Y. J., & Kim, M. K. (2017). Effects of the Bad Ragaz Ring Method on muscle activation of the lower limbs and balance ability in chronic stroke: A randomised controlled trial. Hong Kong Physiotherapy Journal, 37, 39–45. https://doi.org/10.1016/j.hkpj.2017.02.001
Feigin, V. L., Brainin, M., Norrving, B., Martins, S. O., Pandian, J., Lindsay, P., Grupper, M. F., & Rautalin, I. (2025). World Stroke Organization : Global Stroke Fact Sheet 2025. International Journal of Stroke, 20(2), 132–144. https://doi.org/10.1177/17474930241308142
Gento-Andres, L., Sanz-Esteban, I., Rodríguez-Costa, I., Sosa-Reina, M. D., & Castel-Sanchez, M. (2025). Efficacy of Aquatic Therapy in Improving Balance in Patients With Stroke : A Systematic Review and Meta-Analysis. Ahajournals, 4202450389(000), 1–20. https://doi.org/10.1016/j.arrct.2025.100548
Global Burden Diseases. (2024). Articles Global , regional , and national burden of stroke and its risk factors , 1990 – 2021 : a systematic analysis for the Global Burden of Disease Study 2021. 973–1003. https://doi.org/10.1016/S1474-4422(24)00369-7
Jiang, L., Ding, H., Ma, Q., Gao, S., Zhang, X., & Chun, B. (2025). Comparing the effectiveness of different exercise interventions on quality of life in stroke patients : a randomized controlled network meta-analysis. Jiang et Al. BMC Neurology, 25(24), 1–12. https://doi.org/https://doi.org/10.1186/s12883-025-04035-5
Kazi, D. S., Elkind, M. S. V, Deutsch, A., Dowd, W. N., Heidenreich, P., Khavjou, O., Mark, D., Mussolino, M. E., Ovbiagele, B., & Patel, S. S. (2024). Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States Through 2050 : A Presidential Advisory From the American Heart Association. Circulation, 150(July 23), 89–101. https://doi.org/10.1161/CIR.0000000000001258
Kemenkes. (2023). Survei Kesehatan Indonesia (SKI). Badan Kebijakan Pembangunan Kesehatan Kementerian Kesehatan Republik Inoneisa, 1–926.
Lee, S. Y., Im, S. H., Kim, B. R., & Han, E. Y. (2018). The Effects of a Motorized Aquatic Treadmill Exercise Program on Muscle Strength, Cardiorespiratory Fitness, and Clinical Function in Subacute Stroke Patients: A Randomized Controlled Pilot Trial. American Journal of Physical Medicine and Rehabilitation, 97(8), 533–540. https://doi.org/10.1097/PHM.0000000000000920
Li, Y., & Zheng, G. (2021). The ef fi cacy of aquatic therapy in stroke rehabilitation. Medicine, 100(48), 10–12.
Lim, J. H., Lee, H. S., & Song, C. S. (2021). Home-based rehabilitation programs on postural balance, walking, and quality of life in patients with stroke: A single-blind, randomized controlled trial. Medicine (United States), 100(35), E27154. https://doi.org/10.1097/MD.0000000000027154
Lv, Y., Li, D., Liu, R., & He, Y. (2026). Complementary Therapies in Medicine The progress and application of hot spring hydrotherapy in medical fields : A narrative review. Complementary Therapies in Medicine, 96(November 2025), 103312. https://doi.org/10.1016/j.ctim.2025.103312
Marinho-Buzelli, A. R., Vijayakumar, A., Wasilewski, M. B., Linkewich, E., & Hitzig, S. L. (2025). Implementation considerations of aquatic therapy post-stroke: A qualitative study from Ontario, Canada. Complementary Therapies in Clinical Practice, 60(April), 101984. https://doi.org/10.1016/j.ctcp.2025.101984
Morer, C., Michan-Doña, A., Alvarez-Badillo, A., Zuluaga, P., & Maraver, F. (2020). Evaluation of the feasibility of a two-week course of aquatic therapy and thalassotherapy in a mild post-stroke population. International Journal of Environmental Research and Public Health, 17(21), 1–14. https://doi.org/10.3390/ijerph17218163
Nayak, P., Mahmood, A., Natarajan, M., Hombali, A., Prashanth, C. G., & Solomon, J. M. (2020). Effect of aquatic therapy on balance and gait in stroke survivors: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice, 39(January), 101110. https://doi.org/10.1016/j.ctcp.2020.101110
Park, H. K., Lee, H. J., Lee, S. J., & Lee, W. H. (2020). Land-based and aquatic trunk exercise program improve trunk control, balance and activities of daily living ability in stroke: A randomized CLINICAL trial. European Journal of Physical and Rehabilitation Medicine, 55(6), 687–694. https://doi.org/10.23736/S1973-9087.18.05369-8
Pérez-De la Cruz, S. (2020). Comparison of aquatic therapy vs. Dry land therapy to improve mobility of chronic stroke patients. International Journal of Environmental Research and Public Health, 17(13), 1–12. https://doi.org/10.3390/ijerph17134728
Pérez-De La Cruz, S. (2021). Comparison between three therapeutic options for the treatment of balance and gait in stroke: A randomized controlled trial. International Journal of Environmental Research and Public Health, 18(2), 1–11. https://doi.org/10.3390/ijerph18020426
Sanz-esteban, I., Gento-andr, L., Rodríguez-costa, I., Sosa-reina, M. D., & Castel-s, M. (2026). Ef fi cacy of Aquatic Therapy in Improving Balance in Patients With Stroke : A Systematic Review and Meta-Analysis. 42024503897. https://doi.org/10.1016/j.arrct.2025.100548
Sasegbon, A. (2025). The neurorehabilitation of post-stroke dysphagia : Physiology and pathophysiology. JPhysiol, 60(3), 617–634. https://doi.org/10.1113/JP285564
Veldema, J., & Jansen, P. (2021). Aquatic therapy in stroke rehabilitation : systematic review and. Acta Neurol Scand, 143(October 2020), 221–241. https://doi.org/10.1111/ane.13371
Yang, X., Liu, Q., Zhang, H., Lu, Y., & Yao, L. (2024). A predictive model for functionality improvement after stroke rehabilitation. Journal of Neurorestoratology, (September), 100157. https://doi.org/10.1016/j.jnrt.2024.100157
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