A systematic review with meta-analysis on balance, fatigue, and motor function following aquatic therapy in patients with multiple sclerosis

Published:August 13, 2022DOI:


      • Aquatic therapy has positive effects on postural balance in patients with multiple sclerosis.
      • Aquatic therapy improves different kinds of fatigue, including psychological, physical, and cognitive fatigue, in patients with multiple sclerosis.
      • No adverse effects were reported for aquatic therapy for treating patients with multiple sclerosis.



      In this systematic review and meta-analysis, we aimed to evaluate the impact of long-term aquatic exercise training on balance, fatigue, and motor function.


      Scopus, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index to Nursing, and Allied Health Literature were searched on April 19, 2021. The search included randomized and non-randomized controlled trials, case-control studies, case series, and case reports. Two independent reviewers reviewed titles and abstracts to determine which studies satisfied the eligibility criteria. Two reviewers independently surveyed the full texts and conducted the study selection, data extraction, and quality assessment. Data synthesis was applied to summarize information from included studies. Meta-analysis was performed using RevMan 5.


      From 170 studies that were identified in the initial search, 16 trials (794 participants) satisfied the eligibility criteria. Aquatic therapy had a positive effect on fatigue compared to control group based on Modified Fatigue Impact Scale (MFIS) in physical (SMD, -1.29; 95% CI, [(-1.65) - (-0.93)]; I2=88%) cognitive (SMD, -0.75; 95% CI, [(-1.08)-(- 0.43)]; I2=78%), and psychological (SMD, -1.25; 95% CI, [(-1.59) - (-0.90)]; I2=79%) domains, and Fatigue Severity Scale (FSS) (SMD, -0.53; 95% CI, [(-0.86) - (-0.20)]; I2=57%). In addition, aquatic therapy improved balance based on the Berg Balance Scale (BBS) compared to the control group (SMD, 1.19; 95% CI, [(0.62)-(1.76)]; I2=11%)


      Aquatic therapy has positive effects on fatigue and balance. Further research is needed to confirm the clinical utility of aquatic therapy for multiple sclerosis patients in the long term.


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