The Effectiviness of Aquatic Therapy as A Rehabilitation Innovation for Stroke Patients: Water as A Medium of Recovery-A Systematic Literature Review
Abstract
Stroke often causes long-term disabilities, significantly affecting motor and functional abilities. Rehabilitation interventions such as aquatic therapy, which utilize the properties of water to enhance movement and reduce pain, have gained increasing attention as innovative rehabilitation strategies. This systematic literature review aims to analyze and summarize the effectiveness of aquatic therapy as a rehabilitation innovation for improving functional recovery in stroke patients. A systematic search was conducted in three databases—PubMed, ScienceDirect, and Google Scholar—for articles published between January 2020 and January 2025. The keywords used in English included “aquatic therapy,” “stroke rehabilitation,” and “water-based therapy.” From the initial search, a total of 45 articles were identified. After screening titles and abstracts based on inclusion criteria (language, publication year, and open-access availability), 20 full-text articles were reviewed in detail. Following critical appraisal and relevance assessment to the research objectives, 10 articles were selected for final analysis. These articles were then synthesized to evaluate the effects of aquatic therapy on functional recovery, particularly focusing on gait and balance improvement in post-stroke patients. This review found 45 studies after identification. Most studies showed that aquatic therapy significantly improved balance, gait, muscle strength, and quality of life among stroke survivors. Additionally, resistance offered by water supports muscle strengthening without overstraining. However, variations in session duration, water temperature, and exercise intensity across studies suggest a need for standardized protocols. Aquatic therapy is an effective and innovative rehabilitation approach for stroke patients, particularly in enhancing motor recovery and quality of life. Future research should focus on standardized intervention protocols and long-term outcomes.
References
Becker BE. Aquatic therapy in contemporary neurorehabilitation: an update. PM R 2020;12:1251–9.
Bei N, Long D, Bei Z, Chen Y, Chen Z, Xing Z. Effect of Water Exercise Therapy on Lower Limb Function Rehabilitation in Hemiplegic Patients with the First Stroke. Altern Ther Health Med. 2023 Oct;29(7):429-433. PMID: 37573592.
Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. Circ Res 2017;120:472–95.
Carroll LM,MorrisME,O’ConnorWT,CliffordAM.Isaquatictherapy optimally prescribed for Parkinson’s disease? A systematic review and meta-analysis. J Parkinsons Dis 2020;10:59–76.
Carrasco AC, Silva MF, Dela Bela LF, Paixão L, Pelegrinelli ARM, Dias JM, Kawano MM, Facci LM, Cardoso JR. Evaluation of quality of life in individuals with cA case series. NeuroR ehabilitation. 2021;48(4):56.
Chu, K. S., Eng, J. J., Dawson, A. S., Harris, J. E., Ozkaplan, A., & Gylfadottir, S. (2021). Water-based exercise for cardiovascular fitness in people with chronic stroke: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation. , 102(3), 494-500. https://doi.org/10.1016/j.apmr.2020.08.004
Feigin, V. L., Stark, B. A., Johnson, C. O., et al. (2021). Global burden of stroke and risk factors in 204 countries and territories, 1990–2019: a systematic analysis. The Lancet Neurology, 20(10), 795-820. https://doi.org/10.1016/S1474-4422(21)00252-0
Ghai, S., Ghai, I., Effenberg, A. O. (2022). Effect of aquatic therapy on balance and gait in stroke survivors: a systematic review and meta-analysis. Clinical Rehabilitation, 36(5), 642–654. https://doi.org/10.1177/02692155211068997
Giuriati S, Servadio A, Temperoni G, Curcio A, Valente D, Galeoto G. The effect of aquatic physical therapy in patients with stroke: A systematic review and meta-analysis. Top Stroke Rehabil. 2021 Jan;28(1):19-32. doi: 10.1080/10749357.2020.1755816. Epub 2020 Apr 27. PMID: 32340581.
Ghayour NM, Shariat A, Dommerholt J, et al. Aquatic therapy for improving lower limbs function in post-stroke survivors: a systematic review with meta-analysis. Top Stroke Rehabil 2021;19:1–17.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta analyses. BMJ. 2003;327:557-60.
Iatridou G, Stergiou AN, Varvarousis DN, Theodorou A, Doulgeri S, Pelidou HS, Dimakopoulos G, Ploumis A. Comparative Study Between Aquatic Therapy and Land-Based Exercises in Hemiplegic Patients After Stroke: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2025 Apr 1;104(4):305-311. doi: 10.1097/PHM.0000000000002589. Epub 2024 Jul 2. PMID: 38954645.
Kim, K., & Lee, B. (2023). Comparative effectiveness of aquatic versus land-based therapy for stroke rehabilitation: A meta-analysis. Topics in Stroke Rehabilitation, 30(1), 1–11. https://doi.org/10.1080/10749357.2022.2110567
Manning OJ, Rancourt S, Tomasone JR, Finlayson M, DePaul V. Water-based therapeutic exercise in stroke: a scoping review. Disabil Rehabil. 2023 May;45(9):1549-1562. doi: 10.1080/09638288.2022.2063415. Epub 2022 Apr 21. PMID: 35450495.
Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:1.
Nayak P, Mahmood A, Natarajan M, Hombali A, Prashanth CG, Solomon JM. Effect of aquatic therapy on balance and gait in stroke survivors: A systematic review and meta-analysis. Complement Ther Clin Pract. 2020 May;39:101110. doi: 10.1016/j.ctcp.2020.101110. Epub 2020 Jan 30. PMID: 32379645.
Prabhakaran S, Ruff I, Bernstein RA. Acute stroke intervention: a systematic review. JAMA 2015;313:1451–62.
Peisker T, Koznar B, Stetkarova I, Widimsky P. Acute stroke therapy: a review. Trends Cardiovasc Med 2017;27:59–66.
Pérez-de la Cruz, S. (2020). Influence of an aquatic therapy program in Halliwick concept on balance in patients after stroke: A randomized clinical trial. Journal of Stroke and Cerebrovascular Diseases, 29(3), 104478. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104478
Silva, G. M. J., Dei Tos, D., & Fabiano, L. C. (2023). Effects of aquatic therapy on gait and balance in patients with brain vascular accident: a literature review. Revista Uningá, 59(1), eUJ4134. https://doi.org/10.46311/2318-0579.59.euj4134
Stinear CM, Lang CE, Zeiler S, Byblow WD.Advances and challenges in stroke rehabilitation. Lancet Neurol 2020;19:348–60.
Veldema, J., & Jansen, P. (2021). Aquatic therapy in stroke rehabilitation: systematic review and meta-analysis. Acta Neurologica Scandinavica, 143(3), 221–241. https://doi.org/10.1111/ane.13371
Vakilian A, Babaeipour H, Sahebozamani M, Mohammadipour F. The effect of aquatic training on static and semi-dynamic balance of patients with chronic ischemic stroke: A randomized clinical trial. Turk J Phys Med Rehabil. 2021 Sep 1;67(3):315-321. doi: 10.5606/tftrd.2020.5437. PMID: 34870118; PMCID: PMC8607001.
Trisnowiyanto, B., & Andriani, I. (2025). Pemberdayaan Masyarakat Melalui Edukasi Dan Simulasi Terapi Akuatik Pada Rehabilitasi Penyintas Stroke: Community Empowerment In Post Stroke Rehabilitation With Aquatic Therapy. Jurnal Pengabdian Masyarakat Multidisiplin, 8(2), 154–161. Https://Doi.Org/10.36341/Jpm.V8i2.5300
Tuna, A., Unver, B., Karatosun, V. (2022). The impact of aquatic therapy on functional mobility and balance in stroke patients: A meta-analysis. Journal of Stroke and Cerebrovascular Diseases, 31(8), 106499. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106499
WHO. (2022). World Stroke Day 2022. World Health Organization.
Copyright (c) 2025 Indonesian Journal of Global Health Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
