Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain
Authors: Peng Meng-Si , Wang Rui , Wang Yi-Zu , Chen Chang-Cheng , Wang Juan , Liu Xiao-Chen , Song Ge , Guo Jia-Bao , Chen Pei-Jie , Wang Xue-Qiang 
Published: January 2022

ImportanceTherapeutic aquatic exercise is frequently offered to patients with chronic low back pain, but its long-term benefits are unclear.ObjectiveTo assess the long-term effects of therapeutic aquatic exercise on people with chronic low back pain.Design, Setting, and ParticipantsThis 3-month, single-blind randomized clinical trial with a 12-month follow-up period was performed from September 10, 2018, to March 12, 2019, and the trial follow-up was completed March 17, 2020. A total of 113 people with chronic low back pain were included in the experiment.InterventionsParticipants were randomized to either the therapeutic aquatic exercise or the physical therapy modalities group. The therapeutic aquatic exercise group received aquatic exercise, whereas the physical therapy modalities group received transcutaneous electrical nerve stimulation and infrared ray thermal therapy. Both interventions were performed for 60 minutes twice a week for 3 months.Main Outcomes and MeasuresThe primary outcome was disability level, which was measured using the Roland-Morris Disability Questionnaire; scores range from 0 to 24, with higher scores indicating more severe disability. Secondary outcomes included pain intensity, quality of life, anxiety, depression, sleep quality, kinesiophobia, fear avoidance, recommendation of intervention, and minimal clinically important difference in pain and function. Intention-to-treat and per-protocol analyses were performed.ResultsOf the 113 participants, 59 were women (52.2%) (mean [SD] age, 31.0 [11.5] years). Participants were randomly allocated into the therapeutic aquatic exercise group (n = 56) or the physical therapy modalities group (n = 57), and 98 patients (86.7%) completed the 12-month follow-up. Compared with the physical therapy modalities group, the therapeutic aquatic exercise group showed greater alleviation of disability, with adjusted mean group differences of −1.77 (95% CI, −3.02 to −0.51; P = .006) after the 3-month intervention, −2.42 (95% CI, −4.13 to −0.70; P = .006) at the 6-month follow-up, and −3.61 (95% CI, −5.63 to −1.58; P = .001) at the 12-month follow-up (P &amp;lt; .001 for overall group × time interaction). At the 12-month follow-up point, improvements were significantly greater in the therapeutic aquatic exercise group vs the physical therapy modalities group in the number of participants who met the minimal clinically important difference in pain (at least a 2-point improvement on the numeric rating scale) (most severe pain, 39 [69.64%] vs 20 [35.09%]; average pain, 30 [53.57%] vs 12 [21.05%]; and current pain, 22 [39.29%] vs 10 [17.54%]) and disability (at least a 5-point improvement on the Roland-Morris Disability Questionnaire) (26 [46.43%] vs 4 [7.02%]). One of the 56 participants (1.8%) in the therapeutic aquatic exercise group vs 2 of the 57 participants (3.5%) in the physical therapy modalities group experienced low back pain and other pains related to the intervention.Conclusions and RelevanceThe therapeutic aquatic exercise program led to greater alleviation in patients with chronic low back pain than physical therapy modalities and had a long-term effect up to 12 months. This finding may prompt clinicians to recommend therapeutic aquatic exercise to patients with chronic low back pain as part of treatment to improve their health through active exercise rather than relying on passive relaxation.Trial RegistrationChinese Clinical Trial Registry: ChiCTR1800016396