Global research trends in aquatic exercise therapy for musculoskeletal disorders: a bibliometric analysis
DOI:
https://doi.org/10.2340/jrm.v57.42473Keywords:
musculoskeletal disease, elderly group, non-drug intervention, water sports, bibliometricsAbstract
Objective: Aquatic exercise therapy has gained recognition as a valuable non-pharmacological intervention for managing musculoskeletal disorders. Despite the growing body of evidence supporting its efficacy, research on aquatic exercise therapy remains fragmented, with limited understanding of key trends, influential studies, and evolving themes within the field. This study aims to conduct a comprehensive bibliometric analysis to identify publication trends, key authors, and the evolution of research themes in aquatic exercise therapy for musculoskeletal disorders.
Methods: A total of 117 articles were selected based on predefined search terms and inclusion criteria, resulting in 3,985 citations, with an average of 35.9 citations per article and an H-index of 37.
Results: Publications surged between 2013 and 2024, accounting for 88.3% of total output. Peaks occurred in 2019 (n = 14) and 2022 (n = 368 citations). Key contributors include Mariana Arias Avila and Basia Belza, with journals such as BMC Musculoskeletal Disorders and Arthritis & Rheumatism-Arthritis Care & Research playing pivotal roles. Research trends shifted from disease-specific studies to broader quality-of-life outcomes, with keywords such as “rheumatoid arthritis“, “balneotherapy“, and “quality of life” emerging as focal points.
Conclusion: The findings underscore the growing importance of aquatic exercise therapy in clinical rehabilitation and suggest that future research should focus on long-term outcomes, underrepresented populations, and the integration of aquatic exercise therapy with emerging rehabilitation technologies.
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References
GBD 2021 Neck Pain Collaborators. Global, regional, and national burden of neck pain, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2024; 6: e142–e155.
https://doi.org/10.1016/s2665-9913(23)00321-1 DOI: https://doi.org/10.1016/S2665-9913(23)00321-1
GBD 2021 Gout Collaborators. Global, regional, and national burden of gout, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2024; 6: e507–e517.
https://doi.org/10.1016/s2665-9913(24)00117-6 DOI: https://doi.org/10.1016/S2665-9913(24)00117-6
GBD 2021 Rheumatoid Arthritis Collaborators. Global, regional, and national burden of rheumatoid arthritis, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023; 5: e594–e610.
https://doi.org/10.1016/s2665-9913(23)00211-4 DOI: https://doi.org/10.1016/S2665-9913(23)00211-4
GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol 2023; 5: e508–e522.
https://doi.org/10.1016/s2665-9913(23)00163-7 DOI: https://doi.org/10.1016/S2665-9913(23)00163-7
Guduru RKR, Domeika A, Obcarskas L, Ylaite B. The ergonomic association between shoulder, neck/head disorders and sedentary activity: a systematic review. J Healthc Eng 2022; 2022: 5178333.
https://doi.org/10.1155/2022/5178333 DOI: https://doi.org/10.1155/2022/5178333
Feigin VL, Vos T, Alahdab F, Amit AML, Bärnighausen TW, Beghi E, et al. Burden of neurological disorders across the US from 1990–2017: a Global Burden of Disease Study. JAMA Neurol 2021; 78: 165–176.
https://doi.org/10.1001/jamaneurol.2020.4152 DOI: https://doi.org/10.1001/jamaneurol.2020.4152
Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol 2020; 72: 529–556.
https://doi.org/10.1002/art.41191 DOI: https://doi.org/10.1002/art.41191
Santos EJF, Farisogullari B, Dures E, Geenen R, Machado PM. Efficacy of non-pharmacological interventions: a systematic review informing the 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. RMD Open 2023; 9.
https://doi.org/10.1136/rmdopen-2023-003350 DOI: https://doi.org/10.1136/rmdopen-2023-003350
Verhagen AP, Cardoso JR, Bierma-Zeinstra SM. Aquatic exercise & balneotherapy in musculoskeletal conditions. Best Pract Res Clin Rheumatol 2012; 26: 335–343.
https://doi.org/10.1016/j.berh.2012.05.008 DOI: https://doi.org/10.1016/j.berh.2012.05.008
Carayannopoulos AG, Han A, Burdenko IN. The benefits of combining water and land-based therapy. J Exerc Rehabil 2020; 16: 20–26.
https://doi.org/10.12965/jer.1938742.371 DOI: https://doi.org/10.12965/jer.1938742.371
Dias JF, Oliveira VC, Borges PRT, Dutra F, Mancini, MC, Kirkwood RN, et al. Effectiveness of exercises by telerehabilitation on pain, physical function and quality of life in people with physical disabilities: a systematic review of randomised controlled trials with GRADE recommendations. Br J Sports Med 2021; 55: 155–162.
https://doi.org/10.1136/bjsports-2019-101375 DOI: https://doi.org/10.1136/bjsports-2019-101375
Kechichian A, Lafrance S, Matifat E, Dubé F, Lussier D, Benhaim P, et al. Multimodal interventions including rehabilitation exercise for older adults with chronic musculoskeletal pain: a systematic review and meta-analyses of randomized controlled trials. J Geriatr Phys Ther 2022; 45: 34–49.
https://doi.org/10.1519/jpt.0000000000000279 DOI: https://doi.org/10.1519/JPT.0000000000000279
Zeng CY, Zhang ZR, Tang ZM, Hua FZ. Benefits and mechanisms of exercise training for knee osteoarthritis. Front Physiol 2021; 12: 794062.
https://doi.org/10.3389/fphys.2021.794062 DOI: https://doi.org/10.3389/fphys.2021.794062
Korthals-de Bos IB, Hoving JL, van Tulder MW, Rutten-van Mölken MP, Adèr HJ, de Vet HC, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ 2003; 326: 911.
https://doi.org/10.1136/bmj.326.7395.911 DOI: https://doi.org/10.1136/bmj.326.7395.911
Crofford LJ. Adverse effects of chronic opioid therapy for chronic musculoskeletal pain. Nat Rev Rheumatol 2010; 6: 191–197.
https://doi.org/10.1038/nrrheum.2010.24 DOI: https://doi.org/10.1038/nrrheum.2010.24
Torres-Ronda L, Del Alcázar XS. The properties of water and their applications for training. J Hum Kinet 2014; 44: 237–248.
https://doi.org/10.2478/hukin-2014-0129 DOI: https://doi.org/10.2478/hukin-2014-0129
Bento PC, Pereira G, Ugrinowitsch C, Rodacki AL. The effects of a water-based exercise program on strength and functionality of older adults. J Aging Phys Act 2012; 20: 469–483.
https://doi.org/10.1123/japa.20.4.469 DOI: https://doi.org/10.1123/japa.20.4.469
Yázigi F, Espanha M, Vieira F, Messier SP, Monteiro C, Veloso AP. The PICO project: aquatic exercise for knee osteoarthritis in overweight and obese individuals. BMC Musculoskelet Disord 2013; 14: 320.
https://doi.org/10.1186/1471-2474-14-320 DOI: https://doi.org/10.1186/1471-2474-14-320
Camilotti BM, Rodacki AL, Israel VL, Fowler NE. Stature recovery after sitting on land and in water. Man Ther 2009; 14: 685–689.
https://doi.org/10.1016/j.math.2009.03.007 DOI: https://doi.org/10.1016/j.math.2009.03.007
Carroll LM, Volpe D, Morris ME, Saunders J, Clifford AM. Aquatic exercise therapy for people with Parkinson disease: a randomized controlled trial. Arch Phys Med Rehabil 2017; 98: 631–638.
https://doi.org/10.1016/j.apmr.2016.12.006 DOI: https://doi.org/10.1016/j.apmr.2016.12.006
Kargarfard M, Etemadifar M, Baker P, Mehrabi M, Hayatbakhsh R. Effect of aquatic exercise training on fatigue and health-related quality of life in patients with multiple sclerosis. Arch Phys Med Rehabil 2012; 93: 1701–1708.
https://doi.org/10.1016/j.apmr.2012.05.006 DOI: https://doi.org/10.1016/j.apmr.2012.05.006
Pechter Ü, Raag M, Ots-Rosenberg M. Regular aquatic exercise for chronic kidney disease patients: a 10-year follow-up study. Int J Rehabil Res 2014; 37: 251–255.
https://doi.org/10.1097/mrr.0000000000000063 DOI: https://doi.org/10.1097/MRR.0000000000000063
Peng MS, Wang R, Wang YZ, Chen CC, Wang J, Liu XC, et al. Efficacy of therapeutic aquatic exercise vs physical therapy modalities for patients with chronic low back pain: a randomized clinical trial. JAMA Netw Open 2022; 5: e2142069.
https://doi.org/10.1001/jamanetworkopen.2021.42069 DOI: https://doi.org/10.1001/jamanetworkopen.2021.42069
Dundar U, Solak O, Toktas H, Demirdal US, Subasi V, Kavuncu V, et al. Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial. Rheumatol Int 2014; 34: 1505–1511.
https://doi.org/10.1007/s00296-014-2980-8 DOI: https://doi.org/10.1007/s00296-014-2980-8
Dong R, Wu Y, Xu S, Zhang L, Ying J, Jin H, et al. Is aquatic exercise more effective than land-based exercise for knee osteoarthritis? Medicine (Baltimore) 2018; 97: e13823.
https://doi.org/10.1097/md.0000000000013823 DOI: https://doi.org/10.1097/MD.0000000000013823
Barker AL, Talevski J, Morello RT, Brand CA, Rahmann AE, Urquhart DM. Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis. Arch Phys Med Rehabil 2014; 95: 1776–1786.
https://doi.org/10.1016/j.apmr.2014.04.005 DOI: https://doi.org/10.1016/j.apmr.2014.04.005
Heywood S, McClelland J, Mentiplay B, Geigle P, Rahmann A, Clark R. Effectiveness of aquatic exercise in improving lower limb strength in musculoskeletal conditions: a systematic review and meta-analysis. Arch Phys Med Rehabil 2017; 98: 173–186.
https://doi.org/10.1016/j.apmr.2016.08.472 DOI: https://doi.org/10.1016/j.apmr.2016.08.472
Wang T, Wang J, Chen Y, Ruan Y, Dai S. Efficacy of aquatic exercise in chronic musculoskeletal disorders: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2023; 18: 942.
https://doi.org/10.1186/s13018-023-04417-w DOI: https://doi.org/10.1186/s13018-023-04417-w
Feng XW, Hadizadeh M, Zheng LH, Li WH. A bibliometric and visual analysis of exercise intervention publications for Alzheimer’s disease (1998–2021). J Clin Med 2022; 11.
https://doi.org/10.3390/jcm11195903 DOI: https://doi.org/10.3390/jcm11195903
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6: e1000100.
https://doi.org/10.1371/journal.pmed.1000100 DOI: https://doi.org/10.1371/journal.pmed.1000100
Foley A, Halbert J, Hewitt T, Crotty M. Does hydrotherapy improve strength and physical function in patients with osteoarthritis: a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. Ann Rheum Dis 2003; 62: 1162–1167.
https://doi.org/10.1136/ard.2002.005272 DOI: https://doi.org/10.1136/ard.2002.005272
Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, et al. Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial. Phys Ther 2008; 88: 12–21.
https://doi.org/10.2522/ptj.20060040 DOI: https://doi.org/10.2522/ptj.20060040
Bartels EM, Juhl CB, Christensen R, Hagen KB, Danneskiold-Samsøe B, Dagfinrud H, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev 2016; 3: Cd005523.
https://doi.org/10.1002/14651858.CD005523.pub3 DOI: https://doi.org/10.1002/14651858.CD005523.pub3
Batterham SI, Heywood S, Keating JL. Systematic review and meta-analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes. BMC Musculoskelet Disord 2011; 12: 123.
https://doi.org/10.1186/1471-2474-12-123 DOI: https://doi.org/10.1186/1471-2474-12-123
Choong P, Brooks P. Achievements during the Bone and Joint Decade 2000-2010. Best Pract Res Clin Rheumatol 2012; 26: 173–181.
https://doi.org/10.1016/j.berh.2012.03.004 DOI: https://doi.org/10.1016/j.berh.2012.03.004
Lidgren L. The bone and joint decade 2000–2010. Bull World Health Organ 2003; 81: 629.
Hall J, Grant J, Blake D, Taylor G, Garbutt G. Cardiorespiratory responses to aquatic treadmill walking in patients with rheumatoid arthritis. Physiother Res Int 2004; 9: 59–73.
https://doi.org/10.1002/pri.303 DOI: https://doi.org/10.1002/pri.303
Horváth K, Kulisch Á, Németh A, Bender T. Evaluation of the effect of balneotherapy in patients with osteoarthritis of the hands: a randomized controlled single-blind follow-up study. Clin Rehabil 2012; 26: 431–441.
https://doi.org/10.1177/0269215511425961 DOI: https://doi.org/10.1177/0269215511425961
Kiliçoğlu O, Dönmez A, Karagülle Z, Erdoğan N, Akalan E, Temelli Y. Effect of balneotherapy on temporospatial gait characteristics of patients with osteoarthritis of the knee. Rheumatol Int 2010; 30: 739–747.
https://doi.org/10.1007/s00296-009-1054-9 DOI: https://doi.org/10.1007/s00296-009-1054-9
Song MS, Yoo YK, Kim NC. Effects of aquatic exercise on joint angle, pain, stiffness, and physical function in elderly women with osteoarthritis. J Korean Gerontol Nurs 2015; 17: 89–97.
https://doi.org/10.17079/jkgn.2015.17.2.89 DOI: https://doi.org/10.17079/jkgn.2015.17.2.89
Ansari S, Elmieh A, Hojjati Z. Effects of aquatic exercise training on pain, symptoms, motor performance, and quality of life of older males with knee osteoarthritis. Ann Appl Sport Sci 2014; 2: 29–38.
https://doi.org/10.18869/acadpub.aassjournal.2.2.29 DOI: https://doi.org/10.18869/acadpub.aassjournal.2.2.29
Munukka M, Waller B, Rantalainen T, Häkkinen A, Nieminen MT, Lammentausta E, et al. Efficacy of progressive aquatic resistance training for tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis: a randomised controlled trial. Osteoarthritis Cartilage 2016; 24: 1708–1717.
https://doi.org/10.1016/j.joca.2016.05.007 DOI: https://doi.org/10.1016/j.joca.2016.05.007
Heidari F, Mohammad Rahimi N, Aminzadeh R. Aquatic exercise impact on pain intensity, disability and quality of life in adults with low back pain: a systematic review and meta-analysis. Biol Res Nurs 2023; 25: 527–541.
https://doi.org/10.1177/10998004231162327 DOI: https://doi.org/10.1177/10998004231162327
Manning OJ, Rancourt S, Tomasone JR, Finlayson M, DePaul V. Water-based therapeutic exercise in stroke: a scoping review. Disabil Rehabil 2023; 45: 1549–1562.
https://doi.org/10.1080/09638288.2022.2063415 DOI: https://doi.org/10.1080/09638288.2022.2063415
Eyvaz N, Dundar U, Yesil H. Effects of water-based and land-based exercises on walking and balance functions of patients with hemiplegia. NeuroRehabilitation 2018; 43: 237–246.
https://doi.org/10.3233/nre-182422 DOI: https://doi.org/10.3233/NRE-182422
Cugusi L, Manca A, Bergamin M, Di Blasio A, Monticone M, Deriu F, et al. Aquatic exercise improves motor impairments in people with Parkinson’s disease, with similar or greater benefits than land-based exercise: a systematic review. J Physiother 2019; 65: 65–74.
https://doi.org/10.1016/j.jphys.2019.02.003 DOI: https://doi.org/10.1016/j.jphys.2019.02.003
Fransen M, Nairn L, Winstanley J, Lam P, Edmonds J. Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Care & Research 2007; 57: 407–414.
https://doi.org/10.1002/art.22621 DOI: https://doi.org/10.1002/art.22621
Wang TJ, Belza B, Elaine Thompson F, Whitney JD, Bennett K. Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. J Adv Nurs 2007; 57: 141–152.
https://doi.org/10.1111/j.1365-2648.2006.04102.x DOI: https://doi.org/10.1111/j.1365-2648.2006.04102.x
Assis MR, Silva LE, Alves AMB, Pessanha AP, Valim V, Feldman D, et al. A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia. Arthritis Care & Research 2006; 55: 57–65.
https://doi.org/10.1002/art.21693 DOI: https://doi.org/10.1002/art.21693
Lim JY, Tchai E, Jang SN. Effectiveness of aquatic exercise for obese patients with knee osteoarthritis: a randomized controlled trial. PM R 2010; 2: 723–731; quiz 793.
https://doi.org/10.1016/j.pmrj.2010.04.004 DOI: https://doi.org/10.1016/j.pmrj.2010.04.004
Patrick DL, Ramsey SD, Spencer AC, Kinne S, Belza B, Topolski TD. Economic evaluation of aquatic exercise for persons with osteoarthritis. Med Care 2001; 39: 413–424.
https://doi.org/10.1097/00005650-200105000-00002 DOI: https://doi.org/10.1097/00005650-200105000-00002
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