Water-based exercise therapy is better than standard physical therapy for adults with chronic low back pain

Reference

Peng MS, Wang R, Wang YZ, et al. Efficacy of therapeutic aquatic exercise vs physical therapy modalities for patients with chronic low back pain: A randomized clinical trial. JAMA Network Open. 2022;5(1):e2142069.

Synopsis

The optimal physical therapy modalities for chronic low back pain in adults are uncertain. These investigators identified 113 adults, aged 18 to 65 years, with chronic low back pain, with or without lower limb pain, lasting at least 3 months. Participants randomly received assignment (concealed) to receive either therapeutic aquatic exercise (consisting of a 10-minute warmup, 40-minute aquatic session, and 10-minute cooldown per session) or control therapy (consisting of electrical nerve stimulation and infrared ray thermal therapy for a total of 60 minutes per session). Both the intervention and control groups underwent their respective therapy sessions 2 times a week for 3 months. The primary outcome was level of disability, as measured by the Roland-Morris Disability Questionnaire (RMDQ), which uses a scale from 0 to 24 with higher scores indicating worsening disability. Secondary outcomes included pain intensity, quality of life, sleep quality, recommendation of intervention, and minimally clinically important differences. Complete follow-up occurred for 87% of participants at 12 months. Using intention-to-treat analysis, patients in the therapeutic aquatic exercise group reported significantly lower disability and pain scores at 3, 6, and 12 months. At baseline, the average disability score for participants was 8.82 for the water-based exercise group and 8.37 for the physical therapy group. At 12 months, the average disability score decreased to 3.52 for the water-based exercise group but only to 6.67 for the physical therapy group, for a mean adjusted between-group difference of –3.61. In addition, the number of patients who met the minimal clinically important difference of a 2-point improvement in disability score was significantly greater in the aquatic exercise group than in the control group (number needed to treat = 2.1; 95% CI 1.9 - 4.3). Secondary outcomes — including pain intensity, quality of life, and sleep quality — also favored therapeutic aquatic exercise. Just a few caveats: Patients in this study were on the younger side (average age 31 years), pain intensity was on the low side (mean 5.5), and no patients in either group received any land-based exercise.