Water-based exercises for improving activities of daily living after stroke

Background Water-based exercises are used in rehabilitation and might help to reduce disability after stroke. Objectives To investigate the effect of water-based exercises for reducing disability after stroke. Search strategy We searched the Cochrane Stroke Group Trials Register (last searched August 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to April 2010), EMBASE (1980 to April 2010), CINAHL (1982 to April 2010), AMED (1985 to April 2010), SPORTDiscus (1949 to April 2010), the Physiotherapy Evidence Database (PEDro, April 2010) and OT Seeker (1969 to April 2010). In an effort to identify further published, unpublished and ongoing trials we handsearched relevant journals and conference proceedings, searched trials and research registers, checked reference lists and contacted authors. Selection criteria We included studies using random assignment. Data collection and analysis Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. The primary outcome was activities of daily living. Main results We included four trials involving 94 participants in this review. There was a significant improvement in activity of daily living (mean difference (MD) 13.20 points on the 'Capacidad funcional' (functional capacity) subscale of the Brazilian-Portuguese version of the SF-36; 95% confidence interval (CI) 8.36 to 18.04; P < 0.00001) and on muscle strength (MD 1.01 Nm/kg; 95% CI 0.19 to 1.83; P = 0.02) but these results should be interpreted with caution because population numbers were small and the results are based on singlestudies. There was no significant improvement in ability to walk (MD 0.14 m/s; 95% CI -0.32 to 0.606; P = 0.55), postural balance (MD 3.05 points; 95% CI -3.41 to 9.52; P = 0.35) or fitness (MD 3.6 (VO2max; 95% CI -0.53 to 7.73; P = 0.09) after water-based exercises treatment compared to control. Adverse effects were not reported. Authors' conclusions The evidence from randomised controlled trials so far does not confirm or refute that water-based exercises after stroke might help to reduce disability after stroke. There is a lack of hard evidence for water-based exercises after stroke. Better and larger studies are therefore required.