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Hydrokinesitherapy improves balance function in stroke survivors across multiple assessment measuresWater based exercise may improve balance for stroke survivors

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Key Takeaway
Consider hydrokinesitherapy to improve balance function in stroke survivors, though TUGT results were not significant.

This meta-analysis evaluated the impact of hydrokinesitherapy, a water-based exercise intervention, on balance and mobility in 1075 stroke survivors. The analysis synthesized data across several metrics to determine the efficacy of aquatic exercise for rehabilitation.

The primary finding indicates that hydrokinesitherapy significantly improves balance function. Specifically, the Berg Balance Scale (BBS) showed an improvement with an SMD=0.71 (95% CI: 0.28-1.14, P=0.001). Additionally, the Functional Reach Test (FRT) showed a significant improvement with an SMD=0.97 (95% CI: 0.32-1.61, P=0.003). In contrast, no significant improvement was observed for TUGT test times (SMD=-0.46; 95% CI: -0.96 to 0.04, P=0.07).

The authors note several limitations, including methodological limitations, inconsistent results, and clinical heterogeneity. The evidence quality for BBS was assessed as moderate, while the evidence quality for TUGT and MBI was assessed as very low. Given these factors, the moderate strength of evidence suggests that aquatic exercise may improve balance in stroke patients, but clinicians should remain cautious when applying these findings to individual patient care.

How this fits prior evidence

This meta-analysis addresses a gap in non-pharmacological rehabilitation for stroke survivors by evaluating hydrokinesitherapy. While previous coverage has focused on pharmacological interventions like tirofiban and DOAC therapy, as well as behavioral interventions such as CBT for fatigue, this finding provides evidence specifically regarding physical rehabilitation and balance function following a stroke.

Finding your footing after a stroke is a major hurdle. For many survivors, simple tasks like staying upright or moving steadily can feel daunting. New research looks at how water based exercise, known as hydrokinesitherapy, impacts these specific physical goals.

Researchers looked at data from 1,075 stroke survivors to see if the water helped with balance. The results showed that those who participated in water exercises saw improvements in their balance scores and other measures of stability. However, the study did not find a significant improvement in the time it took for patients to complete a specific walking test called the TUGT.

While the evidence suggests water therapy is helpful for balance, the findings come with some caution. The researchers noted that the data was inconsistent in some areas and varied across different clinical settings. Because of these inconsistencies, the results should be viewed as a starting point rather than a guaranteed outcome.

What this means for you:
Water based exercise shows promise for improving balance in stroke survivors, though results vary by specific movement goals.

Common questions

What is hydrokinesitherapy?

Hydrokinesitherapy is a form of water based exercise. It uses the properties of water to help patients perform physical movements. In this study, it was used specifically to see if it could help stroke survivors improve their balance function.

Does water exercise help with walking speed?

The study did not find a significant improvement in the time it took for patients to complete the TUGT, which is a test used to measure walking ability. While balance improved, this specific measure of walking speed did not show a clear change.

How strong is the evidence for using water therapy?

The evidence for improving balance scores was considered moderate in quality. However, the evidence for other measures like the TUGT and MBI was considered very low. Because of these inconsistencies, results should be interpreted with caution.

Study Details

Study typeMeta analysis
Sample sizen = 107
EvidenceLevel 1
PublishedAug 2026
View Original Abstract ↓
BACKGROUND: Balance dysfunction often affects stroke patients. While our earlier research indicated that aquatic exercise therapy could help, the evidence was initially rated as very low. With new studies emerging, this research aims to update the evidence on the effectiveness of water-based exercise in improving balance for stroke survivors. METHODS: The study followed PRISMA guidelines, retrieving records from five databases (Medline, Embase, CENTRAL, CINAHL, and SPORTDiscus) up to July 1, 2025. Two researchers independently conducted a two-step screening of titles, abstracts, and full texts to select studies. Quality was assessed using the ROB2 tool, and data extraction followed a set protocol. All steps were independently performed by two authors, with a third resolving any disagreements. Data extraction followed a set protocol, with two authors independently handling literature screening, bias assessment, and data extraction. Discrepancies were resolved by consulting a third party. Data analysis was conducted using RevMan 5.4 and Stata, calculating combined effect sizes using either SMD or MD based on the Q test results, and choosing between random- or fixed-effects models. Sensitivity analysis was done with Stata 15.0, and publication bias was evaluated using funnel plots and Egger's test. Evidence quality was assessed with the GRADE system. RESULTS: A total of 29 RCTs involving 1075 stroke patients were included in this study. The results indicated that the water-based exercise can improve the balance function of stroke survivors based on BBS score with moderate effect size (N.=523, SMD=0.71, 95% CI: 0.28-1.14, P=0.001) and FRT(n=107, SMD=0.97, 95% CI: 0.32-1.61, P=0.003), while test time for TUGT in the intervention group was not improved (SMD=-0.46, 95% CI: -0.96 to 0.04, P=0.07). The quality of the evidence for BBS was assessed as moderate, and the quality of evidence for TUGT and MBI was assessed as very low. CONCLUSIONS: Moderate strength of evidence suggests that aquatic exercise therapy may improve the balance function of stroke patients. However, due to methodological limitations, inconsistent results, and clinical heterogeneity, this result should be interpreted with caution. Future research employing more rigorous study designs is necessary to substantiate these results.
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