SynthesisFrontiers in medicine2026
In water or on land? A network meta-analysis of aquatic and land-based exercise interventions for pain and disability in chronic lower back pain.
Synthesis in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Chronic non-specific low back pain (CLBP) imposes a substantial healthcare burden. For CLBP, non-pharmacologic pain management within physical therapy/rehabilitation commonly relies on therapeutic exercise (exercise therapy). Aquatic interventions such as exercise and balneotherapy are widely prescribed to treat CLBP, but their comparative effectiveness against land-based exercise, and multi-model programs remain unclear. We performed a network meta-analysis of randomized controlled trials to compare the effects of aquatic, land-based exercise, and multi-modal interventions on pain and disability in patients with chronic low back pain. Methods: We searched from inception to May 2025 for randomized controlled trials in adults with chronic non-specific low back pain that evaluated water-based therapies (aquatic exercise, hydrotherapy/balneotherapy). All randomized arms within eligible trials were retained, allowing comparisons with land-based exercise, combined aquatic + land-based programs, and general care/blank control. Results: We included 26 RCTs, forming a 9-node network (blank control, general care, land-based exercise, aquatic exercise, balneotherapy, and their combinations with general care/land-based exercise). For pain intensity, compared with blank control, balneotherapy + general care (SMD = 2.51, 95% CI 1.26-3.76; Conclusion: In CLBP, multimodal programs that integrate hydrotherapeutic components with general care or exercise tended to provide greater improvements than single interventions for both pain and disability. Among single modalities, effects were outcome-specific: for pain, aquatic exercise performed best and land-based exercise generally exceeded balneotherapy; for disability, balneotherapy and aquatic exercise showed larger improvements than land-based exercise. Land-based exercise remains a beneficial and pragmatic option where aquatic access is limited, while adding general care to land-based exercise did not show a consistent additional benefit. This analysis is substantially limited by very high heterogeneity ( Systematic review registration: Registered on PROSPERO. Unique Identifier: CRD42023432018. Public URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023432018.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.