Evidence map›Paper›PMID 42451015›Full record

ReviewHealthcare (Basel, Switzerland)2026

The Role of Hydrotherapy in Enhancing Recovery After Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Saja Nashmi Alrashedi, Eslam K Fahmy, Hadaya Mosaad Eladl, Maha Ata Alshammari, Safya E Esmaeel, Mustafa Shukry, Olfat Ibrahim Ali, Mohamed Abdelaziz Emam

Abstract readReview
In one paragraph

Review in Healthcare (Basel, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Saja Nashmi AlrashediDepartment of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Sakaka 72388, Saudi Arabia.ORCID 0009-0009-2401-8364
Eslam K FahmyDepartment of Physiology, College of Medicine, Northern Border University, Arar 91431, Saudi Arabia.ORCID 0000-0002-1994-2570
Hadaya Mosaad EladlDepartment of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Sakaka 72388, Saudi Arabia.ORCID 0000-0002-4083-7070
Maha Ata AlshammariDepartment of Physical Therapy and Rehabilitation, Aljouf Cardiac Center, King Abdulaziz Specialist Hospital, Aljouf Health Cluster, Ministry of Health, Sakaka 72388, Saudi Arabia.
Safya E EsmaeelDepartment of Physiology, College of Medicine, Northern Border University, Arar 91431, Saudi Arabia.
Mustafa ShukryDepartment of Biomedical Sciences, College of Veterinary Medicine, King Faisal University, P.O. Box 400, Al-Ahsa 31982, Saudi Arabia.
Olfat Ibrahim AliPhysical Therapy Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia.ORCID 0000-0003-4279-3662
Mohamed Abdelaziz EmamJános Szentágothai Neurosciences Division, Semmelweis University, 1085 Budapest, Hungary.ORCID 0009-0001-6586-2459

Funding

Deanship of Scientific Research at Northern Border University NBU-FFR- 2026-3105-03
6 · The paper itself

Abstract

backgroundTotal knee arthroplasty (TKA) is a common procedure to relieve pain and restore function in osteoarthritis patients. Postoperative rehabilitation is essential to address pain, swelling, reduced range of motion, and functional limitations. Hydrotherapy, using water buoyancy and resistance, may enhance recovery, but evidence on its effectiveness after these surgeries remains limited.

methodsA systematic literature search was conducted across six databases: PubMed, ProQuest, Science Direct, Google Scholar, Scopus, the Cochrane Library, and PEDro, covering studies published up to 30 November 2025. Only prospective randomized controlled trials were considered for inclusion. Studies such as case reports, uncontrolled case series, and those focused on outcomes other than postoperative pain and decreased muscle strength in patients undergoing total knee arthroplasty were excluded. This review was registered in PROSPERO (CRD420251164054).

resultsPooled analysis showed no statistically significant difference between hydrotherapy and land-based or usual-care rehabilitation in Visual Analogue Scale (VAS)-measured pain (MD ≈ -0.35; 95% CI [-1.06, 0.36]; p=0.34) or in WOMAC pain (MD ≈ -0.46; 95% CI [-8.50, 7.58]; p=0.89). In contrast, hydrotherapy produced a moderate, statistically significant improvement in lower-limb muscle strength (Hedges' g=0.46; 95% CI [0.23, 0.69]), particularly in knee extensor and hip abductor strength. Heterogeneity was low for VAS pain and muscle strength but substantial for WOMAC pain (I2≈71%), and no evidence of publication bias was identified.

conclusionsHydrotherapy did not reduce postoperative pain more than land-based exercise or usual care; pain relief was comparable between approaches, whereas hydrotherapy yielded greater gains in muscle strength. Heterogeneity in treatment parameters and the limited number of high-quality trials preclude definitive conclusions; future research should standardize hydrotherapy protocols and investigate long-term outcomes.

Indexed as

aquatic therapyfunctional performancehydrotherapymeta-analysismuscle strengthpostoperative painsystematic reviewtotal knee arthroplasty

Identifiers

PMID42451015
PMCPMC13361691

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.