EFFECTIVENESS OF AQUATIC THERAPY VERSUS LAND-BASED THERAPY ON PAIN AND DISABILITY IN KNEE OSTEOARTHRITIS PATIENTS: A RANDOMIZED CONTROLLED TRIAL IN PAKISTAN

Abstract

BACKGROUND: Knee osteoarthritis (OA) is a leading cause of chronic pain and physical disability among older adults, significantly affecting mobility and quality of life. Exercise-based rehabilitation remains central to OA management, yet debate continues regarding whether aquatic or land-based therapy offers superior outcomes.

OBJECTIVE: To compare the effectiveness of aquatic therapy and land-based therapy on pain and functional disability among patients with knee osteoarthritis in Pakistan using standardized outcome measures.

 METHODOLOGY: A randomized controlled trial was conducted from March to November 2022 across three tertiary care centers in Pakistan, including 120 participants aged 45–70 years with moderate knee OA. Participants were randomly assigned to either an aquatic therapy group (n=60) or a land-based therapy group (n=60). Both groups underwent 45-minute exercise sessions three times weekly for eight weeks. Outcomes were assessed at baseline, four weeks, and eight weeks using the Visual Analog Scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne Functional Index (LFI). Data were analyzed using repeated-measures ANOVA, with significance set at p<0.05.

 RESULTS: Both interventions produced significant improvements in pain and function (p<0.001), but the aquatic therapy group demonstrated greater improvement. Mean VAS scores decreased from 7.8 ± 1.1 to 3.2 ± 0.9 in the aquatic group and from 7.7 ± 1.0 to 5.0 ± 1.2 in the land-based group. The WOMAC total score improved by 49.5% in the aquatic group versus 25.7% in the land-based group, while LFI scores improved by 46.6% and 27.5%, respectively.

CONCLUSION: Aquatic therapy was more effective than land-based therapy in reducing pain and improving physical function among patients with knee osteoarthritis. These findings support incorporating aquatic rehabilitation programs into physiotherapy practice for improved management outcomes.

 KEY TERMS: Aquatic therapy; Exercise therapy; Knee osteoarthritis; Pain management; Physical therapy modalities; Rehabilitation; WOMAC