Aquatic therapy for people with persistent knee pain: A feasibility study

Annually, approximately 25% of people ≥55 years old in the UK experience persistent knee pain (PKP) which causes disability and reduced quality of life (Peat, McCarney, & Croft, 2001). Key management strategies comprise self‐management advice, weight reduction and exercise (Fransen et al., 2015; National Institute for Health and Care Excellence, 2014). Aquatic therapy (AT; exercise in warm water) improves pain and function in long‐term musculoskeletal conditions (Barker et al., 2014; Waller et al., 2014). It utilizes the properties of water, including buoyancy (Harrison & Bulstrode, 1987), resistance (Petrick, Paulsen, & George, 2001; Poyhonen et al., 2001) and heat (optimal water temperature 34–45°C (Becker, 2009; Hall, Bisson, & O’Hare, 1990; Pool Water Treatment Advisory Group, 2013) to aid exercise performance. Evidence from a recent meta‐analysis, including eight high‐ and three moderate‐quality studies (1,092 participants), suggested that AT has a short‐term, small–medium beneficial effect on self‐reported pain, joint mobility and function compared with a control group in people with lower limb osteoarthritis (OA) (Waller et al., 2014). When compared with land‐based exercise, evidence from meta‐analyses of six studies (five with a risk of selection bias due to poor reporting of allocation of concealment; 398 participants) suggested that AT produces similar improvements in self‐reported pain and function (Lu et al., 2015). However, the longer‐term effects of AT are not clear (Cochrane, Davey, & Matthes Edwards, 2005; Lund et al., 2008). There is no consensus on the most clinically‐ or cost‐effective dosage or location of delivery for AT for people with PKP (Bartels