Is Aquatic Therapy More Effective Than Land-Based Therapy for Reducing Pain in Women With Fibromyalgia?

In their study, Neira and colleagues aimed to evaluate the efficacy of two physiotherapeutic interventions—aquatic therapy (AT) and land-based therapy (LBT)—in reducing pain among women diagnosed with fibromyalgia. The findings indicated that AT was superior to LBT in decreasing pain intensity and enhancing sleep quality after a follow-up period of 6 weeks, suggesting that aquatic therapy could be a valuable treatment option for this demographic.

Fibromyalgia is a chronic condition characterized by widespread pain, fatigue, and sleep disturbances, which significantly impact the quality of life. Despite its prevalence, effective treatment options remain limited, necessitating the exploration of alternative therapies. The present study is significant as it addresses the need for accessible and effective non-pharmacological interventions for women with fibromyalgia, specifically comparing the outcomes of AT and LBT, two common therapeutic modalities.

To conduct this investigation, researchers employed a single-blind, randomized controlled equivalence trial design at the Fibromyalgia, Chronic Fatigue Syndrome, and Multiple Chemical Sensitivity Association in A Coruña, Spain. A total of 40 women with fibromyalgia were randomly assigned in a 1:1 ratio to either the AT group or the LBT group, with each group consisting of 20 participants. Both interventions involved therapeutic exercise programs, comprising 60-minute sessions conducted three times a week over 12 weeks, led by a trained physiotherapist. The primary outcome measured was pain intensity, assessed using a visual analogue scale, while secondary outcomes included pressure pain threshold, quality of life, sleep quality, fatigue, and physical ability, evaluated at baseline, after the 12-week intervention, and at an 18-week follow-up.

Although there were no significant differences between the groups immediately post-treatment, the follow-up data revealed notable benefits for the AT group. Participants in the AT group reported a significantly lower pain intensity (median 2.7, interquartile range [IQR], 1.5-4.9) compared to those in the LBT group (median 5.5, IQR 3.3-7.6; P = .023; large effect, Cohen's d = 0.8). Similarly, improvements in sleep quality were observed, with the AT group scoring a median of 12.0 (IQR, 7.3-15.3) compared to the LBT group’s median score of 15.0 (IQR, 13.0-17.0; P = .030; large effect, Cohen's d = 0.8).

Despite the promising results, the study does have limitations, including the relatively small sample size and the lack of long-term follow-up beyond 18 weeks. Additionally, factors such as participant adherence to the intervention and potential variability in the physiotherapist's delivery of therapy could influence outcomes.

“The results suggest that AT is better than LBT for reducing pain intensity and improving sleep quality after 6 weeks of follow-up,” the authors concluded. “AT may be a good treatment option for women with fibromyalgia.”

Reference

Neira SR, Marques AP, Cervantes RF, et al. Efficacy of aquatic vs land-based therapy for pain management in women with fibromyalgia. Physiotherapy. 2024;123:91-101. doi: 10.1016/j.physio.2024.02.005.