Comment on ‘The efficacy and safety of hydrotherapy in patients with knee osteoarthritis: a meta-analysis of randomized controlled trials’

Résumé fourni par la source

Dear Editor, We have perused with keen interest the article entitled ‘The efficacy and safety of hydrotherapy in patients with knee osteoarthritis: a meta-analysis of randomized controlled trials1’. The findings of this study indicate: Hydrotherapy is efficacious and safe for reducing pain and improving functional status in individuals with knee osteoarthritis, without increasing the risk of adverse effects. This is a highly valuable study, and we sincerely appreciate the extensive effort the authors invested in exploring this intriguing topic. However, the article has raised some attention on our part. We would like to pose some pertinent, worthwhile questions to the investigators. Firstly, the study included only six literatures, which is relatively limited, and the sample size is small. While the authors conducted a comprehensive search across databases such as PubMed, EMBASE, Cochrane Library, Science Citation Index, ScienceDirect, and Ovid, we believe that incorporating gray literature from clinical trial registries (such as ClinicalTrials.gov) and conducting manual searches of reference lists are essential steps in a systematic review. Employing these methods may increase the number of included articles. Secondly, the search terms used in this study were “hydrotherapy”, “knee”, “osteoarthritis”, and “randomized”. Upon careful review, we recommend broadening the scope of the search terms: “aquatic training”, “balneology”, and “balneotherapy”. Several crucial articles were overlooked due to the limited scope of the search terms in this study. Utilizing the updated search terms, we conducted a literature search and identified four additional papers that should be included in the analysis: Aquatic cycling improves knee pain and physical functioning in patients with knee osteoarthritis: a randomized controlled trial2. Grouped as follows: the aquatic cycling group (n=55) and the usual care group (n=47). Efficacy of progressive aquatic resistance training for tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis: a randomised controlled trial3. Grouped as follows: the intervention group (n=43) and the control group (n=44). Effects of high-intensity resistance aquatic training on body composition and walking speed in women with mild knee osteoarthritis: a 4-month RCT with 12-month follow-up4 Grouped as follows: the intervention group (n=43) participated in 48 supervised intensive aquatic resistance training sessions over 4 months while the control group (n=44) participated. Effectiveness of aquatic exercises compared to patient-education on health status in individuals with knee osteoarthritis: a randomized controlled trial5. Grouped as follows: aquatic exercise (n=31) and educational program (n=29). Therefore, we recommend a re-evaluation of the database, including the previously omitted literature, to conduct a more thorough analysis and derive more reliable conclusions. Thirdly, exclusion criteria included (1) case reports, crossover studies, letters, editorials, review articles, meta-analysis, and retrospective studies; (2) studies involved in animal experiments; (3) studies with deficiency data or data that cannot be extracted. Nevertheless, Figure 1 excluded two non-randomized controlled trials. We suggest that the exclusion criteria need further clarification: prospective non-randomized controlled studies should also be excluded. Last but not least, the treatment protocols for hydrotherapy in each study and the Kellgren–Lawrence (KL) of knee osteoarthritis (KOA) patients should be meticulously documented. For instance, some studies may have exercise regimens scheduled twice a week for 45 min per session, while others may prescribe three sessions per week lasting 30 min each. The frequency and duration of hydrotherapy, along with the KL grading of KOA patients, are pivotal factors influencing the study outcomes (pain levels and the McMaster Universities Arthritis Index). Hence, we recommend conducting subgroup analyses based on the varying frequencies and durations of hydrotherapy and KL classification to obtain more compelling and nuanced conclusions. In conclusion, we express our sincere appreciation to Lei and his colleagues for their collaborative efforts in investigating the efficacy and safety of hydrotherapy in patients with knee osteoarthritis. They have made significant strides in this clinically relevant field. However, we would like to raise some questions that may contribute to enhancing the clarity of their research findings. Ethical approval Not applicable. Consent Not applicable. Source of funding National Natural Science Foundation of China (82374484 and 82104882). Author contribution H.Z., Y.Z., and W.F.: original draft conception and writing. All authors were involved in the critical revision of the manuscript and have reviewed the manuscript. Conflicts of interest disclosure The author declares no conflict of interest. Research registration unique identifying number (UIN) Not applicable. Guarantor Wenjun Feng. Data availability statement Not applicable. Provenance and peer review Commentary, internally reviewed.

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