Aquatic therapy compared to standard care for chronic low back pain: a randomized controlled trial

BACKGROUND: Anxiety, depression, and pain‐related fears are highly prevalent among individuals with chronic low back pain (CLBP). While aquatic therapy is a promising treatment modality for CLBP, its effects on psychological factors remain poorly understood. OBJECTIVE: To compare the effects of aquatic therapy (AT) versus standard care (SC) on psychological outcomes, pain, and disability in CLBP. METHODS: In this two‐arm randomized controlled trial, 34 participants with CLBP were assigned to AT (n = 18) or SC (n = 16). Both groups received bi‐weekly individual sessions over 10 weeks. Pain, disability, quality of life, anxiety, depression, pain catastrophizing, kinesiophobia, and sleep disturbance were assessed using the following validated questionnaires; Numerical Pain Rating Scale, Modified Oswestry Low Back Pain Disability Index, Short‐Form 12 Item Survey Questionnaire, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia and Insomnia Severity Index, respectively. RESULTS: Mixed‐design analysis of covariance revealed no significant group*time interactions for any outcomes (all p > 0.05). Both groups improved significantly in pain, disability, quality of life, pain catastrophizing, and anxiety (all p < 0.05). Only AT demonstrated significant reductions in kinesiophobia (p = 0.002) and sleep disturbance (p = 0.001). CONCLUSIONS: Aquatic therapy may offer a more comfortable treatment alternative to address psychological factors associated with CLBP. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov identifier is NCT05823857.