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Chandra K A, Amanda A P, Nathania J, Aritonang M. The Effect of Hydrotherapy on Range of Motion and Pain in Hemophilia: A Meta-Analysis. PTJ 2026; 16 (S1) :369-380
URL: http://ptj.uswr.ac.ir/article-1-827-en.html

Purpose: This study aimed to assess the effect of hydrotherapy on range of motion (ROM) and pain in patients with hemophilia.
Methods: This study followed the preferred reporting items for systematic reviews and meta-analysis (PRISMA) 2020 guidelines. A thorough literature search was conducted in October 2024 across several databases, including PubMed, ProQuest, ScienceDirect, and Cochrane. The Cochrane risk of bias (RoB) 2 tool and the risk of bias in non-randomized studies – of interventions (ROBINS-I V2) were applied for study quality assessment, while Review Manager 5.4 was utilized for meta-analysis. 
Results: In total, three studies were analyzed, and the methodological appraisal showed that two had low risk and one had moderate risk of bias. Significant improvements in knee extension ROM (SMD=1.17, 95% confidence interval [CI], 0.15%, 2.185%, P=0.02) and decreases in pain (SMD=-1.46, 95% CI, -2%, -0.91%), P≤0.0001) were observed in the hydrotherapy group versus controls. However, knee flexion ROM improvement was not statistically significant (SMD=2.17, 95% CI, -0.42%, 4.77%], P=0.10). 
Conclusion: Hydrotherapy may improve knee ROM and pain in hemophilia, particularly in knee extension. However, variability across studies limits the certainty of these findings. Further large-scale randomized controlled trials with standardized intervention protocols are required to clarify long-term outcomes and encourage widespread clinical application.