Effects of aquatic interventions in children with neuromotor impairments: a systematic review of the literature.

OBJECTIVE To determine the effectiveness of aquatic interventions in children with neuromotor impairments. DESIGN A search of electronic databases that included MEDLINE, PubMed, ERIC, PsychLit, PEDro, Sport Discus, CINAHL and Cochrane between 1966 and January 2005 was conducted using the following keywords: 'hydrotherapy', 'aquatic therapy', 'water exercise', 'aquatics', 'adapted aquatics', 'aquatic exercise' and 'swimming'. An additional resource, the Aquatic Therapy Research Bibliography until 1999, was explored manually. Titles and abstracts were assessed manually according to the following inclusion criteria: (1) population (children with neuromotor or neuromuscular impairments), (2) intervention (aquatic programme). Articles were reviewed according to merit of design, population participants and outcome measures with respect to International Classification of Function and Disability terminology (changes in body function, activity level and participation). RESULTS Eleven of the 173 articles that were retrieved met the inclusion criteria: one randomized control trial, two quasi-experimental studies, one cohort study, two case control studies and five case reports. Seven articles reported improvement in body functions, and seven articles reported improvement in activity level. Two of the four articles that investigated outcome measures regarding participation described positive effects while the findings of the other two revealed no change. None of the articles reported negative effects due to aquatic interventions. CONCLUSION According to this review, there is a substantial lack of evidence-based research evaluating the specific effects of aquatic interventions in this population.