Emerging technologies in aquatic physical therapy (2026)

In short: This 2026 systematic review brought together 11 randomized controlled trials on technology-enhanced aquatic rehabilitation, such as underwater treadmills, partial weight-support systems, water-jet resistance gait training and aquatic high-intensity interval training. Across the trials, these interventions improved pain, function, gait, balance and quality of life.

About this study

Zacharia and colleagues followed the PRISMA 2020 guidelines and searched PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library and Embase. They included randomized controlled trials of technology-enhanced or structured aquatic rehabilitation in musculoskeletal and neurological conditions. Risk of bias was assessed with the Cochrane RoB 2 tool, and the results were summarized in a narrative synthesis because the studies differed too much to pool.

Main findings

The strongest evidence concerned underwater treadmill training for knee osteoarthritis and chronic stroke, pneumatic partial weight-support treadmill systems, water-jet resistance gait training, aquatic high-intensity interval training and structured aquatic therapy for chronic low back pain.
Across studies, the interventions improved pain, physical function, gait, balance and quality of life, and in some studies muscle morphology.
Risk of bias was mostly rated “some concerns” or “low”, mainly because participants and therapists could not be blinded.
Exoskeleton-integrated, sensor-driven and computer-assisted aquatic systems have not yet been tested enough in clinical trials.

The authors conclude

The authors conclude that technology-enhanced aquatic rehabilitation appears effective in several conditions, particularly knee osteoarthritis, chronic low back pain and gait problems after stroke, and that the evidence is strongest for underwater treadmill-based systems and resistance-modulated aquatic gait training.

Limitations

The included trials had modest sample sizes, reported technical parameters inconsistently, used different comparison treatments and had limited long-term follow-up.

Source

Zacharia AP, Binu DP, Shinde S, Thomas MS. Emerging Technologies in Aquatic Physical Therapy and Rehabilitation: A Systematic Review. Cureus. 2026. doi: 10.7759/cureus.118787. Published under a Creative Commons Attribution (CC BY) licence.