Abstract

Spinal cord injury (SCI) is a complex neurological condition that results in persistent physical, neurological, and physiological impairments, with secondary complications, particularly respiratory and cardiovascular, significantly contributing to morbidity and mortality. Integrated rehabilitation enables simultaneous improvements across multiple functional domains. Aquatic therapy, utilizing buoyancy, viscosity, and hydrostatic pressure, provides a unique environment to enhance motor, sensorimotor, and cardiorespiratory functions. This systematic review was conducted according to guidelines for transparent reporting of systematic reviews and meta-analyses (PRISMA). Included studies comprised randomized and non-randomized controlled trials, quasi-experimental studies, and case-control studies, involving over 300 adult participants of both sexes with complete or incomplete traumatic or non-traumatic SCI at all lesion levels according to the ASIA classification. Only studies with clearly defined primary outcomes of aquatic therapy were included, without restriction by publication date. Outcomes were analyzed using the International Classification of Functioning, Disability, and Health framework. Only primary outcomes were included in the meta-analysis, while other outcomes were presented narratively. Results demonstrated improvements in muscle strength, balance, and cardiorespiratory function, as well as enhancements in coordination, endurance, and quality of life. Aquatic therapy shows potential as an effective complementary rehabilitation method for adults with SCI, supporting the standardization of clinical practice and informing future evidence-based research.

Keywords: aquatic exercise, aquatics, aquatic therapy, aquatic physiotherapy, hydrotherapy