BACKGROUND: Chronic low back pain is a common musculoskeletal disease. With the increasing number of patients, it has become a huge economic and social burden. It is urgent to relieve the burden of patients. There are many common rehabilitation methods, and aquatic physical therapy is one of them. The purpose of this systematic review and meta-analysis is to summarize the existing literature and analyze the impact of aquatic physical therapy on pain intensity, quality of life and disability of patients with chronic low back pain. METHODS: Through 8 databases, we searched randomized controlled trials on the effect of aquatic physical therapy on patients with chronic low back pain. These trials published results on pain intensity, quality of life, and disability. This review is guided by Cochrane Handbook for systematic reviews of interventions version 5.1.0. The level of evidence was assessed through GRADE. RESULTS: A total of 13 articles involving 597 patients were included. The results showed that compared with the control group, aquatic physical therapy alleviated the pain intensity (Visual Analogue Scale: SMD -0.68, 95% CI -0.91 to -0.46, Z 5.92, p < 0.00001) and improved quality of life (physical components of 36-Item Short Form Health Survey or Short-Form 12: SMD 0.63, 95% CI 0.36 to 0.90, Zeta 4.57, p < 0.00001; mental components of 36-Item Short Form Health Survey or Short-Form 12: SMD 0.59, 95% CI 0.10 to 1.08, Zeta 2.35, p = 0.02), and reduced disability (Roland Morris Disability Questionnaire: SMD -0.42, 95% CI -0.66 to -0.17, Zeta = 3.34, p = 0.0008; Oswestry Disability Index or Oswestry Low Back Pain Disability Questionnaire: SMD -0.54, 95% CI -1.07 to -0.01, Zeta 1.99, p = 0.05). However, aquatic physical therapy did not improve patients' pain at rest (Visual Analogue Scale at rest: SMD -0.60, 95% CI -1.42 to 0.23, Zeta 1.41, p = 0.16). We found very low or low evidence of effects of aquatic physical therapy on pain intensity, quality of life, and disability in patients with chronic low back pain compared with no aquatic physical therapy. CONCLUSIONS: Our systematic review showed that aquatic physical therapy could benefit patients with chronic low back pain. However, because the articles included in this systematic review have high bias risk or are unclear, more high-quality randomized controlled trials are needed to verify.

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