PURPOSE: The purpose of this study was to search for, appraise the quality of and collate the research evidence supporting the clinical effectiveness of hydrotherapy. METHOD: A systematic search of literature was performed using ten medical and allied health databases from which studies relevant to physiotherapeutic hydrotherapy practice were retrieved. Patient trials were critically appraised for research merit using recognised published guidelines and the results were collated into clinical, functional and affective outcomes for the investigated populations. RESULTS: Seventeen randomised control trials, two case-control studies, 12 cohort studies and two case reports were included in the appraisal. Two trials achieved appraisal scores indicating high quality evidence in a subjectively evaluated merit categorisation. Fifteen studies were deemed to provide moderate quality evidence for the effectiveness of hydrotherapy. DISCUSSION: Flaws in study design and reporting attenuated the strength of the research evidence. Recommendations were made for the future direction of clinical hydrotherapy research. Randomised controlled trials with larger sample sizes, assessor blinding and the use of validated and reliable outcome measures in subjects with neurological conditions and acute orthopaedic injuries are particularly required. CONCLUSION: The balance of high to moderate quality evidence supported benefit from hydrotherapy in pain, function, self-efficacy and affect, joint mobility, strength, and balance, particularly among older adults, subjects with rheumatic conditions and chronic low back pain.

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