Health Care Professionals and patients report that hydrotherapy is valuable in managing inflammatory arthritis and musculoskeletal pain. However, clinical services are increasingly required to justify the clinical and cost effectiveness of hydrotherapy.
The aims of this thesis were to:
1. Identify the best available evidence for hydrotherapy in adults and children with musculoskeletal pain and inflammatory arthritis for uptake by clinical services using a Critically Appraised Topic (CAT) methodology.
2. Explore how this evidence could be useful in clinical practice and services, through a knowledge mobilisation Community of Practice with a range of stakeholder representatives using a Focus Group study.
Firstly, the CAT methodology determined the best empirical research evidence for the clinical and cost effectiveness of hydrotherapy, producing a clinical bottom line for further exploration. A facilitated discussion was subsequently undertaken with a range of stakeholders in a Community of Practice, and analysed using focus group methodology, to establish how to increase uptake of this evidence, exploring barriers and enablers to implementation.
Seven studies were identified that led to the CAT clinical bottom line. Systematic reviews (n=4) and clinical trials (n=3) show that hydrotherapy improves pain and function for patients with inflammatory arthritis in the short term and is comparable with land based exercises. There was limited evidence to justify cost effectiveness and return to work or school.
Eight members of a stakeholder group attended a community of practice. Eight key themes were highlighted such as the limitation of existing evidence, the need for qualitative studies and the importance of understanding barriers and facilitators in providing hydrotherapy services.
In conclusion this thesis has identified an evidence to practice gap for hydrotherapy as a complex intervention, and suggestions for closing this gap for the management of inflammatory arthritis and musculoskeletal pain.