Analytical-Systematic Review The Effects of Hydrotherapy on Balance, Functional Mobility, Motor Status, and Quality of Life in Patients with Parkinson Disease: A Systematic Review and Meta-analysis Camila Pinto, PT, Ana Paula Salazar, PhD, Ritchele R Marchese, MSc, Cinara Stein, PhD, Aline S Pagnussat, PhD Abstract Background: Individuals with Parkinson disease (PD) present balance and functional mobility disabilities that negatively affect the quality of life (QOL). Objective: To systematically review the effects of hydrotherapy on balance, functional mobility, QOL, and motor status in patients with PD. Design: Systematic review and meta-analysis. Participants: A total of 484 participants were included. The mean age of participants ranged from 54 to 78 years. The average dura- tion of PD ranged from 3 to 10 years. Methods: MEDLINE (PubMed), Embase, Cochrane CENTRAL, SCOPUS, Scielo, Physiotherapy Evidence Database (PEDro), and Google Scholar were searched from inception to December 2017. Randomized controlled trials (RCT), non-RCT, and pre-post studies were included. Main Outcome Measurements: Berg Balance Scale; Timed Up and Go test; Parkinson’ s disease quality of life and Short Form-36 Health Survey; Unified Parkinson Disease Rating Scale-Part III. Results: A total of 19 studies were identified, including eight RCTs, three non-RCTs, and eight pre-post studies. Our meta-analysis showed a moderate quality of evidence for positive effects of hydrotherapy combined or not with land-based therapy on balance (133 patients; MD = 2.00 [95% CI, 0.56 to 3.43; I 2 0%, P = .01]) and functional mobility (133 patients; MD = -1.08 [95% CI, -1.99 to -0.18; I 2 8%, P = .02]). However, hydrotherapy combined or not with land-based therapy did not improve QOL (76 patients; MD = -6.35 [95% CI, -13.04 to 0.33; I 2 7%, P = .06]) and motor status (140 patients; MD = -1.11 [95% CI, -3.27 to 1.04; I 2 0%, P = .31). The risk of bias across the included RCTs was low. Conclusions: Hydrotherapy, combined or not with other therapies, may improve balance and functional mobility of patients with PD when compared to land-based therapy alone or usual care. Level of Evidence: Level I. Introduction Parkinson disease (PD) is the second-most common neurodegenerative disorder around the world. 1 Although predominant in older age groups, this disease may affect 2% to 3% of the population at any time. 2 Bradykinesia, rigidity, and tremor are typical motor symptoms that can reduce muscular strength and postural control. 1,3–5 These impairments affect balance, functional mobility, and gait and, combined with fear of falling, may lead indi- viduals with PD to adopt a sedentary lifestyle. 6 It is well known that physical inactivity impairs clinical and func- tional domains of PD, reduces quality of life (QOL), and increases the risk of falls. 1,6–8 Pharmacological therapy is considered the gold stan- dard treatment for PD. However, dopamine does not alter the disease progression and can induce long-term side effects, including dyskinesia and motor fluctuations. 7,9 PM R 11 (2019) 278–291 www.pmrjournal.org © 2018 American Academy of Physical Medicine and Rehabilitation https://dx.doi.org/10.1016/j.pmrj.2018.09.031