Emerging Technologies in Aquatic Physical Therapy and Rehabilitation: A Systematic Review

Aquatic rehabilitation has evolved substantially from conventional hydrotherapy to encompass technologyenhanced interventions including underwater treadmills, pneumatic partial weight-support systems, waterjet resistance gait training, structured aquatic high-intensity interval training (AHIIT), and imagingsupported outcome assessment.Despite increasing clinical use across musculoskeletal and neurological rehabilitation, no focused synthesis has systematically evaluated the evidence specific to these emerging aquatic rehabilitation technologies.This systematic review aimed to identify, critically evaluate, and synthesize the clinical evidence for technology-enhanced aquatic rehabilitation interventions across musculoskeletal and neurological conditions.Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, systematic searches were conducted across PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase from database inception to July 12, 2026.Eligible studies were randomized controlled trials (RCTs) evaluating technology-enhanced or structured aquatic rehabilitation in human participants.Completed trials were included in the qualitative outcome synthesis.Methodological quality of completed randomized trials was appraised using the Cochrane Risk of Bias 2 (RoB 2) tool.Owing to clinical and methodological heterogeneity, a thematic narrative synthesis was performed.Eleven studies met the eligibility criteria, comprising 11 completed randomized trials.The strongest completed clinical evidence concerned underwater treadmill interventions for knee osteoarthritis (KOA) and chronic stroke, pneumatic partial weight-support treadmill systems, water-jet resistance gait training, aquatic high-intensity interval training in rheumatic and musculoskeletal disease, and structured aquatic therapy for chronic low back pain (CLBP).Across studies, these interventions improved pain, physical function, gait, balance, quality of life, and, in some cases, muscle morphology.RoB 2 assessments indicated predominantly "some concerns" or "low risk" judgements across domains, with limitations primarily related to a lack of participant and therapist blinding.However, the evidence base remains constrained by modest sample sizes, inconsistent reporting of technological parameters, heterogeneous comparators, and limited long-term follow-up.Technology-enhanced aquatic rehabilitation appears effective across several conditions, particularly knee osteoarthritis, chronic low back pain, and poststroke gait dysfunction.Current evidence most strongly supports a limited set of clinically implemented technologies, especially underwater treadmill-based systems and resistance-modulated aquatic gait training.More advanced technologies such as exoskeleton-integrated, sensor-driven, and computationally assisted aquatic systems remain promising but lack sufficient clinical trial validation.