Effects of Aquatic Therapy on Fatigue, Mobility, Physical Function, and Quality of Life in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Background: Aquatic therapy has emerged as a promising rehabilitation strategy for people with multiple sclerosis (MS), potentially improving physical and psychological outcomes through the unique properties of water. The aim of the study was to systematically evaluate the effects of aquatic therapy on fatigue, mobility, physical function, and quality of life (QoL) in people with MS. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Electronic databases (PubMed, Scopus, Web of Science, PEDro, CINAHL, and Cochrane) were searched from inception to February 2026. Eligible studies included adults with MS undergoing aquatic therapy interventions. Risk of bias and methodological quality was assessed using the Cochrane tool and the PEDro scale, respectively. Effect sizes were calculated as standardized mean differences (SMD) using a random-effects model. Results: Seven randomized controlled trials (RCTs) were included in the review. Meta-analysis demonstrated a large reduction in fatigue (SMD ≈ −1.20), moderate improvements in mobility and physical function (SMD ≈ 0.7), and small-to-moderate improvements in QoL (SMD ≈ 0.45) in favour of aquatic therapy. Heterogeneity ranged from moderate to high depending on the outcome. Qualitative synthesis supported these findings and indicated additional benefits in strength, balance, psychological well-being, and disease-related symptoms. No adverse events were reported. Conclusions: Aquatic therapy may represent a generally well-tolerated and potentially beneficial rehabilitation strategy for improving fatigue, mobility, and QoL in people with MS. However, these findings should be interpreted with caution due to the limited number of included RCTs, relatively small sample sizes, and substantial heterogeneity across interventions and outcome measures.