Systematic review of clinical evidence for Kneipp medicine

OBJECTIVE: Kneipp medicine, a naturopathic system based on hydrotherapy, exercise, nutrition, phytotherapy and lifestyle regulation, has a long history but lacks a comprehensive systematic review of its clinical efficacy from randomized controlled trials (RCT). This review aimed to synthesize existing RCT evidence to determine the efficacy of Kneipp medicine interventions compared to control conditions on mortality, morbidity and quality of life. METHODS: An initial information search involved inquiries to Kneipp institutions and practitioners. Subsequently, a systematic literature search was conducted across PubMed, Web of Science, Scopus and EMBASE, adhering to PRISMA guidelines and registered with PROSPERO (CRD420251061013). Inclusion criteria focused on human RCTs evaluating Kneipp interventions with a comparator group and reporting on mortality, morbidity or quality of life. Data extraction and risk of bias assessment (RoB 2.0) were performed by independent reviewers. RESULTS: The search yielded 77 records but only 1 study met the inclusion criteria. This single included study, albeit at a low number of only 30 patients, was an explorative feasibility trial. The systematic review revealed a significant lack of high-quality RCTs evaluating Kneipp therapy as a whole concept or its individual pillars. Identified studies often suffered from methodological limitations, including small sample sizes, inadequate control groups, and lack of blinding. Institutional inquiries provided insights into teaching modalities and promotional activities but lacked robust scientific documentation. CONCLUSION: Despite its historical and cultural significance, Kneipp medicine lacks robust scientific validation from high-quality RCTs to substantiate its medical efficacy as a comprehensive therapeutic approach. Consequently, its contemporary relevance appears to be primarily rooted in traditional, wellness and commercial contexts rather than evidence-based healthcare and medical practice.