Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies


Objective: The objective of this selective EBM review is to determine, “Is aquatic therapy an effective treatment for reducing fatigue in adult females living with MS?”

Study Design: A systematic review of three randomized controlled trials (RCTs) published between 2015 and 2018.

Data Sources: All three RCTs were published in English peer reviewed journals and were discovered on PubMed using selective search criteria. Studies were chosen based on their relevance and competency to answer the clinical question proposed.

Outcome Measured: The main outcome of focus in each of the articles selected for this review was fatigue reduction. Outcomes were measured using the Modified Fatigue Impact Scale (MFIS) and/or the Fatigue Severity Scale (FSS) at baseline and at eight weeks following study completion. The RCT conducted by Kargarfar et al. utilized the MFIS and the RCT by Razazian et al. measured outcomes using the FSS. Both the MFIS and FSS were used for measurement in the RCT by Kooshiear et al.

Results: In the study conducted by Kargarfard et al., aquatic therapy led to a significant reduction in fatigue severity compared with control (P<0.01), supported by a mean change from baseline of 10.3 in the study group versus -16.5 in control. In the RCT by Kooshiar et al., aquatic therapy resulted in a statistically significant reduction in fatigue compared to control (P=0.000), demonstrated by a mean change from baseline of 23.44 versus -1.66. Lastly, Razazian et al. found a statistically significant reduction in fatigue severity with aquatic exercise compared to control (P<0.001) using both the MFIS and FSS, as supported by mean change from baseline values of 11.25 versus -0.71 and 6.69 versus -0.81.

Conclusion: Each of the three studies analyzed in this review determined aquatic therapy to have a large treatment effect in terms of reducing fatigue experienced by adult females living with MS, as evidenced by means and p-values. The results suggest that aquatic therapy would be a beneficial adjunct to pharmacological treatment. Further studies should explore additional population cohorts with more patients to determine generalizability, treatment duration and potential adverse effects.