Hydrotherapy treatment for patients with psoriatic arthritis—A qualitative study


Purpose: To describe how patients living with psoriatic arthritis experience long-term hydrotherapy group treatment. Studies for this group of patients are lacking. Method: Qualitative in terviews were conducted with ten informants after hydrotherapy treatment. The treatment included exercises for increased mobility, coordination, endurance, aerobic fitness, stretching and relaxation. The interviews were analysed with content analysis. Results: A theme “hydrotherapy—a multidimensional experience” and two categories emerged: situational factors and effects of hydrotherapy. The category “situ- ational factors” comprised the subcategories: warm water, training factors and a competent instructor, and the category “effects of hydro- therapy” comprised the subcategories: psy- chological effects, improved physical capacity, social effects, changed pain experience and changes in work and participation in daily life. Conclusion: Positive effects of regular hydro- therapy in a group setting were shown in physical ability, energy, sleep, cognitive function, work and participation in daily life. The instruc- tors had an important coaching role, which needs to be promoted.

Share and Cite:

Lindqvist, M. and Gard, G. (2013) Hydrotherapy treatment for patients with psoriatic arthritis—A qualitative study. Open Journal of Therapy and Rehabilitation, 1, 22-30. doi: 10.4236/ojtr.2013.12005.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Mease, P.J., Gladman, D.D., Kreuger, G.G. and Taylor, W.J. (2005) Prologue: Group for research and assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Annals of the Rheumatic Diseases, 64, 1-2.
[2] O’Neill, T. and Silman, A.J. (1994) Psoriatic arthritis. Historical background and epidemiology. Baillière’s Clinical Rheumatology, 8, 245-261. http://dx.doi.org/10.1016/S0950-3579(94)80017-0
[3] Taylor, W.J., Gladman, D.D., Mease, P.J., Adebajo, A., Nash, P.J. and Feletar, M. (2009) The impact of psoriatic arthritis according to the international classification of functional health and disability (ICF). ACR/ARHD Annual Scientific Meeting, Philadelphia, 17-19 October 2009.
[4] Alamanos, Y., Voulgari, P.V. and Drosos, A.A. (2008) Incidence and prevalence of psoriatic arthritis: A systematic review. Journal of Rheumatology, 35, 1354-1358.
[5] Dhir, V. and Aggarwal, A. (2012) Psoriatic arthritis: A critical review. Clinical Review in Allergy & Immunology, 44, 141-148. http://dx.doi.org/10.1007/s12016-012-8302-6
[6] Sokoll, K.B. and Helliwell, P.S. (2001) Comparison of disability and quality of life in rheumatoid and psoriatic arthritis. Journal of Rheumatology, 28, 1842-1846.
[7] Mustur, D. and Vujasinovic-Stupar, N. (2007) The impact of physical therapy on the quality of life of patients with rheumatoid and psoriatic arthritis. Medicinski Pregled, 60, 241-246. http://dx.doi.org/10.2298/MPNS0706241M
[8] Mease, P. and Goffe, B.S. (2005) Diagnosis and treatment of psoriatic arthritis. Journal of the American Academy of Dermatology, 52, 1-19. http://dx.doi.org/10.1016/j.jaad.2004.06.013
[9] Zink, A., Thiele, K., Huscher, D., Listing, J., Sieper, J., Krause, A., et al. (2006) Healthcare and burden of disease in psoriatic arthritis. A comparison with rheumatoid arthritis and ankylosing spondylitis. Journal of Rheumatology, 33, 86-90.
[10] Battistone, M.J., Manaster, B.J., Reda, D.J. and Clegg, D.O. (1999) The prevalence of sacroilitis in psoriatic arthritis: New perspectives from a large, multicenter cohort. A department of veterans affairs cooperative study. Skeletal Radiology, 28, 196-201. http://dx.doi.org/10.1007/s002560050500
[11] Nash, P. (2006) Therapies for axial disease in psoriatic arthritis. A systematic review. Journal of Rheumatology, 33, 1431-1434.
[12] Taylor, W.J. and Harrison, A.A. (2004) Could the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) be a valid measure of disease activity in patients with psoriatic arthritis? Arthritis & Rheumatism, 51, 311-315. http://dx.doi.org/10.1002/art.20421
[13] Eder, L., Chandran, V., Shen, H., Cook, R.J. and Gladman, D.D. (2010) Is ASDAS better than BASDAI as a measure of disease activity in axial psoriatic arthritis? Annals of the Rheumatic Diseases, 69, 2160-2164. http://dx.doi.org/10.1136/ard.2010.129726
[14] Husted, J.A., Tom, B.D., Farewell, V.T., Schentag, C.T. and Gladman, D.D. (2005) Description and prediction of physical functional disability in psoriatic arthritis: A longitudinal analysis using a Markov model approach. Arthritis & Rheumatism, 53, 404-409. http://dx.doi.org/10.1002/art.21177
[15] Yan, L., Cortinovis, D. and Stone, M.A. (2004) Recent advances in the treatment of the spondyloarthropathies. Current Opinion in Rheumatology, 16, 357-365. http://dx.doi.org/10.1097/01.bor.0000129719.21563.35
[16] Ritchlin, C.T. (2006) Therapies for psoriatic enthesopathy. A systematic review. Journal of Rheumatology, 33, 1435-1438.
[17] Klareskog, L., Saxne, T. and Enman, Y. (2005) Reumatologi. Studentlitteratur, Lund.
[18] Melzack, R. and Wall, P.D. (1965) Pain mechanism: A new theory. Science, 150, 971-979. http://dx.doi.org/10.1126/science.150.3699.971
[19] Kjellgren, A., Sundequist, U., Norlander, T. and Archer, T. (2001) Effects of flotation-REST on muscle tension pain. Pain Research & Management, 6, 181-189.
[20] Bender, T., Karagulle, Z., Balint, G.P., Gutenbrunner, C., Balint, P.V. and Sukenik, S. (2005) Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatology International, 25, 220-224. http://dx.doi.org/10.1007/s00296-004-0487-4
[21] Athern, M., Nicholls, E., Simionato, E., Clark, M. and Bond, M. (1995) Clinical and psychological effects of hydrotherapy in rheumatic diseases. Clinical Rehabilitation, 9, 204-212. http://dx.doi.org/10.1177/026921559500900305
[22] Bilberg, A., Ahlmen, M. and Mannerkorpi, K. (2005) Moderately intensive exercise in a temperate pool for patients with rheumatoid arthritis: A randomized controlled study. Rheumatology (Oxford), 44, 502-508. http://dx.doi.org/10.1093/rheumatology/keh528
[23] Stenström, C.H., Lindell, B., Swanberg, B., Swanberg, P., Harms-Ringdahl, K. and Nordemar, R. (1991) Intensive dynamic training in water for rheumatoid arthritis functional class II. A long term study of effects. Scandinavian Journal of Rheumathology, 20, 358-365. http://dx.doi.org/10.3109/03009749109096812
[24] Eversden, L., Maggs, F., Nightingale, P. and Jobanputra, P. (2007) A pragmatic randomised controlled trial of hydrotherapy and land exercises on overall well being and quality of life in rheumatoid arthritis. BMC Musculoskeletal Disorders, 8, 23. http://dx.doi.org/10.1186/1471-2474-8-23
[25] Helliwell, P.S., Abbott, C.A. and Chamberlain, M.A. (1996) A randomised trial of three different physiotherapy regimes in ankylosing spondylitis. Physiotherapy, 82, 85-90. http://dx.doi.org/10.1016/S0031-9406(05)66956-8
[26] Carr, A., Hewlett, S., Hughes, R., Mitchell, H., Ryan, S. and Carr, M. (2003) Rheumatology outcomes: The patient’s perspective. Journal of Rheumatology, 30, 880-883.
[27] Her, M. and Kavanaugh, A. (2012) Patient-reported outcomes in rheumatoid arthritis. Current Opinion in Rheumatology, 24, 327-334.
[28] Charmaz, K. (1990) Discovering chronic illness: Using grounded theory. Social Science & Medicine, 30, 1161-1172. http://dx.doi.org/10.1016/0277-9536(90)90256-R
[29] Kvale, S. and Torhell, S.-E. (1997) Den kvalitativa forskningsintervjun. Studentlitteratur, Lund.
[30] Gibson, B.E. and Martin, D.K. (2003) Qualitative research and evidence-based physiotherapy practice. Physiotherapy, 89, 350-358. http://dx.doi.org/10.1016/S0031-9406(05)60027-2
[31] Graneheim, U.H. and Lundman, B. (2004) Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105-112. http://dx.doi.org/10.1016/j.nedt.2003.10.001
[32] Moberg, K.U. (2000) Lugn och beröring: Oxytocinets läkande verkan i kroppen. Natur och Kultur i Samarbete med Axelsons Gymnastiska Institut, Stockholm.
[33] Hall, J., Skevington, S.M., Maddison, P.J. and Chapman, K. (1996) A randomized and controlled trial of hydrotherapy in rheumatoid arthritis. Arthritis Care and Research, 9, 206-215. http://dx.doi.org/10.1002/1529-0131(199606)9:3<206::AID-ANR1790090309>3.0.CO;2-J
[34] Geytenbeek, J. (2002) Evidence for effective hydrotherapy. Physiotherapy, 88, 514-529. http://dx.doi.org/10.1016/S0031-9406(05)60134-4
[35] Stenstrom, C.H. and Minor, M.A. (2003) Evidence for the benefit of aerobic and strengthening exercise in rheumatoid arthritis. Arthritis & Rheumatism, 49, 428-434. http://dx.doi.org/10.1002/art.11051
[36] Pollock, M.L. and Vincent, K.R. (1996) Resistance training for Health. The President’s Council on Physical Fitness and Sports Research Digest, Series 2, No. 8.
[37] Martin, J.E. and Dubbert, P.M. (1982) Exercise apllication and promotion in behavioral medicine: Current status and future directions. Journal of Consulting and Clinical Psychology, 50, 1004-1017. http://dx.doi.org/10.1037/0022-006X.50.6.1004
[38] Karageorghis, C.I., Priest, D.L., Terry, P.C., Chatzisarantis, N.L. and Lane, A.M. (2006) Redesign and initial validation of an instrument to assess the motivational quailties of music in exercise: The Brunel Music Rating Inventory-2. Journal of Sports Sciences, 24, 899-909. http://dx.doi.org/10.1080/02640410500298107
[39] Siedliecki, S.L. and Good, M. (2006) Effect of music on power, pain, depression and disability. Journal of Advanced Nursing, 54, 553-562. http://dx.doi.org/10.1111/j.1365-2648.2006.03860.x
[40] Revstedt, P. (2002) Motivationsarbete. 3 Edition, Liber Utbildning AB, FalkÖping.
[41] SBU. (2007) Metoder fär att främja fysisk aktivitet. 111-113.
[42] Stenstrom, C.H. and Swärdh, E. (2006) Rätt doserad träning ger positiva effekter vid reumatoid artrit. Fysioterapi, 4, 40-46.
[43] Bandura, A. (1994) Self-efficacy. In: Ramachaudran, V.S. Ed., Encyclopedia of Human Behavior, Academic Press, New York, 71-81.
[44] Vitorino, D.F., Carvalho, L.B. and Prado, G.F. (2006) Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: Randomized clinical trial. Sleep Medicine, 7, 293-296. http://dx.doi.org/10.1016/j.sleep.2005.09.002
[45] Wolfe, F., Hawley, D.J. and Wilson. K. (1996) The prevalence and meaning of fatigue in rheumatic disease. The Journal of Rheumatology, 23, 1407-1417.
[46] Minnock, P. and Bresnihan, B. (2004) Pain outcome and fatigue levels reported by women with esablished rheumatoid arthritis. Arthritis & Rheumatism, 50, 1171-1198.
[47] Norrbrink, C. and Lundeberg, T. (2010) Om smärta ur ett fysiologiskt perspectiv. Studentlitteratur AB, Lund, 54-55.
[48] Lee, D.M., Pendleton, N., Tajar, A., O’Neill, T.W., O’Connor, D.B., Bartfai, G., et al. (2010) Chronic widespread pain is associated with slower cognitive processing speed in middle-aged and older European men. Pain, 151, 30-36. http://dx.doi.org/10.1016/j.pain.2010.04.024
[49] Munguia-Izquierdo, D. and Legaz-Arrese, A. (2007) Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia. Clinical and Experimental Rheumatology, 25, 823-830.
[50] Templeton, M.S., Booth, D.L. and O’Kelly, W.D. (1996) Effects of aquatic therapy on joint flexibility and functional ability in subjects with rheumatic disease. Journal of Orthopaedic & Sports Physical Therapy, 23, 376-381. http://dx.doi.org/10.2519/jospt.1996.23.6.376
[51] Suomi, R. and Koceja, D.M. (2000) Postural sway characteristics in women with lower extremity arthritis before and after aquatic exercise intervention. Archives of Physical Medicine and Rehabilitation, 81, 780-785.
[52] Sattar, N., McCarey, D.W., Capell, H. and McInnes. I.B. (2003) Explaining how “high-grade” systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation, 108, 2957-2963. http://dx.doi.org/10.1161/01.CIR.0000099844.31524.05
[53] Wallstone, B.S., Alagna, S.W., McEvoy., De Vellis, R. and De Vellis, R. (1983) Social support and physical health: The importance of belonging. Journal of American College Health Association, 53, 276-284.
[54] Hale, C.J., Hannum, J.W. and Espelage, D.L. (2005) Social support and physical health: The importance of belonging. Journal of American College Health, 53, 276-284. http://dx.doi.org/10.3200/JACH.53.6.276-284
[55] Poland, B.D. (1995) Transcription quality as an aspect of rigor in qualitative research. Qualitative Inquiry, 1, 290-310. http://dx.doi.org/10.1177/107780049500100302
[56] Malterud, K. (1998) Kvalitativa metoder i medicinsk forskning. Studentlitteratur, Lund.
[57] McKenna, S.P., Doward, L.C., Whalley, D., Tennant, A., Emery, P. and Veale, D.J. (2004) Development of the PsAQoL: A quality of life instrument specific to psoriatic arthritis. Annals of the Rheumatic Diseases, 63, 162-169. http://dx.doi.org/10.1136/ard.2003.006296

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.