Schitter A.M.1, Fleckenstein J.1,2, Frei P.3, Taeymas J.4, Kurpiers N.3, Radlinger L.4
1University of Bern, Institute of Complementary Medicine, Bern, Switzerland, 2Goethe-University Frankfurt / Institute of Sports Sciences, Department of Sports Medicine, Frankfurt, Germany, 3University of Hildesheim, Institute of Sports Science, Hildesheim, Germany, 4Bern University of Applied Sciences, Section of Health, Bern, Switzerland
Background: To practice WATSU (WaterShiatsu), a therapist stands in 35° C water, moving a client in slow and spacious circular motions. Gentle tractions applied to the client's body are supposed to stretch muscular and fascial structures, and to stimulate meridians, i.e. channels through which according to Traditional Chinese Medicine the life-energy “qi” (氣) is flowing. Developed in the 1980's, WATSU is now practiced worldwide and occasionally reported to be implemented in therapeutic settings.
Purpose: Objective of this first systematic literature review (PROSPERO registration number CRD42016029347) on WATSU is to build a foundation for research on this topic by providing a comprehensive overview of the currently evident knowledge on its use and attributed effects.
Methods: The search without language restrictions for the terms watsu OR watershiatsu OR (water AND shiatsu) was conducted in 23 databases and manually in reference lists of retrieved publications. Authors of recent publications on WATSU, as well as Institutes of Aquatic Bodywork, were contacted to retrieve additional grey literature. All procedures of data collection, screening, inclusion, risk of bias assessment, and data extraction were performed by two independent reviewers. Qualitative information on applications, indications, and effects of WATSU was extracted from the entire body of evidence. Quantitative results concerning effects of WATSU as a stand-alone hydrotherapy delivered in adequate water temperatures (33°-36° C), reported in peer reviewed original articles (regardless of study design), were submitted to risk of bias-assessment.
Results: The search yielded 1,248 articles (without duplicates), of which 459 actually reported on WATSU. Peer reviewed articles were divided into original articles (n=56) and secondary literature (n=74). In 32 of the original articles, elements of WATSU were integrated in hydrotherapeutic programs. Fourteen studies reported on quantitative outcomes regarding effects of genuine WATSU, covering a broad spectrum of indications (e.g. pain, hemiplegia, asthma, depression, or pregnancy). Their overall risk of bias, due to study design (1 random controlled trial, 2 controlled trials, 2 trials without control group, 6 case series, and 3 case reports) and room for improvement in reporting, is high. WATSU was reported to be applied on individuals from childhood to seniority. The intervention aimed for physical (e.g. regarding pain, range of motion, physical quality of life) or mental (e.g. regarding stress, depression, mental quality of life) benefits.
Conclusion(s): This systematic review supports the notion that WATSU is being attributed suitability for a multitude of conditions and also implemented in therapeutic settings. Due to potential risk of bias in most of the retrieved studies, conclusions have to be taken with caution.
Implications: The literature is lacking methodologically sound studies concerning frequency and magnitude of the suggested effects of WATSU, dose-response, or responder-profiles among patients. Therefore, it is proposed that future investigations focus on reassurance of the retrieved information e.g. via qualitative verification by experts, and trials that investigate proposed short- and long-term effects in both, healthy individuals and affected populations.
Funding acknowledgements: None
Topic: Professional practice: other
Ethics approval: Not required for this type of study.
All authors, affiliations and abstracts have been published as submitted.
