Fields of application, indication, and effects of passive hydrotherapy WATSU. A survey among swiss Practitioners.

Schitter, Agnes Maria; Fosbrooke, Vera; Lögler, Silja; Fleckenstein, Johannes; Radlinger, Lorenz; Kurpiers, Nico; Frei, Peter (2018). Fields of application, indication, and effects of passive hydrotherapy WATSU. A survey among swiss Practitioners. (Unpublished). In: Day of BioMedical Research 2018. Bern. 7.11.2018.

Title
Fields of Application, Indication, and Effects of Passive Hydrotherapy WATSU. A Survey Among Swiss Practitioners
Background and Purpose
WATSU is a passive hydrotherapy practiced in 35 °C warm water for wellness and therapeutic purposes. A systematic review (PROSPERO registration number CRD42016029347) disclosed a broad spectrum of applications, indications, and effects of WATSU. The aim of this study was to contrast the scientific literature with the practical experience of practitioners. It also served as a pilot for an international survey on this topic.
Methods
A catalog of items was developed in close adherence to the results of the systematic review and presented as questionnaire to Swiss practitioners of WATSU for validation and extension. The practitioners rated the perceived commonness of each item in clinical practice on a numeric rating scale between 0 (never) and 10 (very common), the estimated effectiveness 0 (not) and 10 (very effective), and assessed the questionnaire itself (0 = not, 10 = very much). Data is expressed as medians / interquartile ranges.
Results
The survey was completed by 20 of the current 42 practitioners with an average of 14.75 (±5.2) years of practical experience. All 25 presented fields of application and indication were confirmed by at least one of the practitioners. WATSU was most commonly (by ≥95% of the practitioners) applied to treat individuals with low back pain (estimated effectiveness: 9.0/1.0), stress (9.0/2.75), neck pain (8.0/1.0), depression (8.0/2.0), sleep disorders (8.0/2.0), healthy individuals (9.0/2.0), and pregnant women (9.0/2.0). All of the 20 presented effects were confirmed by at least 30% of the practitioners. Most common effects (confirmed by ≥95% of the practitioners) were facilitated physical relaxation (estimated effectiveness: 10.0/1.0), relief of physical tension (9.0/2.0), improved respiratory function (9.0/2.0), decreased pain (8.5/1.5), increased mobility and flexibility (8.0/1.0), spiritual experiences (8.0/3.0), and increased psychological health (8.0/3.3). The practitioners contributed descriptions of the use of WATSU for additional somatic (e.g. frozen shoulder, complex regional pain syndrome) and psychologic conditions (e.g. obsessive-compulsive disorder, dissociative identity disorder), and additional effects as the development of confidence and trust. They approved the questionnaire as understandable (8.5/3.0), clearly structured (10.0/1.0), detailed (10.0/1.0), and considered it rather long (4.5/6.3).
Conclusions
The practitioners confirmed the information retrieved from the scientific literature and agreed on the suitability of WATSU to treat physical and psychological conditions in healthy individuals and patients as well. The practitioners’ feedback suggests usability of the questionnaire for international inquiry.
Implications
WATSU appears to be an effective treatment in pain management and several other conditions with high estimated effectiveness as reported by the practitioners. These results should be investigated in clinical trials, concerning subjective and objective acute and long-term effects in healthy individuals and patients. In addition, there is a need for a theoretical framework explaining the mode of action of WATSU. This survey will be repeated worldwide to explore the use and perception of WATSU in other countries and contexts.

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