Article Text

Original research
Clinical effects of Kneipp hydrotherapy: a systematic review of randomised controlled trials
  1. Miriam Ortiz1,
  2. Anna Katharina Koch2,
  3. Holger Cramer3,4,5,
  4. Klaus Linde6,
  5. Gabriele Rotter1,
  6. Michael Teut1,
  7. Benno Brinkhaus1,
  8. Heidemarie Haller7
  1. 1Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin, Germany
  2. 2Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Berlin, Germany
  3. 3Department of Internal and Integrative Medicine, Universitat Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
  4. 4Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
  5. 5Bosch Health Campus, Stuttgart, Germany
  6. 6Institute of General Practice and Health Services Research, Technische Universität München, Munchen, Germany
  7. 7Center for Integrative Medicine and Planetary Health, University of Duisburg-Essen, University Hospital, Essen, Germany
  1. Correspondence to Dr Miriam Ortiz; miriam.ortiz{at}


Objective Hydrotherapy is a traditional prevention and treatment strategy. This study’s aim is to systematically review all available randomised controlled trials (RCTs) investigating clinical effects of hydrotherapy according to Kneipp which is characterised by cold water applications.

Methods RCTs on disease therapy and prevention with Kneipp hydrotherapy were included. Study participants were patients and healthy volunteers of all age groups. MEDLINE (via PubMed), Scopus, Central, CAMbase, and were systematically searched through April 2021 without language restrictions and updated by searching PubMed until April 6th 2023. Risk of bias was assessed using the Cochrane tool version 1.


Twenty RCTs (N=4247) were included. Due to high heterogeneity of the RCTs, no meta-analysis was performed. Risk of bias was rated as unclear in most of the domains. Of 132 comparisons, 46 showed significant positive effects in favour of hydrotherapy on chronic venous insufficiency, menopausal symptoms, fever, cognition, emotional function and sickness absenteeism. However, 81 comparisons showed no differences between groups and 5 were in favour of the respective control group. Only half of the studies reported safety issues.

Conclusion Although RCTs on Kneipp hydrotherapy seem to show positive effects in some conditions and outcomes, it remains difficult to ascertain treatment effects due to the high risk of bias and heterogeneity of most of the considered studies. Further high-quality RCTs on Kneipp hydrotherapy are urgently warranted.

PROSPERO registration number CRD42021237611.

  • rehabilitation medicine
  • clinical trials
  • complementary medicine
  • physical therapy modalities
  • preventive medicine

Data availability statement

Data are available upon reasonable request.

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Supplementary materials


  • MO, AKK, BB and HH are joint first authors.

  • Contributors MO and AKK contributed equally to the first authorship. BB and HH contributed equally to the last authorship. BB, MO and HC initiated the collaborative project and designed it. MO and BB mainly defined inclusion and exclusion criteria. KL, HC, AKK and HH provided essential methodological support. AKK and HH registered the study in PROSPERO, coordinated the literature search and prepared the outcome tables and figures. MO, BB, HC, AKK, HH, GR, MT and KL rated the abstracts and full-texts of the studies found using the Covidence software and by hand-searching. MO searched and ordered grey literature. MO, AKK, HH, BB and HC contributed mainly to the first draft of the manuscript. AKK and HH drafted the methods and results sections and MO drafted the introduction and discussion sections of the manuscript. MO and AKK revised the manuscript after the initial submission with the support from the BB, HC, KL, HH, MT and GR. MO, BB, HC, AKK, HH, GR, KL and MT read and approved the every submitted version of the manuscript. MO act as guarantor.

  • Funding This research was partly supported by the German Ministry of Health (Bundesgesundheitsministerium). The funder had no influence on the review, including the results. Grant number N/A.

  • Competing interests The authors MO, AKK, HC, GR, MT, HH and KL declare that they have no financial or other competing interests. BB was supported by the Kneipp Association in the context of his professorship at the Charité.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.