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Background: Anxiety, depression, and pain-related fears are highly prevalent among individuals with chronic low back pain (CLBP). While aquatic therapy is a promising treatment modality for CLBP, its effects on psychological factors remain poorly understood.

Objective: To compare the effects of aquatic therapy (AT) versus standard care (SC) on psychological outcomes, pain, and disability in CLBP.

Methods: In this two-arm randomized controlled trial, 34 participants with CLBP were assigned to AT (n = 18) or SC (n = 16). Both groups received bi-weekly individual sessions over 10 weeks. Pain, disability, quality of life, anxiety, depression, pain catastrophizing, kinesiophobia, and sleep disturbance were assessed using the following validated questionnaires; Numerical Pain Rating Scale, Modified Oswestry Low Back Pain Disability Index, Short-Form 12 Item Survey Questionnaire, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia and Insomnia Severity Index, respectively.

Results: Mixed-design analysis of covariance revealed no significant group*time interactions for any outcomes (all p > 0.05). Both groups improved significantly in pain, disability, quality of life, pain catastrophizing, and anxiety (all p < 0.05). Only AT demonstrated significant reductions in kinesiophobia (p = 0.002) and sleep disturbance (p = 0.001).

Conclusions: Aquatic therapy may offer a more comfortable treatment alternative to address psychological factors associated with CLBP.

Clinical trial registration: www.clinicaltrials.gov identifier is NCT05823857.