Importantly, these authors conducted a fairly well-designed study in that they took some precautions to eliminate bias through true randomization and concealment processes. However, these findings were not reflected in the physical functional or pain scores. Alongside this, there was a greater number of participants in the Hydrotherapy group compared to the Land-based group leading to potential biases. Secondly, Hall et al. (1996) found that all groups assessed (Hydrotherapy, Seated Immersion, Land Exercise and Progressive Relaxation) demonstrated joint tenderness and pain relief. However, Hydrotherapy presented the most improvements (26% mean decrease) after 4 weeks treatment. This study demonstrates strengths over Eversden et al. (2007) in that they had assessed disease activity rather than just improvements in functionality. However, it was not clearly stated whether or not improvements in Hydrotherapy group were statistically significant and treatment dosage, if longer (>4 weeks) could have produced a greater therapeutic effect. Thirdly, Bilberg and Mannerkorpi (2005) found significant improvements in muscle function and endurance of upper and lower extremities and grip force. However, this was not supported by an increase in aerobic capacity as indicated by their hypothesis and primary outcome measure (Cycle Ergometer Test; Astrand 2006). Unlike, Eversden et al. (2007) and Hall (1996) this study reported intensity of exercise (70% of HR) and addressed longer term effects (12 weeks). However, sample size was small (46 patients) and temperature of pool was not specified, making it difficult to generalise data. Overall, there was inadequate reporting of depth, temperature of pool, type and intensity of exercises. Although, outcome measures differed between studies, they were appropriate for use (Al-Qubaiessy et al). Therefore, there is some evidence showing that Hydrotherapy plays a role in reducing pain (Hall et al. 1996). Finally, this highlights the importance of using standardised exercise procedures, longer term-interventions especially as RA is a chronic condition. This will help in making specific recommendations. Therefore, in accordance to PICO, my research question is ‘The long term effects of using specific Hydrotherapy exercise protocols: Aqua-Aerobics Programme and The Bad-Ragaz Ring Methods for RA. A randomized Controlled Trial’. Research Design From a pragmatic viewpoint, a mixed methods approach will be best-suited for this study as pain is a multi-dimensional phenomenon. However, a positivist would argue that this study should be carried out only objectively as this would allow generalizable conclusions to be drawn (Brooms and Willis, 2007). Alongside this, they would argue that researchers are detached from the investigation, thereby reducing bias (Bryman, 2004). Contrastingly, an interpretivist would support a qualitivate approach which would allow greater and richer insight into patient’s perceptions of pain (Bryman,>