The short-term effects of balneotherapy on pain, disability and fatigue in patients with chronic low back pain treated with physical therapy: A randomized controlled trial.

OBJECTIVE: This study aimed to compare whether there are positive effects of balneotherapy(BT) on pain, quality of life and disability of individuals receiving physical therapy(PT) for chronic low back pain and to examine the effect of body mass index(BMI) on treatment. MATERIALS AND METHOD: This prospective, controlled, single blind study was conducted. Patients were randomized into two groups through a simple randomization in a 1:1 ratio. The clinician and biostatistics expert were blinded. PT group was applied PT, BT + PT group was applied PT + BT. All patients were included in the study for 3 weeks (total of 15 sessions, 5 days per week). All patients applied hot pack, transcutaneous electrical nerve stimulation and ultrasound. Patients in the BT + PT group applied BT in thermo mineralized water pool (20 min at 38-40 °C). Assessments were made using Pain-Visual Analog Scale(VAS), EQ-5D-3 L Scale(EQ5), EQ-VAS, Functional Assessment of Chronic Illness Therapy-Fatigue(FACIT-F), Roland-Morris Disability Questionnaire(RMDQ) and Quebec Back Pain Disability Scale(QBPDS) at the beginning (W0) and end (W3) of treatment. While performing statistical analysis, patients were divided into 3 categories of BMI1(18.5-24.9 kg/m2), BMI2 (25.0-29.9 kg/m2) and BMI3(≥30.0 kg/m2). RESULTS: 270 patients were randomized. 129 patients in PT group and 133 patients in PT + BT group completed the study. In the BT + PT group, there were increases in the EQ5 and EQ-VAS variables and decreases in all other variables compared to the PT group which were found to be statistically significant (for QBPDS p < 0.05, the others p < 0.01). The differences in all variables W0 and W3 were at least half reductions and increases which were found to be statistically significant (p < 0.01). In terms of BMI, there were significant differences for all groups, especially BMI3 had higher means for all variables apart from EQ5 and EQ-VAS than the other two categories. BMI1 was the BMI category with highest means for EQ5 and EQ-VAS. The Group × Time interaction was found to be statistically significant for Pain-VAS, EQ5, EQ-VAS, FACIT-F, QBPDS and RMDQ(p < 0.01). For Pain-VAS, the effect of the Group × Time × BMI interaction was found to be statistically significant(p < 0.05). CONCLUSION: BT plus PT was more effective than PT. BT may have positive contributions to reducing pain, functionality of patients, quality of life, fatigue and disability status.

Balneotherapy in the Treatment of Chronic Shoulder Pain: A Randomized Controlled Clinical Trial.

CONTEXT: To date, the number of studies investigating the effects of balneotherapy (BT) on chronic shoulder pain is small. OBJECTIVE: This study intended to investigate the effects of BT on pain, disability, and quality of life for patients with chronic shoulder pain. DESIGN: The research team designed a prospective, randomized, controlled, single-blinded study. SETTING: The study took place in the Department of Medical Ecology and Hydroclimatology at the Bolu Izzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital (Bolu, Turkey). PARTICIPANTS: Participants were 60 patients with shoulder pain who were admitted to the outpatient clinic at the hospital between April 2016 and September 2016. INTERVENTION: Participants were divided randomly into 2 groups: a control group receiving physical therapy (PT) only, the PT group, and an intervention group receiving PT plus BT, the BT group. All participants received 3 wk of treatment. OUTCOME MEASURES: The study measured pain, disability, and quality of life using a visual analogue scale (VAS), the Shoulder Pain and Disability Index (SPADI), and the Nottingham Health Profile (NHP) at baseline, immediately postintervention, and at 1 mo postintervention. RESULTS: Statistically significant improvements were found on the VAS, SPADI, and NHP at both postintervention timepoints for both groups compared with baseline (P < .05). When the difference scores were compared between the groups, the BT group showed significantly greater improvements at both postintervention timepoints for the VAS and SPADI compared with the PT group (P < .05). For the NHP, the BT group showed significantly greater improvements compared with the PT group immediately postintervention for the pain and energy level subscales and for the total score (P < .05). At 1 mo postintervention, the BT group again showed significantly greater improvements on the NHP compared the PT group for the pain, physical activity, energy level, and sleep subscales and for the total score (P < .05). CONCLUSION: The results of the study suggest that BT can have positive effects on pain and disability. BT may be an alternative for patients with chronic shoulder pain.

Effect of balneotherapy on pain and fatigue in elderly with knee osteoarthritis receiving physical therapy: a randomized trial.

This study aimed to investigate whether balneotherapy (BT) applied in combination with physical therapy (PT) has a more positive effect in patients aged 65 years and older with knee osteoarthritis (KOA) compared to PT alone. A total of 305 individuals were randomized into two groups. Group I was applied PT alone; group II was applied PT + BT. Assessments were made using the Pain (VAS), EQ-5D-3L Scale, Western Ontario And McMaster Universities Osteoarthritis Index (WOMAC), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Scale, Epworth Sleepiness scale (EPWORTH) and the Outcome Measures in Rheumatology-The Osteoarthritis Research Society International set of responder criteria for osteoarthritis (OMERACT-OARSI) at the beginning (T0) and at the end (T1) of treatment. Statistically significant interactions found between treatment (PT alone or PT + BT) and time (before treatment and after treatment) in terms of Pain-VAS, Pain-WOMAC, Stiffness-WOMAC, Physical Function-WOMAC, Total-WOMAC, EQ-5D, EQ-VAS, FACIT-F, and EPWORTH scores (p < 0.0001 for all). According to OMERACT-OARSI criteria, the responder rate was 89.04% in PT alone group and 98.74% in PT + BT group. Balneotherapy plus physical therapy was more effective than physical therapy alone in KOA patients aged over 65 years. Reducing pain, especially, positively contributes to functionality, quality of life, fatigue and sleepiness of KOA patients.

Is the Duration of Spa Cure Treatment Important in Knee Osteoarthritis? A Randomized Controlled Study.

BACKGROUND: Spa therapies are applied in varying durations. Today, the duration of spa therapy may be long for people with active lives. How should we determine the duration of treatment in order to minimize therapy costs and loss of labor force? Does the duration of treatment have an impact on pain, functional status, and quality of life of patients? OBJECTIVE: Our aim was to investigate the role of application time on the efficacy of spa therapy in individuals undergoing the same treatment protocol. METHODS: This was a randomized, controlled, single-blind clinical trial design. Sixty individuals were divided into two groups: 3 weeks of therapy (group 1) and 2 weeks of therapy (group 2). Pretreatment, posttreatment, and 30-day posttreatment findings were recorded using a visual analog scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Nottingham Health Profile (NHP). RESULTS: The measurements revealed significant improvement after treatment compared to those observed prior to the treatment in both groups, except for the social isolation subgroup. When the groups were compared to each other, significant improvement was observed in pain (VAS, WOMAC, NHP) in favor of group 1 at all measurement times. CONCLUSION: Our results suggest that spa therapy has positive effects on pain, physical activity, and quality of life in patients, and 15 sessions of therapy had even better effects on pain. We believe that the duration of therapy should be determined considering the efficacy of the therapy on pain as well as the functional situation and quality of life of patients regarding therapy costs.

The effects of inpatient versus outpatient spa therapy on pain, anxiety, and quality of life in elderly patients with generalized osteoarthritis: a pilot study.

This study aimed to investigate the effect of inpatient vs outpatient spa therapy on pain, quality of life, and anxiety in elderly patients with generalized osteoarthritis. A total of 150 patients were randomized into three groups. Group I was given medical treatment, group II was treated as outpatients, and group III was treated as inpatient spa therapy. Assessments were made using the Pain (VAS), EQ-5D-3L Scale, and State and Trait Anxiety Inventory (STAI) at the beginning of treatment (W0), at the end of treatment (W2), and at the fourth week after treatment (W6). The comparison of outpatient spa group and etodolac treatment group showed that outpatient spa group was superior to etodolac treatment group in all evaluated parameters at W2 vs W0 and W6 vs W0. The comparison of inpatient spa group and etodolac treatment group showed that inpatient spa group was superior to etodolac treatment group in all evaluated parameters at W2 vs W0 and W6 vs W0. The comparison of inpatient spa group and outpatient spa group showed that inpatient spa group was superior to outpatient spa group in all evaluated parameters except STAI-TXII at W2 vs W0 and in all evaluated parameters W6 vs W0. Spa therapy, either as an outpatient or inpatient basis, may have a positive effect on pain, anxiety, and quality of life in geriatric patients with generalized osteoarthritis. The inpatient spa therapy may be more beneficial than outpatient spa therapy. When the side effects of drug treatments are emphasized, spa therapy may be considered as an interesting option for elderly with osteoarthritis.

How does spa treatment affect cardiovascular function and vascular endothelium in patients with generalized osteoarthritis? A pilot study through plasma asymmetric di-methyl arginine (ADMA) and L-arginine/ADMA ratio.

The study aims to investigate the effect of spa treatment on vascular endothelium and clinical symptoms of generalized osteoarthritis. Forty generalized osteoarthritis (GOA) patients referred to a government spa hospital, and 40 GOA patients followed on university hospital locomotor system disease ambulatory clinics were included as study and control groups, respectively. Study group received spa treatment including thermal water baths, physical therapy modalities, and exercises. Control group was followed with home exercises for 15 days. Plasma ADMA, L-arginine, L-arginine/ADMA ratio, routine blood analyses, 6-min walking test, including fingertip O2 saturation, systolic/diastolic blood pressure, and pulse rate, were measured at the beginning and at the end of treatment. Groups were evaluated with VAS pain, patient, and physician global assessment; HAQ; and WOMAC at the beginning, at the end, and after 1 month of treatment. In study group, L-arginine and L-arginine/ADMA ratio showed statistically significant increase after treatment. Plasma ADMA levels did not change. There is no significant difference in intergroup comparison. Study group displayed statistically significant improvements in all clinical parameters. The study showed that spa treatment does not cause any harm to the vascular endothelium through ADMA. Significant increase in plasma L-arginine and L-arginine/ADMA ratio suggests that balneotherapy may play a preventive role on cardiovascular diseases. Balneotherapy provides meaningful improvements on clinical parameters of GOA.

Effects of Balneotherapy on Serum Levels of Shingosine-1-Phosphate in Patients With Osteoarthritis.

Context • Balneotherapy is one of the most commonly used nonpharmacological interventions for osteoarthritis (OA), but its mechanism of action in relieving pain and stiffness and in improving physical function is not well understood. Studies have found that therapy provokes a series of neuroendocrinal reactions with anti-inflammatory and analgesic effects. Sphingosine-1-phosphate (S1P), a bioactive lipid, has been implicated as an important mediator in the maintenance of physiological processes (eg, vascular barrier integrity) and in pathophysiologic processes such as inflammatory conditions. Accordingly, targeting S1P and S1P receptors may offer a potential therapy for arthritis. Objective • The aims of the present study were to determine whether (1) balneotherapy modified the circulating levels of S1P as well as some inflammatory parameters and stress markers, in patients with OA; and (2) to assess the relationship of those parameters to therapeutic efficacy. Design • This study was designed as an uncontrolled longitudinal study. Setting • The study took place at the Bolu Physical Therapy and Rehabilitation Hospital (Bolu, Turkey). Participants • Forty patients who suffered from general OA in at least 3 positions on the body, one of which could be the vertebral column, and who fulfilled the American College of Rheumatology Classification criteria and the Kellgren-Moore radiologic criteria, were enrolled in the intervention group in the study. Intervention • During balneotherapy, the participants were fully immersed in warm thermo-mineral water for 20 min at a temperature of 38°C to 40°C. A total of 15 immersions were performed in a period of 15 d. Outcome Measures • A baseline clinical evaluation of participants' pain, stiffness, and physical function was carried out using the Western Ontario and McMaster Universities questionnaire. Baseline serum levels of S1P, cyclooxygenase 2 (COX-2), matrix metalloproteinase 3 (MMP-3), and heat shock protein 70 (HSP-70) were measured using enzyme-linked immunosorbent assays and high-sensitivity C-reactive protein, with an immunoturbidimetric assay. The clinical evaluations and the biochemical measurements were repeated after completion of the balneotherapy period. Results • Balneotherapy caused a significant reduction in circulating levels of S1P and high-density lipoprotein and a limited increase in HSP-70 levels, in addition to a reduction in pain and stiffness and an improvement in physical function. In the Spearman's correlation analysis, S1P was found to be positively associated with serum levels of HSP-70, COX-2, and MMP-3. Conclusion • Balneotherapy modulated serum S1P levels in patients with OA. The effect of S1P modulation on the clinical outcome of patients with OA should be further investigated.

Balneological outpatient treatment for patients with knee osteoarthritis; an effective non-drug therapy option in daily routine?

This study aims to compare the effects of balneological treatments applied at consecutive and intermittent sessions without interfering with their daily routine in patients with knee osteoarthritis. This is a randomized, controlled, single-blind clinical trial. Fifty patients diagnosed with knee osteoarthritis were included. The patients were divided into two groups. All patients were given a total of ten sessions of balneological treatment consisting of hydrotherapy and mud pack therapy. Group 1 received consecutive treatment for 2 weeks, while group 2 received intermittent treatment for 5 weeks. Local peloid packs at 45 °C were applied for 20 min, after a tap water (38 °C) bath. Evaluations were conducted before, after treatment, and at 12th week of post-treatment by Pain (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-36 (SF-36). Both balneological treatment regimens of knee osteoarthritis had statistically significant clinical effects as well as effects on the quality of life. Patients' well-being continued at 3 months, except for joint stiffness (WOMAC), role-emotional (SF-36), and vitality (SF-36) in group 1 and for mental health (SF-36) in both groups. Both patient groups had improved compared to baseline. However, at 3 months after the treatment, the well-being of group 2 was unable to be maintained in terms of role-physical (SF-36) parameter, while the well-being of group 1 was unable to be maintained in terms of pain, WOMAC (pain, physical functions, total), and SF-36 (physical functioning, role-physical, pain, role-emotional, and mental health) variables, compared to data obtained immediately after treatment. Our study suggests that traditional and intermittent balneological therapies have similar efficacy in patients with knee osteoarthritis.

The effectiveness of balneotherapy in chronic neck pain.

The aim of this study was to investigate the effectiveness of balneotherapy (BT), which is applied in addition to physical therapy (PT), in the treatment of chronic neck pain. Sixty patients with chronic neck pain were divided into study (n = 30) and control (n = 30) groups. All of the patients in both groups were treated with a 15-session standard PT program consisting of hot pack, ultrasound, and transcutaneous electrical stimulation. Patients in the study group were also treated with a 15-session BT program lasting 20 min/day in addition to the standard PT program. Visual analogue scale (VAS), modified neck disability index (mNDI), and Nottingham Health Profile (NHP) scores of all patients were evaluated at three different times as pretreatment, posttreatment, and posttreatment third week. There was no statistically significant difference between the clinical and demographic characteristics of the patients in different groups before treatment. Intragroup analysis revealed significant improvement in all parameters for both of the groups at all time intervals. Intergroup analysis uncovered the superiority of the study group. According to the results of this study, BT in combination with PT is superior to PT alone in reducing pain and disability and improving quality of life in patients with chronic neck pain.