Uso de la balneoterapia y el ejercicio terapéutico en la mejora física y psicosocial en adolescentes con lupus y artritis juvenil: un estudio de método mixto / Use of balneotherapy and therapeutic exercise in physical and psychosocial improvement in adolescents with lupus and juvenile arthritis: A mixed method study

Antecedentes y objetivo: Evaluar los cambios a nivel físico y psicosocial de una intervención combinada de balneoterapia y ejercicio terapéutico en grupo aplicado en jóvenes con lupus eritematoso sistémico y artritis idiopática juvenil. Materiales y métodos: Estudio longitudinal prospectivo pre y postintervención y cualitativo fenomenológico descriptivo. La intervención consistió en un programa combinado de balneoterapia, ejercicio terapéutico en grupo y terapia manual e instrumental. Se evaluaron el dolor percibido (Escala Visual Analógica), el estado funcional (Health Assessment Questionnaire) y la fatiga (Escala de Evaluación Funcional de Terapia de Enfermedades Crónicas-Fatiga). Las entrevistas se analizaron mediante análisis temático. Resultados: Quince adolescentes de 14,1±2,1 años participaron en el estudio. Se observó una mejoría significativa respecto al dolor máximo (p=0,006; TE=1,1), dolor medio (p=0,029; TE=0,5) y estado funcional (p=0,013; TE=0,7). Sin embargo, a pesar de que la fatiga disminuyó, no se encontraron diferencias estadísticamente significativas (p=0,415; TE=0,3). Los temas principales surgidos tras las entrevistas fueron «una experiencia de aprendizaje» y «desventajas», que describen la vivencia de la intervención. Discusión y conclusiones: Parece que la combinación de balneoterapia y el ejercicio terapéutico en grupo es útil para reducir el dolor y mejorar la función física. Ensayos clínicos en diferentes poblaciones reportan resultados similares, hallando una disminución del dolor. Se concluye que la realización de un programa de fisioterapia combinado de balneoterapia y ejercicio terapéutico en grupo produce beneficios con relación al dolor y al estado funcional, favoreciendo además la ampliación de conocimientos y el automanejo de la enfermedad.

Background and objective: To evaluate the physical and psychosocial changes of a combined intervention of balneotherapy and therapeutic exercise applied in young people with systemic lupus erythematosus and juvenile idiopathic arthritis. Materials and methods: Pre- and post-intervention prospective longitudinal and descriptive phenomenological qualitative studies were conducted. The intervention consisted of a combined program of balneotherapy, therapeutic group exercise and physiotherapy techniques. Perceived pain (Visual Analogue Scale), functional status (Health Assessment Questionnaire), and fatigue (Chronic Disease Therapy-Fatigue Functional Assessment Scale) were assessed. The interviews were analysed using thematic analysis. Results: 15 adolescents aged 14.1±2.1 years participated in the study. A significant improvement was observed with respect to maximum pain (P=.006; ES=1.1), mean pain (P=.029; ES=0.5) and functional status (P=.013; ES=0.7). However, despite the decrease in fatigue, no statistically significant differences were found (P=.415; ES=0.3). The main themes that emerged after the interviews were “a learning experience” and “disadvantages of the intervention”. Discussion and conclusions: It seems that the combination of balneotherapy and therapeutic group exercise is effective in reducing pain and improving physical function. Randomized clinical trials performed in different populations report similar results, finding a decrease in pain. It is concluded that carrying out a physiotherapy program combined balneotherapy and therapeutic group exercise produces benefits in relation to pain and functional status, also favoring the expansion of knowledge and self-management of the disease.

Effectiveness of short-term physical agents treatment on macroscopic morphology in patients with plaque psoriasis / Efectividad del tratamiento a corto plazo de los agentes físicos en la morfología macroscópica de las placas de psoriasis

Psoriasis is a chronic inflammatory disease that presents skin rashes which can arise through plaques. The aim of this work was to compare the effectiveness of short-term physical agents treatment on macroscopic morphology (area and erythema) in patients with plaque psoriasis. This prospective randomized experimental study included fourteen subjects, medically diagnosed with psoriasis, with more than one plaque in the skin and voluntarily without topical treatment. All subjects completed the study that consisted of 12 treatment sessions divided in control (C), artificial balneotherapy (AB), phototherapy (PT) or balneophototherapy (BPT) groups. After session 12, there was a significant reduction of the plaque area by all treatments when compared to C group and BPT was the most effective one. However, only AB and PT presented a reduction of erythema. Regarding severity, 9 patients changed to a lower category on the PASI test, and 5 of them maintained a mild psoriasis, but lowered their score. Finally, 13 of 14 subjects improved their quality of life. The physical agents used reduced the severity of psoriasis and improved quality of life of patients after 12 sessions of treatment during a onemonth period. The BPT was the more effective in controlling psoriasis by diminishing its area and PT by attenuating the erythema.

La Psoriasis es una enfermedad inflamatoria crónica que presenta irritación cutánea que puede derivar a placas. El objetivo de este trabajo fue comparar la efectividad del tratamiento a corto plazo con agentes físicos en la morfología macroscópica (área y eritema) en pacientes con placas de psoriasis. Estudio experimental, prospectivo, randomizado. Catorce sujetos participaron con diagnóstico médico de psoriasis, con más de una placa en la piel y sin tener tratamiento tópico de forma voluntaria. Todos los sujetos completaron el estudio, el cual consistió de 12 sesiones de tratamiento dividido en grupo control (C), BA, FT y BFA. Posterior a la sesión 12, se observó una reducción significativa en toda el área de las placas que recibieron tratamiento al compararlas al grupo C y el grupo BFA fue el más efectivo. Sin embargo, solo los grupos BA y FT presentaron una reducción del eritema. Respecto a la severidad, 9 pacientes cambiaron de la baja categoría en el test de PASI y 5 de ellos se mantuvieron en el nivel medio, pero disminuyeron su puntaje. Finalmente, 13 de 14 sujetos mejoraron su calidad de vida. Los agentes físicos usados redujeron la severidad de la psoriasis y mejoraron la calidad de vida de los pacientes después de 12 sesiones de tratamiento durante el período de un mes. La BFA fue la más efectiva en controlar la psoriasis por la disminución en el área y la FT por la atenuación del eritema.

Hydrotherapy and crenotherapy in the treatment of pain: integrative review / Hidroterapia e crenoterapia no tratamento da dor: revisão integrativa

ABSTRACT BACKGROUND AND OBJECTIVES: The Integrative and Complementary Practices were implemented in the Unified Health System as adjunctive modalities in the treatment of pain. This article focuses on crenotherapy and hydrotherapy, whose agents are the natural mineral waters and common for the rehabilitation of functional alterations. The scarcity of these practices for the treatment of pain in the literature justifies this review. This study aimed to check the scientific productions about the efficacy of balneology/balneotherapy/crenotherapy and hydrotherapy in the treatment of pain. CONTENTS: It is an integrative review, carried out in May 2018, searching in the electronically available scientific articles, in full, in the LILACS, Pubmed, BVS and CINAHL database in periodicals published in the last 10 years focusing on crenotherapy and hydrotherapy for pain relief, in the Portuguese, English and Spanish language. The descriptors used were: "Pain", "Balneology", "Crenotherapy", "Hydrotherapy" "Efficacy"; "Effectiveness" in the three languages, combined with the Boolean expressions AND/Y/E and OR/O/U/OU, finding 2306 articles, of which 111 were identified, and only 27 met the inclusion criteria, analyzed and incorporated the evidence that emerged in pain relief. CONCLUSION: This study showed that most of the evidence emerged from the studies analyzed regarding the efficacy of hydrotherapy and balneology in pain pictures focused on levels 1 to 3. Of the 27 studies, 18 showed the efficacy of hydrotherapy and eight of balneology in the pain symptomatology and one in relation to the lack of knowledge of the use of these complementary therapies in pain relief.

RESUMO JUSTIFICATIVA E OBJETIVOS: As Práticas Integrativas e Complementares foram institucionalizadas no Sistema Único de Saúde como modalidades coadjuvantes no tratamento da dor. Este artigo focalizou a utilização de crenoterapia e hidroterapia, cujos agentes são as águas minerais naturais, comum para a reabilitação de alterações funcionais. A escassez da literatura dessas práticas no tratamento da dor, justifica esta revisão. O objetivo deste estudo foi verificar a produção cientifica sobre a eficácia da balneologia/balneoterapia/crenoterapia e da hidroterapia no tratamento da dor. CONTEÚDO: Revisão integrativa, realizada em maio de 2018, cuja busca de artigos científicos disponíveis eletronicamente e na íntegra, na base de dados, LILACS, Pubmed, BVS e CINAHL em periódicos publicados nos últimos 10 anos enfocaram a crenoterapia e hidroterapia para o alívio da dor nos idiomas Português, Inglês e Espanhol. Os descritores utilizados foram: Dor, Balneologia, Crenoterapia, Hidroterapia, Eficácia; nos três idiomas, combinados com as expressões booleanas AND/Y/E e OR/O/U/OU encontrando 2306 artigos, identificados 111 e destes, apenas 27 atenderam aos critérios de inclusão, analisados e incorporadas as evidências emergidas no alívio da dor. CONCLUSÃO: Este estudo mostrou que a maioria das evidências emergidas dos trabalhos analisados quanto à eficácia da hidroterapia e crenoterapia em processos álgicos concentraram-se nos níveis 1 a 3. Dos 27 estudos, 18 mostraram a eficácia da hidroterapia e oito da balneoterapia e crenoterapia nos sintomas dolorosos, e um em relação ao desconhecimento do uso dessas práticas integrativas no alívio da dor.

[Physiotherapy of cancer patients]. / Daganatos betegek fizioterápiája.

Physiotherapy of cancer patients is one of the most controversial issues in our country. Malignant diseases are firstly mentioned as a contraindication of physiotherapy. Until now, physiotherapy was not suggested (or only in limited accessibility) for those patients who had malignant disease in medical history. International medical practice was less restrictive in managing this topic. The development of imaging techniques put this question in a new light. On the basis of evidence, the majority of articles have reported beneficial effects of physiotherapy in cancer patients, and only few articles mentioned it as harmful. Of course, each patient requires an individual assessment, however, if we exclude the possibility of tumor recurrence and metastasis, most of physiotherapy procedures can be used safely. One of the aims of this review is to support the physicians' decisions when to prescribe treatments, in such a way, that more patients could receive physiotherapy. Orv. Hetil., 2016, 157(31), 1224-1231.

Balneotherapy is a potential risk factor for Pseudomonas aeruginosa colonization

ABSTRACT The practice of immersion in burn patient has been abandoned in many parts of the world but in Brazil it is still common. The aim of this study was to ascertain if balneotherapy is a risk factor for Pseudomonas aeruginosa colonization in thermally injured patients. Eighteen patients from a Burn Center were studied for 14 weeks for Pseudomonas aeruginosa. Samples were collected by swabbing the exudate of wounds, before and after giving bath to the patients and from balneotherapy table. Pulsed-field gel electrophoresis was used to determine bacterial genetic relatedness. Thirty-seven P. aeruginosa isolates were detected from 292 swabs collected from patients' burn surface area and from the balneotherapy table. Profile analysis of P. aeruginosa DNA fragmentation showed 10 clones among the 37 strains analyzed. Type A is the most prevalent clone, with 23 strains distributed into eight subtypes. These were present in the swabs collected, before and after the patients' bath, from the surface of the bath table, suggesting that there was cross-contamination between the patients in different ways. This work demonstrates that balneotherapy is a risk factor in the Burn Center studied, because the same clone was found among P. aeruginosa isolates collected at various points and times.

RESUMO A prática de balneotarapia em paciente queimado foi abandonada em muitas partes do mundo, mas no Brasil ainda é comum. O objetivo deste estudo foi verificar se a balneoterapia é um fator de risco para a colonização por Pseudomonas aeruginosa em pacientes queimados. Dezoito pacientes internados em um Centro de Queimadura (CQ) foram acompanhados por 14 semanas. Amostras foram coletadas do exsudato de feridas, antes e depois do banho dos pacientes e também da mesa onde a balneoterapia foi realizada. A relação genética entre as cepas de P. aeruginosa foi determinada pela electroforese em gel de campo pulsado. Trinta e sete cepas foram detectadas a partir de 292 swabs coletados de área de superfície das feridas dos pacientes e da mesa de balneoterapia. Análise de fragmentação do DNA das 37 P. aeruginosa mostrou a existência de 10 clones. O tipo A foi o clone mais prevalente, com 23 cepas distribuídas em oito subtipos. Estas estavam presentes nas lesões dos pacientes antes e após o banho e na mesa onde o banho foi realizado, sugerindo contaminação cruzada inter e intra-pacientes e pacientes e mesa de banho. Este trabalho mostra que a balneoterapia é um fator de risco para colonização por P. aeruginosa, no CQ estudado, pois um mesmo clone da bactéria foi encontrado nos isolados coletados em vários pontos e épocas diferentes.

Termalismo Social em Caldas da Imperatriz - SC: realidade e desafios / Social Thermalism Caldas da Imperatriz - SC: reality and challenges

Entende-se por Termalismo Social a complexidade da utilização das águas termominerais em saúde, pensando-se ainda em seus aspectos ecológicos, históricos, sociais e de lazer. Este artigo pretende contextualizar o Termalismo Social em Caldas da Imperatriz, localidade de Santo Amaro da Imperatriz ­ SC, quanto a seus aspectos históricos, características das águas termais e potencialidades em saúde, desafios vivenciados e possíveis soluções para a concretização do Termalismo Social no local. Para tanto, foram analisados artigos, teses, reportagens de jornais e processos judiciais disponíveis na World Wide Web, além de visitas ao local.O artigo apresenta um breve histórico do Termalismo na localidade, aborda as características físico-químicas e suas indicações terapêuticas e expõe alguns problemas existentes e, por fim, possibilidades para a consolidação do Termalismo Social em Caldas da Imperatriz são exibidas.(AU)

The term Social Thermalism is understood as the complexity of the use of thermo-mineral water in health, still thinking of its ecological, historical, social, recreational aspects. This article aims to contextualize the Social Hydrotherapy in Caldas da Imperatriz, town of Santo Amaro da Imperatriz - SC, as well as its historical aspects, characteristics of thermal waters and potential health, challenges experienced and possible solutions to the implementation of the Social Hydrotherapy. Articles, thesis, newspaper reports and court cases available on the World Wide Web were analyzed, as well as a site visit. The article presents a brief history of the Hydrotherapy in the locality, discusses the physical and chemical characteristics and their therapeutic indications, introduces some existing problems and finally, possibilities for the consolidation of Social Hydrotherapy in Caldas da Imperatriz are presented.(AU)

[The changing position of balneo- and hydrotherapy in medicine]. / A balneo-, hidroterápia helyének változása a medicinában.

Therapy with water has been known for thousands of years. Hot water bath was always pleasant for people. During the 19th century it was applied for the treatment of several diseases and modern medicine should not miss it. Today balneotherapy may help gymnastic procedures and it is commonly used in combination with other types of physiotherapy, too.

[Physiotherapy from the view of health insurance financing]. / A fizioterápia az egészségbiztosítás szemszögébol.

Physiotherapy lacks studies performed with the use of the modern research methodology and, therefore, its use based on empirical considerations. International practice guidelines do not recommend unequivocally the use of all kinds of physiotherapy with the exception of exercise therapy, but Hungarian guidelines support its use in the treatment of several different conditions. National health insurance in Hungary provides financial support for the use of physiotherapy in the fields of home care, out- and inpatient care and spa treatment. In 2011 national health insurance in Hungary supported spa treatments with 4 billion HUF, and the most frequently used treatment was thermal bath in about 2 million occasions. National health insurance in Hungary spent about 1 billion HUF for physiotherapy used in outpatient care; both ultrasound and interference treatments were financed in 2 million occasions in 2011.

Benefícios da talassoterapia e balneoterapia na fibromialgia / Benefits of thalassotherapy and balneotherapy for fibromyalgia

Talassoterapia e balneoterapia são modalidades terapêuticas utilizadas há vários anos em outras regiões do mundo na prevenção e no tratamento de diversas enfermidades, incluindo doenças reumáticas. No entanto, só recentemente têm sido descritas na literatura em fibromialgia (FM), contribuindo para a redução da dor e de outros sintomas da doença e melhorando a qualidade de vida dos pacientes. Nesta revisão são relatados os principais estudos que avaliam a talassoterapia e/ou a balneoterapia como abordagem terapêutica na FM, abordando aspectos a serem investigados no intuito de estabelecer o valor dessa forma de tratamento. Os autores ainda destacam a necessidade da realização de estudos no Brasil, utilizando principalmente a talassoterapia, uma vez que o baixo custo, aliado ao fácil acesso de boa parte das pessoas ao litoral, podem beneficiar pacientes com FM.

Thalassotherapy and balneotherapy are therapeutic strategies commonly used in other countries for the prevention and treatment of several diseases, including rheumatic diseases. However, only in the recent years its use in the treatment of fibromyalgia (FM) has been reported. The potential beneficial effects include the reduction of pain and other related symptoms of FM, thus improving the quality of life. The authors revise studies focusing on thalassotherapy and/or balneotherapy in the treatment of FM, discussing their benefits and methodological biases that still preclude a more precise evaluation on the efficacy of these methods. Finally, the authors emphasize the need for such studies in Brazil, mainly thalassotherapy, since the low cost and good accessibility to sea, might well provide benefit to our patients.