Evaluation of the benefit of thermal spa therapy in plaque psoriasis: the PSOTHERMES randomized clinical trial.

Spa therapy is considered an add-on treatment for psoriasis, but without any objective evaluation in the absence of randomized trials. This multicenter, open-label, randomized trial compared immediate spa therapy versus a control group having usual treatments until study assessments at 4.5 months. Spa therapy was proposed in five French spa resorts with standardized programs. Inclusion criteria were adults with plaque psoriasis, Dermatology Life Quality Index (DLQI) > 10, and stable medical treatment in the last 6 months. The main objective was DLQI ≤ 10 at 4.5 months after inclusion. VQ-Dermato and EQ5D-3L also assessed quality of life (QoL), Perceived Stress Scale (PSS) stress, and visual analogue scales (VAS) pain and pruritus. Between January 2015 and November 2018, 128 patients were randomized to either immediate spa therapy (64) (within 34 days, median) or usual treatments (61) until assessment at 4.5 months. Most were first-time spa users (71.2%). Mean DLQI and Psoriasis Area and Severity Index at inclusion were 16.7 and 10.5, respectively. Immediate spa therapy patients achieved the primary objective for 66.1% [95% CI 52.6% > 77.9%] vs 41.4% [95% CI 28.6% > 55.1%] control group patients (p = 0.007). VQ-Dermato scores and pruritus VAS significantly improved. Outcomes at 12-month follow-up of the immediate spa therapy group showed persistent improvement of DLQI, VQ-Dermato, and pruritus. This randomized controlled trial demonstrated that a cure of spa therapy improves QoL and alleviates certain symptoms of psoriasis, in short and long terms. This justifies its integration in the therapeutic strategies for psoriasis. Trial registration number: ClinicalTrials.gov Identifier: NCT02098213.

A program centered on smart electrically assisted bicycle outings for rehabilitation after breast cancer: A pilot study.

The benefits of physical activity during cancer care and rehabilitation are well established, however introducing and maintaining healthy behaviors in the long-term remains challenging. Technological advances in electrically assisted bicycles and on-board sensors led us to propose an original rehabilitation program combining smart electric bicycle outings with health education. This was a pilot study with physical activity questionnaires and endurance tests to evaluate physical activity following a 6-week program comprising 2 bicycle outings per week in groups of 5 (supervised or not) with briefing and debriefing supplemented by health education sessions. Fourteen post-breast cancer patients participated (median age 52 [IQR 46-55]). A gain of at least 2 International Physical Activity Questionnaire points and over 600 MET.min/week was achieved by 9/10 (90%; 95%CI[55.5-99.7]) women. The feasibility of the program was clearly demonstrated, with excellent patient adherence (11/12 planned 2 h outings per patient). The electric bicycle program strengthened the womens' physiological capacities through personalized levels of electrical assistance made possible by the fine settings of the motorization. This enabled the whole group to achieve the outing objectives together despite very variable levels of deconditioning. The pleasure shared in the group activity and personal empowerment gained should promote long-term maintenance of physical activity.