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Bathing in thermal water has an impressive history and continuing popularity. In this paper a brief overview of the use of water in medicine over the centuries is given.
A brief history of spa therapy
A van Tubergen, S van der Linden
Ann Rheum Dis
Bathing in thermal water has an impressive history and
continuing popularity. In this paper a brief overview of the
use of water in medicine over the centuries is given.
he word “spa” may be derived from the Walloon word
“espa” meaning fountain.
This, in turn, came from the
name of the Belgian town Spa, where in the 14th century
a curative, thermal spring was discovered. Spa may also origi-
nate from the Latin word “spagere” (to scatter, sprinkle, mois-
ten) or may be an acronym of the Latin phrase “sanitas per
aquas” (health through water).
In Britain, the word spa is still
used, whereas in the rest of Europe the term “thermal waters”
is prefer red. Bathing in thermal water for therapeutic
purposes has several descriptions (for example, taking the
waters, balneotherapy, spa therapy, hydrotherapy), which will
all be used throughout this paper, and are more or less inter-
Taking the waters used to be a popular treatment for a wide
range of diseases in classical times. The Greeks preferred baths
in fresh water from natural resources, although bathing in the
sea (thalassotherapy) was also applied. Initially, bathing was
confined to the more wealthy people in private baths, but soon
public baths were opened. The baths were considered sacred
places and were dedicated to several deities.
In Homeric times, bathing was primarily used for cleansing
and hygienic purposes. By the time of Hippocrates (460–370
BC), bathing was considered more than a simple hygienic
measure; it was healthy and beneficial for most diseases.
Hippocrates proposed the hypothesis that the cause of all dis-
eases lay in an imbalance of the bodily fluids. To regain the
balance a change of habits and environment was advised,
which included bathing, perspiration, walking, and
The baths were often combined with sports and
education, the precursors of the gymnasium.
Influenced by the Greeks, the Romans built their own ther-
mal baths at mineral and thermal springs. A military presence
was often the key to development of such a spa resort.
served not only for recuperation of wounded soldiers but also
as rest and recreation centres for healthy soldiers. In contrast
with the Greeks, who took the waters after intensive physical
exercises, the Romans considered the baths more important
than the gymnastics alone.
Besides cleansing, exercises,
socialising, relaxation, and worship, medical treatment was
also applied extensively. Spa treatment consisted of applica-
tion of water to afflicted parts of the body, immersion of the
whole body in the water (especially for rheumatic and
urogenital diseases), and drinking excessive quantities of
Asclepiades (c 124 BC), a Greek physician who practised in
Rome, introduced general hydrotherapy and dr inking cures as
He recommended bathing for both therapeutic
and preventative purposes. Pliny the Elder (
AD 23–79) assigned
different properties and indications for cure to different types
of waters.
Galen (AD 131–201) also advocated the use of
water for the treatment of a variety of diseases.
He preferred
cold water, a concept that was reconsidered periodically
throughout the following ages.
In Rome three different types of baths developed: baths at
home (balnea), private baths (balnea privata), and public
baths (balnea publica) that were run by the state.
With the
introduction of aqueducts, the public baths later developed
into huge and impressive edifices (thermae) with a capacity
for thousands of people. During the heyday of the Roman
bathing culture, the inhabitants of Rome used 1400 litres of
water per person per day, mainly for bathing.
The Roman
legions, far away from their homeland, built their own baths at
mineral and thermal springs in the newly conquered lands.
Examples are found all over Europe.
Throughout the years the Roman bathing culture gradually
changed towards a place for relaxation and pleasure, rather
than for medical treatment, although this was still provided.
The Romans preferred to use the baths and very hot waters for
renewing their appetites and thirst, and the baths became,
rather, centres for various sexual practices.
Deterioration of
morals became manifest, the hygienic and medical indications
for bathing disappeared, and baths as a haunt for pleasure
With the f all of the Roman Empire in 476 and the rise of
Christianity, the bathing culture fell into disrepute and bath-
ing was officially prohibited. Faith in cure through worship
and praying was regarded as more important than a medicinal
Baths were redeveloped as churches, although some
remained available for the aristocrats who were not affected
by the church’s decrees.
The aversion to bathing remained for
many centuries. People abstained from bathing as long as pos-
sible, sometimes for years.
“People abstained from bathing, sometimes for years”
From the 13th century onwards, baths gradually came into
re-use, particularly in southern Europe under the influence of
the Moors. Public baths were rebuilt and the entrance was
usually free. The baths were often crowded and people bathed
for hours, sometimes days in the same bath. Blood letting,
enemas, and drinking cures (up to 10 litres a day) were
prescribed, although relaxation and pleasure were most often
the reasons for bathing.
In the 16th century the image of the public baths again dete-
riorated in many countries, which led to the closure of many
public baths. They were considered to be a source of
contagious diseases such as syphilis, plague, and leprosy, and
the baths became dangerous meeting places for political and
religious dissidents.
In addition, owing to a shortage of
firewood, public baths became more expensive for a popula-
tion that had already become impoverished by many wars.
Nevertheless, the gentry continued to visit the baths, although
they preferred to go to baths from natural sources with warm,
mineral water instead of the public baths.
Taking the waters was now no longer a spontaneous activ-
ity, but it was increasingly prescribed under medical
Several famous Italian doctors recovered lost texts
on medical treatment from the ancient world, and the value of
balneology as a therapeutic modality was reconsidered.
this time, the first attempts to analyse the waters for their
mineral components were made, although the results were
often controversial.
It was equally important to recognise the
quality of each mineral and its effect on the body, as to know
which parts of the body might be influenced by taking the
In 1553 an encyclopaedic work, De balneis omniae qua
extant, was published, containing an overview of ancient and
moder n literature on the use of medicinal water. In 1571, Bacci
published De thermis, in which he taught the art of the baths
from Galen and the Aristotelians. According to Bacci, taking
the waters was not a m atter of empiricism, but a sound disci-
pline with its own rationale, institutes, and doctrine, which
the learned physician alone was qualified to understand.
Minardo published in 1594 a compendium on the two baths of
Caldiero in Verona. The first bath was used for drinking and
bathing, the second was used by bathers with skin conditions,
for bathing of animals, and for washing off therapeutic mud.
Seventy eight conditions that might benefit from these baths
were listed. The treatments consisted of drinking cures, bath-
ing, purging, and application of mud. It was advised to follow
this type of treatment for 15 days, and repeat it every year.
According to Bacci, essential to the cure was a quiet orderly life
in pleasant surroundings with good food and wine, and a
maximum of comfort.
Therefore, he argued, the baths would
do no good to the poor. Other, practical obstacles also
restrained the poor from attending the baths: they had no
time for leisure and the baths and mud were usually not
The new bathing culture that had developed in Italy gradu-
ally spread over other parts of Europe, and was particularly
popular with the elite. The development of spa treatment
north of the Alps was mainly provided by the Paracelsians.
the turn of the 17th century, many spas were rediscovered in
France. Two types of spas existed: hot springs for dr inking and
bathing, and cold springs for drinking cures only.
Taking the
waters in French spas was a serious activity and quite sober.
Doctors created centres for treatment, not for leisure. Much
attention was paid to purging, drinking cures, eating well bal-
anced diets, and bathing. In the afternoons some indoor
leisure activities were provided. Late in the afternoon, people
walked about on the promenade, and went to bed early in the
This was in contrast with many other European
countries, where in the evenings diverse leisure activities were
offered such as theatre and dance.
Around 1800 interest in the bathing culture grew. Further
attempts to analyse the mineral water were made, aiming at
improving its use in medicine, and at preparing mixtures of
water identical to those mineral waters famous for their cura-
tive properties.
Doctors were convinced that for each disease
Mother Nature possessed an appropriate medicinal spring,
which could be discovered through chemical analysis of the
Priessnitz and Kneipp further developed the princi-
ples of balneotherapy (medicinal use of thermal water) and
hydrotherapy (immersion of the body in thermal water for
therapeutic purposes).
Individual treatments were pre-
scribed, based on the composition and temperature of the
water. Also, combinations of treatments were developed
consisting of hot and cold baths, herbal baths, mud packs,
active physical exercises, massages, and diets. Kneipp advo-
cated a holistic approach to the treatment of a disease.
contrast with the spa resorts, which aimed at the elite, Kneipp
directed his attentions to the common man.
The use of mineral waters and the development of hotels
and guesthouses at the springs became prevalent throughout
Europe and North America.
Every spa resort had its own
theatre, casino, and promenades besides the bathing build-
ings. In Britain, Germany, Austria, and Belgium much import-
ance was attached to ostentation. Grand hotels arose with
casinos and dancing establishments surrounding the spa
resorts. The spa resorts became not only a m eeting centre for
the elite but also a place of creativity for painters, writer s, and
The baths were again crowded. Baden Baden
(Ger many) became the most glamorous resort in continental
Europe. It was the place to see and to be seen.
“The medical significance of bathing is acknowledged
by many rheumatologists”
However, in Britain use of the spa declined. The English spa
resorts were run by amateurs, and the medical hydrology was
poorly organised.
13 14
The resorts aimed more at pleasure,
rather than medical treatment, and were exploited by estate
developers with commercial interests.
Competition from
seaside and foreign resorts, and an economic depression in the
1930s led to a further decline. Eventually, spa therapy was
excluded from the National Health Service, which meant that
many spa resorts in Britain closed down.
After the second world war and with the rise in welfare, spa
treatment became available for the common man in many
European countries, mainly owing to reimbursement by state
medical systems.
Other activities and new treatments were
introduced, and balneology, hydrotherapy, and physiotherapy
underwent major developments.
In the past decades, a large change in the use of mineral
water for the treatment of several diseases has taken place in
continental Europe.
The medical significance of bathing is
now acknowledged, especially by many rheumatologists and
der matologists, and this aspect is considered more important
for a number of spa resorts than prestige and leisure. Bathing
is usually combined with many other treatments, such as
physical exercises, hydrotherapy, and mud packs. The spa
resorts are differentiated according to their location (for
example, seaside, mountain area) and the chemical composi-
tion of their mineral water (for example, sulphurous, bicarbo-
nated, or sulphated).
Each spring has its own characteris-
tics and related therapeutic properties.
However, a
substantial number of spa resorts also direct more attention
towards leisure. Steam baths, saunas, whirlpools, and solari-
ums are standard equipment of many such spa resorts, with
the main objective being to relax and strengthen the body and
mind, and to prevent development of disease. In Britain, a
revival of the spa culture may be expected, with the re-opening
of the hot springs in Bath in 2002. This spa will offer facilities
for medical treatment, but, in addition cater for a growing
number of so-called health tourists, who combine their
holidays with an investment in wellbeing.
Despite the popularity of spa therapy, reported scientific
evidence for its efficacy is sparse. A decade ago, Heywood
reviewed well documented records on spa treatment for lead
poisoning in the 18th and 19th century in Bath.
occur ring as a result of chronic lead intoxication (colica
pictonum) was a common problem in those days owing to the
widespread use of lead in household ware, cosmetics, food
colorants, wine, and salts for medicinal use. Already at the
beginning of the 16th century, Bath was famous for curing
paralysis, even in those patients who were regarded as incur-
able. The treatment consisted of bathing, drinking cures, diet,
274 van Tubergen, van der Linden
and purges. Patients admitted to the Bath Hospital came from
all over England, and often had already been treated for their
paralysis elsewhere, without success. However, many of these
presumed incurable patients were cured after their (months)
stay in Bath.
An example can be found in the comparison of medical
records of Bath and Exeter Hospitals between 1762 and
During these five years, 285 patients with colica
pictonum were admitted in Exeter and 281 patients in Bath.
Seventy three per cent of the patients from Exeter were cured
or improved, whereas the figure was 93% from Bath. Moreover,
the group in Bath included some 80 patients referred from
Exeter who had not been cured by treatment in Exeter.
1760 to 1879, 3377 patients were admitted in Bath for paraly-
sis due to lead intoxication. Forty five per cent were cured and
93% had at least improved.
The high cure rates for paralysis by spa therapy in Bath may
be attributed to several factors. Sitting in warm water
produces diuresis, with increased excretion of sodium, potas-
sium, calcium, and also lead.
19 20
Also the good food, exercises,
removal from the source of lead, and the large quantities of
water rich in calcium and iron contributed to the success of
spa therapy in Bath.
In the past decade several randomised controlled trials have
studied the effects of spa therapy in rheumatoid arthritis
and osteoarthritis.
23 27–30
Patients were randomly allocated to
receive spa therapy or sham/no therapy. The authors of a
recent systematic review on the effects of spa therapy in rheu-
matoid arthr itis and osteoarthritis stated that a definite judg-
ment about its efficacy is impossible because of methodologi-
cal flaws in these studies.
Overall, the results showed positive
effects lasting for three to nine months. Recently, a
randomised controlled trial has shown that spa therapy is
clearly effective in ankylosing spondylitis.
Two intervention
groups followed a three week course of spa therapy at two dif-
ferent spa resorts, and were compared with a control group
who stayed at home and continued standard treatment
consisting of anti-inflammatory drugs and weekly group
physical therapy. Significant improvements in function, pain,
global wellbeing, and morning stiffness were found for both
intervention groups until nine months after spa therapy.
Throughout the ages the interest in the use of water in medi-
cine has fluctuated from century to century and from nation
to nation. The (medical) world has viewed it with different
opinions, from very enthusiastic to extremely critical, and
from beneficial to harmful. Today, spa therapy is receiving
renewed attention from many medical specialties and health
tourists, and having a revival. However, the exact therapeutic
potential of spa therapy still remains largely unknown. Better
and more profound scientific evidence for its efficacy is there-
fore warranted, in particular for its effects on the musculo-
skeletal system.
Authors’ affiliations
A van Tubergen, S van der Linden, Department of Internal Medicine,
Division of Rheumatology, University Hospital, Maastricht, Maastricht,
The Netherlands
Correspondence to: Dr A van Tubergen, Department of Internal
Medicine, Division of Rheumatology, University Hospital Maastricht, PO
Box 5800, 6202 AZ Maastricht, The Netherlands;
Accepted 25 September 2001
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History of spa therapy 275
... Sand therapy has been used for centuries to improve function and reduce pain in patients [36]. Siwa is a place that embraces that practice. ...
... It is worth mentioning that there is something else beyond the effect of hot sands that might have boosted the results of this study, which is the harmony between natural forces that is found in Siwa. Maybe it is the special location, below sea level by up to 18 m, the very dry and hot weather, the ecological architecture, the mineral springs, and the salt lakes that work together to encourage body self-healing [36] in a way that is known as climatotherapy rather than sand therapy. ...
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Background and Objectives: The most frequent cause of mortality in rheumatoid arthritis (RA) patients is cardiovascular disease (CVD). Inflammation, dyslipidemia, and decreased physical activity are some of the main risk factors for CVD. Siwan sand therapy is a type of traditional therapy used in Egypt to treat RA. The approach of this therapy depends on the experience of the healers. The aim of the current study was to compare the effects of three sessions of Siwan traditional therapy to five sessions on common CVD risk factors and physical function in rheumatoid arthritis patients. Materials and Methods: Thirty patients (9 male and 21 female) were assigned into two groups of equal size: group (A) received three sessions of Siwan traditional therapy in the form of a sand bath. Group (B) received the same form of therapy for five days. Erythrocyte sedimentation rate (ESR), lipid profile, atherogenic index of plasma (AIP), and a health assessment questionnaire (HAQ) were measured before and after treatment. Results: There was a significant increase above normal within group (A) for ESR (p = 0.001), triglycerides (TG; p = 0.015), total cholesterol (Tot-Chol; p = 0.0001), and low-density lipoprotein (LDL; p = 0.0001). However, there were no considerable differences in high-density lipoprotein (HDL; p = 0.106), very low-density lipoprotein (VLDL; p = 0.213), AIP (p = 0.648), and HAQ (p = 0.875). For the second group, there were significant changes within group B only in Tot-Chol (p = 0.0001), HDL (p = 0.0001), VLDL (p = 0.0001), AIP (p = 0.008), and HAQ (p = 0.014). There was a significant difference between both groups regarding HDL (p = 0.027), LDL (p = 0.005), AIP (p = 0.029), ESR (p = 0.016), and HAQ (p = 0.036). Conclusions: For RA patients, five days of Siwan traditional therapy caused significant changes regarding inflammation, Tot-Chol, LDL, HDL, AIP, and functional activity when compared to three days of Siwan hot sand therapy.
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... Nevertheless, the rise of Christianity in the Middle Ages gradually led the bathing culture into disrepute. The use of baths was officially prohibited, since faith in cure through praying was considered more important than a medicinal bath (Routh et al. 1996;van Tubergen and van der Linden 2002). Finally, during the Ottoman period, the kind of respiratory bath, named Hamam, was the dominant element in public baths until the modern era. ...
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... Since prehistoric times, humankind has learned from experience that hot and cold baths effectively alleviate pain and other symptoms; bathing has been commonly and widely used in health preservation and rehabilitation [1,2]. The contrast bath is a method whereby alternating hot and cold water are applied. ...
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Background: A small, wearable thermo device that uses Peltier elements for programmed heat and cold stimulation has been developed recently and is expected to be applied in conventional contrast bath therapy. This study was aimed to examine improvements in trapezius muscle hardness and subjective symptoms resulting from alternating heat and cold stimulation, with different rates of cooling. Methods: This cross-over study included four conditions. Twenty healthy young male individuals (age, 22.3 ± 4.5 years) participated in this study. These four interventions targeted the unilateral trapezius muscle of the dominant arm after a 15-min typing task. Specifically, heat and cold stimulations were applied at different ratios (the heating/cooling rate of 3:1, 3:2, and 3:3) or not applied. Each intervention was separated by at least one week. Skin temperature at the stimulation area was recorded using a data logger. Outcome measures included muscle hardness (measured using a portable tester) and subjective symptoms (muscle stiffness and fatigue). Each item was assessed at three time points: baseline, after typing, and after the intervention. Results: Two-way analysis of variance with repeated measures found an interaction effect for muscle hardness between four conditions (3:1, 3:2, 3:3, and no) and three time points (p < 0.05). Only in the 3:1 condition were the post-intervention values lower than those after typing (p < 0.01). There was also an interaction effect for subjective muscle stiffness (p < 0.05); the values after the intervention in the 3:1 condition were lower than those after intervention in the no stimulation condition (p < 0.01). There was no significant relationship between changes in muscle hardness and changes in subjective symptoms in the 3:1 condition. Conclusions: Our results demonstrate that alternating heat and cold stimulations with a different cooling rate could affect the degree of improvement in muscle hardness and subjective symptoms. In particular, the 3:1 condition has the possibility to improved muscle hardness within the condition and subjective muscle stiffness between conditions. Trial registration: UMIN000040620. Registered 1 June 2020,
This study develops a framework to explain the loyalty formation process of customers of Thai wellness spas. It examines the process of determination used by customers regarding their perceived value of the spa experience, satisfaction, desire, and loyalty intentions, which depend on the experiences they gain from wellness spa services. The proposed framework and hypothesised relationships were evaluated using structural equation modelling. Data were gathered by surveying 550 Thai wellness day-spa customers in Bangkok, Thailand. The conceptual model satisfactorily fit the data, and the mediating roles of value, satisfaction, and desire were identified. The wellness spa service experience, the perceived value of the spa experience, satisfaction, desire, and loyalty intentions showed significant correlations with each other. Overall, the results indicated that satisfaction is the most salient variable in building customer loyalty intentions. This study employed multidimensional approaches to the attitudinal loyalty phase and successfully built on the existing literature on sequential loyalty frameworks. Its important theoretical and practical implications stem from a highly holistic view of the formation process of Thai wellness spa customers’ loyalty.
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From past to present, people have faced many health problems in different periods of their lives. Some of these health problems are stress, malnutrition, physical and mental fatigue, rheumatism, respiratory, digestive and circulatory diseases. In order to treat such diseases, people sometimes resort to various treatment methods in their own countries, and sometimes cross borders and prefer countries with better health opportunities in different parts of the world. These travels for health purposes have created "Health Tourism". Health tourism is a type of alternative tourism that has started to attract attention all over the world and is growing rapidly. Health tourism is also divided into "thermal tourism", "spa and wellness tourism" and "medical tourism". İspendere (Malatya/Battalgazi), which is the research area, is also included in the field of spa and beverage tourism, which is thermal tourism. The history of this region has a long history and since the time of the Ottoman Empire, people have been visiting the region for healing and treatment purposes. Today, this region, which is within the borders of Battalgazi district of Malatya province, has been organized by Battalgazi municipality and brought to health tourism, and tens of thousands of people visit here every year for treatment and healing. In this study, information is given about the importance of İspenrede İçmeceları in terms of health tourism, what kind of diseases it is good for, SWOT analysis of the region, its advantages, disadvantages and problems and solution suggestions.
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This opinion piece was inspired with how several authors, including those whose works were focused on historical perspective of spas and balneology, used the term spa without any definition and/or without any reference to this word’s origin. Therefore, we have compiled the opinions of several authors that we have considered as the most relevant with regard to the etymology, definitions and positioning of the word, respectively the term “spa”, as well as with regard to defining and positioning the related term “spa tourism” and some other related terms relevant to it (i.e. “health tourism”, “medical tourism” and “wellness tourism”). Apart from selected academic authors, we have also considered the opinions of the most relevant umbrella organisations in spa tourism. The aim of this opinion piece is to contribute to an ongoing debate in tourism science related to the lack of consensus in defining the term “spa” and positioning spa tourism.
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The sulphurous mineral waters of ‘Entre-os-Rios’, which is sited in NW Portugal, are famous for their long history as thermal baths dating back at least to the mid-sixteenth century. Because of the singularity of its water composition, especially the highest sulphur content, the mineral waters of ‘Entre-os-Rios’ are one of the most important sulphurous waters in Portugal. Despite these mineral waters having a protection perimeter buffer zone to avoid water contamination, there are potentially damaging installations (e.g., fuel station) in the closed protection buffer zone that, according to existing law, are not permitted within the protection perimeters, which defeats the purpose of their delineation. A vulnerability map was created using geographic information system (GIS) tools based on multi-criteria analysis, combining thematic maps and parameters of the DRASTIC index, for evaluating the risk of contamination in the protection area. The results showed that within the perimeter, there was a low risk of pollution. The alluvium-covered terrain was vulnerable to moderate contamination, but it was far from the catchment point. Areas of minimal risk corresponded to locations where the granitic massif had not been significantly weathered. The map enables information collection for a better definition of local resource structures and planning, namely, for restricted areas emplacement where some activities should not be allowed (e.g., agriculture and water prospection), given its influence on the confined granitic aquifer.
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Forty patients with classical or definite rheumatoid arthritis in a stage of active disease were treated for two weeks at a spa hotel. The patients were divided into four groups of 10. Group I was treated with daily mud packs, group II with daily hot sulphur baths, group III with a combination of mud packs and hot sulphur baths, and group IV served as a control group. The patients were assessed by a rheumatologist who was blinded to the treatment modalities. Statistically significant improvement for a period of up to three months was observed in the three treatment groups in most of the clinical indices. Improvement in the control group was minor in comparison and not statistically significant. No significant improvement was observed in any of the laboratory variables measured. Except for three mild cases of thermal reaction there were no side effects.
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Immersion in water in spas has been practised for centuries and has many proponents. Despite fierce debate about its efficacy there has been little scientific evaluation of the effect of immersion in mineral waters. Eight normal subjects were immersed in Bath spa water for two hours and the renal, haematological, and cardiovascular responses were compared with those in the control periods before and after immersion. Significant, twofold diuresis and natriuresis, 5% haemodilution, and a 50% increase in cardiac index were observed in subjects immersed, sitting, in Bath spa water at 35 degrees C. These changes may constitute part of the scientific rationale for spa treatment in many states of disease.
Objective: The aim of this study was to evaluate the therapeutic effects of hydrotherapy which combines elements of warm water immersion and exercise. It was predicted that hydrotherapy would result in a greater therapeutic benefit than either of these components separately. Methods: One hundred thirty-nine patients with chronic rheumatoid arthritis were randomly assigned to hydrotherapy, seated immersion, land exercise, or progressive relaxation. Patients attended 30-minute sessions twice weekly for 4 weeks. Physical and psychological measures were completed before and after intervention, and at a 3-month followup. Results: All patients improved physically and emotionally, as assessed by the Arthritis Impact Measurement Scales 2 questionnaire. Belief that pain was controlled by chance happenings decreased, signifying improvement. In addition, hydrotherapy patients showed significantly greater improvement in joint tenderness and in knee range of movement (women only). At followup, hydrotherapy patients maintained the improvement in emotional and psychological state. Conclusions: Although all patients experienced some benefit, hydrotherapy produced the greatest improvements. This study, therefore, provides some justification for the continued use of hydrotherapy.
This pilot study compares the treatment of osteoarthritic hips by hydrotherapy with that of short wave diathermy and exercises. Fourteen patients were randomly allocated to one of the treatment groups. Outcome measures of pain ratings, function and life satisfaction scales, range of motion and gait assessment by pedabarography were used. There were no significant differences between the groups prior to treatment, but at the end of treatment there were significant differences in pain, function and life satisfaction. Following treatment, pain had decreased significantly (p < 0.02) in both groups. Functional ability had improved in the group treated by hydrotherapy (p < 0.05), who also reported a higher score on the life satisfaction scale. Gait and range of motion did not show any statistically significant changes with either treatment.
Objective. The aim of this study was to evaluate the therapeutic effects of hydrotherapy which combines elements of warm water immersion and exercise. It was predicted that hydrotherapy would result in a greater therapeutic benefit than either of these components separately.Method. One hundred thirty-nine patients with chronic rheumatoid arthritis were randomly assigned to hydrotherapy, seated immersion, land exercise, or progressive relaxation. Patients attended 30-minute sessions twice weekly for 4 weeks. Physical and psychological measures were completed before and after intervention, and at a 3-month followup.Results. All patients improved physically and emotionally, as assessed by the Arthritis Impact Measurement Scales 2 questionnaire. Belief that pain was controlled by chance happenings decreased, signifying improvement. In addition, hydrotherapy patients showed significantly greater improvement in joint tenderness and in knee range of movement (women only). At followup, hydrotherapy patients maintained the improvement in emotional and psychological state.Conclusions. Although all patients experienced some benefit, hydrotherapy produced the greatest improvements. This study, therefore, provides some justification for the continued use of hydrotherapy.
Forty-one patients with rheumatoid arthritis were treated for 2 weeks at a Tiberias spa hotel. Randomized into 2 groups, Group 1 received a combination of mineral baths and mud packs, and Group 2 had tap water baths only. Both groups had a significant but temporary improvement in Ritchie index. Group 1 showed a significant improvement in grip strength. No improvement was noticed in morning stiffness, 15 meter walk time and laboratory variables of disease activity in either group. Twelve patients with osteoarthritis (OA) received 2 weeks of treatment with mineral baths and mud packs. Statistically significant improvement for a period of 6 months was noticed in night pain, pain on passive motion, tenderness on palpation and in the index of severity of OA of the knee.
Thirty patients with classical or definite rheumatoid arthritis were randomly divided into two groups of fifteen patients each of similar age, sex, duration and severity of disease, and medical treatment. All patients were treated once a day with bath salts heated to 35 degrees C for twenty minutes. Group I received Dead Sea bath salts and Group II, the control group, received sodium chloride (NaCl). The study was double-blind and of two weeks' duration. All patients were evaluated by one rheumatologist both before treatment, and two weeks later at the end of the treatment period. Follow-up evaluations were made one and three months after conclusion of the treatments. The clinical parameters evaluated included duration of morning stiffness, fifteen meter walk time, hand-grip strength, activities of daily living, circumference of proximal interphalangeal joints, number of active joints, Ritchie index and the patient's own assessment of disease activity. The laboratory parameters evaluated included erythrocyte sedimentation rate and serum levels of amyloid A, rheumatoid factor, sodium, potassium, calcium and magnesium. A statistically significant improvement (p less than 0.01 or p less than 0.05) was observed in Group I only, in most of the clinical parameters assessed. Maximal therapeutic effect was obtained at the end of the treatment and lasted up to one month.