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Clinical improvement of patients with osteoarthritis using thermal mineral water at Szigetvár Spa—results of a randomised double-blind controlled study
Abstract
Since 1966, Szigetvár in Hungary is well recognised as a thermal spa. Many patients suffering from rheumatic diseases are treated with its thermal mineral water. Our objective was to investigate the effects of a 3-week-long outpatient balneotherapy-based rehabilitation program on patients suffering from osteoarthritis of the hips and the knees. During the treatment period, patients received a 30-min underwater jet massage in a bath tub, five times a week. One patient group received jet massage in a bath tub containing mineral water; the other group received the same treatment in tap water. Primary outcomes were measured by range of movement of the involved joints and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Visual analogue scale (VAS) was applied to measure current severity of pain. Furthermore, quality of life was assessed using the Short Form 36 questionnaire (SF-36). Range of movement (ROM) score, Western Ontario and McMaster University Osteoarthritis Index and visual analogue scale were determined before the first treatment, after the last treatment and 3 months after the last treatment. SF-36 questionnaire was filled in before the first and after the last treatment. Fifty patients (17 male, 33 female mean age 66.7 ± 4.79 years) were enrolled. After randomisation, patients were divided into two groups: tap water n = 24 and mineral water n = 26. Treatment with the thermal mineral water of Szigetvár significantly improved ROM, WOMAC scores, and SF-36-scored quality of life of the patients. Our double-blind study provided evidence for the beneficial health effects of another Hungarian thermal mineral water masking the colour, odour and pH of the tap water and mineral water.
... Despite the fact that initial medicinal use of natural mineral waters was empirical; today, its scientific recognition is increasingly acknowledged (Pittler et al., 2006;Falagas et al., 2009). The therapeutic effects associated with thermal waters cover several areas of medical intervention, ranging from respiratory, digestive, and dermatological to musculoskeletal disorders (Pittler et al., 2006;Cantarini et al., 2007;Ferreira et al., 2010;Hanzel et al., 2018;Oliveira et al., 2020). ...
... Spa treatments are still being discussed regarding the therapeutic effects and their role in modern medicine (Verhagen et al., 2000;Cantarini et al., 2007). As an example, few randomized, controlled trials clinical studies, reviews, and meta-analyses have been performed to study the efficacy of these treatments regarding musculoskeletal, respiratory, dermatological disorders and (Pittler et al., 2006; Cantarini et al., 2007;Horváth et al., 2012;Hanzel et al., 2018). ...
... In the post-treatment evaluation, it was observed that all QOL indexes were improved, especially in domains of physical functioning, physical role functioning, bodily pain, and emotional role functioning (Table 2). In line with the data obtained in this study, Hanzel et al. (Hanzel et al., 2018) found that patients suffering from rheumatic diseases treated with thermal water presented a significant improvement in the performance of activities that involve greater physical effort. ...
... Despite the fact that initial medicinal use of natural mineral waters was empirical; today, its scientific recognition is increasingly acknowledged (Pittler et al., 2006;Falagas et al., 2009). The therapeutic effects associated with thermal waters cover several areas of medical intervention, ranging from respiratory, digestive, and dermatological to musculoskeletal disorders (Pittler et al., 2006;Cantarini et al., 2007;Ferreira et al., 2010;Hanzel et al., 2018;Oliveira et al., 2020). ...
... Spa treatments are still being discussed regarding the therapeutic effects and their role in modern medicine (Verhagen et al., 2000;Cantarini et al., 2007). As an example, few randomized, controlled trials clinical studies, reviews, and meta-analyses have been performed to study the efficacy of these treatments regarding musculoskeletal, respiratory, dermatological disorders and (Pittler et al., 2006; Cantarini et al., 2007;Horváth et al., 2012;Hanzel et al., 2018). ...
... In the post-treatment evaluation, it was observed that all QOL indexes were improved, especially in domains of physical functioning, physical role functioning, bodily pain, and emotional role functioning (Table 2). In line with the data obtained in this study, Hanzel et al. (Hanzel et al., 2018) found that patients suffering from rheumatic diseases treated with thermal water presented a significant improvement in the performance of activities that involve greater physical effort. ...
Aim: Thermalism has been used to improve health status, with emphasis on well-being, including relaxation, stress relief, depression, and even recovery and energy reserve. This study aimed to evaluate the perception of quality of life (QOL) by SF- 36v2, and the quality of sleep, using the Pittsburgh Index, in individuals who attended the therapeutic thermalism at Chaves thermal Spa, in different treatment time points, pre-and post-treatment for 14 days. Methodology: Thermal Spa patients attending therapeutic thermalism at Chaves thermal Spa (N=90) completed a questionnaire with information on sociodemographic data, on health-related quality of life (SF-36v2), and on quality of sleep (Pittsburgh Sleep Quality Index (PSQI)). Results: In the thermal pre-treatment evaluation, participants revealed a good quality of life in the physical and social functioning, vitality, emotional role functioning, and mental health domains. In the post-treatment assessment, there all QOL indexes were improved, physical functioning, physical role functioning, bodily pain, and emotional role functioning. The participants revealed a good sleep quality in the following dimensions: sleep duration and efficiency, use of sleeping medications, and daytime dysfunction. In the second evaluation time-point, there was an improvement of all sleep quality indices, except for the sleep duration component. Regarding the quality of life and sleep by sociodemographic variables, data revealed that men had a better quality of life and sleep than women. Conclusion: Thermal treatments provided significant benefits for the quality of life and sleep. These results may contribute to improve the knowledge on the potentialities of thermal treatments and, ultimately to attract tourists seeking the benefits of thermal waters on its holistic vision.
... Literature search initially identified 2805 citations, of which after full text assessment ten [10] studies were considered eligible for this meta-analysis [10,[16][17][18][19][20][21][22][23][24]. A study flow diagram indicating the result of literature search and studies selection procedure for this metaanalysis is presented in ▶ Full-text articles assessed for eligibility (n = 40) ...
... The clinical studies included in this meta-analysis consisted of 435 balneotherapy and mud therapy cases and 396 control cases in total [10,[16][17][18][19][20][21][22][23][24]. Among the included studies the smallest sam ple size was n = 30 and the largest sample was n = 121. ...
... There are 5 studies [10,[21][22][23][24] in which treatment approach in the therapeutic group were mud therapy and in four studies [17][18][19][20] the treatment approach were balneotherapy. In one study the treatment approach in the therapeutic group was mudpack ther apy in combination with the balneotherapy [16]. ...
Objectives To identify literature reporting on thermal mineral water and mud therapy effectiveness on pain, stiffness and knee function in patients with knee osteoarthritis.
Design Systematic evidence scan of MEDLINE and PubMed was performed to identify the randomized controlled trial studies published from 2004 to December 2018.
Study selection Papers reporting the effect of balneotherapy and mud therapy for treating knee OA, a duration of ≥2 weeks and in which Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used as an outcome measure.
Data extraction Not RCT, Studies not in English.
Results A quantitative meta-analysis of ten studies (831 patients) was performed. Five clinical studies (407 patients) measured effectiveness of balneotherapy and there was significant difference between the groups in WOMAC pain score, WOMAC stiffness score and WOMAC function score, with the differences in favour of balneotherapy. Six clinical studies (500 patients) measured effectiveness of mud therapy and there was significant difference between the groups in WOMAC pain score, WOMAC stiffness score and WOMAC function score, with the differences in favour of mud therapy.
Conclusion This meta-analysis indicates that balneotherapy and mud therapy were clinically effective in relieving pain, stiffness, and improving function, as assessed by WOMAC score.
... Previous studies have shown the beneficial effects of balneotherapy in musculoskeletal (chronic low back pain, rheumatoid arthritis, etc), gynecological, and dermatological conditions (psoriasis in particular); peripheral vascular disease; fibromyalgia; and many other disorders (Ayán et al. 2017;Bender et al. 2014;Fioravanti et al. 2018;Hanzel et al. 2018;Karagülle et al. 2018;Péter et al. 2017). ...
... In our previous clinical trial (Hanzel et al. 2018), we have already proven the positive health effects of Szigetvár thermal mineral water on patients suffering from osteoarthritis of the hips and the knees. Several other studies did the same with other thermal waters, spa therapies (Pittler et al. 2006;Franke et al. 2007;Kulisch et al. 2009;Horvath et al. 2012). ...
... We performed the study again at Szigetvár Spa between August 2015 and September 2017, at the same place like we did it in our previous study (Hanzel et al. 2018). The same Regional Ethics Committee of University of Pécs, Hungary, approved the study protocol (Permission No. 5351), in accordance with the 2008 Helsinki declaration. ...
The therapeutic effects of mineral waters have been attributed to the inorganic components alone; however, biologically active organic components are also present. We aimed to investigate whether the healing effect of Szigetvár thermal mineral water could relate to the organic matter in patients suffering from osteoarthritis of the hips and the knees. XAD macroreticular resins were used to prepare the organic fraction. Patients received a 30-min thermal water (34 °C) treatment in a bath tub, five times a week for 3 weeks. After randomization, patients were divided into three groups: tap water, mineral water, and organic fraction group. Primary outcomes were range of movement (ROM), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and visual analog scale (VAS) for pain severity, and the Short Form 36 (SF-36) questionnaire was used. These scores and indices were measured at baseline, after the last treatment, and at the end of the 3-month follow-up period. Seventy-four patients (age 67.3 ± 4.48 years) were enrolled: tap water n = 24, mineral water n = 26, and organic fraction n = 24. Treatment with the redissolved organic fraction significantly improved ROM, WOMAC, and SF-36 scores compared to the tap water. Our clinical trial provided evidence for the beneficial health effects of the organic fraction of Szigetvár medicinal water.
... Experts agree that Spa therapy is effective in reducing the use of Nonsteroidal Antiinflammatory Drugs (NSAIDs) and other analgesics and controlling other disease symptoms in patients with musculoskeletal disorders and (20). In their studies of the impact of spa treatment on various muscle-joint diseases, researchers have previously reported that range of motion in the joints [21], quality of life [3,21,22] and functional capacity are increased while pain [3,10,22] and the symptomatic use of drugs [10,22] is reduced. ...
... Experts agree that Spa therapy is effective in reducing the use of Nonsteroidal Antiinflammatory Drugs (NSAIDs) and other analgesics and controlling other disease symptoms in patients with musculoskeletal disorders and (20). In their studies of the impact of spa treatment on various muscle-joint diseases, researchers have previously reported that range of motion in the joints [21], quality of life [3,21,22] and functional capacity are increased while pain [3,10,22] and the symptomatic use of drugs [10,22] is reduced. ...
... It was seen in the study that the benefit participants received from the balneotherapy showed no significant differences in terms of their age, gender or whether or not they had a chronic condition or illness of the muscoskeletal system (p > 0.05). Many instances of positive outcomes were reported in prior studies with individuals with various musculoskeletal system conditions (3,10,21,22). In this context, it can be seen that our findings are not consistent with the results of prior research. ...
... Reports on the treatment of OA with thermal mineral waters therapy have shown positive results. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Previous systematic reviews and meta-analyses were limited to studying the efficacy of balneotherapy on pain and function in patients with knee OA. In contrast, the efficacy of balneotherapy on hip or hand OA has received less attention. ...
... The QoL was significantly improved in 3 studies that used the SF-36 questionnaire at the end of the treatment process and during the 3-month follow-up period. [22,24,31] Varzaityte et al reported that 1 month after mineral waters treatment, SF-36 was found to be positive, indicating that the intervention group's physical activity increased and pain was reduced. Horváth et al reported that when mineral water temperature is controlled at 38°C or 36°C, the SF-36 shows that the physical component summary (PCS) and the mental component summary (MCS) scores after treatment and during follow-up were substantially different and indicated a permanent improvement. ...
Background:
To evaluate the effectiveness and safety of thermal mineral waters therapy for pain relief, and functional improvement, and quality of life (QoL) in patients with osteoarthritis (OA).
Methods:
Cochrane Library, Web of science, EMBASE, ClinicalTrials.gov and PubMed were systematically searched for randomized controlled trials. Study inclusion criteria included assessment of the visual analog scale and Western Ontario and McMaster Universities scores and the lequesne index to evaluate the effects of thermal mineral waters on pain relief and functional improvement. Also, studies that used the European quality of life 5-dimension scale and health assessment questionnaire to assess the impact of thermal mineral waters therapy on improving QoL were included.
Results:
Sixteen studies were included. A meta-analysis showed that thermal mineral waters therapy could significantly reduce pain as measured visual analog scale and Western Ontario and McMaster Universities assessments (P < .001). Thermal mineral waters significantly reduced the lequesne index (P < .001) and improved joint function. Finally, compared with a control group, European quality of life 5-dimension scale and health assessment questionnaire improved significantly in patients with OA receiving thermal mineral waters therapy (P < .05). There is no evidence that thermal mineral waters is unsafe for treating OA.
Conclusion:
Thermal mineral waters therapy is a safe way to relieve pain, improve physical functions, and QoL in patients with OA.
... Because hot springs in Guizhou are generally rich in physiotherapeutic components such as metasilicic acid and F and are of a relatively appropriate temperature, salinity (TDS), and pH value, the combined effect of physical and chemical components (Hanzel et al. 2018;Di Marco et al. 2019;Rapolien_ e et al. 2020) during hot springs bathing causes hot spring bathing to have good therapeutic effects on bone and joint diseases (Forestier et al. 2016;Karagülle et al. 2017), skin, sleep (Latorre-Román et al. 2015, obesity (Dutheil et al. 2019), mental state (Latorre-Román et al. 2015), and so on. In this study, hot springs are divided into two types, A and B, both of which are associated with health, consistent with other research results (Latorre-Román et al. 2015;Forestier et al. 2016;Karagülle et al. 2017;Hanzel et al. 2018;Di Marco et al. 2019;Rapolien_ e et al. 2020). ...
... Because hot springs in Guizhou are generally rich in physiotherapeutic components such as metasilicic acid and F and are of a relatively appropriate temperature, salinity (TDS), and pH value, the combined effect of physical and chemical components (Hanzel et al. 2018;Di Marco et al. 2019;Rapolien_ e et al. 2020) during hot springs bathing causes hot spring bathing to have good therapeutic effects on bone and joint diseases (Forestier et al. 2016;Karagülle et al. 2017), skin, sleep (Latorre-Román et al. 2015, obesity (Dutheil et al. 2019), mental state (Latorre-Román et al. 2015), and so on. In this study, hot springs are divided into two types, A and B, both of which are associated with health, consistent with other research results (Latorre-Román et al. 2015;Forestier et al. 2016;Karagülle et al. 2017;Hanzel et al. 2018;Di Marco et al. 2019;Rapolien_ e et al. 2020). The results show a lower prevalence of cardiovascular and cerebrovascular diseases and diabetes among residents bathing in Type A hot spring than among nonbathers (all P \ 0.05), a correlation not found for Type B hot springs (all P = 0.05). ...
Aim to classify typical hot springs in Guizhou, China and their relevance to health. Assessing geochemical characters of typical hot springs of Guizhou and classifying through hierarchical cluster analysis, an epidemiologic study was conducted to analyze the correlation between hot spring types and health, which showed typical hot springs in Guizhou can be divided into two types, A and B. Type A is rich in fluorine, metasilicic acid, radon components and a large number of essential elements, such as Na, that the human body needs, with trace elements, such as Cr and V, that are essential or possibly essential. Type B is rich in fluorine, metasilicate, strontium components and a large number of essential elements, Ca, Mg, and S, with trace elements, Cu, Mn, Mo, Co, and Ni, that are essential or possibly essential. These hot springs' effects on the health of those bathing in them showed both types were associated with bone and joint diseases. Having bathed in hot springs during the past year was associated with skin symptoms and bone and joint symptoms, and having bathed within the past two weeks was linked to sleep quality and levels of appetite and energy. However, differences do exist between the correlation between the two types and some chronic diseases, with Type A hot springs significantly related to cardiovascular and cerebrovascular diseases and diabetes and Type B to hypertension. This classification of Guizhou's hot springs can guide the future development and use of hot spring physiotherapy.
... BT is widely used to amplify the effects of drug treatments and recommended for a broad spectrum of diseases, such as arthritis, dermatitis, and fibromyalgia [7][8][9]. The efficacy of BT for osteoarthritis has been approved by several randomized clinical trials but beneficial actions of this treatment are often manifested in subjective improvements of the pain sensation and the quality of life [1,10]. ...
... The exact molecular mechanism of balneotherapy is still not fully understood; however its efficacy was confirmed by several human studies [12,13]. Tap water controlled double blind balneotherapy clinical trials were reported in rheumatoid arthritis (RA) or osteoarthritis (OA) patients in Hungary [2,3,6,10,14,15]. The principal aim of the present study was to develop and validate available experimental animal models of osteo-and rheumatoid arthritis for investigation of the potential anti-inflammatory and analgesic effects of Hévíz thermal water and mud. ...
Arthritic diseases are the most frequent causes of chronic pain and disability. Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation and progressive structural joint damage. Osteoarthritis is a degenerative process of the articular cartilage associated with hypertrophic changes in the bone. The aim of the present study was to investigate the anti-inflammatory and analgesic effects of Hévíz thermal water and mud in monosodium iodoacetate- (MIA-) (25 mg/ml, 20 μ l i.a.) induced osteoarthritis and Complete Freund’s adjuvant- (CFA-) (1 mg/ml, 50–50 μ l s.c) induced rheumatoid arthritis murine models. The mechanonociceptive threshold of female NMRI mice (n=6– 8 mice/ group) was measured by aesthesiometry, and paw volume was monitored with plethysmometry, knee joint diameter with digital micrometer, and dynamic weight bearing on the hind limbs with a Bioseb instrument. Periarticular bone destruction was assessed by SkyScan 1176 in vivo micro-CT. Inflammatory cytokines were detected by ELISA in plasma samples. Treatments (30 min, every working day) with tap water, sand, and a combined therapy of tap water and sand served as controls. Hévíz medicinal water and combined treatment with water and mud significantly decreased the mechanical hyperalgesia and knee oedema in MIA-induced osteoarthritis model. However, balneotherapy did not influence mechanical hyperalgesia, weight bearing, or oedema formation induced by CFA. Neither medicinal water nor mud treatment ameliorated deep structural damage of the bones or the joints in the animal models. On the basis of the present findings, we conclude that balneotherapy is an effective complementary treatment to reduce the pain sensation and swelling in degenerative joint diseases such as osteoarthritis. Our experimental data are in agreement with the previous human studies that also confirmed antinociceptive and anti-inflammatory effects of thermal water and Hévíz mud treatments.
... Among the numerous balneology studies and reviews examining the use of salt waters or peloids matured in these waters, we should highlight those performed in France (Chary-Valckenaere et al. 2018;Constant et al. 1995;Léauté-Labrèze et al. 2001), Germany (Brockow et al. 2007a(Brockow et al. , 2007bSchiener et al. 2007), Greece (Nastos 2010;Spilioti et al. 2017), Hungary (Bálint et al. 2007;Bender et al. 2014;Hanzel et al. 2018;Kulisch et al. 2009;Tefner et al. 2012), Iran (Mahboob et al. 2009); Israel (Halevy and Sukenik 1998;Katz et al. 2012;Matz et al. 2003), Italy (Bazzichi et al. 2013;Bellometti et al. 1997aBellometti et al. , 1997bBellometti et al. , 2000Bellometti et al. , 2002Bellometti et al. , 2007Bellometti and Galzigna 1999;Capurso et al. 1999;Ciprian et al. 2013;Cozzi et al. 2007Cozzi et al. , 2015Fioravanti et al. 2007Fioravanti et al. , 2011Guidelli et al. 2012;Miraglia Del Giudice et al. 2011;Staffieri et al. 1998;Tsoureli-Nikita et al. 2002), Japan (Agishi et al. 2010;Nasermoaddeli and Kagamimori 2005), Tunisia (Fazaa et al. 2014), Turkey (Dönmez et al. 2005;Karagülle 2004, 2015;Karagülle et al. 2007Karagülle et al. , 2017aKaragülle et al. , 2017bKaragülle et al. , 2018aKaragülle et al. , 2018bKardeş et al. 2018;Kesiktas et al. 2012;Ozkurt et al. 2012;Özkuk et al. 2017), Spain (Carretero et al. 2010), and Switzerland (Moufarrij et al. 2014). ...
... In view of all these lines of evidence, it seems clear that the topically use of salt waters and their mud products in Health Resort Medicine, both balneotherapy and thalassotherapy, has yielded good outcomes essentially in the treatment of rheumatic and skin disorders. Among the former conditions treated, we should highlight osteoarthritis (Bálint et al. 2007;Bellometti et al. 1997aBellometti et al. , 1997bBellometti et al. , 2007Elkayam et al. 1991;Fazaa et al. 2014;Hanzel et al. 2018;Karagülle et al. 2007;Kardeş et al. 2018;Özkuk et al. 2017;Wigler et al. 1995), rheumatoid arthritis (Bellometti et al. 2000;Codish et al. 2005;Elkayam et al. 1991;Karagülle et al. 2017a;Karagülle et al. 2018b), back pain or spondylitis (Abu-Shakra et al. 2014;Constant et al. 1995;Cozzi et al. 2007;Karagülle and Karagülle 2015;Kesiktas et al. 2012;Kulisch et al. 2009;Tefner et al. 2012), and fibromyalgia (Bazzichi et al. 2013;Bellometti and Galzigna 1999;Fioravanti et al. 2007;Guidelli et al. 2012;Ozkurt et al. 2012). Among the latter treated with good results, we would underscore psoriasis (Brockow et al. 2007a(Brockow et al. , 2007bHalevy and Sukenik 1998;Schiener et al. 2007;Tsoureli-Nikita et al. 2002). ...
In Health Resort Medicine, both balneotherapy and thalassotherapy, salt waters and their peloids, or mud products are mainly used to treat rheumatic and skin disorders. These therapeutic agents act jointly via numerous mechanical, thermal, and chemical mechanisms. In this review, we examine a new mechanism of action specific to saline waters. When topically administered, this water rich in sodium and chloride penetrates the skin where it is able to modify cellular osmotic pressure and stimulate nerve receptors in the skin via cell membrane ion channels known as “Piezo” proteins. We describe several models of cutaneous adsorption/desorption and penetration of dissolved ions in mineral waters through the skin (osmosis and cell volume mechanisms in keratinocytes) and examine the role of these resources in stimulating cutaneous nerve receptors. The actions of salt mineral waters are mediated by a mechanism conditioned by the concentration and quality of their salts involving cellular osmosis-mediated activation/inhibition of cell apoptotic or necrotic processes. In turn, this osmotic mechanism modulates the recently described mechanosensitive piezoelectric channels.
... Traditional spa therapy interventions have several positive effects in rheumatic patients. Numerous studies have shown that, in patients with OA, a cycle of baths in thermal mineral-rich water can improve motor function and pain, considerably more than immersion in tap water [81,[93][94][95][96][97][98]. ...
Frailty is not limited to the elderly, as patients with rheumatic diseases can also experience this condition. The present scoping review aimed to investigate the possibility of using the health resort setting as an alternative location for managing rheumatic patients with frailty. The research resulted in finding several in vitro, in vivo, and clinical studies, resulting in evidence supporting the effectiveness of spa treatments in reducing pain, improving function, and managing comorbidity in rheumatic diseases. Additionally, spa treatments were demonstrated to modulate the MAPK/ERK pathway and the NF-kB pathway's activation and to reduce proinflammatory molecules' secretion in rheumatic diseases, thus suggesting their potential effective role in the regulation of inflammaging in frailty. Moreover, the health resort setting may offer potential resources to reduce risk factors, such as drug consumption, inactivity, and disease severity, and may serve as a setting for developing prevention protocols for frailty. Future research should explore innovative approaches, such as exercise training and early diagnostics, for the overall management of frailty in rheumatic patients in the spa setting.
... В поисках установления причинно-следственных факторов нарушений остеогенеза и его коррекции сошлемся на мнение видного европейского специалиста в области реабилитационной и профилактической медицины Ксабы Варги, критикующей взгляды на связь лечебного действия минеральных/термальных вод, в первую очередь при заболеваниях костно-мышечной системы, с минеральными элементами и другими химическими соединениями (в частности, в термальных водах), поскольку экспериментально было установлено, что исцеляющим свойством обладает вода, а не ее элементный состав [8]. В то же время, в работе [9] выдвинута версия, что лечебное действие минеральных вод обусловлено наличием в ней органических фракций [10]. Однако Ксаба Варга акцентирует внимание на том, что они могут быть биологически активными в очень низких концентрациях [10]. ...
The analysis of scientific publications on the regulatory effect of peroxide anion radicals and electronic activation of the body on the function of osteogenesis and associated systems of the body is presented according to the following information sources: Scopus database, MEDLINE, Web of Science, eLibrary.ru, Google academy for the availability of peer-reviewed original and review publications on the key words: osteogenesis, musculoskeletal system, reoxygenation, hormonal regulators, electron-donor activity, associated water phase, rehabilitation, on the basis of which search phrases on the research topic were formed. Based on a number of evidencebased scientific studies on the regulatory effect of peroxide anion radicals and electronic activation on biological processes (changes in the functional state of the liver, hematological parameters, macro- and microelement composition of liquid media and animal organs, the course of reparative processes in damaged tissues), a biophysical mechanism of systemic homeostatic action of oxygen anion radicals is proposed. This mechanism consists in antihypoxic and detoxifying action during reoxygenation of ischemic tissues, in increasing proliferative activity and shifting osteogenesis regulators (sRANKL-OPG system) towards osteoprotegerin. At the same time, the processes of binding of intracellular free calcium and trace elements in osteoblasts, activation of the macrophage reaction, neoangiogenesis and restoration of myeloid tissue in the area of bone breakdown occur. It is shown that the use of micellar mechanoactivated calcium carbonate as a source of formation of peroxide anion radicals in an aqueous medium leads to a decrease in the redox state and stabilization of cell pH , activation of mitochondrial activity accompanied by intensification of metabolism, including the exchange of micro- and macroelements, improvement of the functions of the antioxidant defense system and nonspecific immunity of the body, stabilization of physiological and biochemical parameters and the functional state of internal organs.
... Számos kutatás eredménye részben vagy egészben megerősíti saját kutatásunk eredményeit [23][24][25]. A fájdalmat vizsgálva a két mérés között mind a vizsgálati (37,1%), mind a kontrollcsoport eredménye (17,6%) javult. ...
Introduction:
Hip as well as knee osteoarthritis are common diseases. There are numerous therapeutic possibilities to address the problem.
Objective:
To study the effectiveness of the complex conservative treatment in patients with hip as well as knee osteoarthritis.
Method:
In addition to a self-made questionnaire, we applied the visual analogue scale, the Functional Independence Measure, the Barthel Index and the Medical Outcomes Study (MOS) - 36-Item Short-Form Health Survey. Apart from these, joint range of motion was measured. The members of the examined group had different physiotherapy treatments (thermal water, physiotherapy, classic Swedish massage, Bemer treatment, wraps, physiotherapy).
Results:
The results of the visual analogue scale and the Barthel Index were significantly different between the two measurements. Regarding the Functional Independence Measure, we did not find significant difference between the two groups. As for measuring the study group's health condition, we observed improvement in the case of both the physical and mental health dimensions. During the examination of joint range of motion in the study group, after analyzing the participants' data, we detected improvement, except for the passive extension of the left knee.
Conclusion:
The 3-week complex conservative therapy can be an appropriate form of treatment to improve the functionality and the health condition in the case of hip as well as knee osteoarthritis. Orv Hetil. 2022; 163(48): 1917-1922.
... Silvério (2020) indicates that thermalism has been used for health promotion and treatment of inflammatory and chronic processes. Also, Hanzel et al. (2018) report clinical improvements in patients suffering from rheumatic diseases treated with thermal mineral water. ...
The thermal tradition plays an important role for society by naturally promoting and improving individuals' well-being. Thermal treatments help cure diseases and prevent pathologies, including mental and social ones, providing users with a better quality of life. At the same time, such a wellness activity introduces leisure components resulting from a more holistic perspective on health and well-being. Given the importance of this topic, which just recently started to be the object of empirical studies in Portugal, the present study aims to identify the profile of those who attend a thermal spa. For this purpose, a self-administrated questionnaire was applied to the Termas de Chaves' users during the 2021 thermal season, i.e., between August and November. A convenience method of non-probability sampling allowed to obtain a sample of 220 thermal users. This establishment, located in the sub-region of Alto Tâmega, North of Portugal, has 300 years of history and vast experience in providing thermal services for different audiences. To better understand and identify the features of the thermal spa user, sociodemographic data were analysed and identified the characteristics, motivations, behaviours, preferences, and perceptions of the thermal spa users under study. The data collected was submitted to treatment through an exploratory quantitative analysis. The distribution data analysis was elaborated using frequencies, centrality and variability descriptive measures complemented by TwoStep cluster analysis. The results showed that most of the participants in Chaves thermal spa are women, with an average age of 69 years (SD=12.556), married, retired, and living in the northern region of Portugal. They seek these services in the season between summer and autumn, for medical advice, mainly for therapeutic reasons, and stay in the thermal spa, on average, for 14 days (SD=2.667). Moreover, the cluster analysis identifies three different groups of users to which thermal stakeholders should consider different policy approaches. By defining the users' profile, this empirical research presents a practical contribution since it provides a strategic orientation for the thermal establishments' stakeholders aiming, essentially, at the (re)qualification of supply and the increase of demand, thus contributing to the sectoral and regional competitiveness.
... Our study also showed high prevalence of the use of non-pharmacological techniques, which is fortunate, although typically limited to herbal creams, cold compressions, and in one case, warm baths, as Hungary has a long history of balneotherapy [30]. Although pain management methods that could be carried out by the patients themselves seem to be popular, unfortunately the prevalence of professionally guided physiotherapy was low compared to other studies [25,31]. ...
Background:
Osteoarthritis (OA) is a complex disease associated with chronic pain. Many patients treat their joint pain at a symptomatic level with over-the-counter (OTC) pain medications, often without the knowledge of their physicians. The aim of this study was to provide physicians with data about osteoarthritic patients' habits of pain management and to examine the explanatory factors of various ways of self-treatment.
Methods:
A cross-sectional study involving 189 patients with hip or knee OA and scheduled for joint replacement surgery was carried out. Participants filled out a self-administered questionnaire consisting of the Western Ontario and McMaster Universities Osteoarthritis Index and questions about their methods of alleviating pain.
Results:
2.6% of patients did not use anything to alleviate their pain, while 63% practiced a non-pharmacological method. Diclofenac was the most frequently used drug, followed by ibuprofen. Profession had the greatest impact on medication habits; patients doing manual work were significantly more likely to take OTC non-steroidal anti-inflammatory drugs and use topical analgesics.
Conclusions:
Patients utilized a wide variety of pain management techniques. They seemed to use well-known painkillers, even if their side effects were less desirable. Such patients require comprehensive pain management, including educational and behavioural interventions, complemented by topical and oral medication.
... Most of the balneotherapeutic studies abroad have never used a placebo control (15,16,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37), despite the fact that this would be one of the most important steps in proving the beneficial effects of medicinal waters. In Hungarian studies, it is more common to use a placebo control (4,7,(38)(39)(40). In the field of balneotherapy, it is necessary to use only waterbased placebo controls. ...
Background/aim:
To develop and validate an easy-to-use and cheap method capable of producing placebo from tap water for medicinal water efficacy trials.
Patients and methods:
Patients were divided into two groups, medicinal water and tap water group. A single 20-minute-long treatment was performed in bathtubs. Patients were asked four times during the bath to tell if they were treated with medicinal water, tap water, or could not decide. Patients were scored, one point was given for each correct answer.
Results:
A total of 174 patients were enrolled. No significant differences were found either between the average scores or the answers of the two groups. Being familiar with the Harkány medicinal water did not influence the rate of correct answers either. There was no statistically significant difference in the number of changes of opinions between the two groups.
Conclusion:
The used method is appropriate for producing a validated placebo from tap water.
... Our search revealed 22 studies that met the inclusion criteria that were published between 1997 and July 2019 and involved a total of 2410 study participants (including (Branco et al., 2016;Farina et al., 2011;Hanzel et al., 2018;Koçyiğit et al., 2016;Kovács et al., 2016;Santos et al., 2016). A flowchart summarising the study inclusion process is shown in Figure 1. ...
Hot springs bathing is a $56 billion commercial industry worldwide, and systematic reviews suggest hot springs bathing (balneotherapy – BT) has a positive impact on chronic pain and musculoskeletal conditions, yet there are no known reviews on BT and mental health issues such as depression, anxiety, and stress. PRISMA guidelines were followed and the Scopus, PubMed, CINAHL, and Embase databases were examined during May 2020 using search terms to identify English language studies on BT and mental health. The included studies involved a controlled trial of bathing in geothermal mineral water with a no bathing, placebo, or active control group and reported any outcome related to mental health. Of 570 studies, 22 articles (1997–2019) were included. Depression, sleep problems, and stress were all seen to improve and anxiety improved in some but not all studies. BT is a fast-growing worldwide industry and has been shown to positively impact sleep, stress, anxiety, and depression. This has implications for the use of BT as a valid complementary therapy for people with mental health conditions. However, future clinical research is required to determine the populations likely to receive the most benefit from BT and distinguish factors that contribute to positive effects.
... This is mainly achieved through physiotherapy, including restorative massages, êinesiotape, hydrotherapy [4] and other means. The effect of water is multidirectional, by reducing edema, causing an effluent effect, increasing the range of motion of joints [5], activating regenerative processes, improving myo-articular laxity, relaxing spastic hypertonic muscles, improves the manifestation of strength and endurance [6] and dynamic joint stability [7]. Hydrotherapy is also suitable for non-sports, with other injuries of the musculoskeletal system, muscle weakness, limited mobility of traumatic joints, arthrosis, musculoskeletal deformities of the musculoskeletal system [8] and the like. ...
Journal of IMAB ISSN: 1312-773X https://www.journal-imab-bg.org SUMMARY Purpose: To develop and study the effectiveness of methods and algorithms using a specialized magnetotherapy with underwater water-jet massage for chronic lumbar pain. Material/Methods: 30 subjects from two experimental groups (EG-1 from 15 athletes and EG-2 from 15 non-athletes) were examined, all with chronic lumbar pain. Testing is performed-before and after one month of physiotherapy. The test battery includes: anthropometry (height, body weight); visual-analogue pain scale; Laseg test-for the neurodynamics of n.ischiadicus. Physiotherapy includes hydrotherapy, with a water temperature of 36 0-37 0 and magnetotherapy with a duration of 30-35 min-treatment of the paravertebral muscle in the lumbar region, gluteus and lower limbs-dorsal and ventral. The procedures are applied 3 times a week for one month. Results: Methods and algorithms using a specialized magnetotherapy with underwater water-jet massage for patients with chronic lumbar pain have been developed. Pain on the Visual-Ana-log Scale of EG-1 athletes was studied-before physiotherapy (with hydrotherapy) X = 4.93±1.39mm, V% = 28.12%, which is an indicator of severe pain in the lumbar region. After 30 days, physiotherapy was reduced to X = 1.53±0.99mm, at V% = 64.59%. Its decrease is 31.03%, P<0.01. Pain before physiotherapy was found in EG-2 X = 6.87±1.64mm, at V% = 23.91%. After physiotherapy, it is reduced to X = 1.93±1.49mm, at V%=76.89%, P<0.01. A study of the neurodynamics of n.ischiadicus, through the Laseg test, found that passive flexion in the hip joint of the healthy leg-before physiotherapy with EG-1 hydrotherapy was X =76.33±8.76 o , at V% = 11.47%. After hydrotherapy increased to X = 86.33±5.51 o , at V%=6.37%. Passive flexion in the hip joint of the injured leg before hydrotherapy was detected in EG-1. X = 69.67±10.43 o , which indicates its strong limit. Post-hydrotherapy X = 80.33±10.08 o , at V%=12.55%. P<0.0. In EG-2, the passive flexion in the hip joint-before hydrotherapy, the healthy leg was X = 71.67±14.1 o , V% = 19.67%. After hydrotherapy increased to X = 81.53±8.37 o. In V% = 10.26%. In the injured leg, passive flexion-before hydrotherapy was X = 71.00±11.37 o , after it X = 82.07±7.70 o , V% = 9.39%. P<0.01. Conclusion: The proven technique and algorithms of hy-drotherapy, with a specialized magnetotherapy with underwater water jet massage, is effective for the recovery of persons with chronic lumbar pain. The technique reduces the neurological and pain symptoms and the restoration of n.ischiadicus. INTRODUCTION: Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, last 3 months. CLBP represents the second lead in the cause of disability worldwide, being major welfare and economic problem [1]. CLBP may be nociceptive or neuropathic or may incorporate both components. The presence of a neuropathic component is associated with the more intense pain of longer duration, and a higher prevalence of co-morbidities [2]. In sports training and competition, athletes suffer different severity of injuries, followed by a lengthy recovery process by physiotherapists. To maintain the athletic form of the athletes, it is important to speed up the recovery processes in the body and fully integrate them into the next stages of sports training [3]. This is mainly achieved through physiotherapy, including restorative massages, êinesiotape, hydrotherapy [4] and other means. The effect of water is multidirectional, by reducing edema, causing an effluent effect, increasing the range of motion of joints [5], activating regenerative processes , improving myo-articular laxity, relaxing spastic hyper-tonic muscles, improves the manifestation of strength and endurance [6] and dynamic joint stability [7]. Hydrotherapy is also suitable for non-sports, with other injuries of the mus-culoskeletal system, muscle weakness, limited mobility of traumatic joints, arthrosis, musculoskeletal deformities of the musculoskeletal system [8] and the like. The complex positive effect of hydrotherapy on the musculoskeletal system causes an increase in the range of motion in the joints, increases the elasticity of soft tissues, relaxes spastic and toned muscles, influences effluent, pain suppressant, improves the manifestation of strength and endurance , improves dynamic joint stability [9, 10]. Hydrotherapy (with a tangentor) also has a mechanical effect, a massage effect associated with suppression, a proprioceptive effect in impaired proprioception; weak neu-romuscular control, impaired neuromuscular synergism, impaired coordination and equilibrium, impaired dynamic joint stability and locomotor capacity [10], in which cases the restoration of dynamic proprioceptive reactivity is prioritized [9, 10]. Hydrotherapy has also been used as a cryo-effect [11] for the reduction of edema, pain and inflammatory response [12]. It affects the myo-articular tissues-tendons, tendons vagina, ligaments and bursa, muscles. In the presence of pain near the muscle, the reflex response of the muscle is a spasm, thus immobilizing the source of the pain [13].
... Statistically significant improvements were observed in pain at Visual Analogue Scale (VAS) and in the World Health Organization Quality of Life WHOQOL-BREF questionnaire regarding the domain of social relations and environment. Focalizing on OA of the hips and the knees, Hanzel et al. [4] investigated the effects of a 3-week-long balneotherapy-based rehabilitation program in mineral-rich water or in tap water. During the treatment period, patients received a 30-min underwater jet massage in a bathtub, five times a week. ...
Chronic Musculoskeletal Disorders (MSDs) are age-related conditions, linked to functional impairment and decreased quality of life (QoL). As a result of the increased life expectancy in Europe, great attention has been focused on investigating the impact of these diseases on QoL. Thermal environment is a suitable place for providing interventions (mud therapy, bath, exercise, etc.) for chronic MSD patients. Our narrative review aims to assess if Spa therapy may improve QoL in patients with chronic MSDs. We searched randomized clinical trials and clinical trials screening PubMed and Google Scholar databases from 2016 up to March 2020. We included 14 trials testing Spa therapy interventions concerning osteoarthritis, rheumatoid arthritis, chronic shoulder pain and fibromyalgia. In conclusion, even though limitations must be considered, evidence shows that Spa therapy, especially in combination with rehabilitation approach, can significantly improve QoL of patients with chronic MSDs.
... Our findings correlate well with data reported in similar studies that have examined the effects of balneotherapy also used to treat knee osteoarthritis (Bálint et al. 2007;Branco et al. 2016;Cantarini et al. 2007;Costantino 2006;Evcik Fazaa et al. 2014;Forestier et al. 2010Forestier et al. , 2016Fraioli et al. 2011;Hanzel et al. 2018;Karagülle et al. 2007;Kiliçoğlu et al. 2010;Kovacs and Bender 2002;Kulisch et al. 2014;Masiero et al. 2018). However, many inherent limitations of our study and those of others merit detailed discussion (Antonelli et al. 2018;Fioravanti et al. 2010;Forestier et al. 2014;Fraioli et al. 2018;Harzy et al. 2009;Tischler et al. 2004;Wigler et al. 1995), and we have also yet to clarify the action mechanisms underlying the effects observed. ...
Osteoarthritis of the knee joint is a public health concern with considerable social impacts and related-costs. Among the treatments available, several benefits of bathing in natural mineral water have been proposed: (1) to identify possible health benefits (in terms of effects on dimensions of pain, functionality, emotional and social aspects, and quality of life) of a 3-week balneotherapy intervention in patients with knee osteoarthritis; (2) to assess the clinical relevance of any benefits detected; and (3) to determine if these effects persist. Participants of this randomized controlled trial (RCT) were 120 patients randomly assigned to (1) an experimental group (3 weeks of balneotherapy consisting of daily whirlpool baths, hydrokinesitherapy sessions, and knee shower/massages) or (2) control group in which no form of treatment apart from their usual analgesia medication was given. Treatment benefits were assessed using the following tools: (1) visual analogue scale (VAS) of pain, (2) Timed Up & Go Test (TUG), (3) WOMAC osteoarthritis questionnaire, and (4) SF 36 health survey questionnaire. In the experimental group, these tests were conducted immediately before treatment, immediately after treatment, and at 3 months of follow-up. Patients assigned to the control group were assessed at the study start and 3 months later. Data processing and statistical analysis were performed using the SPSS (Statistical Package for Social Science) version 22.0. Out of 60 patients in the experimental group, 45 were found to benefit from the treatment intervention in terms of pain relief among other aspects, and also when test scores were compared to those obtained in the control group. Improvements were often clinical relevant and in most patients persisted 3 months after treatment onset.
... Regarding the results of pain, tap water significantly reduced the pain in the short term (0.55 cm) but was not beneficial for the long term (3 months) just like as in our trial; the mineral water group demonstrated less pain (0.75 cm) in short term and long term (nearly 0.3) (Hanzel et al. 2018). According to Latorre-Román et al.'s randomized trial, the BT of 12 days with the water at Balneario San Andrés makes positive influence on pain, mood, sleep quality, and depression in healthy older people; decrease in pain was 1.2 cm VAS similar with our 40 g/L group (1.5 cm) (Latorre-Román et al. 2015). ...
Musculoskeletal pain is a health challenge with various treatment strategies. The study has been accomplished with the aim to reveal the effect of mineral water with different mineral content on musculoskeletal pain and related symptoms experienced. A randomized controlled single-blinded parallel-group study has been performed (145 participants with pain; 5 groups). The duration of treatment was 2 weeks, whereas follow-up has taken 3 months. Change in pain after a single procedure and the pain parameters with related symptoms during the study period have been measured. The effect size using Cohen’s d has been estimated. Small effect (0.2–0.4) on pain has been distinguished after each mineral water procedure. Tap water procedures have been effective in 60% of cases. Twenty grams per liter water baths have had a small effect on pain intensity and tender points, body flexibility, and spinal mobility, and a medium one on sleep quality, and reduced CRP. Forty grams per liter water has had a small effect on pain intensity, frequency, and spinal mobility, and a medium one on flexibility, fatigue, and sleep quality, and reduced ESR. Sixty grams per liter water has had a small effect on pain parameters and fatigue, and a medium one on flexibility and sleep quality, and reduced ESR. The effect lasting up to 2 months has been identified mostly in the 60 g/L group. Tap water has had a short time effect on pain intensity and tender points. There have not been any changes of sufficient significance identified in the control group and any differences between mineral water groups. Sufficient difference between mineral and tap water groups has been determined in pain intensity, spinal mobility, and sleep quality, whereas in the case of the control group, significant difference in pain intensity and frequency, flexibility, and spinal mobility has been identified. The consumption of pain medication has significantly decreased in all mineral water groups. The total mineral content of the water has no significant influence on the reduction of musculoskeletal pain. Mineral water baths have small effect on pain and medium effect on other musculoskeletal disease-related symptoms and pain medication consumption lasting up to 3 months; it is more beneficial than tap water or no treatment for the improvement of symptoms associated with musculoskeletal diseases. Even single balneotherapy procedure results in small pain reduction.
... In our previous studies, direct and indirect evidences were collected for an unconventional explanation of the mode of action of spa waters used in prevention and therapy (Varga 2012a). We also proved for the first time the real health effects of the pure organic fraction of a thermal/mineral water using similar double-blind studies (Szigetvár, South Carpathian Basin) (Hanzel et al. 2018(Hanzel et al. , 2019. ...
“Spa waters should be left untreated” says the dogmatic approach. Health authorities of European countries having traditional spa culture strictly control hygienic conditions of bathing in thermal/mineral waters. These regulations are based on the assumption that chemical treatment (disinfection) of such waters impacts their healing effects. However, a slow change of paradigm has been observed in studying the mode of action of spa waters that could help overcome recent attitudes. Organic content or the role of microbiome has also been emphasized by some authors recently. The article deals with possible interactions among aquatic microorganisms and the disinfection and health effects of spa waters and tries to explain the new findings in this field.
... A balneoterápia a hazai és a nemzetközi szakirodalomban is széles körben kutatott és publikált terület, melyben a terápia hatásossága megerősítést kap kiemelten ízületi gyulladásos és kopásos megbetegedések tüneteinek enyhítésében [2][3][4][5][6][7], bőrproblémák kezelésében [8,9], a derékfájás panaszainak mérséklésében [10][11][12], valamint keringési rendellenességek javításában is [13][14][15]. ...
Introduction:
The role of spa therapy is well defined and its importance has significantly increased in the healthcare but the utilization indicators of the implemented treatments are less known.
Aim:
The objective of our study was to analyze the utilization and the social insurance indicators of the healthcare publicly financed by health insurance in spa institutions.
Data and methods:
The data used for the analysis were derived from the funding database of the National Health Insurance Fund of Hungary. The period examined covered the years between 2009 and 2016. The spa treatment counts, social insurance expenses, the territorial inequalities in utilization, sex and age distribution of the treatments were examined.
Results:
The treatment counts were the highest (7 349 587) in 2009 and they gradually decreased with 6 558 204 treatments by 2012. 'Spa pool of medicinal water' treatment was the most common care in each year which incidence showed a downward trend during the past years: 2 544 617 treatments were performed in 2009 but 2016 showed only 1 898 338 treatments. We found the highest health insurance expenditures in 2016: 4.261 billion HUF or 13.8 EUR. In the previous years, there was a lower health insurance expenditure: in 2010 3.928 billion HUF (14.3 million EUR), in 2011 3.921 billion HUF (14.0 million EUR) and in 2012 3.875 billion HUF (13.4 million EUR). The utilization made the highest incidence of treatments in Csongrád county with 13 174/10 000 inhabitants and 8160 thousand HUF/10 000 inhabitants of social security subsidy in 2016. The lowest utilization counts for treatments were found in Nógrád county with 3233/10 000 inhabitants and 2192 thousand HUF/10 000 inhabitants of social security subsidy. The highest utilization indicators were found in the age group between 60 and 69 in the distribution of population and genders.
Conclusion:
In the utilization of spa therapy funded by health insurance fund, no significant change has occurred during the past years but territorial discrepancies can be seen in sex, age, and county breakdown. Orv Hetil. 2019; 160(Suppl 1): 22-28.
Objective
The efficacy of balneotherapy in rheumatology remains unclear. We aimed to estimate its benefits and risks in rheumatology.
Methods
We conducted a systematic review of randomised trials assessing any European balneotherapy for a rheumatological indication in adults versus any control, on clinical outcomes. We searched PubMed, Cochrane Library, Embase and https://clinicaltrials.gov/ (up to 28 November 2023). We used the Cochrane risk of bias tool version 2, funnel plot and asymmetry tests. We used a random effects model with an inverse-variance weighting method for standardised mean difference (SMD) and risk ratio (RR). We used the Grading of Recommendations Assessment, Development and Evaluation approach for two primary outcomes, pain and quality of life (QoL) at 3 months, and two safety outcomes, withdrawal and any adverse event (AE).
Results
We included 29 trials in mechanical disorders, 9 in inflammatory diseases and 4 in fibromyalgia. The synthesis suggested a decrease in pain of a very low level of certainty (SMD: −0.72 (95% CI (−1.00; −0.44)), very serious risk of bias and of inconsistency, publication bias strongly suspected); an increase in QoL of a very low level of certainty (SMD: 0.56 (95% CI (0.37; 0.75)), very serious risk of bias and serious risk of inconsistency); inconclusive results regarding the risk of withdrawal (RR: 0.75 (95% CI (0.46; 1.20)), very serious risk of bias and serious risk of imprecision) and of AE (RR: 0.80 (95% CI (0.43; 1.50)), serious risk of bias and of inconsistency and very serious risk of imprecision).
Conclusion
The certainty of the effect of balneotherapy in rheumatology was very low.
PROSPERO registration number
CRD42023448206.
A bibliometric study of the scientific production presented at the World Congresses of the International Society of Medical Hydrology (WC ISMH) during the 2010-2019 period was carried out. For this purpose, the type of work, subject matter of work, geographical origin and institutional origin were analyzed in the abstract books. The Universities Complutense of Madrid and Istanbul are the ones that concentrate the highest percentage of scientific production. The contributions come mainly from Spain, France and Japan. The subjects most studied were the medical benefits of hydrothermal resources. Key words: bibliometry, medical hydrology, health resort medicine, balneotherapy, Thalassotherapy, pelotherapy, ISMH
Contemporary society has an increasingly broad and holistic perspective on health and wellness. It is scientifically proven that thermalism perfectly combines these two aspects. It provides a better quality of life and a complete state of well-being, physically and psychologically. Several studies have been carried out over the years, reflecting a paradigm shift in the conception of thermalism establishments. For this reason, the sector's stakeholders need to be prepared and have the necessary knowledge to respond to the different needs, characteristics, and motivations of both usual and new thermal users to define better action strategies. In this context, the research's main objective is to present a literature review and content analysis on the thermalism topic, through the most recognised databases, exploring the offer, identifying its users’ profiles and pointing out some trends for the market. As a result of the analyses, the growing interest and relevance of thermalism in scientific production stand out, particularly in tourism, as a social science. There are several studies that present a direct link between thermalism and tourism activity. It is notorious that thermal activity has both a recreational and medicinal dimension, all over the world. Literature analysis has also revealed the power of thermal waters for the treatment of a wide range of diseases and health issues, related to different medical specialities. Although the more traditional thermalism is still very present, the most recent studies portray some gradual changes on the demand and supply side, with a constant adjustment of both. Particularly in the user profile, there is evidence of a rejuvenated, healthier and heterogeneous demand, with different motivations to frequent the thermal spas. On the supply side, it can be seen that these establishments are seeking to reinvent themselves in order to complement their basic offer related to medical dimension, also focusing on the leisure, to enrich the experience of their regular users and attract others. Regarding the expected trends, they are mainly related to 1) Increased demand for prevention, leisure and well-being dimension; 2) Changes in the user profile; and 3) High potential for tourism activity.
Besides chemical composition, the water temperature at the emergence site is, as a rule, a requisite for traditional crenotherapy/balneotherapy practice officially recognized in many European countries as a clinically effective complementary approach in the treatment of low-grade inflammation and stress-related pathologies, the absorption of biologically active inorganic and organic substances through the skin playing an effective role, although the mechanisms of action still remain matter of scientific discussion. The history of balneotherapy and of thermalism, i.e. the economic activity addressed to the prevention, therapy, rehabilitation and wellness provided by the use of hot or warm natural mineral water in thermal resorts or health resort medicine spas. This chapter reports the natural requisites of natural mineral water and spring water to be used in health resort medicine, employing the traditional methods and practices of hydrotherapy, crenotherapy and climatotherapy at the balnearies or bathhouses of the so-called health resort spas.
A systematic review on all the clinical trial published on balneotherapy mud performed in the spa center all over the world. Exhaustive bibliographic researche and detailed methodologic analysis
Medical water therapy (also called medical hydrology) is practiced worldwide both for relaxation and treatment of diseases. While this practice is still thriving in Bhutan, there is a lack of proper documentation and critical study. Therefore, the current study reports on the water therapies practiced in Bhutan and their health benefits. We used four-stage process: (1) a review of literature on balneotherapy (both traditional textbooks and scientific papers); (2) listing and surveying the hot springs, mineral, and holy spring waters; (3) reviewing the health records of the patients maintained at the traditional hospitals and interviewing traditional physicians and patients about health benefits; and (4) reviewing available literature to identify existing clinical trials data to provide evidence for hydrotherapies. We found three main forms of hydrotherapies are practiced in Bhutan, which comprises herbal bath therapy, balneotherapy, and spiritually empowered waters. The most popular hydrotherapies are herbal bath and hot spring therapies. Herbal bath therapy needs traditional physicians’ prescriptions, while hot springs do not require it. Through field surveys, ten different hot springs (tsha-chu) and 17 medicinal water or mineral springs (sman-chu), and 17 holy spring-waters (sgrub-chu) were identified. In general, medical water therapies are used by the Bhutanese people to treat various ailments, including gastritis, neurological disorders, arthritis, dermatological diseases, and rheumatological and musculoskeletal disorders. Even though a lack of scientific evidence makes it difficult to draw concrete conclusions on their traditionally claimed efficacy and safety, there are clinical evidences documented from other countries.
Objective:
Conduct a systematic review of systematic reviews and randomised controlled trials (RCTs) from the past year evaluating rehabilitation for people with osteoarthritis, and provide narrative synthesis of findings focused on core recommended treatments for osteoarthritis (exercise, education, biomechanical interventions, weight loss).
Design:
A comprehensive search strategy was used to search PubMed, EMBASE and Cochrane databases (16th May 2017 to 22nd March 2018). Search terms included 'osteoarthritis', 'rehabilitation', 'systematic review', and 'randomised controlled trial'. Inclusion criteria were: (1) RCT, or systematic review of randomised clinical trials (RCTs); (2) human participants with osteoarthritis (any joint); (3) evaluation of rehabilitation intervention; and (4) at least one patient-reported measure. Methodological quality was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) tool (systematic reviews) and PEDro rating scale (RCTs). Narrative synthesis mapped findings to core recommendations from existing osteoarthritis clinical guidelines.
Results:
From 1994 records, 13 systematic reviews and 36 RCTs were included. 73% of these evaluated knee osteoarthritis (36 studies). The remaining studies evaluated hand osteoarthritis (6 studies), hip, hip/knee and general osteoarthritis (each 2 studies), and neck osteoarthritis (1 study). Exercise was the most common intervention evaluated (31%). Updated recommendations for exercise prescription and preliminary guidance for psychological interventions are provided.
Conclusion:
Level 1 and 2 osteoarthritis rehabilitation literature continues to be dominated by knee osteoarthritis studies. Consistent with current clinical guidelines, exercise should be a core treatment for osteoarthritis, but future studies should ensure that exercise programs follow published dose guidelines. There is a clear need for research on rehabilitation for hip, hand, foot/ankle, shoulder and spine osteoarthritis.
Medical significance of the organic fractions of natural waters is still poorly understood. Nevertheless, there are putative biologically active organic compounds found in natural medical waters and related clay or mud samples. Organic fractions of five thermal (spa) water samples of different geochemical origin were tested for photo-biological effects. To study possible effects on the UV sensitivity of Salmonella typhimurium TA strains, the organic isolates were applied in the “plate incorporation” Ames test combined with UV-irradiation. Four samples showed measurable survival of TA100 his+ revertants following exposure to a normally lethal UV dose. Metabolic activation with a mammalian microsomal fraction (S9) elevated the effect detected (up to 61% survival). This is the first study to demonstrate the UV-protective property of organic matter in natural thermal water samples used in balneotherapy.
Osteoarthritis (OA) continues to be one of the leading causes of 'years lived with disability' worldwide. Symptomatic knee OA is highly prevalent among people aged 50 years and over and is destined to become an ever more important healthcare problem. Current management of knee OA includes non-pharmacological and pharmacological treatments. Spa therapy is one of the most commonly used non-pharmacological approaches for OA in many European countries, as well as in Japan and Israel. Despite its long history and popularity, spa treatment is still the subject of debate and its role in modern medicine continues to be unclear. The objective of this review is to summarize the currently available information on clinical effects and mechanisms of action of spa therapy in knee OA. Various randomized controlled clinical trials (RCTs) were conducted to assess the efficacy and tolerability of balneotherapy and mud-pack therapy in patients with knee OA. Data from these clinical trials support a beneficial effect of spa therapy on pain, function and quality of life in knee OA that lasts over time, until 6-9 months after the treatment. The mechanisms by which immersion in mineral or thermal water or the application of mud alleviate suffering in OA are not fully understood. The net benefit is probably the result of a combination of factors, among which the mechanical, thermal and chemical effects are most prominent. In conclusion, spa therapy seems to have a role in the treatment of knee OA. Additional RCTs and further studies of mechanisms of action with high methodological quality are necessary to prove the effects of spa therapy.
Balneotherapy is appreciated as a traditional treatment modality in medicine. Hungary is rich in thermal mineral waters. Balneotherapy has been in extensive use for centuries and its effects have been studied in detail. Here, we present a systematic review and meta-analysis of clinical trials conducted with Hungarian thermal mineral waters, the findings of which have been published by Hungarian authors in English. The 122 studies identified in different databases include 18 clinical trials. Five of these evaluated the effect of hydro- and balneotherapy on chronic low back pain, four on osteoarthritis of the knee, and two on osteoarthritis of the hand. One of the remaining seven trials evaluated balneotherapy in chronic inflammatory pelvic diseases, while six studies explored its effect on various laboratory parameters. Out of the 18 studies, 9 met the predefined criteria for meta-analysis. The results confirmed the beneficial effect of balneotherapy on pain with weight bearing and at rest in patients with degenerative joint and spinal diseases. A similar effect has been found in chronic pelvic inflammatory disease. The review also revealed that balneotherapy has some beneficial effects on antioxidant status, and on metabolic and inflammatory parameters. Based on the results, we conclude that balneotherapy with Hungarian thermal-mineral waters is an effective remedy for lower back pain, as well as for knee and hand osteoarthritis.
The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists, orthopaedic surgeons, general practitioner, psychologist, dietician, clinical epidemiologist and patient representatives. After a preliminary literature review, a first task force meeting and five Delphi rounds, provisional recommendations were formulated in order to perform a systematic review. A literature search of Medline and eight other databases was performed up to February 2012. Evidence was graded in categories I-IV and agreement with the recommendations was determined through scores from 0 (total disagreement) to 10 (total agreement). Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work. The average level of agreement ranged between 8.0 and 9.1. The proposed research agenda included an overall need for more research into non-pharmacological interventions for hip OA, moderators to optimise individualised treatment, healthy lifestyle with economic evaluation and long-term follow-up, and the prevention and reduction of work disability. Proposed educational activities included the required skills to teach, initiate and establish lifestyle changes. The 11 recommendations provide guidance on the delivery of non-pharmacological interventions to people with hip or knee OA. More research and educational activities are needed, particularly in the area of lifestyle changes.
Recently, several measurements have indicated the presence of biologically active organic micropollutants or trace components in different types of waters, including spa and medicinal waters. The wide spectrum and abundance of organic components of spa waters in the Carpathian basin and other European regions has been demonstrated by gas-chromatographic analyses. These components may have main role in the therapeutic and preventive mechanisms. Considering the new analytical data, traditional European classification of spa waters based on the quality and quantity of inorganic ions (salts) should be reevaluated. The association of inorganic components and the therapeutic effects is also necessary to reconsider.
Objective: To evaluate the effectiveness of thermal mineral water compared with magnetotherapy without balneotherapy as control, in the treatment of hand osteoarthritis.
Design: Randomized controlled single-blind follow-up study.
Setting: Rheumatology specialist clinic of Gunaras Health Spa.
Subjects: Patients between 50 and 70 years of age with hand osteoarthritis, randomly assigned into three groups.
Interventions: The subjects in the first two groups bathed in thermal mineral water of two different temperatures (36°C and 38°C) for three weeks five times a week for 20 minutes a day and received magnetotherapy to their hands three times weekly. The third group received only magnetotherapy.
Outcome measures: Visual analogue scale scores, handgrip strength, pinchgrip strength, the number of swollen and tender joints of the hand, the duration of morning joint stiffness, Health Assessment Questionnaire, and Short Form-36 questionnaire. The study parameters were administered at baseline, immediately after treatment and after 13 weeks.
Results: The study included 63 patients. Statistically significant improvement was observed in several studied parameters after the treatment and during the follow-up study in the thermal water groups versus the control group. The 38°C thermal water treatment significantly improved the pinch strength of the right hand (0.6 (95% confidence interval (CI) 0.2 to 1.1) vs. 0.03 (95% CI −0.3 to 0.4), P < 0.05) and the Health Assessment Questionnaire parameters (−0.4 (95% CI −0.6 to −0.2) vs. −0.1 (95% CI −0.2 to 0.1), P < 0.01) even in the long term.
Conclusions: Balneotherapy combined with magnetotherapy improved the pain and function as well as the quality of life in patients with hand osteoarthritis.
Randomization as a method of experimental control has been extensively used in human clinical trials and other biological experiments. It prevents the selection bias and insures against the accidental bias. It produces the comparable groups and eliminates the source of bias in treatment assignments. Finally, it permits the use of probability theory to express the likelihood of chance as a source for the difference of end outcome. This paper discusses the different methods of randomization and use of online statistical computing web programming (www.graphpad.com/quickcalcs or www.randomization.com) to generate the randomization schedule. Issues related to randomization are also discussed in this paper.
Health Resort Medicine, Balneology, Medical Hydrology and Climatology are not fully recognised as independent medical specialties at a global international level. Analysing the reasons, we can identify both external (from outside the field) and internal (from inside the field) factors. External arguments include, e.g. the lack of scientific evidence, the fact that Balneotherapy and Climatotherapy is not used in all countries, and the fact that Health Resort Medicine, Balneology, Medical Hydrology and Climatology focus only on single methods and do not have a comprehensive concept. Implicit barriers are the lack of international accepted terms in the field, the restriction of being allowed to practice the activities only in specific settings, and the trend to use Balneotherapy mainly for wellness concepts. Especially the implicit barriers should be subject to intense discussions among scientists and specialists. This paper suggests one option to tackle the problem of implicit barriers by making a proposal for a structure and description of the medical field, and to provide some commonly acceptable descriptions of content and terminology. The medical area can be defined as "medicine in health resorts" (or "health resort medicine"). Health resort medicine includes "all medical activities originated and derived in health resorts based on scientific evidence aiming at health promotion, prevention, therapy and rehabilitation". Core elements of health resort interventions in health resorts are balneotherapy, hydrotherapy, and climatotherapy. Health resort medicine can be used for health promotion, prevention, treatment, and rehabilitation. The use of natural mineral waters, gases and peloids in many countries is called balneotherapy, but other (equivalent) terms exist. Substances used for balneotherapy are medical mineral waters, medical peloids, and natural gases (bathing, drinking, inhalation, etc.). The use of plain water (tap water) for therapy is called hydrotherapy, and the use of climatic factors for therapy is called climatotherapy. Reflecting the effects of health resort medicine, it is important to take other environmental factors into account. These can be classified within the framework of the ICF (International Classification of Functioning, Disability and Health). Examples include receiving health care by specialised doctors, being well educated (ICF-domain: e355), having an environment supporting social contacts (family, peer groups) (cf. ICF-domains: d740, d760), facilities for recreation, cultural activities, leisure and sports (cf. ICF-domain: d920), access to a health-promoting atmosphere and an environment close to nature (cf. ICF-domain: e210). The scientific field dealing with health resort medicine is called health resort sciences. It includes the medical sciences, psychology, social sciences, technical sciences, chemistry, physics, geography, jurisprudence, etc. Finally, this paper proposes a systematic international discussion of descriptions in the field of Health Resort Medicine, Balneology, Medical Hydrology and Climatology, and discusses short descriptive terms with the goal of achieving internationally accepted distinct terms. This task should be done via a structured consensus process and is of major importance for the publication of scientific results as well as for systematic reviews and meta-analyses.
To update the EULAR recommendations for management of knee osteoarthritis (OA) by an evidence based medicine and expert opinion approach.
The literature search and guidelines were restricted to treatments for knee OA pertaining to clinical and/or radiological OA of any compartment of the knee. Papers for combined treatment of knee and other types of OA were excluded. Medline and Embase were searched using a combination of subject headings and key words. Searches for those treatments previously investigated were conducted for January 1999 to February 2002 and for those treatments not previously investigated for 1966 to February 2002. The level of evidence found for each treatment was documented. Quality scores were determined for each paper, an effect size comparing the treatment with placebo was calculated, where possible, and a toxicity profile was determined for each treatment modality.
497 new publications were identified by the search. Of these, 103 were intervention trials and included in the overall analysis, and 33 treatment modalities were identified. Previously identified publications which were not exclusively knee OA in the initial analysis were rejected. In total, 545 publications were included. Based on the results of the literature search and expert opinion, 10 recommendations for the treatment of knee OA were devised using a five stage Delphi technique. Based on expert opinion, a further set of 10 items was identified by a five stage Delphi technique as important for future research.
The updated recommendations support some of the previous propositions published in 2000 but also include modified statements and new propositions. Although a large number of treatment options for knee OA exist, the evidence based format of the EULAR Recommendations continues to identify key clinical questions that currently are unanswered.
The use of water for medical treatment is probably as old as mankind. Until the middle of the last century, spa treatment, including hydrotherapy and balneotherapy, remained popular but went into decline especially in the Anglo-Saxon world with the development of effective analgesics. However, no analgesic, regardless of its potency, is capable of eliminating pain, and reports of life-threatening adverse reactions to the use of these drugs led to renewed interest in spa therapy. Because of methodologic difficulties and lack of research funding, the effects of 'water treatments' in the relief of pain have rarely been subjected to rigorous assessment by randomised, controlled trials. It is our opinion that the three therapeutic modalities must be considered separately, and this was done in the present paper. In addition, we review the research on the mechanism of action and cost effectiveness of such treatments and examine what research might be useful in the future.
This study investigates the effects of radon (plus CO2) baths on RA in contrast to artificial CO2 baths in RA rehabilitation using a double-blinded trial enrolling 134 randomised patients of an in-patient rehabilitative programme (further 73 consecutive non-randomised patients are not reported here). The outcomes were limitations in occupational context/daily living (main outcome), pain, medication and further quantities. These were measured before the start, after the end of treatment and quarterly in the year thereafter. Repeated-measures analysis of covariance (RM-ANCOVA) of the intent-to-treat population was performed with group main effects (GME) and group × course interactions (G × C) reported. Hierarchically ordered hypotheses ensured the adherence of the nominal significance level. The superiority of the radon treatment was found regarding the main outcome (RM-ANCOVA until 12 months: p
GME = 0.15, p
GxC = 0.033). Consumption of steroids (p
GME = 0.064, p
G × C = 0.025) and NSAIDs (p
GME = 0.035, p
G × C = 0.008) were significantly reduced. The results suggest beneficial long-term effects of radon baths as adjunct to a multimodal rehabilitative treatment of RA.
Objective
The 1987 American College of Rheumatology (ACR; formerly, the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticized for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA.
Methods
A joint working group from the ACR and the European League Against Rheumatism developed, in 3 phases, a new approach to classifying RA. The work focused on identifying, among patients newly presenting with undifferentiated inflammatory synovitis, factors that best discriminated between those who were and those who were not at high risk for persistent and/or erosive disease—this being the appropriate current paradigm underlying the disease construct “rheumatoid arthritis.”
Results
In the new criteria set, classification as “definite RA” is based on the confirmed presence of synovitis in at least 1 joint, absence of an alternative diagnosis that better explains the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in 4 domains: number and site of involved joints (score range 0–5), serologic abnormality (score range 0–3), elevated acute-phase response (score range 0–1), and symptom duration (2 levels; range 0–1).
Conclusion
This new classification system redefines the current paradigm of RA by focusing on features at earlier stages of disease that are associated with persistent and/or erosive disease, rather than defining the disease by its late-stage features. This will refocus attention on the important need for earlier diagnosis and institution of effective disease-suppressing therapy to prevent or minimize the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct “rheumatoid arthritis.”
The objective of this prospective parallel randomized single-blind study was to assess that a cycle of mud-bath therapy (MBT) provides any benefits over usual treatment in patients with bilateral knee osteoarthritis (OA). Patients with symptomatic primary bilateral knee OA, according to ACR criteria, were included in the study and randomized to one of two groups: one group received a cycle of MBT at spa center of Chianciano Terme (Italy) in addition to the usual treatment, and one group continued their regular care routine alone. Clinical assessments were performed 7 days before enrollment (screening visit), at the time of enrollment (basal time), after 2 weeks, and after 3, 6, 9, and 12 months after the beginning of the study. All assessments were conducted by two researchers blinded to treatment allocation. The primary efficacy outcomes were the global pain score evaluated by Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscore for physical function (W-TPFS). Of the 235 patients screened, 103 met the inclusion criteria: 53 patients were included in the MBT group and 50 in the control group. In the group of patients treated with MBT, we observed a statistically significant (p
For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or paraarticular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.
To update the American College of Rheumatology (ACR) 2000 recommendations for hip and knee osteoarthritis (OA) and develop new recommendations for hand OA.
A list of pharmacologic and nonpharmacologic modalities commonly used to manage knee, hip, and hand OA as well as clinical scenarios representing patients with symptomatic hand, hip, and knee OA were generated. Systematic evidence-based literature reviews were conducted by a working group at the Institute of Population Health, University of Ottawa, and updated by ACR staff to include additions to bibliographic databases through December 31, 2010. The Grading of Recommendations Assessment, Development and Evaluation approach, a formal process to rate scientific evidence and to develop recommendations that are as evidence based as possible, was used by a Technical Expert Panel comprised of various stakeholders to formulate the recommendations for the use of nonpharmacologic and pharmacologic modalities for OA of the hand, hip, and knee.
Both “strong” and “conditional” recommendations were made for OA management. Modalities conditionally recommended for the management of hand OA include instruction in joint protection techniques, provision of assistive devices, use of thermal modalities and trapeziometacarpal joint splints, and use of oral and topical nonsteroidal antiinflammatory drugs (NSAIDs), tramadol, and topical capsaicin. Nonpharmacologic modalities strongly recommended for the management of knee OA were aerobic, aquatic, and/or resistance exercises as well as weight loss for overweight patients. Nonpharmacologic modalities conditionally recommended for knee OA included medial wedge insoles for valgus knee OA, subtalar strapped lateral insoles for varus knee OA, medially directed patellar taping, manual therapy, walking aids, thermal agents, tai chi, self management programs, and psychosocial interventions. Pharmacologic modalities conditionally recommended for the initial management of patients with knee OA included acetaminophen, oral and topical NSAIDs, tramadol, and intraarticular corticosteroid injections; intraarticular hyaluronate injections, duloxetine, and opioids were conditionally recommended in patients who had an inadequate response to initial therapy. Opioid analgesics were strongly recommended in patients who were either not willing to undergo or had contraindications for total joint arthroplasty after having failed medical therapy. Recommendations for hip OA were similar to those for the management of knee OA.
These recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines, informed by available evidence, balancing the benefits and harms of both nonpharmacologic and pharmacologic modalities, and incorporating their preferences and values. It is hoped that these recommendations will be utilized by health care providers involved in the management of patients with OA.
PurposeThe purpose of this study was to search for, appraise the quality of and collate the research evidence supporting the clinical effectiveness of hydrotherapy.MethodA systematic search of literature was performed using ten medical and allied health databases from which studies relevant to physiotherapeutic hydrotherapy practice were retrieved. Patient trials were critically appraised for research merit using recognised published guidelines and the results were collated into clinical, functional and affective outcomes for the investigated populations.ResultsSeventeen randomised control trials, two case-control studies, 12 cohort studies and two case reports were included in the appraisal. Two trials achieved appraisal scores indicating high quality evidence in a subjectively evaluated merit categorisation. Fifteen studies were deemed to provide moderate quality evidence for the effectiveness of hydrotherapy.DiscussionFlaws in study design and reporting attenuated the strength of the research evidence. Recommendations were made for the future direction of clinical hydrotherapy research. Randomised controlled trials with larger sample sizes, assessor blinding and the use of validated and reliable outcome measures in subjects with neurological conditions and acute orthopaedic injuries are particularly required.ConclusionThe balance of high to moderate quality evidence supported benefit from hydrotherapy in pain, function, self-efficacy and affect, joint mobility, strength, and balance, particularly among older adults, subjects with rheumatic conditions and chronic low back pain.
Osteoarthritis (OA) is the most common joint disorder in the United States. Symptomatic knee OA occurs in 10% men and 13% in women aged 60 years or older. The number of people affected with symptomatic OA is likely to increase due to the aging of the population and the obesity epidemic. OA has a multifactorial etiology, and can be considered the product of an interplay between systemic and local factors. Old age, female gender, overweight and obesity, knee injury, repetitive use of joints, bone density, muscle weakness, and joint laxity all play roles in the development of joint OA, particularly in the weight-bearing joints. Modifying these factors may reduce the risk of OA and prevent subsequent pain and disability.
The aim of this study was to evaluate the effectiveness of thermal mineral water, compared with tap water in the treatment of low back pain.
This randomized, double-blind, controlled, follow-up study included 71 patients who underwent 20-minute daily treatment sessions with medicinal water or with tap water, both at a temperature of 34 degrees C, on 21 occasions. Both groups underwent additional adjunctive electrotherapy. Outcome measures were visual analogue scale scores, Schober's sign, Domján's signs, Oswestry disability and Short Form-36 questionnaire. The study parameters were administered at baseline, immediately after treatment, and after 15 weeks.
After treatment, there was a significant improvement in all parameters in the thermal water group. This improvement was still evident after 15 weeks. The improvement in the control group was less substantial compared with baseline values. Comparison of the 2 treatments revealed a statistically significant difference in 3 outcome parameters (visual analogue scale scores III, IV and Schober's index). In the subset of patients who completed the study according to the protocol, the greater efficacy of treatment with thermal water was also confirmed by the other study parameters.
In the group treated with thermal water, improvement occurred earlier, lasted longer and was statistically significant.
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.
THE AUTHORS examined the effectiveness of the thermal water of Puspokladany on 62 patients suffering from osteoarthritis of the knee in a double-blind, placebo controlled study. Thermal water decreased pain in movement and tenderness of the knee significantly compared to that of the control group. Bath-reaction (increase of ESR, leukocyte number and spontaneous pain) was observed only in the group treated with thermal water. The results indi cate, that the thermal water of Puspokladany is suitable for treating patients suffering from degenerative arthopathies.
In a previous announcement, Varga and his colleagues had established that a 20-days bath treat ment in the thermal water of Puspokladany signifi cantly reduced the pain of spondylosis patients when the treatment was applied in the undiluted thermal water. Bath reaction was shown on the patients who were treated in the undiluted thermal water, which was proved by the significant increase of the leucocyte number. The present paper deals with the study and tests we conducted to establish the effect of Puspokla dany's thermal water on patients with osteoarthritis of the knee.
For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or para-articular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.
Low back pain is a major public health concern and complementary treatments are frequently used for this condition. The objective of this systematic review and meta-analysis was to assess the evidence for or against the effectiveness of spa therapy and balneotherapy for treating low back pain.
Systematic searches were conducted on Medline, Embase, Amed Cochrane Central, the UK National Research Register and ClincalTrials.gov (all until July 2005). Hand searches were performed and experts contacted. Methodological quality was assessed using a standard scale.
Five randomized clinical trials met all inclusion criteria. Quantitative data synthesis was performed. The data for spa therapy, assessed on a 100 mm visual analogue scale (VAS), suggest significant beneficial effects compared with waiting list control groups (weighted mean difference 26.6 mm, 95% confidence interval 20.4-32.8, n=442) for patients with chronic low back pain. For balneotherapy the data, assessed on a 100 mm VAS, also suggest beneficial effects compared with control groups (weighted mean difference 18.8 mm, 95% confidence interval 10.3-27.3, n=138).
Even though the data are scarce, there is encouraging evidence suggesting that spa therapy and balneotherapy may be effective for treating patients with low back pain. These data are not compelling but warrant rigorous large-scale trials.
To study the effect of thermal mineral water of Nagybaracska (Hungary) on patients with primary knee osteoarthritis in a randomized, double-blind clinical trial, 64 patients with nonsurgical knee joint osteoarthritis were randomly selected either into the thermal mineral water or into the tap water group in a non-spa resort village. The patients of both groups received 30-min sessions of bathing, 5 days a week for four consecutive weeks. The patients were evaluated by a blind observer immediately before and at the end of the trial using Western Ontario and McMaster Osteoarthritis (WOMAC) indices and follow-up assessment 3 months later. Twenty-seven patients of the 32 patients who received thermal mineral water and 25 of the 32 of those treated with tap water completed the trial. The WOMAC activity, pain, and total scores improved significantly in the thermal mineral-water-treated group. The improvement remained also at the end of the 3-month follow-up. The WOMAC activity, pain, and total scores improved significantly also in the tap water group at the end of the treatment course, but no improvement was detected at the end of the 3-month follow-up period. The treatment with the thermal mineral water of Nagybaracska significantly improved activity, pain, and total WOMAC scores of patients with nonsurgical OA of the knee. Even after 3 months, significant improvement was observed compared to the scores before the treatment or to tap water treatment.
Páciens megelégedettségi vizsgálat SF-36 kérdőívvel, a magyarországi normálértékek meghatározása
- N Zs
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Fig. 3 Changes of pain measured by visual analogue scale
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A WOMAC VA3.0 index magyar verziójának vizsgálata térd-és csípőarthrosisos betegeken
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One-year follow-up of mud-bath therapy in patients with bilateral knee osteoarthritis: a randomised, single-blind controlled trial
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https://doi.org/10.1007/s00484-014-0943-0
EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT
- K M Jordan
- N K Arden
- M Doherty
- B Bannwarth
- J W Bijlsma
- P Dieppe
- K Gunther
- H Hauselmann
- Herrero Beaumont
- G Kaklamanis
- P Lohmander
- S Leeb
- B Lequesne
- M Mazieres
- B Martinmola
- E Pavelka
- K Pendleton
- A Punzi
- L Serni
- U Swoboda
- B Verbruggen
- Zimmerman Gorska
- I Dougados
- KM Jordan