Balneotherapy and Spa Rehabilitation program after orthopedic surgery

The word SPA is derived from the name of the Belgian town of Spa, where since medieval times illnesses were treated by drinking iron bearing spring water. International Spa Association definition http://www.experienceispa.com/ Spa is an entity devoted to enhancing overall well-being through a variety of professional services.Balneotherapy is the treatment of disease by bathing and drinking of mineral waters but the term Balneotherapy" is generally applied to everything related to spa treatment.

• Popularity of Balneotherapy is based on its ages long tradition in the Mediterranean cultural area

• Similar water based natural healing procedures can be traced in all civilizations throughout the history

• Together with modern medical technology - Balneotherapy is widely used as a therapeutic procedure promoting natural self-regulation and self-healing processes

Hammam Medina Mayrit - spas in Madrid.

Historical Reconstruction of the Roman Baths in Weisenburg, Germany,

Greece Delphi – Gymnasium and Bath

Support for judicious use and stimulation of natural self-regulation, self-healing, and health maintenance capabilities of human organism can be found in the principles of

osteopathic medicine in the United States

• Osteopathic principles:

Revised in 2002, the core principles are:

The body is a unit, and the person represents a combination of body, mind, and spirit.

The body is capable of self-regulation, self-healing, and health maintenance.

Structure and function are reciprocally interrelated.

Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.

It is a branch of medicine based on the same scientific principles with a same legal position as allopathic medicine and fully recognized by American Medical Association and recognized as equal also in Saudi Arabia. Osteopathic medicine adhere to more patient-centered and holistic approach to treatment.

• Long time before the advent of the computer technology osteopathic medicine emphasized the equal role of the human body information processing (mind and spirit) - software regulations in the process of disease origin and its healing.

• It is well known that a single cell stores in its genes database all information necessary to build the whole body – the immense network giving the mind its material base

• It was less known that the processes in mind can lead all the way down to the switching on and of genes expressions in particular cells through psychoneuroendocrine and psychoneuroimunlogy mechanism linked to autonomous regulations

• Structure and function are reciprocally interrelated...

Despite major medical advances – surgery remains a stressful event for the patient with reactions and

adaptations in all interrelated systems

Spa = Feel better = Heal better

The healing power of water is based on

its universal symbolism of rebirth

and purification.To some extent it

can switch our Autonomous,

Endocrine and Immune regulations to the time when we

were building our body from the single

cell and trigger latent regenerative

capabilities

• Besides well mapped psycho – neurophysiologic responses - in certain situations the placebo effect comes to act as a powerful remedy linking mind to body functioning

• Its effect ranges from 30 to 70% and its use in modern medicine is wider than expected by patients and admitted by drug producers

• Once scientifically well established and verified the concerns about use of placebo are mainly ethical

• Placebo paradox - use of a placebo as a kind of deception is solved when the therapist knows that he is in fact addressing the patient mind with a use of appropriate SYMBOL triggering self healing response.

• Placebo effect in Medical Spa therapy is in fact only adjuvant as it is in other medical specialties.

• Therapeutic procedures used are very physical, and based on physiological reactions and adaptations.

Difference between Spa and Medical Spa• Spa as pleasure and recreation: (UK, US)Therapeutic benefits of the place and natural resources are not specifically defined.Mostly no physician is present and no medical check in examination is done upon arrival.No therapy regimen ordered - Guest has a leisure time in a nice setting, and is free to choose his own program from offered procedure. Community does not participate on payment

• Spa as a serious medical treatment - Medical Spa: (Continental Europe)

Using natural healing resources mainly including mineral springs, environment and climate, known to have beneficial effects on a specific group of conditions named in Indication list.Specialized physician is present and makes admission to the therapy with initial medical check-up including labs and physiological tests as ECG, spirometry etc.Therapy regimen is ordered including diet, daily exercises, physiotherapy procedures and medical follow ups. Leisure time is limited.Medical examination upon discharge and discharge report is providedCommunity often participates on payment (Germany, France, Italy, Spain, Austria, Czech…)

Medical spa treatment has clearly evidence based therapeutic effect documented in rigorous scientific studies done in Germany, France and Italy. Cost effectiveness of medical spa therapy is documented in health statistics as spa therapy leads to statistically significant reduction in sick leaves and hospitalizationshttp://www.law.upenn.edu/fac/jklick/34EEJ364.pdfDo Spa Visits Improve Health: Evidence From German Micro DataJonathan Klicka and Thomas StratmannbCollege of Law, 425 West Jefferson Street Tallahassee, FL 32301-1609, USA.Department of Economics, George Mason University, 1D3 Carow Hall, FairfaxVA 22030, USA.

CONCLUSION: Spa therapy has many proponents and a long history to support it; this may be why a number of European private and public insurers cover spa treatments. Potentially, spa treatments represent a cheaper alternative to standard medical treatments for a number of health problems.Using longitudinal micro data from the GSOEP, we demonstrate that there are statistically significant benefits from spa treatments in terms of lower occupational absenteeism and hospitalization, once we control for the endogeneity of the choice to visit a spa through individual fixed effects. Although these results present credible evidence that there is a causal connection between spa visits and improved health, it is unclear whether the improvements are large enough to justify spa visits on the basis of positive net benefits. Our low estimates imply a reduction in workday losses of between 1 and 2 days in the year after the spa visit, and the largest estimates imply a reduction of 5 work loss days. A typical spa treatment lasts about 2 to 3 weeks or between 10 and 15 working days. This suggests that spa treatments need to have large positive effects on reduced work loss days in subsequent years if treatments are to produce net benefits to the economy. Limited testing suggests that any longer term effects are not large. Although the net economic effects of spa therapy appear to be small, the health improvements generated by spa visits identified in this paper could represent net gains for insurers, suggesting that public and private insurers might be well served by additional research in this area.

Even though USA is not a traditional Spa country

It has a growing Spa industry, including Medical spas

• 340 000 Employees• 11,736 day spas in the U.S., 80% of the total.• 1,345 resort and hotel spas, 9% of the total.

• 976 medical spas, 7% of the total• 428 club spas, 3% of the total.• 51 mineral springs spas, 0.4% of the total

• Annual Revenues of the Spa Industry: in the U.S increased from• $9.7 billion in 2005 to $12.8 billion in 2008.

• Revenues of medical spas more than doubled

• Annual Revenues By Spa Type:• Day spas : $5.294 billion in 2006• Resort and hotel spas: $2.499 billion, up from $2.026 billion.

• Medical spas: $1,063 billion, up from $469 million• Club spas: $242 million, up from $209 million.

European health resorts and spas generate turnover of some €20 billion every year. Employing over 500,000 people in around 1000 Spa places and supporting an additional 1.2 million jobs in related fields, the sector is one of the biggest employers in the EU in both healthcare and tourism – especially in regions where there is little industry.

Czech Republic 10 million people – Central Europe, EU and Schengen member, non-EURO user, historically and culturally close to Austria and Germany

GDP/PPP/Capita /IMF(2010)24 000 Int.$ very close to KSA

Overall Healthcare spending in 2010 was 13 billion USD (1300$/capita).Medical Spa treatment spending fully or partially covered by Healthcare insurance was 200 million USD and number of patients treated in 2010 was 150 000.

Indication list• I. Oncological diseases related conditions• II. Cardiovascular diseases • III. Gastrointestinal diseases• IV. Endocrine and Metabolic disorders• V. Respiratory diseases non infectious• VI. Neurologic diseases• VII. Orthopedics and Rheumatology disorders• IX. Kidney and Urologic diseases• X. Psychiatric disorders• XI. Dermatological diseases• XII. Gynecological diseases

Contraindications:• 1. ANY acute disease• 2. Infectious diseases including asymptomatic carriers • 3. Uncontrolled cardiovascular conditions and hypertension with signs of clinical distress • 4. DVT during last three months• 5. Uncontrolled diabetes mellitus• 6. Bleeding conditions• 7. Cachexia• 8. Oncological diseases during treatment and in progression• 9. Epilepsy during last three years or with persistent EEG findings except for cases with neurological clearance and pediatric patients• 10. Recent recurrence of psychotic symptoms, disorientation or challenging behavior including substance

abuse• 11. Patient with severe impairment in ADLs except for the case with a caregiver• 12. Incontinence except for pediatric patients• 13. Smokers in groups II, V a VI• 14. Gravidity• 15. Chronic skin ulcers except for group X

VII. Orthopedics and Rheumatology disordersThe patient is supposed to have medical recommendation for admission sometimes with recent labs, imaging or physiological tests and approval from his Medical Insurance physician for funding.

Following conditions can get 28 day fully covered and in some cases even repeated Spa therapy if recommended by Orthopedic surgeon or Physiatrist. Not because the Insurance companies are generous but because it is a cost effective treatment.

• Chronic painful musculoskeletal syndromes• Coxarthrosis and gonarthrosis from stage III. exceptionally II.• Joint degenerations of other localizations• Generalized osteoarthritis• Chronic back pain related to spondyloarthropathy and scoliosis• Recovery and rehabilitation after bone and joints trauma and surgery• Recovery and rehabilitation after spinal surgery• Recovery and rehabilitation after joint replacements• Reconditioning and mobility improvement before joint replacement

Medical Spas treating Orthopedics and Rheumatology disorders as Listed in Czech Ministry of Health

regulations• Bechyne• Belohrad• Bludov• Bilina• Bohdanec• Darkov Karvina• Dubi• Frantiskovy

Lazne• Hodonin• Jachymov

• Karlovy Vary• Klimkovice• Konstantinovy

Lazne• Kostelec• Kundratice• Libverda• Luhacovice• Marianske Lazne• Msene

• Ostrozska N.Ves• Podebrady• Slatinice• Teplice v Cechach• Teplice n.Becvou• Tousen• Trebon• Velichovky• Vraz

Rehabilitation Spa - Darkov Karvina with a natural source of Iodine-bromine brine is a universal Spa rehabilitation setting with wide range of indications Neuro-rehabilitation and postsurgical program. It can admit patients with severe combined functional impairment and dependent in ADLs http://www.darkov.com/

Spa – Jachymov is Sanatorium style with natural source of radioactive Radon CO2 saturated water with Rheumatology indications, Chronic painful musculoskeletal syndromes and Joint

degeneration http://www.laznejachymov.cz/en/http://rheumatology.oxfordjournals.org/content/39/8/894.long

Karlovy Vary - Spa treatment of gastrointestinal diseases, but covered also for Metabolic diseases including gouty arthritis, pain in the movement system and recovery post oncological and abdominal surgery http://www.karlovy-vary.cz/en/spa-treatments-wellness

Marianske Lazne – Spa with natural source of high carbon dioxide content mineral waterFor wide range of conditions including all above mentioned Orthopedics and Rheumatology disorders and postoperative rehabilitation. Balanced Spa and rehabilitation programhttp://www.marianske-lazne.info/en/spa

Teplice v Cechach – Spa with natural source of

hydrocarbonate-sulphate-sodium water. For wide

range of conditions including Orthopedics and Rheumatology disorders

and postoperative rehabilitation. Spa can accommodate children

with special needs http://www.lazneteplice.cz/en/spa-treatment/

Deep well in Prince Sultan bin Abdulaziz

Humanitarian City as a Possible source of

thermal healing water

Source: Prince Sultan Mineral Water St. Anna Heilwasser Elisabethenquelle RangauerBad Pyrmonter Total Dissolved Solids (TDS) 2300 mg/l 1800 mg/l 3669 mg/l 3185 mg/l 1607 mg/lCalcium (Ca++) 302 mg/l 304.3 mg/l 469 mg/l 620 mg/l 184 mg/lMagnesium (Mg++) 76 mg/l 84.9 mg/l 97 mg/l 98.8 mg/l 45.5 mg/lSodium (Na+) 367 mg/l 305 mg/l 519 mg/l 325 mg/l 374 mg/lPotassium (K+) 16 mg/l 16.4 mg/l 29 mg/l 21.3 mg/l 7.69 mg/lBicarbonate (HCO3-) 178 mg/l 549 mg/l 730 mg/lChloride (Cl-) 580 mg/l 432 mg/l 719 mg/l 481 mg/l 345 mg/lSulphate (SO4--) 890 mg/l 656 mg/l 1106 mg/l 1640 mg/l 653 mg/lSilica (SiO2) 23 ppmFlouride F- 0.84 mg/l 0.31 mg/lManganese 0.05 mg/l 0.02 mg/lZinc 0.4 mg/lCopper 0.04 mg/l http://www.pmgeiser.ch/mineral/index.php?func=disp&parval=2483Iron 2.75 ppmCadmium less than 0.01 mg/lNitrate 30 mg/lAcidity (PH) 7Temp 65 - Hot mineral spring medially mineralized

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Prince Sultan MineralVater

St. Anna Heilwasser Elisabethenquelle Rangauer Bad Pyrmonter

Total Dissolved Solids(TDS)Sulphate (SO4--)

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Chloride (Cl-)

Calcium (Ca++)

Magnesium (Mg++)

Potassium (K+)

Bicarbonate (HCO3-)

Water composition and its comparison with known mineral springs

• There is strong similarity in mineral composition between the water from SBAHC deep well and known water from Germany - St. Anna Heilwasser.

• Heilwasser meaning is HEALING WATER. There is more than 500 sources of mineral water in Germany majority of them in category common mineralwasser but only 60 categorized as Heilwasser.

• The source of this water is in Bad Windsheim http://en.wikipedia.org/wiki/Bad_Windsheim• For Thermal Spa the link is http://franken-therme.net/

Beneficial analgesic and anti-inflammatory health effects of mineral thermal baths are widely used in cold and

temperate climate zones

It is not about technology transfer You need to get the feelings right…

Healing and recreational potential of thermal spa in subtropical countries is yet to be studied considering important climatic and cultural differences

Thank you for your attention