THE EFFICACY OF THE EFFICACY OF BALNEOTHERAPY BALNEOTHERAPY

IN KNEE OSTEOARTHRITISIN KNEE OSTEOARTHRITIS

Serap ALPER MD.Serap ALPER MD.Dokuz Eylül UniversityDokuz Eylül University

Physical Medicine and Rehabilitation DepartmentPhysical Medicine and Rehabilitation DepartmentİZMİRİZMİR

This study is designed to This study is designed to assess the efficacy of assess the efficacy of balneotherapy in patients balneotherapy in patients with osteoarthritis of the with osteoarthritis of the knees.knees.

32 patients full32 patients full filling the filling the diagnostic criteria of diagnostic criteria of American College of American College of Rheumatology were Rheumatology were included in the study.included in the study.

The patients were divided into The patients were divided into two groups.two groups. Group I was treated with Group I was treated with

balneotherapy for 3 weeks balneotherapy for 3 weeks in Balçova Spa and home in Balçova Spa and home exercise therapy.exercise therapy.

Group II was only treated Group II was only treated with home exercise therapy.with home exercise therapy.

The evaluation parameters were; The evaluation parameters were; self reported Western Ontario self reported Western Ontario MacMaster Questionnaire MacMaster Questionnaire (WOMAC) WOMAC pain, WOMAC (WOMAC) WOMAC pain, WOMAC joint stiffness, WOMAC physical joint stiffness, WOMAC physical function scores, range of motion function scores, range of motion assessment with goniometry, assessment with goniometry, Nottingham Health Profile and Nottingham Health Profile and visuvisueel analog scale for pain.l analog scale for pain.

Osteoarthritis is a chronic Osteoarthritis is a chronic disorder characterized by disorder characterized by softening and disintegration of softening and disintegration of articular cartilage, with articular cartilage, with reactive phenomena reactive phenomena ssuch as uch as vascular congestion and vascular congestion and osteoblastic activity in the osteoblastic activity in the subcortical bone, new growth subcortical bone, new growth of cartilage and bone of cartilage and bone (i,e,.osteophytes) at the joint (i,e,.osteophytes) at the joint margins and capsular fibrosis.margins and capsular fibrosis.

The aim of balneotherapy inThe aim of balneotherapy in

osteoarthritis is:osteoarthritis is: to increase ROMto increase ROM decrease muscle spasmdecrease muscle spasm improve functional mobilityimprove functional mobility decrease paindecrease pain increase QoLincrease QoL

Table 1. Demografic Qualities of the Patients

Spa Therapy Group

Avg ± SS

Control Group

Avg ± SS

Age (Year) 58.43 ± 6.35 58.31 ± 5.60

BMI 30.0 ± 5.39 28.18 ± 3.52

Gender 16 Female 16 Female

Number of case (n) 16 16

Table 2. Comparison of the Groups before Therapy

Spa Therapy GroupAvg ± SS

Control GroupAvg ± SS

Pain during relaxing (VAS) (0 – 10 cm)

4.66 ± 3.03 3.5 ± 2.44

Pain during walking (VAS) (0 – 10 cm)

5.35 ± 2.45 5.87 ± 2.24

Pain while climbing steps (VAS) (0 – 10 cm)

7.59 ± 2.66 7.12 ± 1.40

WOMAC (pain) (0 – 25)

16.12 ± 2.75 14.25 ± 3.33

WOMAC (joint stiffness) (0 – 10)

6.12 ± 2.06 4.12 ± 1.78*

WOMAC (physical function) (0 – 85)

55.62 ± 14.52 48.37 ± 8.67*

VAS : Visuel Analog ScaleWOMAC : Western Ontario MacMaster Questionnaire* : p<0.05

Table 3. Evaluation of the Patients in the Spa Therapy Group Before and After the Therapy

Before the TherapyAvg ± SS

After the TherapyAvg ± SS

Pain during relaxing (VAS) (0 – 10 cm)

4.66 ± 3.03 1.86 ± 2.29 *

Pain during walking (VAS) (0 – 10 cm)

5.35 ± 2.45 2.78 ± 2.19 *

Pain while climbing steps(VAS) (0 – 10 cm)

7.59 ± 2.66 4.23 ± 2.37 *

WOMAC (pain) (0 – 25)

16.12 ± 2.75 11.18 ± 4.21 *

WOMAC (joint stiffness) (0 – 10)

6.12 ± 2.06 4.81 ± 1.83 *

WOMAC (physical function) (0 – 85)

55.62 ± 14.52 41.81 ± 12.66 *

VAS : Visuel Analog ScaleWOMAC : Western Ontario MacMaster Questionnaire* : p<0.05

Table 4. Evaluation of the Patients in the Control Group Before and After the Therapy

Before the TherapyAvg ± SS

After the TherapyAvg ± SS

Pain during relaxing (VAS) (0 – 10 cm)

3.5 ± 2.44 1.37 ± 1.82 *

Pain during walking (VAS) (0 – 10 cm)

5.87 ± 2.24 2.93 ± 2.08 *

Pain while climbing steps(VAS) (0 – 10 cm)

7.12 ± 1.40 3.68 ± 1.92 *

WOMAC (pain) (0 – 25)

14.25 ± 3.33 8.81 ± 3.18 *

WOMAC (joint stiffness) (0 – 10)

4.12 ± 1.78 3.18 ± 1.42 *

WOMAC (physical function) (0 – 85)

48.37 ± 8.67 32.81 ± 9.74 *

VAS : Visuel Analog ScaleWOMAC : Western Ontario MacMaster Questionnaire* : p<0.05

Table 5. Improvements in Subgroups of the Nottingham Health Profile

Spa Therapy Group

Avg ± SS

Control Group

Avg ± SS

Before the Therapy

After the Therapy

Before the Therapy

After the Therapy

Pain 72.72 ± 25.29 33.06 ± 24.29* 66.78 ± 25.92 32.81 ± 24.30*

Physical Activity

43.12 ± 19.56 23.64 ± 12.68* 38.33 ± 22.0 27.49 ± 18.23*

Sleep 44.69 ± 35.32 31.15 ± 28.25 41.48 ± 37.28 37.45 ± 34.02

Fatique 57.52 ± 39.86 44.55 ± 40.06 55.69 ± 41.24 47.64 ± 35.66

Social Isolation

10.95 ± 19.51 5.36 ± 16.54 24.39 ± 23.38 22.99 ± 22.75

Emotional

Reactions22.57 ± 18.32 11.10 ± 16.58* 22.70 ± 29.03 22.70 ± 29.03

* : p<0.05

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ConclusionConclusionIn knee osteoarthritis patients, inIn knee osteoarthritis patients, inearly therapy period early therapy period

balneotherapybalneotherapywas no better than home exercisewas no better than home exercisetherapy.therapy.We need longterm, Large series ofWe need longterm, Large series ofcontrolled studies to find out thecontrolled studies to find out theeffectiviness of balneotherapy ineffectiviness of balneotherapy inknee osteoarthritis.knee osteoarthritis.