THE%20EFFICACY%20OF%20BALNEOTHERAPY%20IN%20KNEE%20OSTEOARTHRITIS

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THE EFFICACY OF BALNEOTHERAPY IN KNEE
OSTEOARTHRITIS
Serap ALPER MD.Dokuz Eylül UniversityPhysical
Medicine and Rehabilitation DepartmentIZMIR
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• This study is designed to assess the efficacy of
  balneotherapy in patients with osteoarthritis of
  the knees.

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

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• The patients were divided into
• two groups.
• Group I was treated with balneotherapy for 3
  weeks in Balçova Spa and home exercise therapy.
• Group II was only treated with home exercise
  therapy.

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

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

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• The aim of balneotherapy in
• osteoarthritis is
• to increase ROM
• decrease muscle spasm
• improve functional mobility
• decrease pain
• increase QoL

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• 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
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• Table 2. Comparison of the Groups before Therapy

Spa Therapy Group Avg SS Control Group Avg 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 Scale WOMAC Western Ontario
MacMaster Questionnaire plt0.05
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• Table 3. Evaluation of the Patients in the Spa
• Therapy Group Before and After the Therapy

Before the Therapy Avg SS After the Therapy Avg 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 Scale WOMAC Western Ontario
MacMaster Questionnaire plt0.05
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• Table 4. Evaluation of the Patients in the
  Control
• Group Before and After the Therapy

Before the Therapy Avg SS After the Therapy Avg 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 Scale WOMAC Western Ontario
MacMaster Questionnaire plt0.05
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• Table 5. Improvements in Subgroups of the
  Nottingham
• Health Profile

Spa Therapy Group Avg SS Spa Therapy Group Avg SS Control 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 Reactions 22.57 18.32 11.10 16.58 22.70 29.03 22.70 29.03
plt0.05
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• Elkayam O, et al.
• Effect of spa therapy in Tiberias
• on patients with rheumatoid
• arthritis and osteoarthritis.
• J. Rheumatol 1991 18 1799-803

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• Sukenik S, et al.
• Balneotherapy at the Dead Sea
• area for knee osteoarthritis.
• IMAJ (Israel Medical Association Journal) 1999
  1 83-85

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• Nguyen M, et al.
• Prolonged effects of 3 week
• therapy in a spa resort on lumbar
• spine, knee and hip osteoarthritis
• Follow-up after 6 months.
• A randomised controlled trial.
• Br.J.Rheumatol 1997 36 77-81

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• Altan L, et al.
• Place of balneotherapy in knee
• osteoarthritis
• Romatizma 1999 2 95-100

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• OReilly CS, et al.
• Quadriceps weakness in knee
• osteoarthritis The effect on
• pain and disability.
• Ann. Rheum.Dis.1998 57 558-94

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• Kovacs I, et al.
• The therapeudic effects of
• Cserkeszolo thermal water
• in osteoarthritis of the knee
• A double blind, controlled,
• Follow-up study.
• Rheumatol Int. 2002 21(6) 218-21

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• Guillemin F, et al.
• Effect on osteoarthritis of spa
• therapy at Bourbonne-Les Bains
• Joint Bone Spine. 2001 68(6) 499-503

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• Tishler M, et al.
• The effect of balneotherapy on
• osteoarthritis.Is an intermittant
• regimen effective ?
• Eur.J.Intern Med.2004 15(2) 93-99

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• Conclusion
• In knee osteoarthritis patients, in
• early therapy period balneotherapy
• was no better than home exercise
• therapy.
• We need longterm, Large series of
• controlled studies to find out the
• effectiviness of balneotherapy in
• knee osteoarthritis.