Medical Hydrology and Balneology: Environmental Aspects

Assessment of Spa therapy in chronic low back
pain. Systematic review of randomized
clinical trials
Françon A (1) , Forestier R (1) , Berkoz F (1)
(1) Centre for Rheumatology and Balneotherapy Research, Aix Les Bains, France
alain-francon@wanadoo.fr
Background
Chronic low back pain (CLBP) is the main disability seen in spa centers in
France,. Six randomized clinical trials (RCT) in the ninety’s and a meta-analysis in
2006 were in favor of an efficacy of spa therapy in CLBP. Since this publication,
five new RCT have been published.
Aim: update of systematic review on efficacy of spa therapy or mineral water in
CLBP.
Method
Bibliographic research of randomized clinical trial (RCT) was realized with the
following keywords “low back pain”, “balneotherapy”, “balneology”, ”crenobalneotherapy”,
“spa therapy”, “mud therapy”, ”mineral water”, ”clinical trial” . Then
we studied the internal and the external validity of the RCT.
Results
We identified 11 RCT’s. None of them carried out a sample size calculation but
statistical power of trials seems to be large enough (number of included patients
between 50 and 224). Two RCT’s didn’t perform a between group difference calculation
and didn’t allow a conclusion about the potential superiority of the treatment
group versus the control group. In four of the RCT’s in which investigator and
patients were not blinded and ITT analysis were not performed, spa therapy was
better than a waiting list for improving pain, function, drug consumption and quality
of life. In one RCT without blinding of the patient and without ITT analysis,
exercises + education + balneotherapy in a spa center improved function and
paracetamol consumption more than exercises + education + physical treatment
(TENS, US, IR) in a rehabilitation center. In one RCT without blinding of patients,
and investigation and with lack of assessment at middle and long-term, physiotherapy
(TENS,US,hotpack) + balneotherapy was better than physiotherapy alone in
pain, stiffness and function. In three of the RCT’s a better improvement was observed
in mineral water bathing than in tap water bathing; but in the 1st of these 3
RCT’s there was no clear assessment of between-group difference and no ITT
Balnea
2012, núm. 6, 66-67
66
ISBN: 978-84-669-1887-0
978-84-669-3482-4