Medical Hydrology and Balneology: Environmental Aspects

Improvement of generalized osteoarthritis after
(creno)balneotherapy: an open study with
evaluation of different outcomes
Berköz FB (1) , Forestier R (2) , Erdogan N (1) , Demircioğlu F (1) , Karagülle MZ (1)
(1) Istanbul University, Istanbul Medical Faculty, Department of Medical Ecology and
Hydroclimatology, Turkey
(2) Centre de Recherche Rhumatologique et Thermal, Aix-Les-Bains, France
romain.forestier@wanadoo.fr
Materials and Methods
Trial design : open prospective study
Participants: patients diagnosed as generalized osteoarthritis according to Kellgren,
American College of Rheumatology and/or Dougados criteria, attending a spa
treatment in Aix Les Bains.
Interventions: 18 days of treatment in 3 weeks (6 days/week). 6 different treatment
modalities in 2 days; combining 15’ mineral mud pack application (45°C), 3
or 7’ showers of 38°C mineral water, 10’ underwater massage (38°C), 10’ swimming
pool underwater hydromassages, 10’mineral cloud (37-45°C Berthollet’s
technique), 25’ supervised pool exercises in 35°C mineral water, 20’ bath tub with
hydrojets (38°C).
Objective: evaluate the change in clinical outcomes of patient with generalized
osteoarthritis after a spa treatment.
Outcomes:
Primary outcomes : improvement at least 50% of patient at the end of therapy
(patient’s opinion on 5 points Likert’s scale).
Secondary outcomes: patient’s acceptable symptom state (PASS), MHAQ,
RAPID3, WOMAC, OSWESTRY DISABILITY INDEX, EuroQol 5D descriptive
system, EuroQol Visual Analog Scale, change in drug consumption.
Sensitivity to change was measured by Standardized response mean.
There was no control group. The therapists were blinded.
Results
245 patients were screened. 99 had generalized osteoarthritis and were analyzed
for the primary outcome,
Outcome 61% of patients were improved at the end of therapy, 68% at 8th
month.
At the end of therapy there was significant improvement in all outcome measures
(p