An Alternative Approach To The Duration Of Balneological Treatment Of Knee Osteoarthritis Patients

Abstract

AİMS: This study aims to compare the effects of balneological treatments applied at traditional and alternative sessions in patients with knee osteoarthritis.

METHODS: Randomized, controlled, single-blind clinical trial. 50 patients were divided into two groups. All patients were given a total of 10 sessions of balneotherapy. Group 1 received consecutive treatment for two weeks, while Group 2 received intermittent treatment for five weeks.  Local peloid at 45°C were applied for 20 minutes, after a tap water (38°C) bath. Evaluations were conducted before, after treatment and at 12th week of post-treatment by Pain (VAS), doctor and patient's global assessment (VAS), Health Assessment Questionnaire and Lequesne Knee Index.

RESULTS: In-group evaluation; all parameters were found to show a statistically significant improvement between the end of treatment and the 12th week measurements of both groups of treatments. There was no statistically significant difference between all the measurements of the two groups.

CONCLUSİON: Our study suggest that traditional and intermittent balneological therapies have similar efficacy in patients with knee osteoarthritis. In terms of health tourism, spa resort managers can arrange alternative treatment combinations that do not require long-term accommodation, allowing many more people to benefit from their facilities.

Keywords

• knee osteoarthritis,peloidotherapy,balneotherapy,spa-treatment

Diz Osteoartirtli Hastaların Balneolojik Tedavilerinde Süreye Alternatif Bir Yaklaşım

Abstract

AMAÇ: Diz osteoartritli hastalarda uygulanan kaplıca küründe geleneksel ve alternatif uygulamaların etkinliğini karşılaştırmak

METOD: Çalışmaya diz osteoartriti olan 50 hasta alındı ve randomizasyonla 25’er kişilik iki gruba ayrıldılar. Tüm hastalara 20 dakika 38°C’de düz su ile banyo sonrasında her iki diz bölgesine 45°C sıcaklıkta kil niteliğinde peloid uygulandı. Geleneksel kür grubunda(Grup 1)  bulunan hastalara olarak 2 hafta süresince haftada 5 gün olacak şekilde ve alternatif grupta(Grup2)ise 5 hafta süresince haftada 2 seans olacak şekilde toplam 10 seans tedavi uygulandı.  Hastalar tedavi öncesinde, tedavi bitiminde ve tedavi sonrası 12. haftada hastanın ağrı değerlendirmesi (VAS), doktorun ve hastanın global değerlendirmesi (VAS), Health Assessment Questionnaire  ve Lequesne Diz İndeksi ile değerlendirildi.

BULGULAR: Grup içi değerlendirmede; tüm parametreler her iki grubun tedavi başına göre tedavi sonu ve 12. hafta ölçümleri arasında istatistiksel olarak anlamlı düzeyde iyileşme gösteren değişim saptandı. İki grup arası yapılan değerlendirmede tüm ölçümler arasında istatistiksel olarak anlamlı düzeyde fark saptanmadı.

SONUÇ: Diz osteoartritli hastalarda günlük yaşam tarzlarını değiştirmeden ve çalışma ortamından uzun süreli uzaklaşmasını gerektirmeden aralıklı verilecek kaplıca tedavi programının etkin bir tedavi seçeneği sağlayabileceğini düşündürmektedir.

Sağlık turizmi açısından alternatif uygulamalarla kaplıca tesis yöneticileri uzun süreli konaklama gerektirmeyen farklı tedavi kombinasyonları düzenleyerek çok daha fazla insanın tesislerinden faydalanmalarını sağlayabilirler.

Keywords

• Diz Osteoartriti,Balneoterapi,Peloidoterapi,spaterapi

References

1. Woolf AD, Pfleger B.( 2003) Burden of major musculoskeletal conditions. Bulletin of the World Health Organization. 81(9):646-656.
2. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL et al.( 2014) The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 73:1323-1330
3. Breedveld FC. (2004) Osteoarthritis—the impact of a serious disease, Rheumatology (Oxford) 2004;43:4-8 https://doi.org/10.1093/rheumatology/keh102
4. Kacar C, Gilgil E, Urhan S et al. (2005) The prevalence of symptomatic knee and distal interphalangeal joint osteoarthritis in the urban population of Antalya, Turkey. Rheumatol Int 25(3): 201-4
5. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H et al. (2014) OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 22:363-88.
6. Tenti S, Cheleschi S, Galeazzi M, Fioravanti A.( 2015) Spa therapy: can be a valid option for treating knee osteoarthritis? Int J Biometeorol 59:1133-1143.
7. Fioravanti A, Karagülle M, Bender T, Karagülle MZ. (2017) Balneotherapy in osteoarthritis: Facts, fiction and gaps in knowledge, Eur. J. Integr. Med http://dx.doi.org/10.1016/j.eujim.2017.01.001
8. Karagülle M, Karagülle MZ. (2015) Effectiveness of balneotherapy and spa therapy for the treatment of chronic low back pain: a review on latest evidence. Clin Rheumatol 34:207-214 doi: 10.1007/s10067-014-2845-2.

9. Gallagher EJ, Liebman M, Bijur PE (2001) Prospective validation of clinically important changes in pain severity measured on a visual analog scale, 38(6):633-638
10. Kucukdeveci AA, Sahin H, Ataman S ve ark. (2004) Issues in crosscultural validity:example from the adaptation, reliability and validity testing of a Turkishversion of the Standford Health Assessment Questionnaire. Arthritis & Rheumatism ;Arthritis Care & Research. 51-1: 14-19.
11. Faucher M, Poiraudeau S, Lefevre-Colau MM, Rannou F, Fermanian J, Revel M. (2003) Assessment of the test-retest reliability and construct validity of a modifi ed Lequesne index in knee osteoarthritis. Joint Bone Spine 70(6):521-5.
12. Blain H, Bernard PL, Canovas G, Raffort N, Desfour H, Soriteau L, Noguès M, Camuzat T, Mercier J, Dupeyron A. (2016) Combining balneotherapy and health promotion to promote active and healthy ageing: the Balaruc-MACVIA- LR® approach. Aging Clin Exp Res 28:1061-1065 DOI 10.1007/s40520-016-0596-4
13. Karagülle M, Kardeş S, Karagülle MZ. (2017)Real-life effectiveness of spa therapy in rheumatic and musculoskeletal diseases: a retrospective study of 819 patients. Int J Biometeorol https://doi.org/10.1007/s00484-017-1384-3
14. Katz U, Shoenfeld Y, Zakin V, Sherer Y, Sukenik S. (2012) Scientific evidence of the therapeutic effects of dead sea treatments: a systematic review. Semin Arthritis Rheum. 42(2):186-200.
15. Harzy T, Ghani N, Akasbi N, Bono W, Nejjari C.(2009) Short- and long-term therapeutic effects of thermal mineral waters in knee osteoarthritis: a systematic review of randomized controlled trials. Clin Rheumatol, 28(5), 501-7
16. Liu H, Zeng C, Gao SG, Yang T, Luo W, Li YS, Xiong YL, Sun JP, Lei GH. (2013) The effect of mud therapy on pain relief in patients with knee osteoarthritis: a meta-analysis of randomized controlled trials. J Int Med Res. 41(5):1418-25.
17. Forestier R, Desfour H, Tessier J-M, et al.(2010) Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial Ann Rheum Dis, 69, 660-665
18. Fioravanti A, Iacoponi F, Bellisai B, Cantarini L, Galeazzi M.(2010) Short- and long-term effects of spa therapy in knee osteoarthritis. Am J Phys Med Rehabil, 89, 125–132.
19. Fioravanti A, Bacaro G, Giannitti C, Tenti S, Cheleschi S, Gui Delli GM, Pascarelli NA, Galeazzi M. (2015) One-year follow-up of mud-bath therapy in patients with bilateral knee osteoarthritis: a randomized, single-blind controlled trial. Int J Biometeorol. 59(9), 1333-43
20. Tishler M, Rosenberg O, Levy O, Elias I, Vazina M.(2004) The effect of balneotherapy on osteoarthritis. Is an intermittent regimen effective? Eur J Intern Med, 15-2, 93-6
21. Sherman G, Zeller L, Avriel A, Friger M, Harari M, Sukenik S.(2009) Intermittent balneotherapy at the Dead Sea area for patients with knee osteoarthritis. Isr Med Assoc J. Feb,11(2):88-93