The effects of balneotherapy on depression and anxiety scale scores in patients with osteoarthritis

Abstract

Backround: Osteoarthritis is a chronic, degenerative condition that causes increased pain, decreased functioning, disability and also socioeconomic burden. It has a huge impact on patients' health, well-being and quality of life, and is associated with depressive and anxiety disorders. The aim of this study was to evaluate the effectiveness of balneotherapy and exercise on depression, anxiety and mental health scale scores, and their possible role in the management of patients with osteoarthritis. Materials and Methods: A total of 131 patients with osteoarthritis were included the study. The following scales were assessed: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and 36-item Short Form Survey (SF-36). Patients received standardized balneotherapy and an exercise schedule. Results: Mean age was 57.99 ± 6.19 years and most of them had gonarthrosis (51.0%). The mean BAI and BDI scores were significantly decreased, while the SF-36 physical health and mental health scores were significantly increased following treatment. Negative correlations were found between pre-treatment BDI scores and SF-36 scores before and after treatment. Regression analysis revealed that pre-treatment BDI score was an effective factor on patients' pre-treatment and post-treatment health status. Conclusion: In conclusion, a combination of balneotherapy and exercise improved psychological scale scores in addition to beneficial effects on osteoarthritis-related anxiety, depression and impaired quality of life. The efficacy of balneotherapy on psychological and physical health may show that utilizing a multi-dimensional, individualized and integrated perspective in the treatment of osteoarthritis provides important advantages.

Keywords

• Anxiety
• Balneotherapy
• Depression
• Osteoarthritis
• Physical therapy

References

1. 1. Zhang W, Doherty M, Peat G, Bierma-Zeinstra M, Arden N, Bresnihan B, et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis. 2010;69(3):483-489.
2. 2. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(7):1323-1330.
3. 3. Sharma A, Kudesia P, Shi Q, Gandhi R. Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open access rheumatology: research and reviews. 2016;8(103.
4. 4. Dilekçi E, Özkuk K, Kaki B. Effect of balneotherapy on pain and fatigue in elderly with knee osteoarthritis receiving physical therapy: a randomized trial. Int J Biometeorol. 2019;63(12):1555-1568.
5. 5. Fioravanti A, Iacoponi F, Bellisai B, Cantarini L, Galeazzi M. Short-and long-term effects of spa therapy in knee osteoarthritis. Am J Phys Med Rehabil. 2010;89(2):125-132.
6. 6. Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev. 1988;8(1):77-100.
7. 7. Ware Jr JE. SF-36 health survey. 1999.
8. 8. Stubbs B, Aluko Y, Myint PK, Smith TO. Prevalence of depressive symptoms and anxiety in osteoarthritis: a systematic review and meta-analysis. Age Ageing. 2016;45(2):228-235.

9. 9. Mcalindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22(3):363-388.
10. 10. Tuncer T, Cay FH, Altan L, Gurer G, Kacar C, Ozcakir S, et al. 2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis. Rheumatol Int. 2018;38(8):1315-1331.
11. 11. Özkuk K, Uysal B, Ateş Z, Ökmen BM, Sezer R, Dilek G. The effects of inpatient versus outpatient spa therapy on pain, anxiety, and quality of life in elderly patients with generalized osteoarthritis: a pilot study. Int J Biometeorol. 2018;62(10):1823-1832.
12. 12. Gaál J, Varga J, Szekanecz Z, Kurko J, Ficzere A, Bodolay E, et al. Balneotherapy in elderly patients: effect on pain from degenerative knee and spine conditions and on quality of life. The Israel Medical Association Journal. 2008;10(5):365.
13. 13. Zwolińska J, Weres A, Wyszyńska J. One-year follow-up of spa treatment in older patients with osteoarthritis: a prospective, single group study. BioMed research international. 2018;2018(
14. 14. Matsumoto H, Hagino H, Hayashi K, Ideno Y, Wada T, Ogata T, et al. The effect of balneotherapy on pain relief, stiffness, and physical function in patients with osteoarthritis of the knee: a meta-analysis. Clin Rheumatol. 2017;36(8):1839-1847.
15. 15. Antonelli M, Donelli D, Fioravanti A. Effects of balneotherapy and spa therapy on quality of life of patients with knee osteoarthritis: a systematic review and meta-analysis. Rheumatol Int. 2018;38(10):1807-1824.