Skip to main content
Top

12-06-2018 | Osteoarthritis | Article

Effects of balneotherapy and spa therapy on quality of life of patients with knee osteoarthritis: a systematic review and meta-analysis

Journal: Rheumatology International

Authors: Michele Antonelli, Davide Donelli, Antonella Fioravanti

Publisher: Springer Berlin Heidelberg

Abstract

Knee osteoarthritis (OA) is a degenerative disease which is expected to become one of the leading causes of disability by the next years. This work aims to assess if balneotherapy and spa therapy can significantly improve Quality of Life (QoL) of patients with knee OA. Medline via PubMed, Scopus, Web of Science, Cochrane Library, and PEDro were systematically searched for articles about trials involving patients with knee OA and measuring the effects of balneotherapy and spa therapy on study participants’ QoL with validated scales. A qualitative and quantitative syntheses were performed. Seventeen studies were considered eligible and included in the systematic review. Fourteen trials reported significant improvements in at least one QoL item after treatment. Ten studies were included in quantitative synthesis. When comparing balneological interventions with standard treatment, results favored the former in terms of long-term overall QoL [ES = − 1.03 (95% CI − 1.66 to − 0.40)]. When comparing balneological interventions with sham interventions, results favored the former in terms of long-term pain improvement [ES = − 0.38 (95% CI − 0.74 to − 0.02)], while no significant difference was found when considering social function [ES = − 0.16 (95% CI − 0.52 to 0.19)]. In conclusion, even though limitations must be considered, evidence shows that BT and spa therapy can significantly improve QoL of patients with knee OA. Moreover, reduction of drug consumption and improvement of algofunctional indexes may be other beneficial effects. Further investigation is needed because of limited available data.
Literature
1.
Zhang Y, Jordan JM (2010) Epidemiology of osteoarthritis. Clin Geriatr Med 26(3):355–369. https://​doi.​org/​10.​1016/​j.​cger.​2010.​03.​001 CrossRefPubMedPubMedCentral
2.
Murray CJ, Vos T, Lozano R et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2197–2223. https://​doi.​org/​10.​1016/​S0140-6736(12)61689-4 CrossRefPubMed
3.
Cross M, Smith E, Hoy D 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. https://​doi.​org/​10.​1136/​annrheumdis-2013-204763 CrossRefPubMed
4.
Hunter DJ, Schofield D, Callander E (2014) The individual and socioeconomic impact of osteoarthritis. Nat Rev Rheumatol 10:437–441. https://​doi.​org/​10.​1038/​nrrheum.​2014.​44 CrossRefPubMed
5.
Losina E, Walensky RP, Reichmann WM et al (2011) Impact of obesity and knee osteoarthritis on morbidity and mortality in older americans. Ann Intern Med 154:217–226. https://​doi.​org/​10.​7326/​0003-4819-154-4-201102150-00001 CrossRefPubMedPubMedCentral
6.
Hochberg MC, Altman RD, April KT et al (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res 64:465–474. https://​doi.​org/​10.​1002/​acr.​21596 CrossRef
7.
McAlindon TE, Bannuru RR, Sullivan MC et al (2014) OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartil 22:363–388. https://​doi.​org/​10.​1016/​j.​joca.​2014.​01.​003 CrossRef
8.
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 28:501–507. https://​doi.​org/​10.​1007/​s10067-009-1114-2 CrossRefPubMed
9.
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. https://​doi.​org/​10.​1007/​s00484-014-0913-6 CrossRefPubMed
10.
Matsumoto H, Hagino H, Hayashi K, Ideno Y, Wada T, Ogata T, Akai M, Seichi A, Iwaya T (2017) The effect of balneotherapy on pain relief, stiffness, and physical function in patients with osteoarthritis of the knee: a meta-analysis. Clin Rheumatol 36:1839–1847. https://​doi.​org/​10.​1007/​s10067-017-3592-y CrossRefPubMed
11.
Ciani O, Pascarelli NA, Giannitti C, Galeazzi M, Meregaglia M, Fattore G, Fioravanti A (2017) Mud-bath therapy in addition to usual care in bilateral knee osteoarthritis: an economic evaluation alongside a randomized controlled trial. Arthritis Care Res 69:966–972. https://​doi.​org/​10.​1002/​acr.​23116 CrossRef
12.
Gutenbrunner C, Bender T, Cantista P, Karagülle Z (2010) A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology. Int J Biometeorol 54:495–507. https://​doi.​org/​10.​1007/​s00484-010-0321-5 CrossRefPubMed
13.
Fioravanti A, Karagülle M, Bender T, Karagülle MZ (2017) Balneotherapy in osteoarthritis: facts, fiction and gaps in knowledge. Eur J Integr Med 9:148–150. https://​doi.​org/​10.​1016/​j.​eujim.​2017.​01.​001 CrossRef
14.
Forestier R, Erol Forestier F, Francon A (2016) Spa therapy and knee osteoarthritis: a systematic review. Ann Phys Rehabil Med 59:216–226. https://​doi.​org/​10.​1016/​j.​rehab.​2016.​01.​010 CrossRefPubMed
15.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. https://​doi.​org/​10.​1371/​journal.​pmed.​1000100 CrossRefPubMedPubMedCentral
16.
Altman R, Asch E, Bloch D et al (1986) Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum 29:1039–1049. https://​doi.​org/​10.​1002/​art.​1780290816 CrossRefPubMed
17.
Carr A (2003) Adult measures of Quality of Life: The Arthritis Impact Measurement Scales (AIMS/AIMS2), Disease Repercussion Profile (DRP), EuroQoL, Nottingham Health Profile (NHP), Patient Generated Index (PGI), Quality of Well-Being Scale (QWB), RAQoL, Short Form-36 (SF-36), Sickness Impact Profile (SIP), SIP-RA, and World Health Organization’s Quality of Life Instruments (WHOQoL, WHOQoL-100, WHOQoL-Bref). Arthritis Care Res. https://​doi.​org/​10.​1002/​art.​11414 CrossRef
18.
Bruce B, Fries JF (2003) The Stanford Health Assessment Questionnaire: dimensions and practical applications. Health Qual Life Outcomes 1:20. https://​doi.​org/​10.​1186/​1477-7525-1-20 CrossRefPubMedPubMedCentral
19.
Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD (2011) Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int 31(11):1409. https://​doi.​org/​10.​1007/​s00296-011-1999-3 CrossRefPubMed
20.
Fioravanti A, Giannitti C, Bellisai B, Iacoponi F, Galeazzi M (2012) Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee. Int J Biometeorol 56(4):583–590. https://​doi.​org/​10.​1007/​s00484-011-0447-0 CrossRefPubMed
21.
Fioravanti A, Bellisai B, Iacoponi F, Manica P, Galeazzi M (2011) Phytothermotherapy in osteoarthritis: a randomized controlled clinical trial. J Altern Complement Med 17(5):407–412. https://​doi.​org/​10.​1089/​acm.​2010.​0294 CrossRefPubMed
22.
Antúnez LE, Puértolas BC, Burgos BI, Payán JMP, Piles STT (2013) Effects of mud therapy on perceived pain and quality of life related to health in patients with knee osteoarthritis. Reumatología Clínica (English Edition) 9(3):156–160. https://​doi.​org/​10.​1016/​j.​reumae.​2013.​03.​001 CrossRef
23.
Forestier R, Desfour H, Tessier JM, Françon A, Foote AM, Genty C, Rolland C, Roques CF, Bosson JL (2009) Spa therapy in the treatment of knee osteoarthritis, a large randomised multicentre trial. Ann Rheum Dis. https://​doi.​org/​10.​1136/​ard.​2009.​113209 PubMedCrossRef
24.
Nguyen M, Revel M, Dougados M (1997) Prolonged effects of 3 week therapy in a spa resort on lumbar spine, knee and hip osteoarthritis: follow-up after 6 months. A randomized controlled trial. Br J Rheumatol 36(1):77–81. https://​doi.​org/​10.​1093/​rheumatology/​36.​1.​77 CrossRefPubMed
25.
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(2):125–132. https://​doi.​org/​10.​1097/​PHM.​0b013e3181c1eb81​ CrossRefPubMed
26.
Fioravanti A, Bacaro G, Giannitti C, Tenti S, Cheleschi S, Guidelli 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):1333–1343. https://​doi.​org/​10.​1007/​s00484-014-0943-0 CrossRefPubMed
27.
Cantarini L, Leo G, Giannitti C, Cevenini G, Barberini P, Fioravanti A (2006) Therapeutic effect of spa therapy and short wave therapy in knee osteoarthritis: a randomized, single blind, controlled trial. Rheumatol Int 27(6):523–529. https://​doi.​org/​10.​1007/​s00296-006-0266-5 CrossRefPubMed
28.
Branco M, Rêgo NN, Silva PH, Archanjo IE, Ribeiro MC, Trevisani VF (2016) Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial. Eur J Phys Rehabil Med 52(4):422–430PubMed
29.
Kulisch A, Benkö A, Bergmann A et al (2014) Evaluation of the effect of Lake Hévíz thermal mineral water in patients with osteoarthritis of the knee: a randomized, controlled, single-blind, follow-up study. Eur J Phys Rehabil Med 50:373–381PubMed
30.
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 11(2):88PubMed
31.
Yurtkuran M, Yurtkuran M, Alp A, Nasırcılar A, Bingöl Ü, Altan L, Sarpdere G (2006) Balneotherapy and tap water therapy in the treatment of knee osteoarthritis. Rheumatol Int 27(1):19–27. https://​doi.​org/​10.​1007/​s00296-006-0158-8 CrossRefPubMed
32.
Evcik D, Kavuncu V, Yeter A, Yigit İ (2007) The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. Jt Bone Spine 74(1):60–65. https://​doi.​org/​10.​1016/​j.​jbspin.​2006.​03.​009 CrossRef
33.
Güngen G, Ardic F, Fιndıkoğlu G, Rota S (2012) The effect of mud pack therapy on serum YKL-40 and hsCRP levels in patients with knee osteoarthritis. Rheumatol Int 32(5):1235–1244. https://​doi.​org/​10.​1007/​s00296-010-1727-4 CrossRefPubMed
34.
Sarsan A, Akkaya N, Özgen M, Yildiz N, Atalay NS, Ardic F (2012) Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis. J Back Musculoskelet Rehabil 25(3):193–199. https://​doi.​org/​10.​3233/​BMR-2012-0327 CrossRefPubMed
35.
Tefner IK, Gaál R, Koroknai A, Ráthonyi A, Gáti T, Monduk P, Kiss E, Kovács C, Bálint G, Bender T (2013) The effect of Neydharting mud-pack therapy on knee osteoarthritis: a randomized, controlled, double-blind follow-up pilot study. Rheumatol Int 33(10):2569–2576. https://​doi.​org/​10.​1007/​s00296-013-2776-2 CrossRefPubMed
36.
Özkuk K, Gürdal H, Karagülle M, Barut Y, Eröksüz R, Karagülle MZ (2017) Balneological outpatient treatment for patients with knee osteoarthritis; an effective non-drug therapy option in daily routine? Int J Biometeorol 61(4):719–728. https://​doi.​org/​10.​1007/​s00484-016-1250-8 CrossRefPubMed
37.
Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14(1):135. https://​doi.​org/​10.​1186/​1471-2288-14-135 CrossRefPubMedPubMedCentral
38.
Luo D, Wan X, Liu J, Tong T (2016) Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. https://​doi.​org/​10.​1177/​0962280216669183​ PubMedCentralCrossRefPubMed
39.
Cuijpers P, Weitz E, Cristea IA, Twisk J (2017) Pre-post effect sizes should be avoided in meta-analyses. Epidemiol Psychiatr Sci 26(4):364–368. https://​doi.​org/​10.​1017/​S204579601600080​9 CrossRefPubMed
40.
Taccari E, Spadaro A, Rinaldi T, Riccieri V, Sensi F (1998) Comparison of the Health Assessment Questionnaire and Arthritis Impact Measurement Scale in patients with psoriatic arthritis. Revue du rhumatisme (English Ed) 65(12), 751–758
41.
Kvien TK, Kaasa S, Smedstad LM (1998) Performance of the Norwegian SF-36 Health Survey in patients with rheumatoid arthritis. II. A comparison of the SF-36 with disease-specific measures. J Clin Epidemiol 51(11):1077–1086. https://​doi.​org/​10.​1016/​S0895-4356(98)00099-7 CrossRefPubMed
42.
Söderman P, Malchau H (2000) Validity and reliability of Swedish WOMAC Osteoarthritis Index: a self-administered disease-specific questionnaire (WOMAC) versus generic instruments (SF-36 and NHP). Acta Orthop Scand 71(1):39–46. https://​doi.​org/​10.​1080/​0001647005294387​4 CrossRefPubMed
43.
Salaffi F, Leardini G, Canesi B, Mannoni A, Fioravanti A, Caporali R, Lapadula G, Punzi L (2003) Gonarthrosis and Quality Of Life Assessment (GOQOLA) Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. Osteoarthritis Cartil 11:551–560CrossRef
44.
Gignac MA, Cao X, Mcalpine J, Badley EM (2011) Measures of disability: Arthritis Impact Measurement Scales 2 (AIMS2), Arthritis Impact Measurement Scales 2-Short Form (AIMS2-SF), The Organization for Economic Cooperation and Development (OECD) Long-Term Disability (LTD) Questionnaire, EQ-5D, World Health Organization Disability Assessment Schedule II (WHODASII), Late-Life Function and Disability Instrument (LLFDI), and Late-Life Function and Disability Instrument-Abbreviated Version (LLFDI-Abbreviated). Arthritis Care Res. https://​doi.​org/​10.​1002/​acr.​20640 CrossRef
45.
Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2009) Introduction to meta-analysis. Wiley, ChichesterCrossRef
46.
Gaál J, Varga J, Szekanecz Z, Kurko J, Ficzere A, Bodolay E, Bender T (2008) Balneotherapy in elderly patients: effect on pain from degenerative knee and spine conditions and on quality of life. Isr Med Assoc J 10(5):365PubMed
47.
Yilmaz B, Goktepe AS, Alaca R, Mohur H, Kayar AH (2004) Comparison of a generic and a disease specific quality of life scale to assess a comprehensive spa therapy program for knee osteoarthritis. Jt Bone Spine 71(6):563–566. https://​doi.​org/​10.​1016/​j.​jbspin.​2003.​09.​008 CrossRef
48.
Guillemin F, Virion JM, Escudier P, de Talancé N, Weryha G (2001) Effect on osteoarthritis of spa therapy at Bourbonne-les-Bains. Jt Bone Spine 68(6):499–503. https://​doi.​org/​10.​1016/​S1297-319X(01)00314-1 CrossRef
49.
Benedetti F, Pollo A, Lopiano L, Lanotte M, Vighetti S, Rainero I (2003) Conscious expectation and unconscious conditioning in analgesic, motor, and hormonal placebo/nocebo responses. J Neurosci 23(10):4315–4323CrossRefPubMedPubMedCentral
50.
Miller FG, Kaptchuk TJ (2008) The power of context: reconceptualizing the placebo effect. J R Soc Med 101(5):222–225. https://​doi.​org/​10.​1258/​jrsm.​2008.​070466 CrossRefPubMedPubMedCentral
51.
Goold SD, Lipkin M (1999) The doctor–patient relationship. J Gen Intern Med 14(S1):26–33. https://​doi.​org/​10.​1046/​j.​1525-1497.​1999.​00267.​x CrossRef
52.
Lau J, Ioannidis JP, Terrin N, Schmid CH, Olkin I (2006) Evidence based medicine: the case of the misleading funnel plot. Br Med J 333(7568):597. https://​doi.​org/​10.​1136/​bmj.​333.​7568.​597 CrossRef