Balneotherapy for osteoarthritis
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 17 OCT 2007
Assessed as up-to-date: 19 AUG 2007
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Verhagen AP, Bierma-Zeinstra SMA, Boers M, Cardoso JR, Lambeck J, de Bie R, de Vet HCW. Balneotherapy for osteoarthritis. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006864. DOI: 10.1002/14651858.CD006864.
- Publication Status: Edited (no change to conclusions)
- Published Online: 17 OCT 2007
Balneotherapy (or spa therapy, mineral baths) for patients with arthritis is one of the oldest forms of therapy. One of the aims of balneotherapy is to soothe the pain and as a consequence to relieve patients' suffering and make them feel well. In this update we included one extra study.
To assess the effectiveness of balneotherapy for patients with osteoarthritis (OA).
We searched the following databases up to October 2006: EMBASE, PubMed, the Cochrane 'Rehabilitation and Related Therapies' Field database, PEDro, CENTRAL (Issue 3, 2006) and performed reference checking and communicated with authors to retrieve eligible studies.
Randomised controlled trials (RCT) comparing balneotherapy with any intervention or no intervention. At least 90% of the patient population had to be diagnosed with OA.
Data collection and analysis
Two authors independently assessed quality and extracted data. Disagreements were solved by consensus. In the event of clinical heterogeneity or lack of data we refrained from statistical pooling.
Seven trials (498 patients) were included in this review. Two studies compared spa-treatment with no treatment. One study evaluated baths as an add-on treatment to home exercises and another compared thermal water from Cserkeszölö with tap water (placebo). Three studies evaluated sulphur or Dead Sea baths with no treatment or mineral baths with tap water baths or no treatment. Only one of the trials performed an intention-to-treat analysis and two studies provided data to perform an intention-to-treat analysis ourselves. A 'quality of life' outcome was reported by one trial.
silver level evidence concerning the beneficial effects on pain, quality of life and analgesic intake of mineral baths compared to no treatment (SMD between 1.82 and 0.34).
a statistically significant difference in pain and function of Dead Sea + sulphur versus no treatment, only at end of treatment (WMD 5.7, 95%CI 3.3 to 8.1), but not at 3 month follow-up (WMD 2.6, 95%CI -1.1 to 6.3).
no statistically significant differences in pain or function at one or three months of Dead Sea baths versus no treatment (WMD 0.5, 95%CI -0.6 to 1.6) or at one or three months of sulphur baths versus no treatment (WMD 0.4, 95%CI -0.9 to 1.7).
Adverse events were not measured in the included trials.
We found silver level evidence (www.cochranemsk.org) concerning the beneficial effects of mineral baths compared to no treatment. Of all other balneological treatments no clear effects were found. However, the scientific evidence is weak because of the poor methodological quality and the absence of an adequate statistical analysis and data presentation. Therefore, the noted "positive findings" should be viewed with caution.
Plain language summary
Balneotherapy or spa-therapy for Osteoarthritis
This summary of a Cochrane review presents what we know from research about the effect of Balneotherapy (mineral baths) for Osteoarthritis (OA). The review shows that in people with OA:
- Spending time in a mineral bath compared to no treatment may improve pain and quality of life.
- Spending time in both a sulfur bath and a dead sea bath compared to no treatment may improve pain one month after treatment.
- Spending time in a sulfur bath or a Dead Sea bath compared to no treatment may not lead to any difference in pain.
There is not enough data to tell if spending time in mineral baths has any effect on a person's physical function or their quality of life.
How people felt overall and any side effects were not measured in these studies.
What is osteoarthritis (OA) and what is balneotherapy?
Osteoarthritis is a disease of the joints. When joints lose cartilage, the bone in your joints tries to repair the damage. Instead of making things better, however, the bone grows abnormally and makes things worse. For example, the bone can become misshapen and make the joint painful and unstable.
Doctors used to think that osteoarthritis was caused by wear and tear on the cartilage. However, it's now thought that osteoarthritis is a disease of the whole joint. OA is one of the most common forms of arthritis and affects men and women equally. For many people OA is one of the main causes of long-term disability.
Balneotherapy or spa-therapy is an ancient and popular therapy. It involves spending time in an indoor pool filled with mineral water at temperature of between 31 to 34 degrees Celsius (88 to 93 degrees Farenheit). Different types of mineral water may be used in this therapy.
搜尋包括到2006年10月EMBASE, PubMed, the Cochrane ‘Rehabilitation and Related Therapies’ Field database, PEDro, CENTRAL (Issue 3, 2006)。同時手動搜尋回顧文章之參考文獻及詢問專家以獲得合適的文章。
在這項回顧中包括了7個研究包含498例病患。2篇比較溫泉浴療與未治療，1篇比較浴療加家中運動與家中運動，另1篇比較由Cserkesz來的熱水比上自來水﹝安慰劑﹞。3篇研究硫磺或死海浴比上不治療或礦物浴比上自來水浴或未治療。只有1篇進行意圖治療分析，另2篇提供資料作意圖治療分析。只有1篇分析生活指標。礦物浴比上未治療對疼痛、生活品質、吃止痛藥為銀級證據 (SMD between 1.82 and 0.34)。死海浴加硫磺比上未治療對疼痛及功能有統計差異，只有在治療結束有效(WMD 5.7, 95% CI 3.3 to 8.1)， 但追蹤3個月時無顯著差異(WMD 2.6, 95% CI −1.1 to 6.3)。在疼痛及功能方面，死海浴一到三個月比上未治療對疼痛(WMD 0.5, 95% CI −0.6 to 1.6)及功能無統計顯著差異，或硫磺浴一到三個月比上未治療對疼痛及功能無統計顯著差異(WMD 0.4, 95% CI −0.9 to 1.7)。研究中未評估副作用。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
溫泉浴療治療退化性關節炎。 此Cochrane 回顧摘要了我們所知道有關浴療法(礦物浴)治療退化性關節炎效果的研究。回顧顯示，在退化性關節炎患者：與不治療相比，花費時間在礦泉浴可以改善疼痛和生活品質。與不治療相比，花時間在含硫磺浴加死海浴1個月可改善疼痛。與不治療相比，花時間在硫磺浴或死海浴可能不會導致任何疼痛的差異。沒有足夠的數據來判斷是否花時間在礦物浴對患者的身體功能或生活品質有任何效果。在這些研究中並沒有測量患者整體感受和副作用。 什麼是退化性關節炎和浴療法是什麼？ 退化性關節炎是一種關節疾病。當關節軟骨失去時，關節的骨頭會嘗試修復損壞。但這不是使事情更好，反而，骨生長異常使事情變得更糟。例如，骨頭變得畸形，使關節疼痛和不穩定。醫生曾經認為退化性關節炎是由於軟骨的磨損和撕裂。但是，現在認為退化性關節炎是一種整體關節的疾病。退化性關節炎是一種關節炎最常見的形式，影響男性和女性機率是同等的。對於許多人，退化性關節炎是造成長期殘疾其中一個主要的原因。浴療法或溫泉療法是一種古老和流行的療法。它涉及花時間在一個充滿溫度達攝氏31至34度(88至93華氏度)礦泉的室內池，。不同類型的礦泉都可用於這一療法。