Intervention Review

Balneotherapy for osteoarthritis

  1. Arianne P Verhagen1,*,
  2. Sita MA Bierma-Zeinstra2,
  3. Maarten Boers3,
  4. Jefferson Rosa Cardoso4,
  5. Johan Lambeck5,
  6. Rob de Bie6,
  7. Henrica CW de Vet7

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 19 AUG 2007

DOI: 10.1002/14651858.CD006864


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.

Author Information

  1. 1

    Erasmus University Medical Centre, Department of General Practice, 3000 DR Rotterdam, Netherlands

  2. 2

    Erasmus Medical Centre University, Department of General Practice, Rotterdam, Netherlands

  3. 3

    Free University Hosptial, Department of Clinical Epidemiology, 1007 MB Amsterdam, Netherlands

  4. 4

    Universidade Estadual de Londrina, Physical Therapy Department, Londrina, Paraná, Brazil

  5. 5

    Universiteit Leuven Tervuursevest, Faculty of Kinesiology and rehabilitation sciences Katholieke, Leuven, Belgium

  6. 6

    Maastricht University, Department of Epidemiology, Maastricht, Netherlands

  7. 7

    Vrije Universiteit Medical Center, EMGO Institute, Amsterdam, Netherlands

*Arianne P Verhagen, Department of General Practice, Erasmus University Medical Centre, PO Box 1738, 3000 DR Rotterdam, Netherlands. a.verhagen@erasmusmc.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

To assess the effectiveness of balneotherapy for patients with osteoarthritis (OA).

Search methods

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.

Selection criteria

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.

Main results

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.

We found:

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.

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

溫泉浴療治療退化性關節炎患者

溫泉浴療(或 溫泉浴、礦物浴)治療關節炎,是古老治療形式之一。溫泉浴療目標之一為緩解疼痛,使患者感覺良好,本更新包括一篇額外研究。

目標

研究溫泉浴療法治療退化性關節的有效性

搜尋策略

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。

選擇標準

隨機對照試驗比較溫泉浴療與任何治療或未治療,其中至少90% 患者為退化性關節炎。

資料收集與分析

兩位作者獨立進行資料摘錄。若有不同意見,由共識決定。若臨床資料有異質性或缺漏就不進行統合分析。

主要結論

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。

作者結論

礦物浴比上未治療之益處為銀級證據。其它溫泉浴療效果不清楚。但因研究方法弱點及無適當統計分析及資料呈現而造成科學證據薄弱。因此這項正面結果,應小心詮釋。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

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。