Advertisement

Rheumatology International

, Volume 27, Issue 1, pp 19–27 | Cite as

Balneotherapy and tap water therapy in the treatment of knee osteoarthritis

  • Merih YurtkuranEmail author
  • Mustafa Yurtkuran
  • Alev Alp
  • Aşkın Nasırcılar
  • Ümit Bingöl
  • Lale Altan
  • Gülnazik Sarpdere
Original Article

Abstract

To investigate if spa water is superior to tap water (TW) in relieving the symptoms of pain, joint motion, life quality in knee osteoarthritis (KOA) patients. In this randomized placebo-controlled trial, 52 patients with KOA were followed in two groups. In group I (n = 27), patients were treated in the pool full of spa water at 37°C for 20 min a day, 5 days a week, for a period of 2 weeks. In group II (n = 25), the same protocol was used but spa water was replaced by TW heated to 37°C. Patients in both groups were given a home-based standardized exercise program. Evaluation parameters were pain (pVAS), tenderness score (TS), 50-ft walking duration, quadriceps muscle strength (QMS), active flexion degree (AFD), WOMAC OA index, and Nottingham Health Profile (NHP). The first evaluation was done after the informed consent was obtained. Second and third evaluations were done at the 2nd and 12th week. PVAS, 50-ft walking duration, AFD, TS, WOMAC, and NHP variables improved in group I. Same variables except QMS improved also in group II. Comparison of the groups just after treatment showed that only pVAS (P = 0.015), NHP pain score (P = 0.020), and TS (P = 0.002) differed significantly in favor of group I at the 2nd or 12th week. Both of the thermal treatment modalities were found to be effective in the management of the clinical symptoms and quality of life in KOA patients. However, pain and tenderness improved statistically better with balneotherapy. There were no significant differences between the groups for the other variables.

Keywords

Balneotherapy Knee osteoarthritis Spa therapy 

Notes

Acknowledgments

We would like to thank the medical secretary Türkan Sarıgül and clinic nurse Neziha Görgeç for their assistance in the preparation of the manuscript.

References

  1. 1.
    Pritzker K (2003) Pathology of osteoarthritis. In: Brandt K, Doherty M, Lohmander LS (eds) Osteoarthritis, 2nd edn. Oxford University Press, Oxford, pp 49–58Google Scholar
  2. 2.
    Jordan KM, Arden NK, Doherty M et al (2003) EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 62:1145–1155PubMedCrossRefGoogle Scholar
  3. 3.
    Dieppe P, Lohmander S (2005) Pathogenesis and management of pain in osteoarthritis. Lancet 365:965–973PubMedCrossRefGoogle Scholar
  4. 4.
    Ehrlich GE (2003) The rise of osteoarthritis. Bull WHO 81:630PubMedGoogle Scholar
  5. 5.
    Woof AD, Akesson K (2001) Understanding the burden of musculoskeletal conditions. The burden is huge and not reflected in national health priorities. BMJ 322:1079–1080CrossRefGoogle Scholar
  6. 6.
    Dieppe P, Basler HD, Chard J, Croft P, Dixon J, Hurley M (1999) Knee replacement surgery for osteoarthritis: effectiveness, practice variations, indications and possible determinants of utilisation. Rheumatology (Oxford) 38:73–77CrossRefGoogle Scholar
  7. 7.
    American College of Rheumatology Subcommittee on Osteoarthritis Guidelines (2000) Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum 43:1905–1915Google Scholar
  8. 8.
    Pendleton A, Arden N, Dougados M et al (2000) EULAR recommendations for the management of knee osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 59:936–944PubMedCrossRefGoogle Scholar
  9. 9.
    Yurtkuran M, Kocagil T (1999) TENS, electroacupuncture and ice massage: comparison of treatment for osteoarthritis of the knee. Am J Acupunct 27:133–140PubMedGoogle Scholar
  10. 10.
    Ay A, Yurtkuran M (2005) Influence of aquatic and weight-bearing exercises on quantitative ultrasound variables in postmenopausal women. Am J Phys Med Rehabil 84(1):52–61PubMedCrossRefGoogle Scholar
  11. 11.
    Sukenik S, Flusser D, Abu-Shakra (1999) The role of spa therapy in various rheumatic disease. Rheum Dis North Am 25:883–897CrossRefGoogle Scholar
  12. 12.
    Yurtkuran M, Kahraman Z, Sivriglu K, Afşin Y, Doğan M (1997) Balneotherapy in low back pain. Eur J Phys Med Rehabil 7:120–123Google Scholar
  13. 13.
    Yurtkuran M, Yurtkuran MA, Dilek K, Güllülü M, Karakoç Y, Özbek L et al (1999) A randomized, controlled study of balneotherapy in patients with rheumatoid arthritis. Phys Rehabil Kur Med 9:92–96Google Scholar
  14. 14.
    Sukenik S, Baradin R, Codish S, Neumann L, Flusser D, Abu-Shakra M et al (2001) Balneotherapy at the Dead Sea area for patients with psoriatic arthritis and concomitant fibromyalgia. Isr Med Assoc J 3:147–150PubMedGoogle Scholar
  15. 15.
    Neumann L, Sukenik S, Bolotin M, Abu-Shakra M, Amir M, Flusser D (2001) The effect of balneotherapy at the Dead Sea on the quality of life of patients with fibromyalgia syndrome. Clin Rheumatol 20:15–19PubMedCrossRefGoogle Scholar
  16. 16.
    Altan L, Bingöl U, Aykaç M, Koc Z, Yurtkuran M (2004) Investigation of the effects of pool-based exercise on fibromyalgia syndrome. Rheumatol Int 24(5):272–277PubMedCrossRefGoogle Scholar
  17. 17.
    Verhagen AP, Bierma-Zeinstra SMA, Cardoso JR, de Bie RA, Boers M, de Vet HCW (2005) Balneotherapy for rheumatoid arthritis. Cochrane Database Syst Rev 1Google Scholar
  18. 18.
    Elkayam O, Wigler I, Tishler M, Rosenblum I, Caspi D, Segal R (1991) Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. J Rheumatol 18:1799–1803PubMedGoogle Scholar
  19. 19.
    Franke A, Reiner L, Pratzel HG, Franke T, Resch KL (2000) Long term efficacy of radon spa therapy in rheumatoid arthritis; a randomized sham-controlled study and follow-up. Rheumatology 39:894–902PubMedCrossRefGoogle Scholar
  20. 20.
    Lehmann JE (ed) (1990) Krusen’s handbook of physical Medicine and rehabilitation. W.B. Saunders Company, PhiladelphiaGoogle Scholar
  21. 21.
    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 36:77–81PubMedCrossRefGoogle Scholar
  22. 22.
    Guillemin F, Virion JM, Escudier P, De Talance N, Weryha G (2001) Effect on osteoarthritis of spa therapy at Bourbonne-les Bains. Joint Bone Spine 68:499–503PubMedCrossRefGoogle Scholar
  23. 23.
    Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Knipschild PG (2001) Balneotherapy for rheumatoid arthritis and osteoarthritis (Cochrane review). In: The Cochrane Library, Issue 1. Oxford: Update SoftwareGoogle Scholar
  24. 24.
    Altman RD, Blach DA, Bole GG, Brandt KD, Cooke DV, Greenwald RA (1999) Development of criteria for osteoarthritis. J Rheumatol 26:1959–1963Google Scholar
  25. 25.
    Kellgren JS, Lawrence JS (1957) Radiological assessment of osteoarthrosis. Ann Rheum Dis 16:494–502PubMedGoogle Scholar
  26. 26.
    Huskisson EC (1983) Visual analogue scale. In: Melzack R (ed) Pain measurement and assessment. Raven Press, New York, pp 33–37Google Scholar
  27. 27.
    Fisher AA (1986) Pressure threshold meter: its use for quantification of tender spots. Arch Phys Med Rehabil 67:836–838Google Scholar
  28. 28.
    Yurtkuran M, Çeliktaş M (1996) A randomised controlled trial of balneotherapy in the treatment of patients with primary fibromyalgia syndrome. Phys Rehabil Kur Med 6:109–112Google Scholar
  29. 29.
    Bellamy N, Buchanan WW, Goldsmith CH, Camphell J, Stiff LW (1986) Validation study of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Arthritis Rheum 29:1039–1049Google Scholar
  30. 30.
    Bellamy N, Buchanan WW, Goldsmith CH, Camphell J, Stiff LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip and knee. J Rheumatol 15:1833–1840PubMedGoogle Scholar
  31. 31.
    Bores M, Brooks P, Strand VC et al (1998) The OMERACT filter for outcome measures in rheumatology. J Rheumatol 25:198–199Google Scholar
  32. 32.
    Martini CJM, Waugh IM (1978) A method for self. Assessment of disability before and after hip replacement operation. BMJ 2:258–259Google Scholar
  33. 33.
    Kucukdeveci AA, Mckenna SP, Kutlay S, Gursel Y, Whalley D, Arasıl T (2000) The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. Int J Rehabil Res 23:31–38PubMedCrossRefGoogle Scholar
  34. 34.
    Becker BE (1994) The biologic aspects of hydrotherapy. J Back Musculoskeletal Rehabil 4:255–264Google Scholar
  35. 35.
    Golland A (1981) Basic hydrotherapy. Physiotherapy 67:258–262PubMedGoogle Scholar
  36. 36.
    Sukenik S (1994) Spa treatment for arthritis at the Dead Sea area. Editorial. Isr J Med Sci 30:919–921PubMedGoogle Scholar
  37. 37.
    O’hare JP, Heywood A, Summerhayes C et al (1985) Observations on the effect of immersion in bath spa water. BMJ 291:1747–1751PubMedCrossRefGoogle Scholar
  38. 38.
    Lange U, Muller-Ladner U, Schmidt KL (2005) Balneotherapy in rheumatic diseases—an overview of novel and known aspects. Rheumatol Int 12:1–3Google Scholar
  39. 39.
    Forestier R (2001) Magnitude and duration of the effects of two spa therapy courses on knee and hip osteoarthritis: an open prospective study in 51 consecutive patients. With fibromyalgia syndome. Clin Rheumatol 20:15–19CrossRefGoogle Scholar
  40. 40.
    Lehmann J, Lateur B (1994) Ultrasound, shortwave, microwave, laser, superficial heat and cold in the treatment of pain. In: Wall P, Melzack R (eds) Textbook of pain. Churchill Livingstone, London, pp 1237–1246Google Scholar
  41. 41.
    Yurtkuran M, Ulus H, İrdesel J (1993) The effect of balneotherapy on plasma endorphine level in patients with osteoarthritis. Phys Rehabil Kur Med 3:130–138CrossRefGoogle Scholar
  42. 42.
    Davis B, Harrison R (1988) Treatment of specific conditions. In: Davis B, Harrison R (eds) Hydrotherapy in practise. Churchill Livingstone, Singapore, pp 137–170Google Scholar
  43. 43.
    Kondrad K, Tatrai T, Hunka A, Vereckei E, Korondi I (1992) Controlled trial of balneotherapy in treatment of low back pain. Ann Rheum Dis 51:820–822CrossRefGoogle Scholar
  44. 44.
    Böhmer H, Resch KL, Gutenbrunner C (1999) Sulfat-Heilwässer-eine zeitgemäße medikamentöse Alternative? Phys Rehabil Kur Med 9:1–5Google Scholar
  45. 45.
    Karagülle MZ, Tütüncü ZN, Aslan O et al (1996) Effects of therma sulfur bath cure on adjuvant arthritic rats. Phys Rehabil Kur Med 6:53–57Google Scholar
  46. 46.
    Kovacs I, Bender T (2002) The therapeutic effects of Cserkeszölö thermal water in osteoarthritis of the knee: a double blind, controlled, follow up study. Rheumatol Int 21:258–261CrossRefGoogle Scholar
  47. 47.
    Sukenic S, Flusser D, Codish S, Ahu-Shakra M (1999) Balneotherapy at the dead sea area for knee osteoarthritis. Isr Med Assoc J 1:83–85Google Scholar
  48. 48.
    Wigler I, Elkayam O, Paran D, Yaron M (1995) Spa therapy for gonarthrosis: a prospective study. Rheumatol Int 15:65–68PubMedCrossRefGoogle Scholar
  49. 49.
    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 36:77–81PubMedCrossRefGoogle Scholar
  50. 50.
    Goldsmith CH, Boers M, Bombardier C, Tugwell P (1993) Criteria for clinically important changes in outcomes: development, scoring and evaluation of rheumatoid arthritis patient and trial profiles. OMERACT committee. J Rheumatol 20:561–565PubMedGoogle Scholar
  51. 51.
    Bellamy N, Kirwan J, Boers M, Brooks P, Strand V, Tugwell P (1997) Recommendations for a core set outcome measure for future phase III clinical trials in knee, hip and hand OA. Consensus development at OMERACT III. J Rheumatol 24:799–802PubMedGoogle Scholar
  52. 52.
    Angst F, Aeschlimann A, Steiner W, Stucki G (2001) Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention. Ann Rheum Dis 60:834–840PubMedGoogle Scholar
  53. 53.
    Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W (2004) Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain 8(4):283–291PubMedCrossRefGoogle Scholar
  54. 54.
    Wann-Hansson C, Hallberg I, Risberg B et al (2004) A comparison of the Nottingham Health Profile and Short Form 36 Health Survey in patients with chronic lower limb ischaemia in a longitudinal perspective. Health Qual Life Outcomes 2(1):9PubMedCrossRefGoogle Scholar
  55. 55.
    Szücs L, Ratko L, Lesko T, Szoor I, Genti G et al (1989) Double blind trial on the effectiveness of the Puspokladany thermal water on arthrosis of the knee joint. Roy Soc Health J 109:7–9Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Merih Yurtkuran
    • 1
    Email author
  • Mustafa Yurtkuran
    • 2
  • Alev Alp
    • 1
  • Aşkın Nasırcılar
    • 1
  • Ümit Bingöl
    • 1
  • Lale Altan
    • 1
  • Gülnazik Sarpdere
    • 1
  1. 1.Division of RheumatologyUludag University Atatürk Rehabilitation CenterBursaTurkey
  2. 2.Department of Internal Medicine, Division of NephrologyUludag UniversityBursaTurkey

Personalised recommendations