International Journal of Biometeorology

, Volume 63, Issue 3, pp 351–357 | Cite as

Efficacy of balneological outpatient treatment (hydrotherapy and peloidotherapy) for the management of chronic low back pain: a retrospective study

  • Hidayet YücesoyEmail author
  • İlker Geçmen
  • Tuba Adıgüzel
  • Mine Karagülle
  • Müfit Zeki Karagülle
Original Paper


The aim of this study was to evaluate the efficacy of balneological outpatient treatment including hydrotherapy and peloidotherapy on patients with chronic low back pain. In this retrospective observational study, the records (between 2008 and 2016) of patients who have undergone balneological outpatient treatment at the Department of Medical Ecology and Hydroclimatology were analyzed. The patients were examined and assessed by an experienced physician before and after the treatment. Outcome measures were the Pain Visual Analog Scale (VAS), patient’s and physician’s global assessment (VAS), Health Assessment Questionnaire (HAQ), and the Waddell Disability Index. A total of 139 patients were included in the study. After the treatment, statistically significant improvement in all evaluated outcome measures was found. The detailed analysis showed age, the duration of treatment, and sex did not affect the effectiveness of the treatment. Balneological outpatient treatment may be an effective option for treatment of chronic low back pain patients with the advantages of being integrated into daily routine and not causing any days off by improving pain and increasing the quality of life. Randomized controlled trials are needed to confirm these preliminary results.


Balneotherapy Peloidotherapy Hydrotherapy Low back pain 


Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. Abu-Shakra M, Mayer A, Friger M, Harari M (2014) Dead Sea mud packs for chronic low back pain. Isr Med Assoc J 16:574–577Google Scholar
  2. Bruce B, Fries JF (2005) The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol 23:14–18Google Scholar
  3. 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: economic evaluation alongside a randomized controlled trial. Arthritis Care Res (Hoboken) 69(7):966–972CrossRefGoogle Scholar
  4. Constant F, Collin JF, Guillemin F, Boulangé M (1995) Effectiveness of spa therapy in chronic low back pain: a randomized clinical trial. J Rheumatol 22:1315–1320Google Scholar
  5. Constant F, Guillemin F, Collin JF, Boulangé M (1998) Use of spa therapy to improve the quality of life of chronic low back pain patients. Med Care 36:1309–1314CrossRefGoogle Scholar
  6. Deyo RA, Rainville J, Kent DL (1991) What can the history and physical examination tell us about low back pain. Jama 268(6):760–765CrossRefGoogle Scholar
  7. Dogan M, Sahin O, Elden H, Hayta E, Kaptanoglu E (2011) Additional therapeutic effect of balneotherapy in low back pain. South Med J 104:574–578CrossRefGoogle Scholar
  8. Fioravanti A, Cantarini L, Guidelli GM, Galeazzi M (2011) Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there? Rheumatol Int 31(1):1–8. CrossRefGoogle Scholar
  9. 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 59:1333–1343CrossRefGoogle Scholar
  10. 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. CrossRefGoogle Scholar
  11. Gáti T, Tefner IK, Kovács L, Hodosi K, Bender T (2018) The effects of the calcium-magnesium-bicarbonate content in thermal mineral water on chronic low back pain: a randomized, controlled follow-up study. Int J Biometeorol 62:897–905CrossRefGoogle Scholar
  12. Giannitti C, De Palma A, Pascarelli NA, Cheleschi S, Giordano N, Galeazzi M, Fioravanti A (2017) Can balneotherapy modify microRNA expression levels in osteoarthritis? A comparative study in patients with knee osteoarthritis. Int J Biometeorol 61(12):2153–2158CrossRefGoogle Scholar
  13. Gutenbrunner C, Bender T, Cantista P, Karagulle Z (2010) A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology. Int J Biometeorol 54:495–507CrossRefGoogle Scholar
  14. Huskisson EC (1982) Measurement of pain. J Rheumatol 9(5):768–769Google Scholar
  15. Karagulle MZ (2002) Kaplıca Tıbbı ve Kaplıca Tedavisi. In: Karagulle MZ (ed) Balneoloji ve Kaplıca Tıbbı. Nobel Kitapevi, Istanbul, pp 15–36Google Scholar
  16. Karagülle M, Karagülle Z (2015) Effectiveness of balneotherapy and spa therapy for the treatment of chronic low back pain: a review on latest evidence. Clin Rheumatol 34:207–214CrossRefGoogle Scholar
  17. Kardeş S, Karagülle M, Geçmen İ, Adıgüzel T, Yücesoy H, Karagülle MZ (2018) Outpatient balneological treatment of osteoarthritis in older persons: a retrospective study. Z Gerontol Geriatr.
  18. Kesiktas N, Karakas S, Gun K, Gun N (2012) Balneotherapy for chronic low back pain: a randomized, controlled study. Rheumatol Int 32:3193–3199CrossRefGoogle Scholar
  19. Koes B, Van Tulder MW, Thomas S (2006) Diagnosis and treatment of low back pain. BMJ 332:1430–1434CrossRefGoogle Scholar
  20. Konrad 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
  21. Küçükdeveci A, Şahin H, Ataman Ş, Griffiths B, Tennant A (2004) Issue in cross-cultural validity: example from the adaptation, reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis Rheum 51:14–19CrossRefGoogle Scholar
  22. Onat ŞŞ, Taşoğlu Ö, Güneri FD, Özişler Z, Safer VB, Özgirgin N (2014) The effectiveness of balneotherapy in chronic low back pain. Clin Rheumatol 33:1509–1513CrossRefGoogle Scholar
  23. Özkuk K, Gürdal H, Karagulle M (2017) Balneological outpatient treatment for patients with knee osteoartritis; an effective non drug therapy option in daily routine? Int J Biometeorol 61:719–728CrossRefGoogle Scholar
  24. Pittler M, Karagulle Z, Karagulle M, Ernst E (2006) Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials. Rheumatology 45:880–884CrossRefGoogle Scholar
  25. Şen U, Karagülle MZ, Karagülle M, Erkorkmaz Ü (2008) The efficacy of peloidotherapy on the patients with chronic low back pain. Turkiye Klinikleri J Med Sci 28:5–11Google Scholar
  26. Van Middelkoop M, Rubinstein SM, Verhagen AP et al (2010) Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol 24:193–204CrossRefGoogle Scholar
  27. Waddell G, Main CJ (1984) Assessment of severity in low-back disorders. Spine 9:204–208CrossRefGoogle Scholar

Copyright information

© ISB 2019

Authors and Affiliations

  • Hidayet Yücesoy
    • 1
    • 2
    Email author
  • İlker Geçmen
    • 3
  • Tuba Adıgüzel
    • 1
    • 2
  • Mine Karagülle
    • 1
    • 2
  • Müfit Zeki Karagülle
    • 1
    • 2
  1. 1.Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
  2. 2.Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp FakültesiİstanbulTurkey
  3. 3.Department of Medical Ecology and Hydroclimatology, Kanuni Sultan Süleyman Education and Research HospitalIstanbul Health Sciences UniversityIstanbulTurkey

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