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Spa therapy for elderly: a retrospective study of 239 older patients with osteoarthritis

Abstract

Very few studies tested the effectiveness of spa therapy in older patients with osteoarthritis. Therefore, we aimed to evaluate the short-term effects of spa therapy in patients aged 65 years and older with generalized, knee, hip, and cervical and lumbar spine osteoarthritis. In an observational retrospective study design at the Medical Ecology and Hydroclimatology Department of Istanbul Medical Faculty, we analyzed the records of 239 patients aged over 65 years with the diagnosis of all types of osteoarthritis who were prescribed a spa therapy course in some spa resorts in Turkey between 7 March 2002 and 31 December 2012. They travelled to a spa resort where they stayed at a thermal spa hotel and followed the usual therapy packages for 2 weeks. Patients were assessed by an experienced physician within a week before the spa journey and within a week after the completion of the spa therapy. Compared with baseline in whole sample, statistically significant improvements were observed in pain (visual analog scale, VAS), patient and physician global assessments (VAS), Health Assessment Questionnaire disability index (HAQ-DI), Lequesne algofunctional index (LAFI) for knee, Western Ontario and McMaster Universities index (WOMAC), Waddell disability index (WDI), and Neck Pain and Disability Scale (NPAD). According to Outcome Measures in Rheumatology—Osteoarthritis Research Society International (OMERACT-OARSI) Set of Responder Criteria, responder rate were 63.8 % (51/80) in generalized, 52 % (13/25) in knee, 50 % (2/4) in hip, 66.7 % (8/12) in lumbar, and 100 % (6/6) in cervical osteoarthritis subgroups. Spa therapy improved pain and physical functional status in older patients with osteoarthritis, especially generalized osteoarthritis and multiple joint osteoarthritis with involvement of knee. This improvement was clinically important in majority of the patients. To confirm the results of this preliminary study, there is a need of a randomized controlled clinical study comparing spa therapy with usual care in the elderly population with osteoarthritis.

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Fig. 1

Abbreviations

OA:

Osteoarthritis

OARSI:

Osteoarthritis Research Society International

VAS:

Visual analog scale

HAQ-DI:

Health Assessment Questionnaire disability index

LAFI:

Lequesne algofunctional index

WOMAC:

Western Ontario and McMaster Universities index

WDI:

Waddell disability index

NPAD:

Neck Pain and Disability Scale

PGA:

Patient global assessments

MDGA:

Physician global assessments

OMERACT:

Outcome Measures in Rheumatology

SD:

Standard deviation

SPSS:

Statistical Package for the Social Sciences

EULAR:

European League Against Rheumatism

TLAR:

Turkish League Against Rheumatism

References

  1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and therapeutic criteria committee of the American Rheumatism Association. Arthritis Rheum 29:1039–1049

    CAS  Article  Google Scholar 

  2. Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K et al (1990) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum 33:1601–1610

    CAS  Article  Google Scholar 

  3. Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K et al (1991) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 34:505–514

    CAS  Article  Google Scholar 

  4. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt 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 or knee. J Rheumatol 15:1833–1840

    CAS  Google Scholar 

  5. Bijlsma JW, Berenbaum F, Lafeber FP (2011) Osteoarthritis: an update with relevance for clinical practice. Lancet 377:2115–2126

    Article  Google Scholar 

  6. Brosseau L, Macleay L, Robinson V, Casimiro L, Pelland L, Wells G et al (2002) Efficacy of balneotherapy for osteoarthritis of the knee: a systematic review. Phys Ther Rev 7:209–222

    Article  Google Scholar 

  7. Bruce B, Fries JF (2005) The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol 23:S14–S18

    CAS  Google Scholar 

  8. Corbett MS, Rice SJ, Madurasinghe V, Slack R, Fayter DA, Harden M et al (2013) Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta- analysis. Osteoarthritis Cartilage 21:1290–1298

    CAS  Article  Google Scholar 

  9. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M 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

    Article  Google Scholar 

  10. Cuperus N, Mahler EA, Vliet Vlieland TP, Hoogeboom TJ, van den Ende CH (2015) Measurement properties of the Health Assessment Questionnaire Disability Index for generalized osteoarthritis. Rheumatology (Oxford) 54:821–826

    Article  Google Scholar 

  11. Erol FB, Forestier RJ, Güneri FD, Karagülle MZ, Erdoğan N (2015) Spa therapy for generalized osteoarthritis: an open, observational, preliminary study. Therapie 70:273–281

    Article  Google Scholar 

  12. Falagas ME, Zarkadoulia E, Rafailidis PI (2009) The therapeutic effect of balneotherapy: evaluation of the evidence from randomised controlled trials. Int J Clin Pract 63:1068–1084

    CAS  Article  Google Scholar 

  13. 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 89:125–132

    Article  Google Scholar 

  14. 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 56:583–590

    Article  Google Scholar 

  15. Forestier R, Françon A (2008) Crenobalneotherapy for limb osteoarthritis: systematic literature review and methodological analysis. Joint Bone Spine 75:138–148

    Article  Google Scholar 

  16. Forestier R, Desfour H, Tessier JM, Françon A, Foote AM, Genty C et al (2010) Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial. Ann Rheum Dis 69:660–665

    CAS  Article  Google Scholar 

  17. Fortunati NA, Fioravanti A, Seri G, Cinelli S, Tenti S (2016) May spa therapy be a valid opportunity to treat hand osteoarthritis? A review of clinical trials and mechanisms of action. Int J Biometeorol.60:1–8. doi:10.1007/s00484-015-1030-x

  18. Gaál J, Varga J, Szekanecz Z, Kurkó 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 10:365–369

    Google Scholar 

  19. 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

    Article  Google Scholar 

  20. 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

    Article  Google Scholar 

  21. Huskisson EC (1974) Measurement of pain. Lancet 2:1127–1131

    CAS  Article  Google Scholar 

  22. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P 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 62:1145–1155

    CAS  Article  Google Scholar 

  23. Karagülle MZ, Karagülle M (2000) Balneotherapy and spa therapy in elderly. Turk J Geriatr 3:119–124

    Google Scholar 

  24. Karagülle MZ, Karagülle M (2004) Balneotherapy and spa therapy of rheumatic diseases in Turkey: a systematic review. Forsch Komplementarmed Klass Naturheilkd 11:33–41

    Article  Google Scholar 

  25. Karagülle M, Karagülle MZ (2015) Effectiveness of balneotherapy and spa therapy for the treatment of chronic low back pain: a review on latest evidence. Clin Rheumatol 34:207–214

    Article  Google Scholar 

  26. Karagülle M, Karagülle MZ, Karagülle O, Dönmez A, Turan M (2007) A 10-day course of SPA therapy is beneficial for people with severe knee osteoarthritis. A 24-week randomised, controlled pilot study. Clin Rheumatol 26:2063–2071

    Article  Google Scholar 

  27. Kraus VB, Blanco FJ, Englund M, Karsdal MA, Lohmander LS (2015) Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use. Osteoarthritis Cartilage 23:1233–1241

    CAS  Article  Google Scholar 

  28. Lawrence JS (1969) Generalized osteoarthrosis in a population sample. Am J Epidemiol 90:381–389

    CAS  Google Scholar 

  29. Lequesne MG (1997) The algofunctional indices for hip and knee osteoarthritis. J Rheumatol 24:779–781

    CAS  Google Scholar 

  30. Masiero S (2008) Thermal rehabilitation and osteoarticular diseases of the elderly. Aging Clin Exp Res 20:189–194

    Article  Google Scholar 

  31. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM et al (2014) OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 22:363–388

    CAS  Article  Google Scholar 

  32. McAlindon TE, Driban JB, Henrotin Y, Hunter DJ, Jiang GL, Skou ST et al (2015) OARSI clinical trials recommendations: design, conduct, and reporting of clinical trials for knee osteoarthritis. Osteoarthritis Cartilage 23:747–760

    CAS  Article  Google Scholar 

  33. Muraki S, Akune T, Oka H, Ishimoto Y, Nagata K, Yoshida M et al (2012) Incidence and risk factors for radiographic lumbar spondylosis and lower back pain in Japanese men and women: the ROAD study. Osteoarthritis Cartilage 20:712–718

    CAS  Article  Google Scholar 

  34. 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 36:77–81

    CAS  Article  Google Scholar 

  35. Pham T, van der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M et al (2004) OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthritis Cartilage 12:389–399

    CAS  Article  Google Scholar 

  36. Sarzi-Puttini P, Cimmino MA, Scarpa R, Caporali R, Parazzini F, Zaninelli A, Atzeni F, Canesi B (2005) Osteoarthritis: an overview of the disease and its treatment strategies. Semin Arthritis Rheum 35:1–10

    CAS  Article  Google Scholar 

  37. 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

    Article  Google Scholar 

  38. Tuncer T, Cay HF, Kacar C, Altan L, Atik OS, Aydin AT et al (2012) Evidence-based recommendations for the management of knee osteoarthritis: a consensus report of the Turkish League Against Rheumatism. Turkish J Rheumatol 27:1–17

    Article  Google Scholar 

  39. United Nations (2015) Probabilistic population projections based on the world population prospects: the 2015 revision. Population Division, DESA. http://esa.un.org/unpd/ppp/. Accessed 6 Jan 2016

  40. Verhagen AP, Bierma-Zeinstra SM, Boers M, Cardoso JR, Lambeck J, de Bie RA, de Vet HC (2007) Balneotherapy for osteoarthritis. Cochrane Database Syst Rev CD006864

  41. Waddell G, Main CJ (1984) Assessment of severity in low-back disorders. Spine 9:204–208

    CAS  Article  Google Scholar 

  42. Wheeler AH, Goolkasian P, Baird AC, Darden BV (1999) 2nd. Development of the Neck Pain and Disability Scale. Item analysis, face, and criterion-related validity. Spine 24:1290–1294

    CAS  Article  Google Scholar 

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Correspondence to Mine Karagülle.

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Karagülle, M., Kardeş, S., Dişçi, R. et al. Spa therapy for elderly: a retrospective study of 239 older patients with osteoarthritis. Int J Biometeorol 60, 1481–1491 (2016). https://doi.org/10.1007/s00484-016-1138-7

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Keywords

  • Spa therapy
  • Balneotherapy
  • Osteoarthritis
  • Geriatrics
  • Elderly