Abstract
Traditionally, in the past, patients with musculoskeletal diseases visit the spa centers (Salus per aquam) for traditional treatments, including mud therapy, or for holiday. Spas have begun to offer, as the only means of treatment, rehabilitation therapy for patients with musculoskeletal disabilities alone or in association with other traditional thermal therapies. The purpose of this paper is to describe the results of a recent survey on Italian thermal centers conducted by a section of “Rehabilitation in the Thermal Environment” of the Italian Society of Physical Medicine and Rehabilitation. The study investigated the current diffusion, type, and overall quality of rehabilitation treatments performed at the Italian spas. The survey requested information from 174 centers, but only 132 responded by returning the completed questionnaire. Eighty-nine percent of the centers offered rehabilitation therapy for orthopedic-rheumatological diseases, including post-operative conditions (after hip or knee replacement), 37% offered rehabilitation therapy for neurological diseases and 10% rehabilitation for lymph-vascular conditions. Seventy-one percent employed a multidisciplinary team (which included a physiatrist, a physiotherapist, and other figures such as a hydrologist or rheumatologist). The rehabilitative approach generally included therapeutic exercises (land or aquatic therapies), instrumental physical therapies (ultrasounds, electrotherapy, LASER-therapy, and others), and, less frequently, health education and preventive measures. The survey did not investigate respiratory or nasopharyngeal diseases. In conclusion, the results of this survey suggest that rehabilitation, performed in the thermal environment, could be a new opportunity to treat many musculoskeletal disabilities.
Similar content being viewed by others
References
Antonelli M, Donelli D (2018) Effects of balneotherapy and spa therapy on levels of cortisol as a stress biomarker: a systematic review. Int J Biometeorol 62(6):913–924. https://doi.org/10.1007/s00484-018-1504-8
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: an economic evaluation alongside a randomized controlled trial. Arthritis Care Res 69(7):966–972. https://doi.org/10.1002/acr.23116
Cimbiz A, Bayazit V, Hallaceli H, Cavlak U (2005) Effect of combined spa and physical therapy on pain in various chronic diseases. Neurosciences (Riyadh) 10(2):137–143
Cochrane T, Davey RC, Matthes-Edwards SM (2005) Randomized controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis. Health Technol Assess 9(31):iii–iiv ix-xi, 1–114
Evcik D, Kavuncu V, Yeter A, Yigit I (2007) The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. Joint Bone Spine 74(1):60–65
Fioravanti A, Perpignano G, Tirri G, Cardinale G, Gianniti C, Lanza CE, Loi A, Tirri E, Sfriso P, Cozzi F (2007) Effects of mud-bath treatment on Fibromyalgia patients: a randomized clinical trial. Rheumatol Int 27(12):1157–1161
Fioravanti A, Bacaro G, Giannitti C, Tenti S, Cheleschi S, Gui Delli GM, Pascarelli NA, Galeazzi M (2015a) One-year follow-up of mud-bath therapy in patients with bilateral knee osteoarthritis: a randomized, single-blind controlled trial. Int J Biometeorol 59(9):1333–1343. https://doi.org/10.1007/s00484-014-0943-0
Fioravanti A, Giannitti C, Cheleschi S, Simpatico A, Pascarelli NA, Galeazzi M (2015b) Circulating levels of adiponectin, resistin and visfatin after mud-bath therapy in patients with bilateral knee osteoarthritis. Int J Biometeorol 59(11):1691–1700. https://doi.org/10.1007/s00484-015-0977-y
Fioravanti A, Karagülle M, Bender T, Karagülle MZ (2017) Balneotherapy in osteoarthritis: facts, fiction and gaps in knowledge. Eur J Intern Med 9:148–150
Forestier R, Desfour H, Tessier JM, Françon A, Foote AM, Genty C, Rolland C, Roques CF, Bosson JL (2010) Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial. Ann Rheum Dis 69(4):660–665. https://doi.org/10.1136/ard.2009.113209
Gálvez I, Torres-Piles S, Ortega E (2018a) Innate/inflammatory bioregulation and clinical effectiveness of whole-body hyperthermia (balneotherapy) in elderly patients with osteoarthritis. Int J Hyperth 35(1):340–347. https://doi.org/10.1080/02656736.2018.1502896
Gálvez I, Torres-Piles S, Ortega-Rincón E (2018b) Balneotherapy, immune system, and stress response: a hormetic strategy? Int J Mol Sci 19(6). https://doi.org/10.3390/ijms19061687
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):2153–2158. https://doi.org/10.1007/s00484-017-1420-3
Guillemin F, Virion JM, Escudier P, De Talancé N, Weryha G (2001) Effect on osteoarthritis of spa therapy at Bourbonne-les-Bains. Joint Bone Spine 68(6):499–503.
Keevil VL, Romero-Ortuno R (2015) Ageing well: a review of sarcopenia and frailty. Proc Nutr Soc 74(4):337–347. https://doi.org/10.1017/S0029665115002037
Koller D, Schön G, Schäfer I, Glaeske G, van den Bussche H, Hansen H (2014) Multimorbidity and long-term care dependency--a five-year follow-up. BMC Geriatr 14:70. https://doi.org/10.1186/1471-2318-14-70
Lianov L, Johnson M (2010) Physician competencies for prescribing lifestyle medicine. JAMA 304(2):202–203. https://doi.org/10.1001/jama.2010.903
Machtey I (1992) Hydrotherapy and balneotherapy: state of the art. In: Balint G, Gomor B, Hodinka L (eds) Rheumatology: State of the Art. Excerpta Medica, Amsterdam, pp 390–392
Masiero S (2008) Thermal rehabilitation and osteoarticular diseases of the elderly. Aging Clin Exp Res 20(3):189–194
Masiero S, Bonaldo L, Pigatto M, Lo Nigro A, Ramonda R, Punzi L (2011) Rehabilitation treatment in patients with ankylosing spondylitis stabilized with tumor necrosis factor inhibitor therapy: a randomized controlled trial. J Rheumatol 38(7):1335–1342. https://doi.org/10.3899/jrheum.100987
Masiero S, Vittadini F, Ferroni C, Bosco A, Serra R, Frigo AC, Frizziero A (2018) The role of thermal balneotherapy in the treatment of obese patient with knee osteoarthritis. Int J Biometeorol 62(2):243–252. https://doi.org/10.1007/s00484-017-1445-7
Masiero S, Maghini I, Mantovani ME, Bakdounes L, Koutsikos K, Del Felice A, Sale P (2019) Is the aquatic thermal environment a suitable place for providing rehabilitative treatment for person with Parkinson's disease? A retrospective study. Int J Biometeorol 63(1):13–18. https://doi.org/10.1007/s00484-018-1632-1
Morer C, Roques CF, Françon A, Forestier R, Maraver F (2017) The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials. Int J Biometeorol 61(12):2159–2173. https://doi.org/10.1007/s00484-017-1421-2
Musumeci A, Pranovi G, Masiero S (2018) Patient education and rehabilitation after hip arthroplasty in an Italian spa center: a pilot study on its feasibility. Int J Biometeorol 62(8):1489–1496. https://doi.org/10.1007/s00484-018-1548-9
Ortega E, Gálvez I, Hinchado MD, Guerrero J, Martín-Cordero L, Torres-Piles S (2017) Anti-inflammatory effect as a mechanism of effectiveness underlying the clinical benefits of pelotherapy in osteoarthritis patients: regulation of the altered inflammatory and stress feedback response. Int J Biometeorol 61(10):1777–1785. https://doi.org/10.1007/s00484-017-1361-x
Paoloni M, Bernetti A, Brignoli O, Coclite D, Fraioli A, Masiero S, Napoletano A, Quirino N, Rengo F, Ruosi C, Viora U, Vitale M, Santilli V (2017) Appropriateness and efficacy of spa therapy for musculoskeletal disorders. A Delphi method consensus initiative among experts in Italy. Ann Ist Super Sanita 53(1):70–76. https://doi.org/10.4415/ANN_17_01_13
Schmidt KL (1995) Scientific basis of Spa treatment in rheumatic diseases. Rheumatol Eur 24:136–40.21
Stucki G, Cieza A, Melvin J (2007) The international classification of functioning, disability and health (ICF): a unifying model for the conceptual description of the rehabilitation strategy. J Rehabil Med 39(4):279–285
Sukenik S, Flusser D, Abu-Shakra M (1999) The role of spa therapy in various rheumatic diseases. Rheum Dis Clin N Am 25(4):883–897
Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Knipschild PG (2000) Balneotherapy for rheumatoid arthritis and osteoarthritis. Cochrane Database Syst Rev 2:CD000518
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 4:CD006864
Woźniak-Holecka J, Romaniuk P, Holecki T, Frączkiewicz-Wronka A, Jaruga S (2017) Health promotion development in the spa treatment. perspectives for the European countries learned from Poland's experiences. Front Pharmacol 8:29. https://doi.org/10.3389/fphar.2017.00029
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Masiero, S., Litwocenko, S., Agostini, F. et al. Rehabilitation in an Italian thermal setting: a new therapeutic strategy for patients with musculoskeletal disability—the results of an Italian survey. Int J Biometeorol 64, 951–954 (2020). https://doi.org/10.1007/s00484-019-01765-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00484-019-01765-3