Skip to main content
SpringerLink
Log in

The effects of inpatient versus outpatient spa therapy on pain, anxiety, and quality of life in elderly patients with generalized osteoarthritis: a pilot study

  • Original Paper
  • Published:
International Journal of Biometeorology Aims and scope Submit manuscript

Abstract

This study aimed to investigate the effect of inpatient vs outpatient spa therapy on pain, quality of life, and anxiety in elderly patients with generalized osteoarthritis. A total of 150 patients were randomized into three groups. Group I was given medical treatment, group II was treated as outpatients, and group III was treated as inpatient spa therapy. Assessments were made using the Pain (VAS), EQ-5D-3L Scale, and State and Trait Anxiety Inventory (STAI) at the beginning of treatment (W0), at the end of treatment (W2), and at the fourth week after treatment (W6). The comparison of outpatient spa group and etodolac treatment group showed that outpatient spa group was superior to etodolac treatment group in all evaluated parameters at W2 vs W0 and W6 vs W0. The comparison of inpatient spa group and etodolac treatment group showed that inpatient spa group was superior to etodolac treatment group in all evaluated parameters at W2 vs W0 and W6 vs W0. The comparison of inpatient spa group and outpatient spa group showed that inpatient spa group was superior to outpatient spa group in all evaluated parameters except STAI-TXII at W2 vs W0 and in all evaluated parameters W6 vs W0. Spa therapy, either as an outpatient or inpatient basis, may have a positive effect on pain, anxiety, and quality of life in geriatric patients with generalized osteoarthritis. The inpatient spa therapy may be more beneficial than outpatient spa therapy. When the side effects of drug treatments are emphasized, spa therapy may be considered as an interesting option for elderly with osteoarthritis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

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 62:913–924

    Article  Google Scholar 

  • Bair MJ, Wu J, Damush TM, Sutherland JM, Kroenke K (2008) Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med 70:890–897. https://doi.org/10.1097/PSY.0b013e318185c510

    Article  CAS  Google Scholar 

  • Bender T, Karagulle Z, Balint GP, Gutenbrunner C, Balint PV, Sukenik S (2005) Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatol Int 25:220–224. https://doi.org/10.1007/s00296-004-0487-4

    Article  Google Scholar 

  • Blain H et al (2016) Combining balneotherapy and health promotion to promote active and healthy ageing: the Balaruc-MACVIA-LR ((R)) approach. Aging Clin Exp Res 28:1061–1065. https://doi.org/10.1007/s40520-016-0596-4

    Article  CAS  Google Scholar 

  • Breedveld FC (2004) Osteoarthritis--the impact of a serious disease. Rheumatology (Oxford, England) 43(Suppl 1):i4–i8. https://doi.org/10.1093/rheumatology/keh102

    Article  Google Scholar 

  • Constant F, Collin JF, Guillemin F, Boulange M (1995) Effectiveness of spa therapy in chronic low back pain: a randomized clinical trial. J Rheumatol 22:1315–1320

    CAS  Google Scholar 

  • Costa EC, Vale S, Sobral M, Graca Pereira M (2015) Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain. Psychol Health Med 21:1–13. https://doi.org/10.1080/13548506.2015.1109673

    Article  Google Scholar 

  • Cuperus N, Hoogeboom TJ, Kersten CC et al (2015) Randomized trial of the effectiveness of a non-pharmacological multidisciplinary face-to-face treatment program on daily function compared to a telephone-based treatment program in patients with generalized osteoarthritis. Osteoarthr Cartil 23:1267–1275

    Article  CAS  Google Scholar 

  • Dubois O et al (2010) Balneotherapy versus paroxetine in the treatment of generalized anxiety disorder. Complementary therapies in medicine 18:1–7. https://doi.org/10.1016/j.ctim.2009.11.003

    Article  Google Scholar 

  • EuroQolGroup (1990) EuroQol--a new facility for the measurement of health-related quality of life health policy (Amsterdam, Netherlands) 16:199–208

  • 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. https://doi.org/10.1016/j.eujim.2017.01.001

    Article  Google Scholar 

  • Gaál J, Varga J, Szekanecz Z et al (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 

  • Gallagher EJ, Liebman M, Bijur PE (2001) Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med 38:633–638. https://doi.org/10.1067/mem.2001.118863

    Article  CAS  Google Scholar 

  • Jeste ND, Hays JC, Steffens DC (2006) Clinical correlates of anxious depression among elderly patients with depression. J Affect Disord 90:37–41. https://doi.org/10.1016/j.jad.2005.10.007

    Article  Google Scholar 

  • Kahyaoglu Sut H, Unsar S (2011) Is EQ-5D a valid quality of life instrument in patients with acute coronary syndrome? Anadolu kardiyoloji dergisi : AKD = the Anatolian Journal of Cardiology 11:156–162. https://doi.org/10.5152/akd.2011.037

    Article  Google Scholar 

  • Karagülle M, Kardes S, Disci R, Gurdal H, Karagulle MZ (2016) Spa therapy for elderly: a retrospective study of 239 older patients with osteoarthritis. Int J Biometeorol 60:1481–1491. https://doi.org/10.1007/s00484-016-1138-7

    Article  Google Scholar 

  • Karagülle M, Kardes S, Karagulle MZ (2017) Real-life effectiveness of spa therapy in rheumatic and musculoskeletal diseases: a retrospective study of 819 patients. Int J Biometeorol 61:1945–1956. https://doi.org/10.1007/s00484-017-1384-3

    Article  Google Scholar 

  • Karagülle M, Kardeş S, Dişçi R, Karagülle MZ (2018a) Spa therapy adjunct to pharmacotherapy is beneficial in rheumatoid arthritis: a crossover randomized controlled trial. Int J Biometeorol 62:195–205

    Article  Google Scholar 

  • Karagülle M, Kardeş S, Karagülle MZ (2018b) Long-term efficacy of spa therapy in patients with rheumatoid arthritis. Rheumatol Int 38:353–362

    Article  Google Scholar 

  • 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. doi: https://doi.org/10.1007/s00391-018-1370-3

  • Koga K et al (2015) Coexistence of two forms of LTP in ACC provides a synaptic mechanism for the interactions between anxiety and chronic pain. Neuron 85:377–389. https://doi.org/10.1016/j.neuron.2014.12.021

    Article  CAS  Google Scholar 

  • Koyuncu E, Okmen BM, Ozkuk K, Tasoglu O, Ozgirgin N (2016) The effectiveness of balneotherapy in chronic neck pain. Clin Rheumatol 35:2549–2555. https://doi.org/10.1007/s10067-016-3199-8

    Article  Google Scholar 

  • Latorre-Roman PA, Rentero-Blanco M, Laredo-Aguilera JA, Garcia-Pinillos F (2015) Effect of a 12-day balneotherapy programme on pain, mood, sleep, and depression in healthy elderly people. Psychogeriatrics: the official journal of the Japanese Psychogeriatric Society 15:14–19. https://doi.org/10.1111/psyg.12068

    Article  Google Scholar 

  • Matsumoto H et al (2017) The effect of balneotherapy on pain relief, stiffness, and physical function in patients with osteoarthritis of the knee: a meta-analysis. Clin Rheumatol 36:1839–1847. https://doi.org/10.1007/s10067-017-3592-y

    Article  Google Scholar 

  • Matzer F, Nagele E, Lerch N, Vajda C, Fazekas C (2018) Combining walking and relaxation for stress reduction-a randomized cross-over trial in healthy adults. Stress Health 34:266–277

    Article  Google Scholar 

  • Morer C, Roques CF, Francon 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 61:2159–2173. https://doi.org/10.1007/s00484-017-1421-2

    Article  Google Scholar 

  • Naumann J, Grebe J, Kaifel S, Weinert T, Sadaghiani C, Huber R (2017) Effects of hyperthermic baths on depression, sleep and heart rate variability in patients with depressive disorder: a randomized clinical pilot trial. BMC Complement Altern Med 28(17):172

    Article  CAS  Google Scholar 

  • 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

    Article  CAS  Google Scholar 

  • Oosterveld FG, Rasker JJ, Floors M et al (2009) Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis. A pilot study showing good tolerance, short-term improvement of pain and stiffness, and a trend towards long-term beneficial effects. Clin Rheumatol 28:29–34

    Article  Google Scholar 

  • Öner N, Compte AL (1998) Süreksiz Durumluk-Sürekli Kaygı Envanteri El Kitabı. Boğaziçi Üniversitesi Yayınevi, İstanbul

    Google Scholar 

  • Özkuk K, Gurdal H, Karagulle M, Barut Y, Eroksuz R, Karagulle MZ (2017) Balneological outpatient treatment for patients with knee osteoarthritis; an effective non-drug therapy option in daily routine? Int J Biometeorol 61:719–728. https://doi.org/10.1007/s00484-016-1250-8

    Article  Google Scholar 

  • Rapolienė L, Razbadauskas A, Sąlyga J, Martinkėnas A (2016) Stress and fatigue management using balneotherapy in a short-time randomized controlled trial. Evid Based Complement Alternat Med 2016(9631684):1–10

    Article  Google Scholar 

  • Reyes-Gibby CC, Aday L, Cleeland C (2002) Impact of pain on self-rated health in the community-dwelling older adults. Pain 95:75–82

    Article  Google Scholar 

  • Spielberger CD, Gorsuch RL, Lushene RE (1970) Manual for the state-trait anxiety inventory Consulting Psychologists Press, Palo Alto

  • Stier-Jarmer M, Frisch D, Oberhauser C, Berberich G, Schuh A (2016) The effectiveness of a stress reduction and burnout prevention program. Dtsch Arztebl Int 113:781–788

    Google Scholar 

  • Stier-Jarmer M, Frisch D, Oberhauser C, Immich G, Kirschneck M, Schuh A (2017) Effects of single moor baths on physiological stress response and psychological state: a pilot study. Int J Biometeorol 61:1957–1964

    Article  CAS  Google Scholar 

  • Stolee P, Lim SN, Wilson L, Glenny C (2012) Inpatient versus home-based rehabilitation for older adults with musculoskeletal disorders: a systematic review. Clin Rehabil 26:387–402. https://doi.org/10.1177/0269215511423279

    Article  Google Scholar 

  • Treede RD et al (2015) A classification of chronic pain for ICD-11. Pain 156:1003–1007. https://doi.org/10.1097/j.pain.0000000000000160

    Article  Google Scholar 

  • Uyar M, Köken İ (2017) Kronik ağrı nörofizyolojisi. Neurophysiology of chronic pain TOTBİD Dergisi 16:70–76. https://doi.org/10.14292/totbid.dergisi.2017.12

    Article  Google Scholar 

  • WHO (2015) Health in older age. In: World Report on Ageing and Health. World Health Organization, Geneva, Switzerland

    Google Scholar 

  • Woolf AD, Pfleger B (2003) Burden of major musculoskeletal conditions. Bull World Health Organ 81:646–656

    Google Scholar 

  • Zhuo M (2014) Long-term potentiation in the anterior cingulate cortex and chronic pain. Philos Trans R Soc Lond Ser B Biol Sci 369:20130146. https://doi.org/10.1098/rstb.2013.0146

    Article  CAS  Google Scholar 

  • Zwolińska J, Weres A, Wyszyńska J (2018) One-year follow-up of spa treatment in older patients with osteoarthritis: a prospective, single group study. Biomed Res Int

Download references

Acknowledgments

The authors thank Barış Kaki, Ph.D., from Usak University, for his technical help in performing statistical analysis. The authors also thank Sinan Kardeş, MD, from Istanbul Faculty of Medicine, for English editing and proofreading of the manuscript and for his critical assistance in revising the manuscript according to the reviewers’ comments.

Author information

Authors and Affiliations

  1. Department of Medical Ecology and Hydroclimatology, Faculty of Medicine, Uşak University, Ankara İzmir Yolu 8.Km 1.Eylül Kampüsü, Uşak, Turkey

    Kağan Özkuk

  2. Department of Physical Medicine and Rehabilitation, Izzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, Bolu, Turkey

    Bilal Uysal, Zeynep Ateş, Refia Sezer & Gamze Dilek

  3. Department of Physical Medicine and Rehabilitation, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey

    Burcu Metin Ökmen

Authors
  1. Kağan Özkuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bilal Uysal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zeynep Ateş
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Burcu Metin Ökmen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Refia Sezer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gamze Dilek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kağan Özkuk.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Ethics Committee (25.02.2016-2015/88) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all participants prior to being included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Özkuk, K., Uysal, B., Ateş, Z. et al. The effects of inpatient versus outpatient spa therapy on pain, anxiety, and quality of life in elderly patients with generalized osteoarthritis: a pilot study. Int J Biometeorol 62, 1823–1832 (2018). https://doi.org/10.1007/s00484-018-1584-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00484-018-1584-5

Keywords

Search

Navigation