Skip to main content

Advertisement

Log in

The effect of balneotherapy on pain relief, stiffness, and physical function in patients with osteoarthritis of the knee: a meta-analysis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

This meta-analysis was performed to determine the effect of balneotherapy on relieving pain and stiffness and improving physical function, compared to controls, among patients with knee osteoarthritis. We searched electronic databases for eligible studies published from 2004 to December 31, 2016, with language restrictions of English or Japanese. We screened publications in Medline, Embase, Cochrane library, and the Japan Medical Abstracts Society Database using two approaches, MeSH terms and free words. Studies that examined the effect of balneotherapy for treating knee osteoarthritis of a ≥2-week duration were included. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used as the outcome measure. A total of 102 publications were assessed according to the exclusion criteria of the study; eight clinical trial studies, which comprised a total of 359 cases and 375 controls, were included in this meta-analysis. The meta-analysis analyzed improvement in WOMAC score at the final follow-up visit, which varied from 2 to 12 months post-intervention. Our meta-analysis indicates that balneotherapy was clinically effective in relieving pain and stiffness, and improving function, as assessed by WOMAC score, compared to controls. However, there was high heterogeneity (88 to 93%). It is possible that balneotherapy may reduce pain and stiffness, and improve function, in individuals with knee osteoarthritis, although the quality of current publications contributes to the heterogeneity observed in this meta-analysis.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. McAlindon T (2012) Osteoarthritis Research Society International (OARSI) classification and guidelines. HSS journal : the musculoskeletal journal of Hospital for Special Surgery 8(1):66–67. doi:10.1007/s11420-011-9231-2

    Article  PubMed  Google Scholar 

  2. Yoshimura N, Muraki S, Oka H, Kawaguchi H, Nakamura K, Akune T (2010) Cohort profile: research on Osteoarthritis/Osteoporosis Against Disability study. Int J Epidemiol 39(4):988–995. doi:10.1093/ije/dyp276

    Article  PubMed  Google Scholar 

  3. Yoshimura N, Muraki S, Oka H, Mabuchi A, En-Yo Y, Yoshida M, Saika A, Yoshida H, Suzuki T, Yamamoto S, Ishibashi H, Kawaguchi H, Nakamura K, Akune T (2009) Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: the research on osteoarthritis/osteoporosis against disability study. J Bone Miner Metab 27(5):620–628. doi:10.1007/s00774-009-0080-8

    Article  PubMed  Google Scholar 

  4. Hoops ML, Rosenblatt NJ, Hurt CP, Crenshaw J, Grabiner MD (2012) Does lower extremity osteoarthritis exacerbate risk factors for falls in older adults? Women’s Health (Lond Engl) 8(6):685–696 . doi:10.2217/whe.12.53quiz 697-688

    Article  CAS  Google Scholar 

  5. Muraki S, Akune T, Oka H, En-Yo Y, Yoshida M, Nakamura K, Kawaguchi H, Yoshimura N (2011) Prevalence of falls and the association with knee osteoarthritis and lumbar spondylosis as well as knee and lower back pain in Japanese men and women. Arthritis care & research 63(10):1425–1431. doi:10.1002/acr.20562

    Article  Google Scholar 

  6. Arden NK, Crozier S, Smith H, Anderson F, Edwards C, Raphael H, Cooper C (2006) Knee pain, knee osteoarthritis, and the risk of fracture. Arthritis Rheum 55(4):610–615. doi:10.1002/art.22088

    Article  PubMed  Google Scholar 

  7. 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

    Article  CAS  Google Scholar 

  8. Tishler M, Rosenberg O, Levy O, Elias I, Amit-Vazina M (2004) The effect of balneotherapy on osteoarthritis. Is an intermittent regimen effective? European journal of internal medicine 15(2):93–96. doi:10.1016/j.ejim.2004.01.002

    Article  PubMed  Google Scholar 

  9. Santos I, Cantista P, Vasconcelos C (2016) Balneotherapy in rheumatoid arthritis—a systematic review. Int J Biometeorol 60(8):1287–1301. doi:10.1007/s00484-015-1108-5

    Article  PubMed  Google Scholar 

  10. Naumann J, Sadaghiani C (2014) Therapeutic benefit of balneotherapy and hydrotherapy in the management of fibromyalgia syndrome: a qualitative systematic review and meta-analysis of randomized controlled trials. Arthritis research & therapy 16(4):R141. doi:10.1186/ar4603

    Article  Google Scholar 

  11. Bender T, Balint G, Prohaszka Z, Geher P, Tefner IK (2014) Evidence-based hydro- and balneotherapy in Hungary—a systematic review and meta-analysis. Int J Biometeorol 58(3):311–323. doi:10.1007/s00484-013-0667-6

    Article  CAS  PubMed  Google Scholar 

  12. Corbett MS, Rice SJ, Madurasinghe V, Slack R, Fayter DA, Harden M, Sutton AJ, Macpherson H, Woolacott NF (2013) Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society 21(9):1290–1298. doi:10.1016/j.joca.2013.05.007

    Article  CAS  Google Scholar 

  13. Verhagen A, Bierma-Zeinstra S, Lambeck J, Cardoso JR, de Bie R, Boers M, de Vet HC (2008) Balneotherapy for osteoarthritis. A cochrane review. J Rheumatol 35(6):1118–1123

    PubMed  Google Scholar 

  14. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151(4):W65–W94

    Article  PubMed  Google Scholar 

  15. 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(12):1833–1840

    CAS  PubMed  Google Scholar 

  16. 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(4):583–590. doi:10.1007/s00484-011-0447-0

    Article  PubMed  Google Scholar 

  17. Gaal J, Varga J, Szekanecz Z, Kurko 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. The Israel Medical Association journal : IMAJ 10(5):365–369

    PubMed  Google Scholar 

  18. Karagulle 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(10):1481–1491. doi:10.1007/s00484-016-1138-7

    Article  PubMed  Google Scholar 

  19. Sarsan A, Akkaya N, Ozgen M, Yildiz N, Atalay NS, Ardic F (2012) Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis. Journal of back and musculoskeletal rehabilitation 25(3):193–199. doi:10.3233/bmr-2012-0327

    Article  PubMed  Google Scholar 

  20. Odabasi E, Turan M, Erdem H, Tekbas F (2008) Does mud pack treatment have any chemical effect? A randomized controlled clinical study. Journal of alternative and complementary medicine (New York, NY) 14(5):559–565. doi:10.1089/acm.2008.0003

    Article  Google Scholar 

  21. Gungen G, Ardic F, Findikoglu G, Rota S (2012) The effect of mud pack therapy on serum YKL-40 and hsCRP levels in patients with knee osteoarthritis. Rheumatol Int 32(5):1235–1244. doi:10.1007/s00296-010-1727-4

    Article  CAS  PubMed  Google Scholar 

  22. Tefner IK, Gaal R, Koroknai A, Rathonyi A, Gati T, Monduk P, Kiss E, Kovacs C, Balint G, Bender T (2013) The effect of Neydharting mud-pack therapy on knee osteoarthritis: a randomized, controlled, double-blind follow-up pilot study. Rheumatol Int 33(10):2569–2576. doi:10.1007/s00296-013-2776-2

    Article  PubMed  Google Scholar 

  23. Espejo Antunez L, Caro Puertolas B, Ibanez Burgos B, Porto Payan JM, Torres Piles ST (2013) Effects of mud therapy on perceived pain and quality of life related to health in patients with knee osteoarthritis. Reumatologia clinica 9(3):156–160. doi:10.1016/j.reuma.2012.09.005

    Article  PubMed  Google Scholar 

  24. Mahboob N, Sousan K, Shirzad A, Amir G, Mohammad V, Reza M, Mansour VA, Hadi V (2009) The efficacy of a topical gel prepared using Lake Urmia mud in patients with knee osteoarthritis. Journal of alternative and complementary medicine (New York, NY) 15(11):1239–1242. doi:10.1089/acm.2009.0304

    Article  Google Scholar 

  25. Fraioli A, Serio A, Mennuni G, Ceccarelli F, Petraccia L, Fontana M, Grassi M, Valesini G (2011) A study on the efficacy of treatment with mud packs and baths with Sillene mineral water (Chianciano Spa Italy) in patients suffering from knee osteoarthritis. Rheumatol Int 31(10):1333–1340. doi:10.1007/s00296-010-1475-5

    Article  PubMed  Google Scholar 

  26. Forestier R, Desfour H, Tessier JM, Francon 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. doi:10.1136/ard.2009.113209

    Article  CAS  PubMed  Google Scholar 

  27. Kulisch A, Benko A, Bergmann A, Gyarmati N, Horvath H, Kranicz A, Mando ZS, Matan A, Nemeth A, Szakal E, Szanto D, Szekeres L, Bender T (2014) Evaluation of the effect of Lake Heviz thermal mineral water in patients with osteoarthritis of the knee: a randomized, controlled, single-blind, follow-up study. European journal of physical and rehabilitation medicine 50(4):373–381

    CAS  PubMed  Google Scholar 

  28. Forestier R, Genty C, Waller B, Francon A, Desfour H, Rolland C, Roques CF, Bosson JL (2014) Crenobalneotherapy (spa therapy) in patients with knee and generalized osteoarthritis: a post-hoc subgroup analysis of a large multicentre randomized trial. Annals of physical and rehabilitation medicine 57(4):213–227. doi:10.1016/j.rehab.2014.03.001

    Article  CAS  PubMed  Google Scholar 

  29. Fioravanti A, Cantarini L, Bacarelli MR, de Lalla A, Ceccatelli L, Blardi P (2011) Effects of spa therapy on serum leptin and adiponectin levels in patients with knee osteoarthritis. Rheumatol Int 31(7):879–882. doi:10.1007/s00296-010-1401-x

    Article  PubMed  Google Scholar 

  30. Kilicoglu O, Donmez A, Karagulle Z, Erdogan N, Akalan E, Temelli Y (2010) Effect of balneotherapy on temporospatial gait characteristics of patients with osteoarthritis of the knee. Rheumatol Int 30(6):739–747. doi:10.1007/s00296-009-1054-9

    Article  PubMed  Google Scholar 

  31. Ceccarelli F, Perricone C, Alessandri C, Modesti M, Iagnocco A, Croia C, Di Franco M, Valesini G (2010) Exploratory data analysis on the effects of non pharmacological treatment for knee osteoarthritis. Clin Exp Rheumatol 28(2):250–253

    CAS  PubMed  Google Scholar 

  32. Karagulle M, Karagulle MZ, Karagulle O, Donmez 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(12):2063–2071. doi:10.1007/s10067-007-0618-x

    Article  PubMed  Google Scholar 

  33. Cantarini L, Leo G, Giannitti C, Cevenini G, Barberini P, Fioravanti A (2007) Therapeutic effect of spa therapy and short wave therapy in knee osteoarthritis: a randomized, single blind, controlled trial. Rheumatol Int 27(6):523–529. doi:10.1007/s00296-006-0266-5

    Article  PubMed  Google Scholar 

  34. Yilmaz B, Goktepe AS, Alaca R, Mohur H, Kayar AH (2004) Comparison of a generic and a disease specific quality of life scale to assess a comprehensive spa therapy program for knee osteoarthritis. Joint, bone, spine : revue du rhumatisme 71(6):563–566. doi:10.1016/j.jbspin.2003.09.008

    Article  Google Scholar 

  35. Branco M, Rego NN, Silva PH, Archanjo IE, Ribeiro MC, Trevisani VF (2016) Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial. European journal of physical and rehabilitation medicine 52(4):422–430

    PubMed  Google Scholar 

  36. Fazaa A, Souabni L, Ben Abdelghani K, Kassab S, Chekili S, Zouari B, Hajri R, Laatar A, Zakraoui L (2014) Comparison of the clinical effectiveness of thermal cure and rehabilitation in knee osteoarthritis. A randomized therapeutic trial. Annals of physical and rehabilitation medicine 57(9–10):561–569. doi:10.1016/j.rehab.2014.09.007

    Article  CAS  PubMed  Google Scholar 

  37. Fioravanti A, Iacoponi F, Bellisai B, Cantarini L, Galeazzi M (2010) Short- and long-term effects of spa therapy in knee osteoarthritis. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 89(2):125–132. doi:10.1097/PHM.0b013e3181c1eb81

    Article  Google Scholar 

  38. Sherman G, Zeller L, Avriel A, Friger M, Harari M, Sukenik S (2009) Intermittent balneotherapy at the Dead Sea area for patients with knee osteoarthritis. The Israel Medical Association journal : IMAJ 11(2):88–93

    PubMed  Google Scholar 

  39. 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 : revue du rhumatisme 74(1):60–65. doi:10.1016/j.jbspin.2006.03.009

    Article  Google Scholar 

  40. Balint GP, Buchanan WW, Adam A, Ratko I, Poor L, Balint PV, Somos E, Tefner I, Bender T (2007) The effect of the thermal mineral water of Nagybaracska on patients with knee joint osteoarthritis—a double blind study. Clin Rheumatol 26(6):890–894. doi:10.1007/s10067-006-0420-1

    Article  PubMed  Google Scholar 

  41. Yurtkuran M, Yurtkuran M, Alp A, Nasircilar A, Bingol U, Altan L, Sarpdere G (2006) Balneotherapy and tap water therapy in the treatment of knee osteoarthritis. Rheumatol Int 27(1):19–27. doi:10.1007/s00296-006-0158-8

    Article  PubMed  Google Scholar 

  42. Xiang J, Wu D, Li J (2016) Clinical efficacy of mudpack therapy in treating knee osteoarthritis: a meta-analysis of randomized controlled studies. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 95(2):121–131. doi:10.1097/phm.0000000000000354

    Article  Google Scholar 

  43. 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(7):1068–1084. doi:10.1111/j.1742-1241.2009.02062.x

    Article  CAS  PubMed  Google Scholar 

  44. O’Hare JP, Heywood A, Summerhayes C, Lunn G, Evans JM, Walters G, Corrall RJ, Dieppe PA (1985) Observations on the effect of immersion in bath spa water. Br Med J (Clin Res Ed) 291(6511):1747–1751

    Article  Google Scholar 

  45. Mooventhan A, Nivethitha L (2014) Scientific evidence-based effects of hydrotherapy on various systems of the body. N Am J Med Sci 6(5):199–209. doi:10.4103/1947-2714.132935

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Becker BE (1994) The biologic aspects of hydrotherapy. Journal of back and musculoskeletal rehabilitation 4(4):255–264. doi:10.3233/bmr-1994-4405

    Article  CAS  PubMed  Google Scholar 

  47. Fioravanti A, Valenti M, Altobelli E, Di Orio F, Nappi G, Crisanti A, Cantarini L, Marcolongo R (2003) Clinical efficacy and cost-effectiveness evidence of spa therapy in osteoarthritis. The results of “Naiade” Italian Project. Panminerva Med 45(3):211–217

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by a Health and Labour Sciences Research Grant (Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus, H25-ippan-029).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hiromi Matsumoto.

Ethics declarations

Disclosures

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsumoto, H., Hagino, H., Hayashi, K. et al. 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 (2017). https://doi.org/10.1007/s10067-017-3592-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-017-3592-y

Keywords

Navigation