1. THE EFFICACY OF BALNEOTHERAPY IN KNEE OSTEOARTHRITIS Serap ALPER MD. Dokuz Eylül University Physical Medicine and Rehabilitation Department İZMİR

2.  This study is designed to assess the efficacy of balneotherapy in patients with osteoarthritis of the knees.

3.  32 patients full filling the diagnostic criteria of American College of Rheumatology were included in the study.

4. The patients were divided into two groups.  Group I was treated with balneotherapy for 3 weeks in Balçova Spa and home exercise therapy.  Group II was only treated with home exercise therapy.

5.  The evaluation parameters were; self reported Western Ontario MacMaster Questionnaire (WOMAC) WOMAC pain, WOMAC joint stiffness, WOMAC physical function scores, range of motion assessment with goniometry, Nottingham Health Profile and visuel analog scale for pain.

6.  Osteoarthritis is a chronic disorder characterized by softening and disintegration of articular cartilage, with reactive phenomena such as vascular congestion and osteoblastic activity in the subcortical bone, new growth of cartilage and bone (i,e,.osteophytes) at the joint margins and capsular fibrosis.

7. The aim of balneotherapy in osteoarthritis is:  to increase ROM  decrease muscle spasm  improve functional mobility  decrease pain  increase QoL

8. Table 1. Demografic Qualities of the Patients Spa Therapy Group Avg ± SS Control Group Avg ± SS Age (Year)58.43 ± 6.3558.31 ± 5.60 BMI30.0 ± 5.3928.18 ± 3.52 Gender16 Female Number of case (n)16

9. Table 2. Comparison of the Groups before Therapy Spa Therapy Group Avg ± SS Control Group Avg ± SS Pain during relaxing (VAS) (0 – 10 cm) 4.66 ± 3.033.5 ± 2.44 Pain during walking (VAS) (0 – 10 cm) 5.35 ± 2.455.87 ± 2.24 Pain while climbing steps (VAS) (0 – 10 cm) 7.59 ± 2.667.12 ± 1.40 WOMAC (pain) (0 – 25) 16.12 ± 2.7514.25 ± 3.33 WOMAC (joint stiffness) (0 – 10) 6.12 ± 2.064.12 ± 1.78* WOMAC (physical function) (0 – 85) 55.62 ± 14.5248.37 ± 8.67* VAS : Visuel Analog Scale WOMAC : Western Ontario MacMaster Questionnaire * : p<0.05

10. Table 3. Evaluation of the Patients in the Spa Therapy Group Before and After the Therapy Before the Therapy Avg ± SS After the Therapy Avg ± SS Pain during relaxing (VAS) (0 – 10 cm) 4.66 ± 3.031.86 ± 2.29 * Pain during walking (VAS) (0 – 10 cm) 5.35 ± 2.452.78 ± 2.19 * Pain while climbing steps(VAS) (0 – 10 cm) 7.59 ± 2.664.23 ± 2.37 * WOMAC (pain) (0 – 25) 16.12 ± 2.7511.18 ± 4.21 * WOMAC (joint stiffness) (0 – 10) 6.12 ± 2.064.81 ± 1.83 * WOMAC (physical function) (0 – 85) 55.62 ± 14.5241.81 ± 12.66 * VAS : Visuel Analog Scale WOMAC : Western Ontario MacMaster Questionnaire * : p<0.05

11. Table 4. Evaluation of the Patients in the Control Group Before and After the Therapy Before the Therapy Avg ± SS After the Therapy Avg ± SS Pain during relaxing (VAS) (0 – 10 cm) 3.5 ± 2.441.37 ± 1.82 * Pain during walking (VAS) (0 – 10 cm) 5.87 ± 2.242.93 ± 2.08 * Pain while climbing steps(VAS) (0 – 10 cm) 7.12 ± 1.403.68 ± 1.92 * WOMAC (pain) (0 – 25) 14.25 ± 3.338.81 ± 3.18 * WOMAC (joint stiffness) (0 – 10) 4.12 ± 1.783.18 ± 1.42 * WOMAC (physical function) (0 – 85) 48.37 ± 8.6732.81 ± 9.74 * VAS : Visuel Analog Scale WOMAC : Western Ontario MacMaster Questionnaire * : p<0.05

12. Table 5. Improvements in Subgroups of the Nottingham Health Profile Spa Therapy Group Avg ± SS Control Group Avg ± SS Before the Therapy After the Therapy Before the Therapy After the Therapy Pain 72.72 ± 25.2933.06 ± 24.29*66.78 ± 25.9232.81 ± 24.30* Physical Activity 43.12 ± 19.5623.64 ± 12.68*38.33 ± 22.027.49 ± 18.23* Sleep 44.69 ± 35.3231.15 ± 28.2541.48 ± 37.2837.45 ± 34.02 Fatique 57.52 ± 39.8644.55 ± 40.0655.69 ± 41.2447.64 ± 35.66 Social Isolation 10.95 ± 19.515.36 ± 16.5424.39 ± 23.3822.99 ± 22.75 Emotional Reactions 22.57 ± 18.3211.10 ± 16.58*22.70 ± 29.03 * : p<0.05

13. Elkayam O, et al. Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. J. Rheumatol 1991; 18: 1799-803

14. Sukenik S, et al. Balneotherapy at the Dead Sea area for knee osteoarthritis. IMAJ (Israel Medical Association Journal) 1999; 1: 83-85

15. Nguyen M, et al. Prolonged effects of 3 week therapy in a spa resort on lumbar spine, knee and hip osteoarthritis: Follow-up after 6 months. A randomised controlled trial. Br.J.Rheumatol 1997; 36: 77-81

16. Altan L, et al. Place of balneotherapy in knee osteoarthritis Romatizma 1999; 2: 95-100

17. O’Reilly CS, et al. Quadriceps weakness in knee osteoarthritis: The effect on pain and disability. Ann. Rheum.Dis.1998; 57: 558-94

18. Kovacs I, et al. The therapeudic effects of Cserkeszolo thermal water in osteoarthritis of the knee: A double blind, controlled, Follow-up study. Rheumatol Int. 2002; 21(6): 218-21

19. Guillemin F, et al. Effect on osteoarthritis of spa therapy at Bourbonne-Les Bains Joint Bone Spine. 2001; 68(6): 499-503

20. Tishler M, et al. The effect of balneotherapy on osteoarthritis.Is an intermittant regimen effective ? Eur.J.Intern Med.2004; 15(2): 93-99

21. Conclusion In knee osteoarthritis patients, in early therapy period balneotherapy was no better than home exercise therapy. We need longterm, Large series of controlled studies to find out the effectiviness of balneotherapy in knee osteoarthritis.