title: Comparison of a generic and a disease specific quality of life scale to assess a comprehensive spa therapy program for knee osteoarthritis. Intermittent balneotherapy at the Dead Sea area for patients with knee osteoarthritis. Conscious Expectation and Unconscious Conditioning in Analgesic, Motor, and Hormonal Placebo/Nocebo Responses One-year follow-up of mud-bath therapy in patients with bilateral knee osteoarthritis: a randomized, single-blind controlled trial Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial. The effect of Neydharting mud-pack therapy on knee osteoarthritis: a randomized, controlled, double-blind follow-up pilot study
   Balneotherapy in elderly patients: effect on pain from degenerative knee and spine conditions and on quality of life. Balneological outpatient treatment for patients with knee osteoarthritis; an effective non-drug therapy option in daily routine? Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee 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. Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis. Therapeutic effect of spa therapy and short wave therapy in knee osteoarthritis: a randomized, single blind, controlled trial Evaluation of the effect of Lake Hévíz thermal mineral water in patients with osteoarthritis of the knee: a randomized, controlled, single-blind, follow-up study. Phytothermotherapy in osteoarthritis: a randomized controlled clinical trial. Balneotherapy and tap water therapy in the treatment of knee osteoarthritis The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. Effect on osteoarthritis of spa therapy at Bourbonne-les-Bains. Validity and reliability of Swedish WOMAC osteoarthritis index: A self-administered disease-specific questionnaire (WOMAC) versus generic instruments (SF-36 and NHP) Effects of mud therapy on perceived pain and quality of life related to health in patients with knee osteoarthritis. Short- and Long-Term Effects of Spa Therapy in Knee Osteoarthritis
abstract: OBJECTIVES To compare the differences or correlation between the results obtained from a generic and a disease-specific instrument for the study group and to assess the short-term effects of spa therapy on quality of life of patients with knee osteoarthritis . PATIENTS AND METHODS Fifty patients with knee osteoarthritis were r and omly recruited . They underwent a comprehensive spa therapy program for 21 days . Forty-six patients completed the study . The results were evaluated with Medical Outcomes Study 36-Item Short Form-36 ( SF-36 ) and Arthritis Impact Measurement Scale 2 ( AIMS 2 ) . RESULTS Statistically significant improvement was observed in all subscales of SF-36 . All subscales of AIMS 2 improved too , but only half of them were significant . Correlation between matching subscales of each test was also significant , except physical activity . CONCLUSION Comprehensive spa therapy seems to increase the quality of life of patients with knee osteoarthritis for short term BACKGROUND Balneotherapy , traditionally administered during a continuous stay at the Dead Sea area , has been shown to be effective for patients suffering from knee osteoarthritis . OBJECTIVES To evaluate the effectiveness of an intermittent regimen of balneotherapy at the Dead Sea for patients with knee osteoarthritis . METHODS Forty-four patients with knee osteoarthritis were included in a prospect i ve r and omized single-blind controlled study . The patients were divided into two groups : a treatment group ( n=24 ) , which were treated twice weekly for 6 consecutive weeks in a sulfur pool heated to 35 - 36 degrees C , and a control group ( n=20 ) treated in a Jacuzzi filled with tap water heated to 35 - 36 degrees C. Participants were assessed by the Lequesne index of osteoarthritis severity , the WOMAC index , the SF-36 quality of health question naire , VAS scales for pain ( completed by patients and physicians ) , and physical examination . RESULTS A statistically significant improvement , lasting up to 6 months , was observed in the treatment group for most of the clinical parameters . In the control group the only improvements were in the SF-36 bodily pain scale at 6 months , the Lequesne index at 1 month and the WOMAC pain score at the end of the treatment period . Although the patients in the control group had milder disease , the difference between the two groups was not statistically significant . CONCLUSIONS Intermittent balneotherapy appears to be effective for patients with knee osteoarthritis The placebo and nocebo effect is believed to be mediated by both cognitive and conditioning mechanisms , although little is known about their role in different circumstances . In this study , we first analyzed the effects of opposing verbal suggestions on experimental ischemic arm pain in healthy volunteers and on motor performance in Parkinsonian patients and found that verbally induced expectations of analgesia/hyperalgesia and motor improvement/worsening antagonized completely the effects of a conditioning procedure . We also measured the effects of opposing verbal suggestions on hormonal secretion and found that verbally induced expectations of increase/decrease of growth hormone ( GH ) and cortisol did not have any effect on the secretion of these hormones . However , if a preconditioning was performed with sumatriptan , a 5-HT1B/1D agonist that stimulates GH and inhibits cortisol secretion , a significant increase of GH and decrease of cortisol plasma concentrations were found after placebo administration , although opposite verbal suggestions were given . These findings indicate that verbally induced expectations have no effect on hormonal secretion , whereas they affect pain and motor performance . This suggests that placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved , whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play , even though a conditioning procedure is performed The objective of this prospect i ve parallel r and omized single-blind study was to assess that a cycle of mud-bath therapy ( MBT ) provides any benefits over usual treatment in patients with bilateral knee osteoarthritis ( OA ) . Patients with symptomatic primary bilateral knee OA , according to ACR criteria , were included in the study and r and omized to one of two groups : one group received a cycle of MBT at spa center of Chianciano Terme ( Italy )  in addition to the usual treatment , and one group continued their regular care routine alone .  Clinical assessment s were performed 7 days before enrollment ( screening visit ) , at the time of enrollment ( basal time ) , after 2 weeks , and after 3 , 6 , 9 , and 12 months after the beginning of the study . All assessment s were conducted by two research ers blinded to treatment allocation . The primary efficacy outcomes were the global pain score evaluated by Visual Analog Scale ( VAS ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) subscore for physical function ( W-TPFS ) .  Of the 235 patients screened , 103 met the inclusion criteria : 53 patients were included in the MBT group and 50 in the control group . In the group of patients treated with MBT , we observed a statistically significant ( p < 0.001 ) reduction of VAS and W-TPFS score at the end of the treatment ; this improvement was significant ( p < 0.05 ) also at 3 months of follow-up . The control group did not show significant differences between baseline time and all other times . The differences between one group were significant for both primary parameters already from the 15th day and persisted up to the 9th month . This beneficial effect was confirmed by the significant reduction of symptomatic drug consumption . Tolerability of MBT seemed to be good , with light and transitory side effects . Our results confirm that a cycle of MBT added to usual treatment provides a beneficial effect on the painful symptoms and functional capacities in patients with knee OA that lasts over time . Mud-bath therapy can represent a useful backup to pharmacologic treatment of knee OA or a valid alternative for patients who do not tolerate pharmacological treatments Objective To determine whether spa therapy , plus home exercises and usual medical treatment provides any benefit over exercises and usual treatment , in the management of knee osteoarthritis . Methods Large multicentre r and omised prospect i ve clinical trial of patients with knee osteoarthritis according to the American College of Rheumatology criteria , attending French spa resorts as out patients between June 2006 and April 2007 . Zelen r and omisation was used so patients were ignorant of the other group and spa personnel were not told which patients were participating . The main endpoint criteria were patient self-assessed . All patients continued usual treatments and performed daily st and ardised home exercises . The spa therapy group also received 18 days of spa therapy ( massages , showers , mud and pool sessions ) . Main Endpoint The number of patients achieving minimal clinical ly important improvement ( MCII ) at 6 months , defined as ≥19.9 mm on the visual analogue pain scale and /or ≥9.1 points in a normalised Western Ontario and McMaster Universities osteoarthritis index function score and no knee surgery . Results The intention to treat analysis included 187 controls and 195 spa therapy patients . At 6 months , 99/195 ( 50.8 % ) spa group patients had MCII and 68/187 ( 36.4 % ) controls ( χ2=8.05 ; df=1 ; p=0.005 ) . However , no improvement in quality of life ( Short Form 36 ) or patient acceptable symptom state was observed at 6 months . Conclusion For patients with knee osteoarthritis a 3-week course of spa therapy together with home exercises and usual pharmacological treatments offers benefit after 6 months compared with exercises and usual treatment alone , and is well tolerated . Trial registration number NCT00348777 BACKGROUND Osteoarthritis is a degenerative disease associated with pain , reduced range of motion , and impaired function . Balneotherapy or bathing in thermal or mineral waters is used as a non-invasive treatment for various rheumatic diseases . AIM To evaluate the effectiveness of hot sulfurous and non-sulfurous waters in the treatment of  knee osteoarthritis  . DESIGN A r and omized , assessor-blind , controlled trial . SETTING A spa resort . POPULATION One hundred and forty patients of both genders , mean age of 64.8±8.9 years , with knee osteoarthritis and chronic knee pain . METHODS Patients were r and omized into three groups : the sulfurous water ( SW ) group ( N.=47 ) , non-sulfurous water ( NSW ) group ( N.=50 ) , or control group ( N.=43 ) who received no treatment . Patients were not blinded to treatment allocation . Treatment groups received 30 individual thermal baths ( three 20-minute baths a week for 10 weeks ) at 37 - 39 ° C . The outcome measures were pain ( visual analog scale , VAS ) , physical function ( Western Ontario and McMaster Universities Osteoarthritis Index , WOMAC ; Lequesne Algofunctional Index , LAFI ; Stanford Health Assessment Question naire , HAQ ) , and use of pain medication . Patients were assessed before treatment ( T1 ) , at treatment endpoint ( T2 ) , and two months post-intervention ( T3 ) . Intra- and intergroup comparisons were performed at a significance level of 0.05 ( P<0.05 ) . RESULTS A significant decrease in VAS pain scores ( pain during movement , at rest , and at night ) and use of pain medication , and improvement in WOMAC , LAFI and HAQ scores were observed from baseline to T2 and T3 within treatment groups ( P<0.001 ) , and between controls and both treatment groups at T2 and T3 ( P<0.001 ) . No significant differences in these variables were observed between treatment groups at T2 , but patients in the SW group reported less pain and better functional status than those in the NSW group at T3 , showing a lasting effect of sulfurous water baths . CONCLUSIONS Both therapeutic methods were effective in the treatment of knee osteoarthritis ; however , sulfurous baths yielded longer-lasting effects than non-sulfurous water baths . CLINICAL REHABILITATION IMPACT Baths in thermal waters , especially those in sulfurous waters , are effective in reducing pain and improving physical function in patients with knee osteoarthritis The aim of this study was to evaluate the effects of Neydharting mud-pack therapy on the clinical parameters and quality of life in patients with knee osteoarthritis . In this double-blind , r and omized , follow-up study on 53 patients with knee osteoarthritis , one group received hot mud-pack therapy , whereas the other ( control ) group was treated with hot packs of a substance manufactured on 10 occasions for 2 weeks . Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) , EuroQoL-5D quality -of-life measure and need for analgesics and non-steroidal anti-inflammatory drugs were recorded before treatment , at the end of treatment ( at Week 2 ) , and at Weeks 6 and 12 . The WOMAC and the EQ5D quality -of-life scores improved from the baseline to the end of treatment in both groups , and further improvement was observed during the follow-up period ( p < 0.001 , respectively , in both groups ) . The need for medications for knee joint pain improved in both groups , and these changes were significant only in the mud-treated group ( p < 0.001 ) , but not in the control group ( p = 0.106 ) compared to baseline . The number of patients requiring medications for knee joint pain showed a continuous downward trend at the subsequent post-treatment visits by the mud-treated group , and these changes became significant by Visit 4 compared to baseline ( p = 0.016 ) . The control group showed only temporary and not significant decrease . The difference was not significant between the groups in any of the outcome parameters at any visits . The Neydharting mud pack has a favorable effect on the clinical parameters , quality of life , and need for medications in patients with knee osteoarthritis . To evaluate the chemical effect , the number of patients should be increased BACKGROUND Balneotherapy is an established treatment modality for musculoskeletal disease , but few studies have examined the efficacy of spa therapy in elderly patients with degenerative spine and joint diseases . OBJECTIVES To assess the effects of balneotherapy on chronic musculoskeletal pain , functional capacity , and quality of life in elderly patients with osteoarthritis of the knee or with chronic low back pain . METHODS The 81 patients in the study group underwent a 1 day course of 30 minute daily baths in mineral water . Changes were evaluated in the following parameters : pain intensity , functional capacity , quality of life , use of non-steroidal anti-inflammatory or analgesic drugs , subjective disease severity perceived by the patients , investigator-rated disease severity , and severity of pain perceived by the patients . We analyzed the results of 76 subjects as 5 did not complete the study . RESULTS Compared to baseline , all monitored parameters were significantly improved by balneotherapy in both investigated groups . Moreover , the favorable effect was prolonged for 3 months after treatment . CONCLUSIONS This study showed that balneotherapy is an effective treatment modality in elderly patients with osteoarthritis of the knee or with chronic low back pain , and its benefits last for at least 3 months after treatment This study aims to compare the effects of balneological treatments applied at consecutive and intermittent sessions without interfering with their daily routine in patients with knee osteoarthritis . This is a r and omized , controlled , single-blind clinical trial . Fifty patients diagnosed with knee osteoarthritis were included . The patients were divided into two groups . All patients were given a total of ten sessions of balneological treatment consisting of hydrotherapy and mud pack therapy . Group 1 received consecutive treatment for 2 weeks , while group 2 received intermittent treatment for 5 weeks . Local peloid packs at 45 ° C were applied for 20 min , after a tap water ( 38 ° C ) bath .  Evaluations were conducted before , after treatment , and at 12th week of post-treatment by Pain ( VAS ) , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and Short Form-36 ( SF-36 ) . Both balneological treatment regimens of knee osteoarthritis had statistically significant clinical effects as well as effects on the quality of life . Patients ’ well-being continued at 3 months , except for joint stiffness ( WOMAC ) , role-emotional ( SF-36 ) , and vitality ( SF-36 ) in group 1 and for mental health ( SF-36 ) in both groups . Both patient groups had improved compared to baseline . However , at 3 months after the treatment , the well-being of group 2 was unable to be maintained in terms of role-physical ( SF-36 ) parameter , while the well-being of group 1 was unable to be maintained in terms of pain , WOMAC ( pain , physical functions , total ) , and SF-36 ( physical functioning , role-physical , pain , role-emotional , and mental health ) variables , compared to data obtained immediately after treatment . Our study suggests that traditional and intermittent balneological therapies have similar efficacy in patients with knee osteoarthritis The aims of this study were to evaluate whether balneotherapy with mineral sulphate – bicarbonate – calcium water could determine substantial symptomatic improvement , and to detect any changes in the quality of life ( QoL ) of patients with symptomatic knee osteoarthritis ( OA ) . This was a prospect i ve r and omized , single blind controlled trial . Sixty out patients with primary bilateral knee OA , according to ACR criteria , were included in the study and r and omized to one of two groups : group I ( 30 patients ) was treated with a daily sulphate – bicarbonate – calcium mineral water bath ; group II ( 30 patients ) , the control group , continued their regular outpatient care routine . At baseline , after 15 days and after 12 weeks , patients were evaluated by Visual Analogue Scale ( VAS ) for spontaneous pain , Lequesne and Womac Index for gonarthrosis , SF-36 , Arthritis Impact Measurement Scale ( AIMS ) and symptomatic drugs consumption . We observed a significant improvement of all parameters at the end of the cycle of balneotherapy which persisted throughout the follow-up period , whereas in the control group no significant differences were noted . This symptomatic effect was confirmed by the significant reduction of symptomatic drugs consumption . The differences between the two groups were significant for all considered parameters already from the 15th day and persisted during follow-up . Tolerability of balneotherapy  seemed to be good , with light and transitory side effects . Our results confirm that the beneficial effects of balneotherapy in patients with knee OA last over time , with positive effects on the painful symptomatology , a significant improvement on functional capacities and QoL.  Balneotherapy can represent a useful backup to pharmacological treatment of knee OA or a valid alternative for patients who do not tolerate pharmacological treatments Spa therapy is frequently used in daily rheumatological practice , but its benefit remains to be evaluated . A prospect i ve r and omized controlled study was conducted in 1993 in patients with osteoarthritis of the hip , knee or lumbar spine . Treatment was either  spa therapy at Vichy ( France ) of 3 weeks duration ( spa group ) or usual therapy ( control group ) . Assessment criteria were pain ( visual analogue scale ) , functional impairment ( Lequesne 's index for hip or knee disease , Main and Waddell 's for lumbar spinal diseases ) , quality of life index [ revised Arthritis Impact Measurement Scale ( AIMS 2 ) ] , and  analgesic and /or non-steroidal anti-inflammatory drug ( NSAID ) consumption .  Patients were included by r and omization into one of the two arms ( spa or control ) and assessment criteria were collected before spa therapy or the control period , and 3 and 24 weeks thereafter . A total of 188 patients ( lumbar spine 95 , knee 64 , hip 29 ) were included in the study ( spa group 91 , control group 97 ) . Changes in the assessment criteria after a 6 month follow-up period showed improvement in terms of pain , functional impairment and quality of life , with a reduced intake of symptomatic drugs ( NSAID and analgesic drugs ) in the spa group . This study suggests that spa therapy of 3 weeks duration has a prolonged , beneficial , symptomatic effect in osteoarthritis OBJECTIVE The objective of this study is to compare the efficacy of mature mud pack and hot pack therapies on patients with knee osteoarthritis . DESIGN This study was design ed as a prospect i ve , r and omized-controlled , and single-blinded clinical trial . Twenty-seven patients with clinical and radiologic evidence of knee osteoarthritis were r and omly assigned into two groups and were treated with mature mud packs ( n 15 ) or hot packs ( n=12 ) . Patients were evaluated for pain [ based on the visual analog scale ( VAS ) ] , function ( WOMAC , 6 min walking distance ) , quality of life [ Short Form-36 ( SF-36 ) ] , and serum levels of tumor necrosis factor-alpha ( TNF-α ) , interleukin-6 ( IL-6 ) , and insulin-like growth factor-1 ( IGF-1 ) at baseline , post-treatment , and 3 and 6~months after treatment . RESULTS The mud pack group shows a significant improvement in VAS , pain , stifness , and physical function domains of WOMAC . The difference between groups of pain and physical activity domains is significant at post-treatment in favor of mud pack . For a 6 min walking distance  , mud pack shows significant improvement , and the difference is significant between groups in favor of mud pack at post-treatment and 3 and 6 months after treatment . Mud pack shows significant improvement in the pain subscale of SF-36 at the third month continuing until the sixth month after the treatment . Significant improvements are found for the social function , vitality/energy , physical role disability , and general health subscales of SF-36 in favor of the mud pack compared with the hot pack group at post-treatment . A significant increase is detected for IGF-1 in the mud pack group 3 months after treatment compared with the baseline , and the difference is significant between groups 3 months after the treatment . CONCLUSION Mud pack is a favorable option compared with hotpack for pain relief and for the improvement of functional conditions in treating patients with knee osteoarthritis Spa therapy and short wave therapy are two of the most commonly used non-pharmacological approaches for  osteoarthritis .  The aim of this study was to assess their efficacy in comparison to conventional therapy in patients with osteoarthritis of the knee in a single blind , r and omized , controlled trial . Seventy-four out patients were enrolled ; 30 patients were treated with a combination of daily local mud packs and arsenical ferruginous mineral bath water from the thermal resort of Levico Terme ( Trento , Italy ) for 3 weeks ; 24 patients were treated with short wave therapy for the same period and 20 patients continued regular , routine ambulatory care . Patients were assessed at baseline , upon completion of the 3-week treatment period , and 12 weeks later . Spa therapy and short wave therapy both demonstrated effective symptomatic treatment in osteoarthritis of the knee at the end of the treatment , but only the spa therapy was shown to have efficacy persistent over time . Our study demonstrated the superiority of arsenical ferruginous spa therapy compared to short wave therapy in the treatment of osteoarthritis of the knee , probably in relationship to the specific effects of the minerals in this water BACKGROUND Osteoarthritis is the most frequent joint disease and is a leading cause of pain and locomotor disability in elderly people . The treatment of osteoarthritis includes non-pharmacological , pharmacological , and surgical therapies . Silver level evidence has been found concerning balneotherapy in osteoarthritis . AIM OF THE STUDY The aim of this study was to evaluate how Lake Hévíz thermal mineral water therapy influences pain , knee function , and quality of life in patients with knee osteoarthritis , compared to the control group . STUDY DESIGN r and omized , controlled , single-blind , follow-up study . SETTING Spa Hévíz and St. And rew Hospital for Rheumatic Diseases POPULATION This study included 77 out patients between 45 and 75 years of age with mild to moderate osteoarthritis of the knee meeting the American College of Rheumatology classification criteria . METHODS Patients were r and omized into two groups . In group I ( n = 38 ) , subjects bathed in Lake Hévíz and in group II ( N.=39 ) , patients were treated in a pool full of tap water . Water temperature was 34 ° C for both groups . Participants underwent 30-minute therapy sessions , five times a week for three weeks . Outcome measures were pain visual analogue scale scores , active flexion degree , knee circumference , stair-climb time , Western Ontario and McMaster Universities osteoarthritis index ( WOMAC ) , and EuroQoL Group 5-Dimension Self-Report Question naire score ( EQ-5D ) . Study parameters were recorded at baseline , immediately after treatment , and after 15 weeks . RESULTS Comparison of the two groups revealed a statistically significant difference in pain visual analogue scale scores ( P<0.01 ) , active flexion degree ( P<0.01 ) , physical function components of WOMAC ( P<0.05 ) , and EQ-5D scores ( P<0.05 ) even after 15 weeks . CONCLUSIONS Balneotherapy  improved pain , function as well as the quality of life in patients with knee osteoarthritis . CLINICAL REHABILITATION IMPACT Balneotherapy is a potentially useful treatment modality for patients with knee osteoarthritis OBJECTIVE The aim of this study was to assess the efficacy of adding a cycle of phytothermotherapy ( a traditional treatment with fermenting grass used in Trentino-Alto Adige , Italy ) to the usual drug treatment , in patients with primary symptomatic osteoarthritis ( OA ) of the knee , hip , or lumbar spine . METHODS In this r and omized , single-blind , controlled trial , 218 out patients were enrolled ; 109 patients were treated with a cycle of phytothermotherapy at the thermal resort of Garniga Terme ( Trento , Italy ) for 10 days ; the other 109 patients continued regular outpatient care . Patients were assessed at baseline , after 2 weeks , and after 3 months from the beginning of the study and were evaluated using a visual analogue scale ( VAS ) for spontaneous pain , a Health Assessment Question naire , the Lequesne index for hip and knee osteoarthritis , and the Roll and Morris Question naire for lumbar spine OA and symptomatic drug consumption . RESULTS In patients treated with phytothermotherapy , a significant improvement of VAS and a reduction of nonsteroidal anti-inflammatory drug consumption at the end of treatment and 3 months later were observed . In the control group , no significant differences were noted . The analyses performed separately for each subgroup for OA localization showed that the best results were evident in lumbar spine OA . Concerning tolerability , in the group treated with phytothermotherapy 10 % of patients presented side-effects due to treatment , but these were of low intensity and did not interrupt the therapy . CONCLUSIONS In conclusion , the results show beneficial effects of a cycle of phytothermotherapy in patients with OA of the hip , knee , or lumbar spine .  Phytothermotherapy may therefore be a useful aid alongside the usual pharmacologic and physiokinesic therapies , or may be used as a valid alternative for patients who do not tolerate pharmacologic treatments To investigate if spa water is superior to tap water ( TW ) in relieving the symptoms of pain , joint motion , life quality in knee osteoarthritis ( KOA ) patients . In this r and omized placebo-controlled trial , 52 patients with KOA were followed in two groups . In group I ( n = 27 ) , patients were treated in the pool full of spa water at 37 ° C for 20 min a day , 5 days a week , for a period of 2 weeks . In group II ( n = 25 ) , the same protocol was used but spa water was replaced by TW heated to 37 ° C . Patients in both groups were given a home-based st and ardized exercise program . Evaluation parameters were pain ( pVAS ) , tenderness score ( TS ) , 50-ft walking duration , quadriceps muscle strength ( QMS ) , active flexion degree ( AFD ) , WOMAC OA index , and Nottingham Health Profile ( NHP ) . The first evaluation was done after the informed consent was obtained . Second and third evaluations were done at the 2nd and 12th week . PVAS , 50-ft walking duration , AFD , TS , WOMAC , and NHP variables improved in group I. Same variables except QMS improved also in group II . Comparison of the groups just after treatment showed that only pVAS ( P = 0.015 ) , NHP pain score ( P = 0.020 ) , and TS ( P = 0.002 ) differed significantly in favor of group I at the 2nd or 12th week . Both of the thermal treatment modalities were found to be effective in the management of the clinical symptoms and quality of life in KOA patients . However , pain and tenderness improved statistically better with balneotherapy . There were no significant differences between the groups for the other variables OBJECTIVES Knee osteoarthritis ( OA ) is a common chronic degenerative disorder . There are various treatment modalities . This study was planned to investigate the efficacy of balneotherapy , mud-pack therapy in patients with knee OA . METHODS A total of 80 patients with knee OA were included . Their ages ranged between 39 - 78 . The patients were separated in to three groups . Group I ( n=25 ) received balneotherapy , group II ( n=29 ) received mud-pack therapy and group III ( n=26 ) was hot-pack therapy group . The therapies were applied for 20 min duration , once a day , five times per week and a total of 10 session . Patients were assessed according to pain , functional capacity and quality of life parameters . Pain was assessed by using Visual Analogue Scale ( VAS ) and Western Ontario McMaster Osteoarthritis Index ( WOMAC ) pain scale ( 0 - 4 likert scale ) . Functional capacity was assessed by using WOMAC functional capacity and WOMAC global index . Quality of life was evaluated by Nottingham Health Profile ( NHP ) self-administered question naire . Also physician 's global assessment and the maximum distance that patient can walk without pain , were evaluated . The assessment parameters were evaluated before and after three months . RESULTS There were statistically significant improvement in VAS and WOMAC pain scores in group I ( p<0.001 ) , group II and III ( p<0.05 ) . The WOMAC functional and global index also decreased in group I ( p<0.05 ) , group II ( p<0.001 ) and hot-pack group ( p<0.05 ) . Quality of life results were significantly improved in balneotherapy and mud-pack therapy groups ( p<0.05 ) . No difference was observed in hot-pack therapy group ( p>0.05 ) . The maximum distance was improved both in group I and II ( p<0.05 ) but not in group III . Also physician 's global assessment was found to be improved in all groups ( p<0.05 ) . CONCLUSIONS Balneotherapy and mud-pack therapy were effective in treating patients with knee OA OBJECTIVES Several studies suggest a beneficial overall effect of spa therapy in chronic musculoskeletal diseases . The present open controlled study investigated the effects of spa therapy at Bourbonne-Les-Bains , France , in patients with hip or knee osteoarthritis or low back pain . PATIENTS AND METHODS In 1998 , 102 men and women older than 50 years were included in the study . All had low back pain or lower limb osteoarthritis , and none had contraindications to spa therapy .  Quality of life was assessed three times at intervals of 4 weeks , twice before and once immediately after 3 weeks of spa therapy , using the Duke Health Profile ( five dimensions and five dysfunctions ) . RESULTS Mean age was 66.4 years , and 67 % of the patients were women .  Quality of life was markedly decreased as compared to the population at large ( 1996 , CFES ) . The two pretreatment evaluations produced similar quality -of-life scores .  Spa therapy was associated with significant improvements in overall quality of life ( P=0.004 ) , self-esteem ( P=0.009 ) , and pain ( P=0.01 ) . CONCLUSION These findings support those of other studies conducted in France and in other European countries . They indicate that patients report meaningful improvements in their quality of life after spa therapy We assessed whether a disease-specific , self-administered question naire could replace a generic instrument as an outcome tool after total hip replacement , and tested the validity and reliability of the Swedish WOMAC osteoarthritis index . 58 patients operated on with total hip arthroplasty 2 - 10 years ago were r and omized to the study . All patients were asked to answer one disease-specific question naire ( WOMAC osteoarthritis index ) and two generic instruments ( NHP and SF-36 ) in the same week . The procedure was repeated after 4 weeks . We tested content validity , construct validity , criterion validity , test-retest reliability and internal consistency reliability according to total score , domains and items . We found that both the generic instruments ( NHP and SF-36 ) and the disease-specific test ( WOMAC ) had a high validity , i.e. , measuring what they were supposed to measure ( high validity ) . The question naires were also reproducible over time ( high reliability ) . We suggest the Swedish WOMAC to be used after total hip arthroplasty in future studies OBJECTIVE To analyze the effects of mud therapy on perceived pain , Health Related Quality of Life ( HRQL ) and drug use in patients diagnosed with knee osteoarthritis . MATERIAL AND METHODS A prospect i ve , controlled clinical trial . The sample ( n=147 ) was divided into an experimental group ( EG ) of 61 subjects ( 69.13 ± 5,60 years ) who received 11 consecutive sessions of peloids in the knee/s affected by the process described and a control group ( CG ) of 60 subjects ( 73.08 ± 8,90 years ) who continued routine drug treatment . The sample was assessed before and after intervention using the SF-36 , Visual Analogue Scale and changes in drug use , setting a significance level of P ≤ .05 . RESULTS After the intervention , there were statistically significant differences ( P<.05 ) in all parameters analyzed between EG and CG , reduced drug use in the EG versus no change in the CG . The general health , bodily pain and perceived pain are those that show major changes between the two groups . CONCLUSIONS Mud therapy in patients diagnosed with knee osteoarthritis attains immediate effects on perceived pain and HRQOL , reducing the consumption of specific drugs . Studies are needed to evaluate the scientific evidence from the effects of such intervention Fioravanti A , Iacoponi F , Bellisai B , Cantarini L , Galeazzi M : Short- and long-term effects of spa therapy in knee osteoarthritis . Objective : To assess both the short- and long-term effectiveness of spa therapy in patients with primary knee osteoarthritis in a prospect i ve , r and omized , single-blinded , controlled trial . Design : Eighty out patients were enrolled in this study ; 40 patients were treated with a combination of daily local mud packs and bicarbonate-sulfate mineral bath water from the spa center of Rapolano Terme ( Siena , Italy ) for 2 wks , and 40 patients continued regular , routine ambulatory care . Patients were assessed at baseline time ; after 2 wks ; after 3 , 6 , and 9 mos after the beginning of the study and were evaluated by Visual Analog Scale for spontaneous pain , Lequesne index , Western Ontario and McMaster Universities Index for gonarthrosis , Arthritis Impact Measurement Scale-1 , and symptomatic drug consumption . Results : We observed a significant improvement of all evaluated parameters at the end of the cycle of spa therapy , which persisted throughout the whole of the follow-up period , whereas in the control group no significant differences were noted . This symptomatic effect was confirmed by the significant reduction of symptomatic drug consumption . Tolerability of spa therapy seemed to be good , with light and transitory side effects . Conclusions : The results from our study confirm that the beneficial effects of spa therapy in patients with knee osteoarthritis lasts over time , with positive effects on the painful symptomatology and a significant improvement on functional capacities .  Spa therapy can represent a useful backup to pharmacologic treatment of knee osteoarthritis or a valid alternative for patients who do not tolerate pharmacologic treatments
target: In conclusion , even though limitations must be considered , evidence shows that BT and spa therapy can significantly improve QoL of patients with knee OA .
  Moreover , reduction of drug consumption and improvement of algofunctional indexes may be other beneficial effects .
background: Knee osteoarthritis ( OA ) is a degenerative disease which is expected to become one of the leading causes of disability by the next years .
  This work aims to assess if balneotherapy and spa therapy can significantly improve Quality of Life ( QoL ) of patients with knee OA .