title: Hydrotherapy--a new approach to improve function in the older patient with chronic heart failure. Balneotherapy for atopic dermatitis in children at Comano spa in Trentino, Italy Effect of inhalation of thermal water on airway inflammation in chronic obstructive pulmonary disease. SPA therapy of upper respiratory tract inflammations Balneotherapy in medicine: A review One-Year Effectiveness of a 3-Week Balneotherapy Program for the Treatment of Overweight or Obesity Effects of Inhalation of Thermal Water on Exhaled Breath Condensate in Chronic Obstructive Pulmonary Disease Sulphurous-arsenical-ferruginous (thermal) water inhalations reduce nasal respiratory resistance and improve mucociliary clearance in patients with chronic sinonasal disease: preliminary outcomes Clinical and economic analysis of spa therapy in Parkinson's disease. Effects of a bicarbonate-alkaline mineral water on gastric functions and functional dyspepsia: a preclinical and clinical study. Sulphurous thermal water inhalations in the treatment of chronic rhinosinusitis. [Psoriasis and mud bath therapy: clinical-experimental study]. Health resort treatment improved the neurosteroid profile in thyroidectomized women. The efficacy of alum-containing ferrous thermal water in the management of chronic inflammatory gynaecological disorders--a randomized controlled study. Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure. Balneotherapy versus paroxetine in the treatment of generalized anxiety disorder. Clinical, functional and quality of life changes after balneokinesis with sulphurous water in patients with varicose veins. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. [Experimental study on efficacy of thermal muds of Ischia Island combined with balneotherapy in the treatment of psoriasis vulgaris with plaques]. Language of publication restrictions in systematic reviews gave different results depending on whether the intervention was conventional or complementary. Completeness of reporting of trials published in languages other than English: implications for conduct and reporting of systematic reviews [The rhinogenic deafness and SPA therapy: clinical-experimental study]. Randomized trial of balneotherapy associated with patient education in patients with advanced chronic venous insufficiency.
abstract: AIMS Hydrotherapy , i.e. exercise in warm water , as a rehabilitation program has been considered potentially dangerous in patients with chronic heart failure ( CHF ) due to the increased venous return caused by the hydrostatic pressure . However , hydrotherapy has advantages compared to conventional training . We studied the applicability of an exercise programme in a temperature-controlled swimming pool , with specific reference to exercise capacity , muscle function , quality of life and safety . METHODS AND RESULTS Twenty-five patients with CHF ( NYHA II-III , age 72.1+/-6.1 ) were r and omised into either 8 weeks of hydrotherapy ( n=15 ) , or into a control group ( n=10 ) . The training program was well tolerated with no adverse events . Patients in the hydrotherapy group improved their maximal exercise capacity ( + 6.5 vs.-5.9 W , P=0.001 ) , isometric endurance in knee extension ( + 4 vs.-9 s , P=0.01 ) together with an improvement in the performance of heel-lift ( + 4 vs. -3 n.o . , P=<0.01 ) , shoulder abduction ( + 12 vs. -8 s , P=0.01 ) and shoulder flexion ( + 6 vs. + 4 , P=0.01 ) in comparison to patients in the control group . CONCLUSION Physical training in warm water was well tolerated and seems to improve exercise capacity as well as muscle function in small muscle groups in patients with CHF . This new approach broadens the variety of training regimes for older patients with CHF Abstract Background : No controlled studies have investigated whether balneotherapy is effective in  atopic dermatitis ( AD ) .  Objectives : To investigate the efficacy and safety of balneotherapy performed at Comano spa ( Trentino , Italy ) compared to topical corticosteroids ( TCS ) in the treatment of AD . Methods : This was an open , r and omized , clinical trial including 104 children ( aged 1–14 years ) with mild to moderate AD who were assigned either to balneotherapy ( n = 54 ) or TCS ( n = 50 ) once daily for 2 weeks . AD severity and quality of life were measured using the SCORAD , investigator global assessment ( IGA ) , patients ' self global assessment ( PSGA ) , children 's dermatology life quality index ( CDLQI ) and family dermatitis impact question naire ( FDIQ ) . Subjective measures were re-evaluated 4 months after the end of therapy . Results : Balneotherapy and TCS result ed in a significant reduction of all parameters at week 2 . TCS were more effective than balneotherapy  regarding SCORAD ( 46 % ± 7.71 vs 26 % ± 9.4 , mean ± SD ; p < 0.03 ) . In contrast , IGA , PSGA , CDLQI and FDIQ improvement was similar . At month 4 , the number and duration of relapses were less in patients treated with balneotherapy compared to those treated with TCS ( p < 0.0001 ) . Conclusions : Balneotherapy at Comano spa appears to be beneficial in children with mild to moderate AD Thermal water inhalations have been traditionally used in the treatment of upper and lower chronic airway diseases . However , the benefit and the mechanism of this treatment have not been properly assessed . To determine whether inhaled salt-bromide-iodine thermal water improves lung function , quality of life and airway inflammation , 39 patients with chronic obstructive pulmonary disease ( COPD ) were r and omly assigned to receive 2-weeks inhalation treatment with thermal water ( active , no. = 20 ) or normal saline ( control , no. = 19 ) in single blind . Lung volumes were measured , Saint George 's respiratory question naire ( SGRQ ) was administered and induced sputum was performed before and after treatment . No changes in pre- and post-salbutamol lung volumes was observed after inhalation treatment in both groups . SGRQ score showed a significant improvement in active group compared with control group at the end of the trial . The concentration of total cells in induced sputum increased significantly in both active ( P < 0.05 ) and control groups ( P < 0.05 ) . Inhalation of thermal water induced a small but significant decrease in percentages of sputum neutrophils ( P < 0.01 ) and a parallel increase in macrophages ( P < 0.01 ) . In contrast , normal saline inhalation was not associated with changes in differential sputum cell counts . In conclusion , treatment with inhaled salt-bromide-iodine thermal water in COPD is associated with a reduced proportion of neutrophils in induced sputum suggesting that thermal water may have a mild anti-inflammatory effect on the airways . However , the short-term improvement in some components health-related quality of life was not related with changes in lung function or with the degree of airway inflammation The upper airway respiratory diseases ( i.e. common cold , allergic rhinitis , nonallergic/vasomotor rhinitis , acute and chronic rhinosinusitis and nasal polyposis ) in which nasal congestion is a common symptom are often undertreated due to the frequent inadequate efficacy and safety concern with current therapies . In scientific literature , few studies seem to support the hypothesis that nasal inhalatory treatment with thermal water promotes the improvement of nasal symptoms , even if the mechanisms by which the improvement from SPA therapy can be expected remain debated . A prospect i ve comparative study with a pre – post design has been performed consecutively enrolling 33 ( males 70 % ) patients of both genders older than 12 years of age , affected by chronic sinonasal inflammation . All patients underwent a 14-days course of radioactive water warm vapour inhalations followed by nasal aerosol of the same thermal water 10 min each once/day at Merano Therme . At the beginning and end of the study , in all the subjects , nasal function evaluation by active anterior rhinomanometry , mucociliary transport time ( MCTt ) determination and nasal cytology were performed . After the inhalatory treatment , the mucociliary function was improved and the pathologic mucociliary transport times recorded at the beginning of the study being significantly reduced to physiologic ones . Besides , before treatment , the cytologic picture showed an inflammatory cell infiltration ( eosinophils , neutrophils with/without bacteria , mast cells ) in 37 % of patients ; after therapy in 66 % of these patients , the rhinocytogram was normal . Our results suggest , according to the literature data , that SPA therapy with radioactive water could represent an alternative choice in chronic inflammatory diseases of the upper airways , nonresponsive to pharmacological therapy Bathing in water ( balneotherapy or spa therapy ) has been frequently and widely used in classical medicine as a cure for diseases . This paper review s the present literature on the use of balneotherapy in dermatologic , chronic musculoskeletal ( inflammatory and non-inflammatory ) , metabolic and psychological conditions . We performed a systematic review on related papers appearing in the Medline and Cochrane Library data base from 1966 to 2003 that included r and omized controlled and non-r and omized clinical trials using balneotherapy . We also determined to reflect where possible the chemical compositions of spas . The major dermatologic and musculoskeletal diseases that are frequently treated by balneotherapy with a remarkable rate of success are atopic dermatitis , psoriasis , rheumatoid arthritis ( RA ) , ankylosing spondylitis , osteoarthritis and low back pain . Moreover , the effects of spa therapy on several metabolic conditions are discussed . The mechanisms by which broad spectrums of diseases respond to spa therapy probably incorporate chemical , thermal and mechanical effects . The importance of balneotherapy either alone or as complement to other therapies should be considered after , or accompanying , orthodox medical treatments Objective . To assess the one-year effectiveness on weight loss of a 3-week balneotherapy program ( BT ) . Method . A Zelen double consent r and omised controlled trial to compare one-year BMI loss between a 3-week  BT program versus usual care ( UC ) for overweight or obese patients ( BMI : 27–35 kg/m2 ) , associated or not with a dietary motivational interview ( DMI )  during the follow-up , using a 2 × 2 factorial design . Main analysis was a per protocol analysis comparing patients attending BT to patients managed by UC , matched on sex , overweight or obese status , DMI r and omisation and a propensity score to attend BT or to be managed by UC . Results . From the 257 patients who completed the follow-up , 70 patients of each group could be matched . Mean BMI loss was 1.91 kg/m2 [ 95%CI : 1.46 ; 2.35 ] for the BT patients and 0.20 kg/m2 [ −0.24 ; 0.64 ] for the UC patients ( P < 0.001 ) , corresponding to a significant BT benefit of 1.71 kg/m2 [ 1.08 ; 2.33 ] . There was no significant effect of DMI and no interaction with BT or UC . No adverse reaction was observed for patients attending BT . Conclusion . A 3-week BT program provided a significant one-year benefit over the usual GP dietary advice for overweight and obese patients Background : Inhalation of thermal water ( TW ) is traditionally used as part of the treatment of chronic obstructive pulmonary disease ( COPD ) , but its benefit and mechanisms are controversial . We previously observed a reduced proportion of neutrophils in induced sputum after treatment with TW . Objectives : The aim of this study was to determine whether inhalation of TW in COPD patients is associated with biochemical changes of airway lining fluid , including a reduction in the neutrophil chemoattractant leukotriene B4 ( LTB4 ) . Methods : Thirteen COPD patients were r and omly assigned to receive a 2-week course of TW and normal saline inhalation in a cross-over , single-blind study design . Exhaled breath condensate ( EBC ) was collected before and after treatments . LTB4 concentrations in EBC were determined by  ELISA  , and EBC pH was measured before and after argon deaeration . Results : No significant differences in LTB4 concentrations in EBC were detected with either treatment . A significant decrease in pH of non-deaerated EBC was observed after a st and ard course of TW ( median 7.45 , interquartile range 6.93–7.66 , vs. median 6.99 , interquartile range 6.57–7.19 ; p = 0.05 ) , which disappeared after argon deaeration . Conclusions : There is no evidence that TW treatment affects LTB4 concentration in EBC . The results of EBC pH measurements suggest that TW inhalation induces an imbalance of volatile components of the buffer system in airway lining fluid Conclusions : In order to confirm these preliminary results , a prospect i ve double-blind study has been instituted in Padova University ENT Section to compare the efficacy of sulphurous-arsenical-ferruginous thermal water nasal irrigations vs isotonic sodium chloride solution nasal irrigations after functional endoscopic sinus surgery for chronic sinusitis . Objectives : Despite their widespread use , much uncertainty exists about the indications and therapeutic mechanisms of nasal thermal water inhalations in the treatment of sinonasal chronic disease . The aim of the present study was to evaluate the effects of sulphurous-arsenical-ferruginous thermal water inhalations on nasal respiratory flow , mucociliary transport , nasal cytology , and chemo-physics of nasal mucus in a group of consecutive patients with chronic sinonasal disease . Patients and methods : Thirty-seven patients with chronic sinonasal disease underwent a 12-day course of sulphurous-arsenical-ferruginous thermal water warm vapour inhalations ( 38 ° C ) followed by nasal aerosol of the same thermal water ( 7 microns micelle ) . Results : This preliminary study showed that a course of sulphurous-arsenical-ferruginous thermal water inhalations determined a significant improvement in nasal flow and reduction of nasal resistance ; a statistically significant reduction of mean mucociliary transport time , from pathologic to physiologic values , has also been shown . Statistical analysis of our data confirmed that the presence of nasal bacteria was significantly reduced by thermal water inhalations The effectiveness of spa therapy in the management of patients with Parkinson 's disease ( PD ) has never been evaluated . This is assessed in this pilot study . A prospect i ve , r and omized , cross-over , controlled study was conducted in 31 PD patients who underwent a 20-week spa period , including spa therapy for 3 weeks , and a 20-week non-spa period .  Effectiveness was assessed using quality of life scales ( PDQ-39 and SF-36 ) , motor scale ( UPDRS ) and psychological question naire ( GHQ-28 ) , at baseline and at 4 ( T4 ) and at 20 weeks ( T20 ) . Direct medical costs ( radiological and laboratory tests , physician fees , drug therapy , and ancillary care ) were recorded over each 20-week period . At T4 , spa therapy improved significantly several dimensions of PDQ-39 and SF-36 , part IV of the UPDRS , and GHQ-28 . At T20 , no difference in any parameter was found . The mean direct medical cost over 20 weeks ( euro;1,328 + /- 167 ; pound 776 + /- 97 per patient ) in the spa period was slightly but significantly reduced in comparison with that of the non-spa period ( euro;1380 + /- 523 ; pound 807 + /- 306 per patient ) . This cost-effectiveness analysis suggests that spa therapy is more effective and less expensive than conventional treatment alone and could be beneficial in the management of PD The present study was performed in order to evaluate : ( 1 ) the influence of a bicarbonate-alkaline mineral water ( Uliveto ) on digestive symptoms in patients with functional dyspepsia ; ( 2 ) the effects of Uliveto on pre clinical models of gastric functions . Selected patients complained of dyspeptic symptoms in the absence of digestive lesions or Helicobacter pylori infection within the previous 3 months . They were treated with Uliveto water ( 1.5 l day(-1 ) ) for 30 days . Frequency and severity of symptoms were assessed at baseline and day 30 by a score system . Pre clinical experiments were carried out on rats , allowed to drink Uliveto or oligomineral water for 30 days . Animals then underwent pylorus ligation to evaluate gastric secretion of acid , pepsinogen , and mucus . In separate experiments , gastric emptying was assessed . Crenotherapy was associated with a relief of epigastric pain , retrosternal pyrosis , postpr and ial fullness and gastric distention . At pre clinical level , Uliveto water increased acid and pepsinogen secretions as well as gastric emptying , without changes in bound mucus . The enhancing actions of Uliveto on gastric secretions and emptying were prevented by L-365,260 , an antagonist of gastrin/CCK-2 receptors . These findings indicate that a regular intake of Uliveto favors an improvement of dyspeptic symptoms . The pre clinical study suggests that the clinical actions of Uliveto water depend mainly on its ability to enhance gastric motor and secretory functions INTRODUCTION The aim of this study was to evaluate the efficiency of sulphurous thermal water in the treatment of chronic rhinosinusitis ( CRS ) . METHODS Eighty patients with CRS were included and r and omly assigned into two groups . Patients underwent a 12-day course of warm vapour inhalations and nasal irrigations with sulphurous thermal water in group A , and a physiological solution in group B. RESULTS Compared with group B , in group A the results were as follows : serum concentration of IgE was significantly lower ( p<0.05 ) 12 days ( 76.27 + 26.3 mg/dl vs. 97.44±45.4 ) and 3 months after the beginning of the treatment ( 75.48 + 26.1 mg/dl vs. 98.37±41.4 ) ; IgA titers were not significantly higher 12 days ( 231.09±120.3 mg/dl vs. 220.44 + 114.4 mg/dl ) and 3 months after the beginning of the treatment ( 235.44±118.5 mg/dl vs. 214.51±111.8 mg/dl ) ; VAS scores were significantly ( p<0.05 ) improved at 12 days ( 1.7 + 0.18 vs. 6.9±0.51 ) and 3 months after the start ( 1.8 + 0.22 vs. 7.1±0.59 ) ; NMIT was normal at 12 days ( 11.54±1.59 min vs. 17.38 + 1.83 min ) and 3 months after the beginning of the treatment ( 11.46 + 2.07 min vs. 17.43±2.01 min ) ; total nasal resistances were significantly ( p<0.05 ) decreased at 12 days and 3 months . CONCLUSION Our results indicate the efficiency and applicability of sulphurous thermal water in the treatment of CRS OBJECTIVE The psoriasis is chronic disease characterized from an acceleration of the kinetic of the cells of epidermis . To front of the empirical evidence of the benefits of the thermal therapy in the psoriasis , the experimentals-clinics studies is insufficient . The aim of research it has been that of quantify the benefits of the mud-bath therapy with mineral water in the psoriasis . PATIENT AND METHODS The study has been channel on a champion of 30 subjects of which 19 of male sex and 11 of female sex with middle equal age to 56 years + /- 5.3 affected from psoriasis . The subjects of the examined champion have been divided to r and om in 2 groups : A and B. The group A has been treated with drugs used for psoriasis for 12 days ; the B group has been treated , always for 12 consecutive days , with mud-bath therapy ( FBT ) with mineral water obtained from the mineral sources ( chlorinate-sulphureous-bicarbonate ) of the Spa of Stabia in Castellammare ( NA ) . To the beginning and at the end of the advised treatments has been valued the prurient symptomatology and the PASI ( Psoriasis and Severity Index ) . RESULTS The data highlight an significant ( P < 0.05 ) reduction is of the prurient symptomatology and of the PASI in both the groups considered . CONCLUSIONS The results of this first step of investigations seems to highlight that the FBT treatment , to the same way of the drugs anti-psoriasis , results useful in the ameliorate the quality of life of these patients OBJECTIVE The aim was to study the effect of climatotherapy and spa treatment on selected neuro- and immunomodulatory steroids known to affect well-being , and homocysteine , in a homogenous group of thyroidectomized women under st and ard substitution regime . METHODS Dehydroepi and rosterone , its precursors and metabolites , cortisol , major sex steroids , SHBG , and homocysteine were measured before and after three-weeks stay in a health resort Jeseník ( Graefenberg ) in Czech Republic . The studied group consisted of 21 women after total thyroidectomy which was performed at least 3 months before the admission to the spa resort . All patients received thyroid hormone substitution treatment which was not changed during their stay in that resort . RESULTS Out of the steroids investigated , five , namely dehydroepi and rosterone , and rostenedione , testosterone , 7beta-hydroxy-dehydroepi and rosterone and cortisol were changed significantly after treatment . The most considerable was the decrease of cortisol and of homocysteine ( p < 0.000 each ) . CONCLUSION Spa resort treatment of thyroidectomized women substituted with thyroid hormones result ed in significant , mostly beneficial effects on steroid spectrum . This effect was achieved without any use of psychopharmacs OBJECTIVES Treatment of gynaecological disorders is a frequent , but only barely substantiated application of balneotherapy . This study investigated potential differences between the clinical symptoms , pelvic blood flow and specific laboratory parameters of patients undergoing balneotherapy with two different types of immersion : alum-containing and tap water . STUDY DESIGN The study population comprised 40 patients ( mean age : 39.4 years ) , r and omized into two groups . All subjects took 20 min baths in 38 degrees C water every other day , for 10 occasions altogether . Study parameters were : pain relief , reduction in tissue growth , hormone levels , psychic status , and pelvic blood flow . RESULTS Thermal water improved the clinical parameters of both groups significantly . In comparison with tap water , treatment with alum-containing water accomplished significantly greater progress , as reflected by the relief of pain elicited by h and ling the uterus and improvement of psychic status . Laboratory parameters ( FSH , LH , prolactin , oestradiol and beta-endorphin serum levels ) and the Doppler index did not change in either group . CONCLUSIONS As demonstrated by our results , 3-week balneotherapy is a potentially useful adjunct for the management of chronic pelvic inflammatory disease , but further , long-term studies are notwithst and ing necessary BACKGROUND Chronic heart failure is characterized by increased peripheral vascular resistance and reduced peripheral perfusion due to adrenergic and renin angiotensin activation and impaired endothelial function . Recent studies have shown that nonpharmacological peripheral vasodilation with thermal therapy by means of warm-water baths and sauna has beneficial effects in chronic heart failure . European hydrotherapy ( according to Kneipp ) additionally uses short cold water stimuli , which lead to prolonged vasodilation and adaptive responses . Studies on the efficacy of hydrotherapy in chronic heart failure are lacking . METHODS We studied 15 patients ( 5 men , 10 women , mean ( + /- SD ) age 64.3 + /- 1.8 years ) with mild chronic heart failure ( NYHA functional class II to III , ejection fraction 30%-40 % ) . Patients were r and omly assigned to 6 weeks of intensive home-based hydrotherapy or 6 weeks restriction in a crossover intervention trial . Quality of life and heart-failure -- related symptoms were assessed by means of a vali date d question naire ( PLC ) . Grade d bicycle exercise test with incremental workloads ( 0 , 50 , 75 , 100 watts ) was performed at the end of each treatment period . The hydrotherapeutic program consisted of a structured combination of daily home-based external warm- and cold-water applications . RESULTS Baseline characteristics were balanced between the groups . With hydrotherapy , a significant ( P < or = .05 ) improvement in 3 of 6 dimensions of quality of life ( mood , physical capacity , enjoyment ) and a significant reduction in heart-failure-related symptoms was found . Heart rates at rest and at 50-Watt workload were significantly reduced by hydrotherapy ;  blood pressure decreased nonsignificantly at rest and during exercise . The hydrotherapeutic treatment was well accepted and no relevant adverse effects were observed . CONCLUSIONS A home-based hydrotherapeutic thermal treatment program improves quality of life , heart-failure-related symptoms and heart rate response to exercise in patients with mild chronic heart failure . The results of this investigation suggest a beneficial adaptive response to repeated brief cold stimuli in addition to enhanced peripheral perfusion due to thermal hydrotherapy in patients with chronic heart failure INTRODUCTION Preliminary studies have suggested that balneotherapy ( BT ) is an effective and well-tolerated treatment for  generalized anxiety disorder ( GAD ) and psychotropic medication withdrawal syndrome .  We carried out a study in 4 spa resorts to assess the efficacy of BT in GAD . METHOD We compared BT to paroxetine in terms of efficacy and safety in a r and omized multicentre study lasting 8 weeks . Patients meeting the diagnostic criteria of GAD ( DSM-IV ) were recruited . Assessment s were conducted using the Hamilton Rating Scale for Anxiety ( HAM-A ) and other scales , by a specifically trained and independent physician . The primary outcome measure was the change in the total HAM-A score between baseline and week 8 . RESULTS A total of 237 out patients were enrolled in four centres ; 117 were assigned r and omly to BT and 120 to paroxetine .  The mean change in HAM-A scores showed an improvement in both groups with a significant advantage of BT compared to paroxetine ( -12.0 vs -8.7 ; p<0.001 ) . Remission and sustained response rates were also significantly higher in the BT group ( respectively 19 % vs 7 % and 51 % vs 28 % ) . CONCLUSION BT is an interesting way of treating GAD . Due to its safety profile it could also be tested in resistant forms of generalized anxiety and in patients who do not tolerate or are reluctant to use pharmacotherapies BACKGROUND Purpose of this study was to assess the effects of thermal hydrotherapy ( balneokinesis ) with a sulphurous water on clinical symptoms , quality of life and some functional parameters in patients with varicose veins . PATIENTS AND METHODS 70 patients with primary or secondary symptomatic varicosis were enrolled and su bmi tted to elastic compression therapy . Patients were then r and omized to receive ( 50 pts , group A ) or not receive ( 20 pts , group B ) balneokinetic treatment for 12 days " on top " of elastic compression . Clinical symptoms , quality of life and functional parameters obtained with light reflex plethysmography ( PPG ) and laser Doppler fluxmetry ( LDF ) were assessed after 3 and 6 months . RESULTS Scores for subjective symptoms as pain , edema , and venous claudication were decreased after 6 months in both groups , but more evidently in group A su bmi tted to balneokinesis . Some parameters related to quality of life evaluation as " bodily pain " and " emotional role " were improved only in patients undergoing balneokinesis . Regarding functional parameters , with PPG venous refilling time after foot exercise moderately increased in both groups . With LDF a significant improvement in the veno-arteriolar reflex was seen in the group treated with balneokinesis . CONCLUSIONS These results show additional benefits of balneokinetic treatment in patients with symptomatic varices su bmi tted to elastic compression . In fact , clinical and quality of life improvements were observed . The associated amelioration in the veno-arteriolar reflex may support these subjective benefits BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions  to improve the management of cancer pain . Each study assessment was completed independently by two review ers using each tool . We analysed the inter-rater reliability of each tool 's individual domains , as well as final grade assigned to each study . RESULTS The EPHPP had fair inter-rater agreement for individual domains and excellent agreement for the final grade . In contrast , the CCRBT had slight inter-rater agreement for individual domains and fair inter-rater agreement for final grade . Of interest , no agreement between the two tools was evident in their final grade assigned to each study . Although both tools were developed to assess ' quality of the evidence ' , they appear to measure different constructs . CONCLUSIONS Both tools performed quite differently when evaluating the risk of bias or method ological quality of studies in knowledge translation interventions for cancer pain . The newly introduced CCRBT assigned these studies a higher risk of bias . Its psychometric properties need to be more thoroughly vali date d , in a range of research fields , to underst and fully how to interpret results from its application A lot of studies show the efficacy of thermal therapy in psoriasis . The main indications concern all forms of psoriasis ( except for pustolosa and eritrodermic ) especially diffuse psoriasis , intensive itchy , artropatic psoriasis and gutted psoriasis child . Benefit effects of thermal water and muds , which are important parameters in psoriasis ' treatment , they are excellent to reduce inflammation , scaling , and erythema . In this study we evaluated the clinical efficacy of thermal bath plus muds in patients affected by psoriasis . 18 patients has been examined and r and omly divided in 3 group ( A-B-C ) . All the patients received thermal therapy for 4 weeks . To evaluate the behaviour of the disease we performed ( corneometry , sebometry , phmetry ) , as well as evaluation of P.A.S.I. At the end of the study , values of P.A.S.I. showed a reduction from 10 to 6 unites P.A.S.I. for patients belong to group A , more 12 to less 10 for patients belong to group C e no significant variations for group B ( because represent control group ) . Results obtained can be considered useful , considering that thermal treatment was used alone in the treatment of all patients OBJECTIVE To assess whether language of publication restrictions impact the estimates of an intervention 's effectiveness , whether such impact is similar for conventional medicine and complementary medicine interventions , and whether the results are influenced by publication bias and statistical heterogeneity . STUDY DESIGN AND SETTING We set out to examine the extent to which including reports of r and omized  controlled trials ( RCTs ) in language s other than English ( LOE ) influences the results of systematic review s , using a broad data set of 42 language -inclusive systematic review s , involving 662 RCTs , including both conventional medicine ( CM ) and complementary and alternative medicine ( CAM ) interventions .  RESULTS For CM interventions , language -restricted systematic review s , compared with language -inclusive ones , did not introduce biased results , in terms of estimates of intervention effectiveness ( r and om effects ration of odds rations ROR=1.02 ; 95 % CI=0.83 - 1.26 ) . For CAM interventions , however , language -restricted systematic review s result ed in a 63 % smaller protective effect estimate than language -inclusive review s ( r and om effects ROR=1.63 ; 95 % CI=1.03 - 2.60 ) . CONCLUSION Language restrictions do not change the results of CM systematic review s but do substantially alter the results of CAM systematic review s. These findings are robust even after sensitivity analyses , and do not appear to be influenced by statistical heterogeneity and publication bias BACKGROUND Lately , the number of systematic review s published has increased substantially . Many systematic review s exclude trials published in language s other than English . However , there is little empirical evidence to support this action . We looked for differences in the completeness of reporting between trials published in other language s and those published in English , to see whether the exclusion of trials published in other language s is justified . METHODS We compared completeness of reporting , design characteristics , and analytical approaches of 133 r and omised controlled trials ( RCTs ) published in English between 1989 and 1994 and 96 published in French , German , Italian , or Spanish during the same time . RCTs were identified by h and search ing of journals ( seven in English and six in the other language s ) . FINDINGS We found no significant differences between trials published in English and other- language trials for any single item in the completeness of reporting scale ( r and omisation , double-blinding , withdrawals ) , or for the overall score ( percentage of maximum possible score 51.0 % for trials in English , 46.2 % for trials in other language s ; 95 % CI for difference -1.1 to 10.5 ) . Other- language trials were more likely than English- language trials to have adult participants , to use two or more interventions , and to compare two or more active treatments without an untreated control group . Trials in other language s were less likely to report a clearly prespecified primary outcome or any rationale for sample size estimation . INTERPRETATION These results provide evidence for inclusion of all trial reports , irrespective of the language in which they are published , in systematic review s. Their inclusion is likely to increase precision and may reduce systematic errors . We hope that our findings will prove useful to those developing guidelines and policies for the conduct of reporting of systematic review OBJECTIVES The sulphur SPA inhalation therapy is useful in respiratory and otolaryngologic chronic inflammatory diseases in adult subjects and children . The therapeutic action relies on anti-inflammatory , mucolytic and trophic effects . Particularly in children , the sulphur SPA inhalation therapy , using endotympanic ventilation or Politzer method , would be suitable in the treatment of the rhinogenic deafness . Several reports have demonstrated the effectiveness of endotympanic ventilation while the results on the Politzer method are inconclusive . On the basis of these considerations , aim of our study was to analyze the effectiveness and the safety of the aerosol+Politzer with a sulphur mineral water in children affected by rhinogenic deafness or chronic inflammatory processes responsible for the onset or persistence of rhinogenic deafness . PATIENTS AND METHODS The study has been performed on 23 subjects in pediatric age ( 61 % women and 39 % males ; mean age : 6+/-2.4 years ; age range : 3 - 14 years ) affected by chronic catarrhalis otitis , chronic rhino-pharyngitis inflammations , chronic or recurrent adenoiditis with dysfunction of the Eustachian Tube . The investigated subjects underwent 12 consecutive days sulphur SPA inhalation therapy ( aerosol+Politzer ) at the Terme of Stabia in Castellammare ( Naples , Italy ) . At the beginning and at the end of the SPA cycle the functionality of the middle ear and the tolerability were evaluated . RESULTS The results have shown an increase of the impedance curves that correspond to the normal ventilation of the tympanic box ( type A ( 13 % before therapy and of 57 % post-therapy ) and a decrease of the pathological curves of type B and type C ( 87 % pre-therapy and of 43 % post-therapy ) ; a significant increase of compliance ( p 0.05 ) in pathological curves of type B and C. No adverse reaction to the SPA inhalation therapy has been reported during the study . CONCLUSIONS In concordance with the literature our data demonstrated that the sulphur SPA inhalation treatment induce a improvement of middle ear function of the subjects examined with good local and systemic tolerability OBJECTIVES Except for compression therapy , physical therapy has scarcely been evaluated in the treatment of chronic venous disorders ( CVD ) .  Spa treatment is a popular way to administer physical therapy for CVD in France , but its efficacy has not been evaluated yet . This study aim ed to assess the efficacy of balneotherapy associated with patient education , as performed in the spa resort of La Léchère , in patients with advanced chronic venous insufficiency ( CEAP clinical classes C4/C5 ) . METHODS The study was a r and omized controlled trial , spa therapy being administered on top of the usual medical care . Evaluation was by a blinded independent investigator . Subjects were patients with primary or post-thrombotic CVD with skin changes but no active ulcer ( C4a , C4b , or C5 ) , living in Grenoble area , and willing to undergo a spa treatment course in La Léchère . The treated group had the three week spa treatment course in La Léchère , soon after r and omization ; the control group also had a spa treatment , but starting at day 365 . The treatment consisted of four balneology sessions per day , six days a week during three weeks , and three educational workshops . An independent follow-up was performed in Grenoble hospital every three months for 15 months . The main outcome criterion was the severity of the skin changes , as evaluated by means of malleolar chromametry . Quality of life , as measured by the Chronic Venous Insufficiency Question naire 2 scale , a visual analog scale ( VAS ) for leg symptoms , and the occurrence of leg ulcers were used as secondary criteria . The year after spa treatment in the treated group was compared with the year before spa treatment in the control group . RESULTS Fifty-nine subjects were enrolled ( 29 in the treatment group and 30 in the control group ) . No statistically significant difference between groups was found at study onset regarding age , sex , etiology , CEAP " C " class , and the outcome variables . After treatment , chromametry showed significantly decreased pigmentation and erythema in the treatment group compared with the controls ( P < .01 ) . Quality of life ( P < .01 ) and symptoms ( P < .001 ) also improved significantly . These differences remained significant after one year follow-up . The control patients improved similarly after their own spa treatment ( day 450 ) . CONCLUSION This study shows that spa therapy , associating balneotherapy and patient education , is able to improve significantly the skin trophic changes of the CVD patients and their CVD related quality of life and symptoms . This effect is of large magnitude and remains significant one year after the treatment course
target: HRM  treatment is associated with clinical improvement in diseases of the skin , respiratory , circulatory , digestive and nervous system among others .
  The scientific literature of the last decade has shown that a number of non-musculoskeletal disorders are treated with different kinds of  HRM .
background: Health resort medicine ( HRM ; in German : Kurortmedizin ) is a field of medicine with long-lasting tradition in several European countries .
  A number of systematic review s have shown the effectiveness of HRM  in musculoskeletal conditions .
  Review s focusing on the effectiveness of HRM in non-musculoskeletal disorders are rare .
  This systematic review aims to provide an overview about all types of health resort treatments applied in non-musculoskeletal conditions , to summarize evidence for its effectiveness and to assess the quality of published studies .