Balneotherapy for Osteoarthritis. A Cochrane Review

ARIANNE VERHAGEN; SITA BIERMA-ZEINSTRA; JOHAN LAMBECK; JEFFERSON ROSA CARDOSO; ROB de BIE; MAARTEN BOERS; HENRICA C.W. de VET

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Table 1.

Characteristics of included studies. From Verhagen, et al. Cochrane Database Sys Review 2007; CD006864; with permission.

Study	Methods	Participants	Interventions	Outcomes	Results	Notes
Allard 1998¹⁹	Unclear allocation concealment; overall quality score: 1	Northern France spa, rheumatic disease, 4% patients with RA, n = 148	I: Spa therapy, n = 74 C: No treatment, n = 74 Also nonrandomized spa therapy group (n = 72)	Medication, costs	No data	14 dropouts in I, 6 in C; study designed to evaluate costs
Green 1993²⁰	Unclear allocation concealment; blinded outcome assessment; overall quality score: 3	St. James Hospital, Leeds, UK; radiographic hip OA; n = 63	I: Deep pool baths twice weekly + home exercise twice daily, n = 24; 25% male, mean age 65.7 yrs C: Home exercise twice daily, n = 23; 26% male, mean age 68 yrs; treatment for 6 wks; followup at 9, 12, 18 wks	Pain (VAS), function, range of motion, muscle strength	Stiffness: WMD = 19.2 (95% CI −4.4; 42.7)	16 dropouts
Kovacs 2002²¹	Unclear allocation concealment; blinded patients and outcome assessment; overall quality score: 4	Cserkeszölö health resort, Hungary; clinically and radiologically established knee OA; n = 70	I: Deep bathing in thermal water for 30 min for 15 days, n = 31 C: Daily bathing in tap water (placebo) for 30 min for 15 days, n = 27	Pain (VAS), range of motion (goniometer), function (stair climbing, 4-pt Likert), perceived recovery	Pain: Abs ben: 0.0006%	12 dropouts; only pre-post analysis
Nguyen 1997²²	Unclear allocation concealment; observer clearly aware of treatment allocation; overall quality score:4	France; knee, hip or lumbar spine OA; n = 233	I: Spa treatment for 21 days, n = 91; 22% male, mean age 64 yrs; mean DOC 11 yrs C: No treatment, routine maintained, n = 97; 16% male, mean age 63, mean DOC 12 yrs; followup at 24 wks	Pain (VAS), function (WDI, AIMS), mobility, medication	Pain: Abs ben: 0.09%; Rel ben: 18.5% (WMD = −0.3; 95%CI −0.6; −0.1); AIMS: WMD = −0.4; (95% CI −0.7; −0.1)	45 dropouts directly after randomization, 4 exrtra dropouts
Sukenik 1999²³	Unclear allocation concealment; blinded outcome assessment; overall quality score: 4	Outpatient clinic, Soroka Medical Centre, Israel; moderate or severe radiographic knee OA, n = 40	I1: Sulfur baths, n = 10; 20% male, mean age 63.2 yrs, mean DOC 11.6 yrs; I2: Dead Sea baths, n = 10; 10% male, mean age 65.4 yrs, mean DOC 9.2 yrs; I3: I1 + I2; n = 10; 0% male, mean age 57.6 yrs; mean DOC 9.3 yrs C: No treatment, n = 10; 11% male; mean age 65.9 yrs, mean DOC 8.4 yrs. All treatments 20 min twice daily for 2 wks	Pain (patient assessment of severity), function (Lequesne Index), range of motion	Pain: Abs ben I1 vs C: 0.004%; 12 vs C: 0.009%; 13 vs C: 0.014%; Rel ben I1 vs C: 6.6% (WMD = −0.4; 95% CI −1.8; 1.0); I2 vs C: 14.8% (WMD = −0.5; 95% CI −1.7; 0.7); I3 vs C: 23% (WMD = −0.9; 95% CI −2.5; 0.7)	3 dropouts in 13, 1 in C; only pre-post analysis
Tishler 2004²⁴	Unclear allocation concealment; overall quality score: 4	Israel, patients with knee OA, n = 72	I: Mineral baths once weekly for 6 weeks, n = 48; 21% male, mean age 65.2 yrs, mean DOC 8.6 yrs C: No treatment, n = 24; 21% male, mean age 63.1 yrs, mean DOC 7.5 yrs; followup at 10 wks	Pain (VAS), pain (WOMAC), analgesic intake	Pain: Abs ben: 0.376%; Rel ben: 56.6% (WMD = −1.6; 95%CI −2.2; −1.1); analgesic intake: RR = 0.05 (95% CI 0.01; 0.2)	4 dropouts in I; pre-post analysis
Wigler 1995²⁵	Unclear allocation concealment; blinded patients and outcome assessment; overall quality score: 6	Tiberias spa hotel, Israel; moderate or severe radiographic knee OA, n = 33	I: Mineral baths daily + mud packs on alternate days for 20 min, n = 11; 9% male, mean age 66 yrs, mean DOC 8 yrs C1: Mineral baths daily + rinsed mud packs on alternate days, n = 10; 10% male, mean age 63 yrs, mean DOC 10 yrs C2: tap water baths daily + rinsed mud packs on alternate days for 20 min, n = 12; 16% male, mean age 65 yrs, mean DOC 7 yrs; treatment period of 2 wks; followup: 20 wks	Pain (VAS), function (ISK)	No data	2 dropouts

OA: osteoarthritis, DOC: duration of complaints; I: intervention; C: control; VAS: visual analog scale; WDI: Waddel Disability Index; HAQ: Health Assessment Questionnaire; WMD: weighted mean difference; ISK: index of severity knee osteoarthrosis; WOMAC: Western Ontario and McMaster Universities OA Index; Abs ben: absolute benefit; Rel ben: relative benefit; sign: statistical significant difference. RR: relative risk; CI: confidence interval.