Spa therapy and knee osteoarthritis: A systematic review

Abstract

Background

Osteoarthritis (OA) is a public health problem that will probably increase in the future with the aging of the population. Crenobalneotherapy is commonly used to treat OA, but evidence from previous reviews was not sufficient. This systematic review aimed to identify the best evidence for the clinical effect of crenobalneotherapy for knee OA.

Methods

We systematically searched MEDLINE via PubMed, PEDRO and the Cochrane Central Register of Controlled Trials for articles published up to September 2015. Articles were included if trials were comparative, if one or more of the subgroups had knee OA with separate data, and if spa therapy or any hydrotherapy techniques involving mineral water or mineral mud was compared to any other intervention or no treatment. Statistical validity, external validity and quality of side effects assessment were evaluated by personal checklists. Risk of bias was assessed by the CLEAR NTP.

Results

Treatments (hot mineral water baths, mud therapy, hot showers, and sometimes massage and supervised water exercises) delivered in spa centers across Europe and the Middle East seem to improve symptoms in knee OA. They may be effective for pain and function. There are conflicting results about the effect on quality of life and drug consumption.

Conclusions

Improvements with spa therapy for knee OA appear to be clinically relevant until 3 to 6 months and sometimes 9 months.

1 Introduction

Osteoarthritis (OA) is a public health problem that will probably increase in the future with the aging of the population. We have many guidelines about the management of OA, but only a few cite spa therapy (crenobalneotherapy, balneotherapy). The last Osteoarthritis Research Society International (OARSI) recommendations for knee OA restricted spa use to a subgroup of patients with generalized OA and associated comorbidities because of lack of evidence . European League Against Rheumatism (EULAR) guidelines for non-pharmacological treatment of OA did not recommend crenobalneotherapy . A Cochrane review of 7 trials and 498 patients stated that “Balneotherapy might be beneficial, but the evidence is yet insufficient to make a definitive statement about its use” . Some authors of the EULAR guidelines reported that the article selection for the guidelines may have excluded trials of balneotherapy and other non-pharmacological interventions that are relevant and for which evidence is available . In fact, none of the previous authors included the most recent trials on the subject in the analysis. For example, the most recent trial analysed in the 2014 review of McAlindon et al. was published in 2009 .

However, spa therapy is usually prescribed for OA in the clinical practice of many European and Middle East countries. A recent meeting estimated the number of patients in spa centres at 2,000,000 to 1,900,000 in Germany, 1,300,000 in Hungary, 1,400,000 in Italy, 1,000,000 in Poland, 580,000 in Lithuania, 540,000 in France, 360,000 in the Czech Republic, 350,000 in Estonia, 250,000 in Spain, 130,000 in Latvia, and 100,000 in Portugal and it is well known that many of them have OA.

We aimed to systematically review the highest evidence provided by published trials to estimate the clinical effect of crenobalneotherapy for knee OA.

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