Patient education and rehabilitation after hip arthroplasty in an Italian spa center: a pilot study on its feasibility

Short-time effects of spa rehabilitation on pain, mood and quality of life among patients with degenerative or post-surgery musculoskeletal disorders

Clinical trials have demonstrated traditional spa therapy effects in musculoskeletal disorders (MSDs). This is the first observational study in Italy aimed at evaluating in real-life the short-time effects of spa rehabilitation on pain, mood and quality of life (QoL) among degenerative or post-surgery MSDs patients. Through the involvement of six Italian spa facilities, 160 patients were enrolled; data from 123 patients were finally analysed. Seventy-nine patients (64.3%) accessed the spa for degenerative MSDs, while 44 (35.8%) had a post-surgical condition. All the patients included in the study underwent 12 sessions of water-based exercise (joint exercises, muscle strengthening, gait training, proprioceptive and balance techniques) conducted in thermal or in warm water pools, six sessions per week, for a period of 2 weeks from March 2019 up to October 2019. A group of 45 patients (36.6%) also received traditional thermal therapies, including 12 mud therapy sessions and 12 thermal baths, six times each week, for 2 weeks. Evaluation before and after the treatment included the Numerical Rating Scale (NRS), the Short Form Health Survey (SF-12) and the EuroQol-5D (EQ-5D). The analysis of the scores reported in the questionnaires after the treatment showed a significant improvement in all the scores evaluated. Comparison between patients that performed water-based exercise protocols alone (group A) and patients that in addition to water exercise performed traditional thermal interventions (group B) showed no statistically significant differences in NRSp, NRSa, NRSm, SF-12 PCS, SF-12 MCS and EQ-5D variations; only NRSa value reduction was lower in group B. Sulphate water was found to be associated with a lower reduction of all the scores considered, when compared to the other water types. Patients with degenerative or post-surgery MSDs showed favourable effects on pain, mood and QoL after water exercise training alone or in combination with traditional thermal therapy. Our research provides the first proof that spa rehabilitation can be in real-life conditions an appropriate alternative strategy for post-orthopaedic surgical outcomes recovery. In the future, these results will need to be further investigated.

Clinical Impact of Balneotherapy and Therapeutic Exercise in Rheumatic Diseases: A Lexical Analysis and Scoping Review

To review the evidence regarding the clinical effect of spa therapy for rheumatic diseases, with particular attention given to association protocols between balneotherapy and rehabilitation interventions, and to support the literature research and studies’ selection with lexical analysis. Methods: A lexical analysis was performed considering a list of words representing diseases and outcome measures linked to the theme studied in our review. Then, two independent researchers conducted a literature search on PubMed using the string employed for lexical analysis, including Randomized Controlled Trials regarding spa therapy’s clinical effects on patients affected by rheumatic diseases published in the last 30 years. After the exclusion of works that did not meet the eligibility criteria, 14 studies were included in the final scoping review. Results: Spa therapy has shown a favourable effect on pain, function and quality of life in patients with Osteoarthritis, Fibromyalgia and Rheumatoid Arthritis. Different treatment modalities and types of water have demonstrated beneficial long-term clinical improvement. Furthermore, the association between thermal therapy and rehabilitation treatments has shown better clinical outcomes, probably due to the synergistic effect between the peculiar properties of the thermal waters and the therapeutic exercise program, if conducted in the same context. Conclusions: The combination of balneotherapy and rehabilitative interventions seems to be effective in ameliorating several outcomes in patients with rheumatic diseases. However, due to the wide variety of methodologies and interventions employed, these findings need to be further investigated. The lexical analysis should represent an auxiliary support for an extensive evaluation of scientific literature.

Educational Intervention in Rehabilitation to Improve Functional Capacity after Hip Arthroplasty: A Scoping Review

(1) Background: The prevalence of coxarthrosis associated with ageing is one of the main reasons for the increase in hip arthroplasty. Educational intervention in the pre- and postoperative period of hip arthroplasty can improve functionality and, consequently, quality of life. Therefore, we intend to map the educational interventions that improve the functional capacity of people undergoing hip arthroplasty on their rehabilitation process. (2) Methods: Scoping review. The search was carried out in the databases: CINAHL complete, MEDLINE Complete, Nursing and Allied Health Collection: Comprehensive, Cochrane Methodology Register, Library, Information Science and Technology Abstracts, MedcLatina, and Google Academic. We included studies that evaluated the implementation of educational rehabilitation interventions that enable the empowerment and teaching of people undergoing hip arthroplasty. (3) Results: Thirteen studies were analysed that met the eligibility criteria and allowed the research question to be answered. Education in the perioperative period promotes training to perform rehabilitation exercises, improves the hospitalisation experience, increases participation in the rehabilitation process, allows early mobilisation, and increases the functional potential, thus enabling faster reintegration into society. (4) Conclusion: Early mobilisation plays a very important role in a person′s functional recovery, as well as in the prevention of thromboembolic complications. Exercise produces benefits in relation to physical function, namely, in improving strength, balance, facilitating functional activities, and preventing complications.

Characteristics of patients with knee and/or hip osteoarthritis undergoing spa treatment: the prospective KHOALA cohort study

Knee and hip osteoarthritis (KHOA) are a source of functional impairment. With aging, the management of osteoarthritis (OA) is a major issue in the search for improved quality of life. Spa treatment provides short- and mid-term symptom relief without serious side effects. This study aimed to identify characteristics of patients with KHOA associated with use of spa treatment. The prospective KHOALA cohort included 878 adults aged 40 to 75 years with symptomatic KHOA. We separately analyzed knee and hip OA data and compared patients who never had spa treatment with those who had at least one or multiple treatments during 5 years of follow-up in terms of socio-demographic characteristics, clinical data, quality of life (OAKHQOL, SF-36), physical activity (MAQ), functional impairment (WOMAC), and health care consumption (pharmacological and non-pharmacological treatments). Factors associated with at least one or multiple spa treatments were evaluated with regression logistic models. In all, 607 (69.1%) patients had knee OA (KOA), 222 (25.3%) hip OA (HOA) and 49 (5.6%) both, 91 (13.9%) with KOA, and 33 (12.2%) with HOA had at least one spa treatment. In the KOA cohort, the probability of at least one, two, or three spa treatments was increased with older age (odds ratio = 1.6 [95% confidence interval 1.2-2.2], 1.8 [1.2-2.8], 2.4 [1.4-4.2], respectively), greater use of physiotherapy (OR = 3.9 [2.1-7.1], 2.7 [1.3-5.6], 2.5 [1.1-5.9]), having a prosthesis (OR = 2.1 [1.2-3.8], 2.2 [1.1-4.3], 2.5 [1.1-5.5]), and low MAQ score (OR = 0.7 [0.6-0.9], 0.7 [0.5-1.0], 0.7 [0.5-1.0]). In the HOA cohort, female sex was associated with at least one (OR = 3.0 [1.1-8.0]) or two (OR = 5.1 [1.2-22.5]) spa treatments. In this cohort of KHOA, repeated spa treatment over 5 years was strongly associated with older age, greater use of physiotherapy and presence of a prothesis with KOA and female sex with HOA. This study may help to better understand spa treatment determinants in OA.

Effect of Intensive Rehabilitation Program in Thermal Water on a Group of People with Parkinson's Disease: A Retrospective Longitudinal Study

The main objective of this study is to test the effect of thermal aquatic exercise on motor symptoms and quality of life in people with Parkinson's Disease (PD). Fourteen participants with diagnosis of idiopathic PD completed the whole rehabilitation session and evaluation protocol (Hoehn and Yahr in OFF state: 2-3; Mini Mental State Examination >24; stable pharmacological treatment in the 3 months prior participating in the study). Cognitive and motor status, functional abilities and quality of life were assessed at baseline and after an intensive rehabilitation program in thermal water (12 sessions of 45 min in a 1.4 m depth pool at 32-36 ∘C). The Mini Balance Evaluation System Test (Mini-BESTest) and the PD Quality of Life Questionnaire (PDQ-39) were considered as main outcomes. Secondary assessment measures evaluated motor symptoms and quality of life and psychological well-being. Participants kept good cognitive and functional status after treatment. Balance of all the participants significantly improved (Mini-BESTest: p<0.01). The PDQ-39 significantly improved after rehabilitation (p=0.038), with significance being driven by dimensions strongly related to motor status. Thermal aquatic exercise may represent a promising rehabilitation tool to prevent the impact of motor symptoms on daily-life activities of people with PD. PDQ-39 improvement foreshows good effects of the intervention on quality of life and psychological well-being.

The effectiveness of balneotherapy and thermal aquatic exercise in postoperative persistent lumbar pain syndrome

In our study, we aimed to investigate the effectiveness of balneotherapy and aquatic exercises in patients with postoperative chronic low back pain. Forty-three patients over the age of 18 who had been operated on for herniated disc and who had at least 6 months of back and/or leg pain were included in the study. The patients have been distributed randomly into 2 groups prior to the treatment. The program comprising aquatic exercises distributed into 5 days a week for 2 weeks and 20 min (min) a day, in a 33 °C spa pool was applied to the first group. After the first group's treatment was completed, a program consisting of walking out of the pool and strengthening and stretching exercises for the hip, abdominal, back, and waist muscles was distributed into 5 days a week for 2 weeks for a total duration of 20 min per day was applied to both groups. The patients subjected to the study were evaluated before treatment, after treatment (2nd week), and at 1st and 6th months after treatment. The Visual Analogue Scale, Modified Schober Test, Finger-to-Floor Distance, Sorensen Test, Progressive Iso-inertial Lifting Evaluation, Rolland Morris Disability Index, Leeds Disability Scale, Beck Depression Inventory, Nottingham Health Profile, and Short Form 36 Health Survey parameters were evaluated. We detected a significant improvement in all parameters except for the Sorensen test, in both groups. We observed that the changes in VAS, Sorensen, NHP, and SF 36 tests in the aquatic exercise group were significantly better than those in the non-aquatic exercise group.

Italian and Japanese public attention toward balneotherapy in the COVID-19 era

Italian and Japanese public widely use balneotherapy. The population interest in balneotherapy in coronavirus disease-2019 (COVID-19) era should be investigated. Therefore, we aimed to exploit Google Trends analysis, as a measure of peoples' interest in balneotherapy, in two countries, Italy and Japan. In this infodemiology study, Google Trends was queried for the lay terms widely used by the Italian population to refer to the balneotherapy setting (terme + termale) and by the Japanese to refer to the bathing place and balneotherapy facilities ( + スパ). The internet searches in 2020 were compared to overlapping time spans in 2016-2019 and were correlated with new confirmed cases/deaths. This study demonstrated that from February 23 to June 20, 2020, and from October 4 to December 26, 2020, the internet searches of the Italian words corresponding to balneotherapy were statistically significantly decreased; however, the internet searches were not significantly different in June 21 to October 3, 2020, compared to overlapping time spans in 2016-2019 in Italy. The study also showed that from March 15 to September 5, 2020, and from November 29 to December 26, 2020, the internet searches of the Japanese words corresponding to balneotherapy were statistically significantly decreased; however, the internet searches were significantly increased in September 13 to November 7, 2020, and were not significantly different in November 8 to 28, 2020, compared to overlapping time spans in 2016-2019 in Japan. There were significant negative correlations between the relative search volume and number of new cases (rho=-0.634; p<0.001)/deaths (rho=-0.856; p<0.001) in Italy and the number of new deaths (rho=-0.348; p=0.012) in Japan. Population interest in balneotherapy has changed in the COVID-19 era both in Italy and Japan. During the early stage of pandemic (March to June), the interest was lower. After this early stage, the interest showed a recovery in both countries. In Italy, the population interest reached to its prior levels in late June through early October, with a peak in August. In Japan, the recovery exceeded the prior 4-year levels in mid-September through early November. Then, both countries demonstrated a decline in interest: began in early October in Italy and late November in Japan. This information would allow us to understand/address the population response in the pandemic in respect of the balneotherapy and would guide the preparedness of healthcare providers and planners both in this pandemic and future similar situations.

Future burden of primary and revision hip arthroplasty in Germany: a socio-economic challenge

INTRODUCTION

Total hip arthroplasty (THA) rates have increased dramatically in the recent decades worldwide, with Germany being one of the leading countries in the prevalence of THA. Simultaneously, a rising number of revision procedures is expected, which will put an enormous economic burden on future health care systems.

METHODS

Nationwide data provided by the Federal Statistical Office of Germany were used to quantify primary and revision arthroplasty rates as a function of age and gender. Projections were performed with use of Negative Binomial and Poisson regression models on historical procedure rates in relation to population projections from 2020 to 2060.

RESULTS

A 62% increase in the incidence rate of primary THAs is projected until 2060. At the same time, the annual total number of revision procedures is forecast to rise about 40% by the year 2060. The highest numbers of revision arthroplasties were calculated around year 2043. The greatest proportions of revision surgery will be observed in women and in those aged 70 years or older. The revision burden is projected to stabilize around 15% by 2060.

CONCLUSIONS

The present projections allow a quantification of the increasing economic burden that (revision) THA will place on the German health care system in the upcoming decades. This study may serve as a model for other countries with similar demographic development as the country-specific approach predicts a substantial increase in the number of these procedures. This highlights the need for appropriate financial and human resource management in the future.

Physical fitness changes induced by thermal aquatic standardized exercise in chronic venous disease patients

BACKGROUND

Lack of physical activity represents a risk factor for both cardiovascular and chronic venous diseases (CVD), nevertheless a specific exercise protocol for CVD patient is still missing. This investigation was aimed to assess the impact of a standardized exercise protocol in a thermal water environment on physical fitness and quality-of-life (QoL) in CVD patients.

METHODS

Sixteen (16) CVD patients performed 5 standardized exercise sessions in a thermal water pool. Before starting the exercise protocol, the cohort filled International Physical Activity Questionnaire (IPAQ) to determine their physical activity level. At baseline and at the end of the exercise program, leg volume, QoL, musculoskeletal and cardiovascular physical fitness were assessed by means of water plethysmography, validated questionnaire and functional test, blood pressure and heart rate at rest were also reported.

RESULTS

All the patients were categorized as physically inactive: average activity time 235.6 (155.2) MET-minutes per week. At the end of the study, a significant leg volume reduction was found (-16%; p < .002). Significant improvement in lower limb strength (p < .0001), endurance (p < .006), rapidity and balance (p < .05) together with decrease in resting heart rate (-1.8%, p < .0001) and systolic blood pressure (-1.1%, p < .04) were reported, significant improvement in bodily pain (p < .0005) and social function (p < .002) QoL items were observed.

CONCLUSIONS

The proposed exercise protocol in thermal aquatic environment demonstrated to be an effective treatment modality improving both cardiovascular and musculoskeletal outcomes and QoL in sedentary CVD patients. Aquatic environment investigations require proper analysis of the various factors involved, in a standardized and reproducible way. The herein report can be a reference for further studies on different health related conditions.

The Effects of Thermal Water Physical Exercise in Patients with Lower Limb Chronic Venous Insufficiency Monitored by Bioimpedance Analysis

BACKGROUND

Lower limb chronic venous diseases (CVD) lead to possible edema. The aim of the present investigation was to study the effect of thermal aquatic standardize exercise on lower limb edema control in CVD patients assessed by bioimpedance analysis (BIA).

METHODS

Seventeen patients (34 legs) affected by CVD clinical class CEAP C3, 4c, Ep, As, Pr were included. All the cohort performed a standardized exercise protocol in thermal water environment for a total of five sessions. BIA, leg volume, and heart rate at rest were measured.

RESULTS

After the five exercise sessions, BIA showed a significant percentage of extracellular water (ECW) reduction from 42.1 ± 5.8 to 41.24 ± 5.5%; p < 0.001. Moreover, an improvement of resistance (p < 0.0009) and reactance (p < 0.009) was assessed. At the same time, the leg volume reduction rate was 15.7%, p <0.0001. A moderate-strong correlation was found between % ECW and leg volume variation (R = 0.59, p < 0.01). Finally, a significant HR at rest reduction was recorded, p < 0.0001.

CONCLUSION

The investigated exercise protocol significantly affects the lower limb volume, and BIA parameters related to the tissue drainage improvement. The correlation founded between the ECW rate and volume variations suggest the possible use of BIA as a biomarker for monitoring the treatments aimed to reduce edema in CVD.

Does aquatic thermal therapy improve quality of life after total hip replacement? A retrospective preliminary pilot study

Hydrokinesiotherapy has antalgic and muscle relaxant properties, as well as anti-edema and anti-inflammatory effects. Currently, the management of persons with total hip replacement (THR) consists of multiple pharmacologic and non-pharmacologic therapies, which include therapeutic exercise, physical therapies, and education. Our hypothesis is that kinesiotherapy in thermal water would improve functional outcome. The aim of the study was to assess thermal hydrokinesiotherapy efficacy on pain, mood, and quality of life. We enrolled 11 participants (mean age of 70.55 ± 14 years) with total hip replacement (THR) after early hospital discharge at a residential rehabilitation facility. All participants underwent a standardized combined land-based and hydrokinesiotherapy rehabilitation program for 2 consecutive weeks. Clinical data were collected at beginning and end of rehabilitation; pain, anxiety, and quality of life scores were collected at admission, discharge, 3 and 6 months from surgery. Functional outcome scores improved and were maintained at 6-month follow-up. These preliminary data demonstrate that thermal hydrokinesiotherapy may positively influence functional recovery in orthopedic post-surgical patients. Further randomized controlled trials are mandatory to consolidate this finding.

Rehabilitation in an Italian thermal setting: a new therapeutic strategy for patients with musculoskeletal disability-the results of an Italian survey

Traditionally, in the past, patients with musculoskeletal diseases visit the spa centers (Salus per aquam) for traditional treatments, including mud therapy, or for holiday. Spas have begun to offer, as the only means of treatment, rehabilitation therapy for patients with musculoskeletal disabilities alone or in association with other traditional thermal therapies. The purpose of this paper is to describe the results of a recent survey on Italian thermal centers conducted by a section of "Rehabilitation in the Thermal Environment" of the Italian Society of Physical Medicine and Rehabilitation. The study investigated the current diffusion, type, and overall quality of rehabilitation treatments performed at the Italian spas. The survey requested information from 174 centers, but only 132 responded by returning the completed questionnaire. Eighty-nine percent of the centers offered rehabilitation therapy for orthopedic-rheumatological diseases, including post-operative conditions (after hip or knee replacement), 37% offered rehabilitation therapy for neurological diseases and 10% rehabilitation for lymph-vascular conditions. Seventy-one percent employed a multidisciplinary team (which included a physiatrist, a physiotherapist, and other figures such as a hydrologist or rheumatologist). The rehabilitative approach generally included therapeutic exercises (land or aquatic therapies), instrumental physical therapies (ultrasounds, electrotherapy, LASER-therapy, and others), and, less frequently, health education and preventive measures. The survey did not investigate respiratory or nasopharyngeal diseases. In conclusion, the results of this survey suggest that rehabilitation, performed in the thermal environment, could be a new opportunity to treat many musculoskeletal disabilities.

Is the aquatic thermal environment a suitable place for providing rehabilitative treatment for person with Parkinson's disease? A retrospective study

Many authors showed that aquatic physiotherapy could improve quality of life and reduce postural instability and risk of falling in elderly subjects. The aim of this research was to explore if the thermal aquatic environment is a suitable place for rehabilitative training in person with Parkinson disease (PwP) with results comparable to the standard physiotherapy. A retrospective study was conducted on a database of 14 persons with Parkinson who were admitted to a thermal aquatic rehabilitation to undergo treatments made to improve gait and balance impairments. The rehabilitation training consisted of 45-min sessions conducted twice a week, on non-consecutive days, over 4 weeks of functional re-education and kinesitherapy in the thermal pool. Educational and prevention instructions were also given to the patients during each session. Additionally, nutrition (diet), health education, and cognitive behavioral advice were given to our patients by therapists. The clinical characteristics of the sample were age 66 ± 9, disease duration 7 ± 5, and Hoehn and Yahr 1.5 ± 0.5. The statistical analysis showed a statistically significant improvement for the UPDRS p = 0.0005, for The Berg Balance Scale p = 0.0078, for the PDQ8 p = 0.0039, Tinetti p = 0.0068, and for Mini BESTest p = 0.0002. Our data suggest that this intervention could become a useful strategy in the rehabilitation program of PwP. The simplicity of treatment and the lack of side effects endorse the use of thermal aquatic environment for the gait and balance recovery in PwP.