The short-term effects of balneotherapy on pain, disability and fatigue in patients with chronic low back pain treated with physical therapy: A randomized controlled trial

The Impact of Hot Spring Hydrotherapy on Pain Perception and Dysfunction Severity in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Background

Chronic Low Back Pain (CLBP) is a prevalent global health issue, leading to prolonged discomfort and functional limitations. Hot spring hydrotherapy, which utilizes mineral-rich, warm spring water, offers a unique physical therapy that holds promise in alleviating CLBP symptoms.

Objective

This meta-analysis aims to assess the effectiveness of hot spring hydrotherapy in improving CLBP symptoms, encompassing pain intensity, functional disability, quality of life, and medication usage.

Methods

A systematic review and meta-analysis were conducted by searching relevant literature in multiple databases. Included studies compared hot spring hydrotherapy with control interventions or other treatments. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated for pain intensity, functional disability, medication usage, and quality of life.

Results

A total of 16 studies met the inclusion criteria, involving 1656 participants with chronic low back pain across various countries. The meta-analysis demonstrated that hot spring hydrotherapy was effective in reducing pain intensity (SMD = -0.901, 95% CI [-1.777, -0.025], P < 0.05) and improving functional disability (SMD = -3.236, 95% CI [-4.898, -1.575], P < 0.0001) in CLBP patients. Hot spring hydrotherapy also resulted in a significant reduction in medication usage (P < 0.05). Subgroup analysis showed that the effects of hot spring hydrotherapy were more pronounced in patients aged 60 and above, while no significant differences were observed in patients below 60 years of age, single hot Spring Hydrotherapy help improve patients' quality of life.

Conclusion

Hot spring hydrotherapy is an effective intervention for improving CLBP symptoms, including pain intensity, functional disability, and medication usage. It is particularly beneficial for CLBP patients aged 60 and above. These findings support the integration of hot spring hydrotherapy into the treatment approach for CLBP, although further research is needed to determine its efficacy in younger patients and to explore the underlying mechanisms of its therapeutic effects.

Prospero Id

CRD42023430860.

The effects of immersion in 42℃ radon, natrium, calcium, bicarbonate content thermal-mineral water on chronic low back pain. Controlled, follow-up study

In our minimized follow-up trial with 137 participants with chronic low back pain, one group of participants received regular outpatient care, and the other group received balneotherapy by immersion in 42℃ thermal-mineral water in addition to regular outpatient care on 15 occasions for 3 weeks. Pain on movement and at rest on the 0-100 mm visual analogue scale (VAS), Oswestry index, the number of participants evaluating the symptoms clinically acceptable (Patient Acceptable Symptom State, PASS) and the EuroQol-5D-5L (EQ-5D-5L) quality of life questionnaire were assessed at basal time (at week 0) and after balneotherapy (at weeks 3 and 12). The VAS pain scores, the Oswestry index, the EQ-5D-5L index and the EQ-VAS significantly improved in the balneotherapy group after treatment at week 3 (p < 0.001) and week 12 (p < 0.001) compared to baseline, with a significant between group difference at week 3 (p < 0.001) and week 12 (p < 0.001). The pain VAS score on movement was 66.82 ± 11.48, 26.69 ± 21.49, and 20.09 ± 23.29 in the balneotherapy group, and 63.67 ± 14.77, 67.35 ± 15.44, and 70.23 ± 18.26 in the control group at the consecutive visits. The PASS increased in both groups at week 3 and week 12 compared to the baseline, with a significant between-group difference at week 3 and week 12 for the balneotherapy group. Our results suggest the therapeutic efficacy of immersion in 42℃ thermal mineral water on chronic low back pain.ClinicalTrials.gov Identifier: NCT05342051.

Effects of complex spa therapy in patients with osteoarthritis of the spine receiving treatments in health resorts in south-eastern Poland

Management of patients with degenerative diseases commonly comprises health-resort based treatment programs, including spa therapies, balneotherapy as well as terrain therapy making use of microclimate factors. The study was designed to assess short- and long-term effects of spa therapy administered to patients with osteoarthritis of the spine who received treatment in health resorts located in Poland. The study involved 102 patients receiving treatment in health resorts, a group of subjects receiving outpatient treatment (100 patients) and a group receiving no therapy (100 patients). The assessment survey included: Pain VAS and Laitinen, LISAT-9 and HAQ-20 questionnaires. The assessments were carried out three times: at the start of the therapy program, as well as one month and six months after the end of the program. Short-term effects showed statistically significant improvement in all the outcome measures in spa group and outpatient treatment group. The long-term effects showed statistically significant improvement in all the outcome measures in spa group only. In conclusion spa therapy reduces pain, improves functional efficiency and increases the level of life satisfaction in patients with osteoarthritis of the spine. Its effects are sustained for at least six months. Spa therapy is more effective long-term, than outpatient treatment.

Trial registration: The study was registered at Clinical Trials: NCT03974308. First registration: 04/06/2019.

Post COVID-19 persistent fatigue: a proposal for rehabilitative interventions in the spa setting

With this letter to Editor, we aim at offering our viewpoint on the potential use of the spa resources to contribute to the treatment of persistent COVID-19 sequelae. In particular, our argumentations focus on the comprehensive management of fatigue persisting after the resolution of the acute infection. This sequela seems to be the most frequent disabling outcome, leading to a delay in social reintegration and return to working life.We suggest that spa facilities including multidisciplinary interventions and trained staffs could be an appropriate setting for providing rehabilitative protocols to treat chronic fatigue in post COVID-19 subjects. Spa treatments may improve the physical symptoms of chronic fatigue and modulate the immune imbalance, reducing persisting inflammation. Moreover, in the spa setting, specific respiratory rehabilitation and neuropsychological interventions could be provided. The rehabilitative protocol could also properly address comorbidities.In conclusion, respecting the hygiene and preventive measures, the spa setting could represent the appropriate environment to take care of post-COVID chronic fatigue, offering adequate and multidisciplinary rehabilitation protocols. Further, prospective trials on this topic are needed to fully evaluate the positive impact of a comprehensive rehabilitative treatment in the spa environment for subjects with post-COVID-19 fatigue.

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.

Effect of Balneotherapy on Chronic Low Back Pain at Hot Springs in Southern Ethiopia: Perceived Improvements from Pain

Background

Low back pain (LBP) is an important musculoskeletal condition results in clinical, social and public health problems globally. Hydrotherapy, using water and heat together can be utilized to treat conditions, relieve pain and increase muscular power and a range of joint movement in patients with chronic lower back pain. Most patients with acute LBP improve spontaneously within four weeks; however, chronic LBP is extremely common and usually mechanical in nature.

Objective

The objective of the current study was to assess effect of balneotherapy in decreasing the lower back pain and its improvements among adults using a spa in southern Ethiopia.

Methods

We employed a single arm cohort study and convenient sampling method to select 442 study participants from four hot springs located in Sidama Region and Gedeo Zone, Southern Ethiopia. Structured and pretested questionnaire was used and administered face-to-face by trained data collectors. Data were entered using EpiData and transferred to SPSS for cleaning and analysis. Descriptive and bivariate analyses were made.

Results

A total of 427 participants were included in the study giving response rate of 96.6%. The mean (standard deviation) age of respondents was 42.55 (±14.92) years. Perceived improvement from back pain was 332 (77.8%) with 95% confidence interval (CI) of 74–82%. Factors showing association with perceived improvement from back pain after spa therapy were, study site being near Hawassa (Burkitu) with crude odds ratio (COR) of 3.3 and 95%CI: 1.83–5.98 and p-value <0.001; and sex of respondents that the odds of perceived improvements among males were about twofold compared with females, (COR: 1.7, 95%CI: 1.07–2.74, p-value 0.025.

Conclusion

Our study shows significant perceived improvement from back pain after utilization of spa water. This is associated with type of hot spring used, male sex, and having neurological symptoms. Therefore, hot spring spa water had better therapeutic effect for back pain and emphasis should be given to integrate it with modern medicine and further experimental study to be conducted to recommend it for medical purposes.

Public interest in spa therapy during the COVID-19 pandemic: analysis of Google Trends data among Turkey

In Turkey, spas are widely used and preferred by patients who are seeking relief from their disability and pain. The spa therapy program is partly reimbursed by the national health insurance system. The objective of the present study was to leverage Google Trends to elucidate the public interest in spas in Turkey during the COVID-19 pandemic. Google Trends was queried to analyze search trends within Turkey for the Turkish term representing a spa (i.e., kaplıca) from January 01, 2016, to September 30, 2020. The relative search volume of "kaplıca" was statistically significantly decreased in the March 15-May 30, 2020 (- 73.04%; p < 0.001); May 31-July 25, 2020 (- 41.38%; p < 0.001); and July 26-September 19, 2020 (- 29.98%; p < 0.001) periods compared to similar periods of preceding 4 years (2016-2019). After June 1, 2020, the relative search volume was shown to have a moderate recovery, without reaching the level of 2016-2019. Public interest in spas showed an initial sharp decline between mid-March and May, with a moderate increase during the June-August period. This finding might be indicative of public preference in undertaking spa therapy during the COVID-19 period. In Turkey, spas might be used to increase places providing rehabilitation for both non-COVID-19 patients and survivors of COVID-19 with long-term symptoms during the pandemic.