Mud therapy and rehabilitation - scientific relevance in the last six years (2015 – 2020) Systematic literature review and meta-analysis based on the PRISMA paradigm

Abstract Background. Balneotherapy is a stimulation - adaptation treatment method applied in the forms of bathing, drinking, and inhalation cures performed with natural therapeutic factors, a method which is acting in three main ways: thermally, mechanically, and chemically. Mud or peloids are natural therapeutic factors formed by natural processes under the influence of biological and geological phenomena, which in a finely dissolved state and mixed with water (mud) are used in medical practice in the form of baths or local procedures. Objective. This systematic review aims to rigorously select related articles and identify within their content, the main possible uses of therapeutic mud and physiological mechanisms, to see the main region of scientific interest for pelotherapy, and to discuss the value of mud therapy in rehabilitation medicine. Methods. The working method is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for open-access articles published in English, between January 2015 and December 2020, from the following databases: Cochrane, Elsevier, NCBI/PubMed, NCBI/PMC, PEDro, and ISI Web of Knowledge/Science (the latter was also used to identify ISI indexed articles). The contextually searched syntax used was ”Pelotherapy/Peloidotherapy/Mud-therapy/ /Fango-therapy AND Rehabilitation”. The selected articles were analyzed in detail regarding pathologies addressed by mud therapy and country scientific relevance for this therapeutic method. The meta-analysis proceeded was designated to estimate the prevalence of various pathologies in the use of mud therapy. Results. Our search identified, first, 394 articles. Based on the successive filtering stages and, respectively, on the classification criteria of the Physiotherapy Evidence Database (PEDro), we finally identified/retained and analyzed 68 articles. Although, in principle, a rigorous method – and we have followed the PRISMA type paradigm – there still might be some missing works of our related article selection. On the other hand, to augment/ consolidate our documentation base, we have used also 40 papers freely found in the literature, and even – aiming, too, at an as exhaustive knowledge underpinning as possible – derogatively, we have also considered some articles which, probably being very new, couldn't yet have reached the PEDro threshold score we have settled. Conclusions. This paper overviews the current state-of-the-art knowledge in the approach of peloidotherapy in rehabilitation, with a focal point on the therapeutic properties of peloids. Keywords: mud-therapy, pelotherapy, peloidotherapy, fango therapy, rehabilitation, balneotherapy, natural therapeutic factors,