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Int J Biometeorol. 2017 Apr;61(4):719-728. doi: 10.1007/s00484-016-1250-8. Epub 2016 Oct 7.

Balneological outpatient treatment for patients with knee osteoarthritis; an effective non-drug therapy option in daily routine?

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Department of Medical Ecology and Hydroclimatology, İzzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, 14020, Bolu, Turkey.
Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey.
Department of Medical Ecology and Hydroclimatology, Büyükçekmece Public Hospital, İstanbul, Turkey.
Department of Medical Ecology and Hydroclimatology, Yüksekİhtisas Training and Research Hospital, Bursa, Turkey.


This study aims to compare the effects of balneological treatments applied at consecutive and intermittent sessions without interfering with their daily routine in patients with knee osteoarthritis. This is a randomized, controlled, single-blind clinical trial. Fifty patients diagnosed with knee osteoarthritis were included. The patients were divided into two groups. All patients were given a total of ten sessions of balneological treatment consisting of hydrotherapy and mud pack therapy. Group 1 received consecutive treatment for 2 weeks, while group 2 received intermittent treatment for 5 weeks. Local peloid packs at 45 °C were applied for 20 min, after a tap water (38 °C) bath. Evaluations were conducted before, after treatment, and at 12th week of post-treatment by Pain (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-36 (SF-36). Both balneological treatment regimens of knee osteoarthritis had statistically significant clinical effects as well as effects on the quality of life. Patients' well-being continued at 3 months, except for joint stiffness (WOMAC), role-emotional (SF-36), and vitality (SF-36) in group 1 and for mental health (SF-36) in both groups. Both patient groups had improved compared to baseline. However, at 3 months after the treatment, the well-being of group 2 was unable to be maintained in terms of role-physical (SF-36) parameter, while the well-being of group 1 was unable to be maintained in terms of pain, WOMAC (pain, physical functions, total), and SF-36 (physical functioning, role-physical, pain, role-emotional, and mental health) variables, compared to data obtained immediately after treatment. Our study suggests that traditional and intermittent balneological therapies have similar efficacy in patients with knee osteoarthritis.


Balneotherapy; Intermittent; Knee osteoarthritis; Peloidotherapy; Spa treatment

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