The present study showed that complex spa therapy programs applied to individuals with osteoarthritis of the spine, in the patients’ opinion, produce desirable effects which are maintained for a minimum of six months.
Spa therapy, an important element of complex non-pharmacological treatment, is commonly applied in Europe and worldwide in a variety of rheumatic diseases, e.g., in degenerative disorders affecting the joints and the spine 12,21−23. Spa therapy leads to reduced pain, improved efficiency in daily life, and increased resistance to stress 11,12,17,23. According to WHO early old age starts at 60 years. Those aged 65 + constitute approximately 8.3% of the global population, and in this group degenerative diseases of the peripheral joints and the spine are observed at a rate exceeding 60% 3. The subjects enrolled for the present study on average were aged 67.3 years.
The study was designed to assess effectiveness of inpatient spa therapy administered at health resorts in comparison to ambulatory treatment program without balneotherapy and to changes occurring during the same period of time in a non-intervention control group. Short-term and long-term effects were investigated.
Assessment of short-term effects showed reduced pain, improved functional efficiency and greater life satisfaction in both the spa group and the outpatient treatment group. The observed changes were comparable in these two groups.
The current findings related to long-term effects reflected by reduced pain as well as improved functional efficiency and life satisfaction suggest that spa treatment produces better and more sustainable therapeutic outcomes in elderly patients with osteoarthritis of the spine, compared to ambulatory physiotherapy. The current findings are even more significant given the fact that the highest rate of obesity was identified in the spa therapy group, and this factor tends to adversely impact effectiveness of rehabilitation and treatments designed to reduce pain. The control group was not receiving any systematic treatments, and as it was anticipated, these subjects achieved the best results in the first assessment. No significant short- or long-term changes were identified in this group. Although, the second survey showed improvement in the Pain VAS measurement, this effect was not confirmed by the scores on Laitinen scale.
Numerous studies have demonstrated effectiveness of spa therapy reflected by reduced pain, improved functional efficiency and better quality of life. Good effects were identified in studies which did not involve control groups 1,3,4,24. In other studies, better effects were found in spa therapy groups compared to outpatient treatment groups 2,9 and compared to non-intervention control groups 6,10. Angioni et al. showed positive effects of inpatient spa therapy on pain severity and functional status, but the authors did not observe improvement in the quality of life 16. Other researchers reported greater improvement as a result of inpatient spa therapy compared to outpatient spa therapy and non-intervention, although effectiveness of the outpatient spa therapy was also satisfying 12. Likewise, Yücesoy et al. reported significantly better results in a group receiving inpatient spa therapy compared to outpatient spa therapy, but they also emphasised that outpatient spa therapy produces satisfying effects and may be an alternative to inpatient spa therapy 25. Positive effects of balneotherapeutic factors on treatment outcomes were also reported in other studies where greater improvements were observed in outpatient treatment groups receiving balneotherapy compared to outpatient groups receiving treatments without balneotherapy 5,8,19,20. A review of the related literature also shows that spa therapy is effective in reducing pain, improving functional efficiency and quality of life in patients with rheumatic disorders, including osteoarthritis of the spine 26,27.
Effects of spa therapy are maintained for some time after the end of the treatment 17. Healthy habits acquired during the stay in a health resort contribute to that 10. According to studies by other authors, effects of spa therapy were maintained at the follow-up after 4 weeks 12, after 9 weeks 5, after 10 weeks 8, after 3 months 2,20, after 15 weeks 18, after 4 months 6 and after 6 months 28. In the current study better scores reflecting positive effects of spa therapy were observed after 6 months, compared to the non-intervention control group and the group receiving ambulatory treatment; in the latter long-term improvement was only reflected by the scores in Laitinen Questionnaire.
During the initial period of spa therapy problems related to pain may temporarily become aggrevated 17. As a rule, however, the therapy is well tolerated, as a result of which it can be applied multiple times 17,18,21. Other researchers reported such undesirable events as: more severe pain, increased blood pressure, weakness, allergic reaction and higher temperature. These symptoms usually disappeared after a few hours or a few days 1,27,28. A literature review showed that only 1% of patients receiving balneotherapy had to discontinue the treatment due to adverse effects 27. In the current study more severe pain was reported by two subjects and excessive decrease in blood pressure by one subject in the therapy group.
The authors of a literature reviews emphasise drawbacks of the related research, i.e., small study groups, inhomogeneity of the therapies investigated as well as insufficient duration of observation following the therapy 27,29. Furthermore, because of the complex nature of spa therapies and the characteristic features of the natural materials, it is often impossible to apply a placebo therapy in the control group 6,12,30. Another frequent limitation of the related research lies in the fact that a significant percentage of subjects refuse to participate in the follow-up assessments. In a study by Puszczałowska- Lizis the survey response rate at the follow-up after three months amounted to 61% in the study group and to 50% in the control group 2. In the present study the entire research procedure was completed by 89% of the subjects in the spa group, 80% of those in the outpatient treatment group and 75% of the controls. Limitations of the current study are related to the specificity of spa therapy in health resorts. Blinding was not applied in the specific groups because of the nature of the therapy and the research protocol adopted. Randomisation, blinding of the participants and placebo type interventions usually are not feasible in research focusing on balneotherapies. Furthermore, it would be unethical to deprive patients of the treatment in order to enable comparative analyses. In view of the above the current study was an attempt to assess combined effects of the complex factors existing and applied in health resorts. The study applied methods of survey and subjective self-assessment, as a result of which it was possible to conduct the second assessment one month after the end of the therapy, and the third assessment six months after the end of the therapy, by means of phone calls.
Environmental factors and climate contribute to the effectiveness of spa therapy 3. The current study was carried out in health resorts located in south-eastern Poland, where patients can benefit from heliotherapy and climate therapy throughout the year because of the excellent solar and wind related characteristics 31. A study by Lewicka et al. showed improved health status in 82% of patients after they received treatment in health resorts located in south-eastern Poland 32.
Spa towns in south-eastern Poland have for many years been attracting patients from all over Poland and from abroad, owing to their natural medicinal and scenic assets. The current findings suggest that rehabilitation and recreation in the climate of south-eastern Poland can be recommended as an effective and affordable therapy to individuals with osteoarthritis of the spine. In order to enable promotion and financing of this form of therapy it is necessary to present supporting evidence confirming the effectiveness of spa therapy provided in health resorts, in accordance with EBM requirements.