Innovation in balneotherapy – challengeof new target diseases and conditions

Innovation in balneotherapy – challengeof new target diseases and conditions

National Institute of Rheumatologyand Physiotherapy, Budapest, Hungary

National Institute of Rheumatologyand Physiotherapy, Budapest, Hungary

László Hodinka and Ildikó TefnerLászló Hodinka and Ildikó Tefner

Traditional balneotherapy is usuallyTraditional balneotherapy is usually

• disease orienteddisease oriented

• applying mostly conventional treatment modalities and applying mostly conventional treatment modalities and combinationscombinations

• based on community groupsbased on community groups

• advertising effectivity more empirically than evidence-advertising effectivity more empirically than evidence-basedbased

• Using more damage-specific, less functional and Using more damage-specific, less functional and psychosocial evidencespsychosocial evidences

Things for considerationThings for consideration

Phisical medicine tools - including balneotherapy - rarely have specific but Phisical medicine tools - including balneotherapy - rarely have specific but produce mostly of symptomatic or physiological effects (as used for ill or produce mostly of symptomatic or physiological effects (as used for ill or healthy persons).healthy persons).

Clients of physical medicine tools represent a continuum of people with Clients of physical medicine tools represent a continuum of people with symptoms, or discomfort or intending to prevent something or simply symptoms, or discomfort or intending to prevent something or simply improving the quality of their life.improving the quality of their life.

Pysical medicine tools also represent a continuumPysical medicine tools also represent a continuum– from medicinal use to spa and wellnes from medicinal use to spa and wellnes

– from approved to hypotheticfrom approved to hypothetic

– from usual triggers e.g. (thermomineral waters) to unusual onesfrom usual triggers e.g. (thermomineral waters) to unusual ones(light, colours, touch schents, sounds etc.)(light, colours, touch schents, sounds etc.)

Approved methods have also placebo effects and alternative tools may Approved methods have also placebo effects and alternative tools may produce objective (e.g. mental or QoL) changes. produce objective (e.g. mental or QoL) changes.

Combination of tools are more effective than single use.Combination of tools are more effective than single use.

Challenge for traditional Challenge for traditional balneotherapybalneotherapy

Recently people (ill and healthy) preferRecently people (ill and healthy) prefer– an action targeted to their specific needsan action targeted to their specific needs

• an individual programme an individual programme – a combination of different triggersa combination of different triggers

– an attractive and prestigious surrounding and climatean attractive and prestigious surrounding and climate

– a short and effective packagea short and effective package

Search for new applicationsSearch for new applications

Keyword „balneotherapy”: 1725 abstracts in English Keyword „balneotherapy”: 1725 abstracts in English

Excluded primary targets:Excluded primary targets:rheumatic diseasesrheumatic diseases

pulmonary diseasespulmonary diseases

dermatologydermatology

urologyurology

gynecologygynecology

cerebrovascular conditionscerebrovascular conditions

cardiovascular conditionscardiovascular conditions

metabolic conditionsmetabolic conditions

Analyzed: 7 pulicationsAnalyzed: 7 pulications

PublicationPublication DiseaseDisease TreatmentTreatment ControlControl TargetTarget IndicatorIndicator ChangeChange

PsychiatryPsychiatryR. Rastelli et alR. Rastelli et al19851985

anxietyanxietysyndromessyndromes

balneoth.balneoth.3 WK3 WK

yes, withoutyes, withoutbalneoth.balneoth.

anxiety,anxiety,somatisation,somatisation,drug needdrug need

Zung andZung andCrown quest.Crown quest.

ImprovementImprovementin treatedin treated

Strauss-BlascheStrauss-Blascheet al 2000et al 2000

pain and pain and discomfortdiscomfort

balneoth.gymn.balneoth.gymn.education education 3 wk3 wk

nonoGeneralGeneralwell-beingwell-being

pain,pain,mood,mood,fatiguefatigue

ImprovementImprovementin youngerin younger

Yokota Yokota et al 1997et al 1997

PsychiatricPsychiatriccomplicatiouscomplicatiousof bronchial festhmaof bronchial festhma

balneoth., inhalationbalneoth., inhalationswimming, mud packswimming, mud pack

nonodepression,depression,motivation,motivation,frustrationfrustration

CMI (Cornell, Med Ind),CMI (Cornell, Med Ind),SDS (Self-r Depr Sc.)SDS (Self-r Depr Sc.)CAI (Compr.Asthma Inst.)CAI (Compr.Asthma Inst.)

improvementimprovementin psychosocial in psychosocial scalesscales

KamiokaKamiokaet al 2003et al 2003

PsychologialPsychologialtensiontension

balneoth.balneoth.ow/3 moow/3 mo..exercise,exercise,educationeducation

yes, withoutyes, withoutbalneoth.balneoth.

anxyety,anxyety,tensiontension

QuestionnaireQuestionnaireon stresson stress

ImprovementImprovementin treatedin treated

KamiokaKamiokaet al 2004et al 2004

DepressionDepressionand vigorousnessand vigorousness

balneoth.balneoth.ow/ 6 mo.ow/ 6 mo.exerciseexerciseeducationeducation

yes, withoutyes, withoutbalneoth.balneoth.

DepressionDepressionvigorousnessvigorousness

BDI,BDI,self rated qu vestself rated qu vest

ImprovementImprovementin treatedin treated

NeurologyNeurologyBrefel-CourbonBrefel-Courbonet al 2003et al 2003

Parkinson'sParkinson'sdiseasedisease

spa.thspa.th(?)(?)

yes,yes,crossovercrossover

QoLQoLmotor function,motor function,psychic state,psychic state,direct costsdirect costs

PDQ, SF-36PDQ, SF-36UPDR ScaleUPDR ScaleGHQ-28GHQ-28

ImprovementImprovementshort term,short term,lower costslower costs

OncologyOncologyStrauss-BlascheStrauss-Blasche

BreastBreastcancercancerpostoperativepostoperative

COCO22 bath, bath,

mud pack,mud pack,exerciseexerciselymph dr.lymph dr.psych/relaxpsych/relax

nono

QoL,QoL,anxiety,anxiety, depression, depression,CA 15-3 tumorCA 15-3 tumormarkermarker

EORTCEORTCQLQ-C30QLQ-C30HADSHADSlaboratorylaboratory

QoL, mood,QoL, mood,tumor markertumor markerimprovedimproved

Attempt to identify target oriented modalities for Attempt to identify target oriented modalities for balneotherapy alone or in combinationbalneotherapy alone or in combination

CO2CO2 pain/spasticitypain/spasticity anxiety/panicanxiety/panic depression/fatiguedepression/fatiguefunctions/self-functions/self-

esteemesteem

thermomineralthermomineral ++ + + ++ ++ + + ++

hydrotherapyhydrotherapy ++ ?? ?? ?? ++

turkish bath/hammumturkish bath/hammum ++ ?? + + ? ? ++ ??

mud, oil, plant, etc., mud, oil, plant, etc., packspacks

++ ?? ?? ++

aromaticsaromatics ?? + + ?? + + ? ? ++ ??

light/colourlight/colour ?? ++ ++ ??

sound sound ?? ++ ++ ??

gymnastics and kinesisgymnastics and kinesis ++ ?? + + ? ? ++ ++

massagesmassages ++ ?? ?? ++

location/climatelocation/climate ?? ++ ++ ++

Not evaluated and not recommendedNot evaluated and not recommended: soft laser, polarized light, magnetic field, acupuncture, reflexology, : soft laser, polarized light, magnetic field, acupuncture, reflexology, homeopathy, bioresonance, ayurveda, neural therapyhomeopathy, bioresonance, ayurveda, neural therapy

Comments on new target Comments on new target balneotherapy applicationsbalneotherapy applications

Weaknesses ( of some protocols):Weaknesses ( of some protocols):Unclear target definitionUnclear target definition

Traditional treatment panels, short term trial settings.Traditional treatment panels, short term trial settings.

Little effort to identify the supposed effective factorsLittle effort to identify the supposed effective factors

The effects of balneotherapy cannot be investigated The effects of balneotherapy cannot be investigated independently from the other physical medicine components, independently from the other physical medicine components, lack of adequate controlslack of adequate controls

StrengthStrengthIntention of objectivity, use of validated measuresIntention of objectivity, use of validated measures

Conclusion and suggestionsConclusion and suggestions

Symptoms caused by somatic and psychic interactions Symptoms caused by somatic and psychic interactions (pain, anxiety, depression) seem to be promising targets (pain, anxiety, depression) seem to be promising targets for balneotherapy.for balneotherapy.

It is advisable to investigate the effects of balneotherapy It is advisable to investigate the effects of balneotherapy combined with different other triggers in the above combined with different other triggers in the above conditions.conditions.

Development and use of objective indicators in Development and use of objective indicators in recommendedrecommended