Comparison of 2 Different Spa Therapy Regimens in the Management of Chronic Low Back Pain; Single Blind Randomize Controlled Trial
Didem Takinacı, Müfit Zeki Karagülle
Istanbul University, Istanbul Medical Faculty,Department of Medical Ecology and Hydroclimatology
Objective
We aimed to determine the effectiveness of spa therapy in short and long term on functions and pain, in chronic low back pain
To compare two different spa therapy program in chronic low back pain.
Study design
Randomized Controlled Single blind Follow up 6 months
Study Diagram
19 patient completed 3. month1 patient didn’t come to 3rd.month measurement
outcome measurements Before therapy- end of
therapyand 3. month
2 weeks duration Pool-bath tub
Gönen Spa Hotel
n=20Spa therapy(pool-bath tub)
24 patient completed 3. month
outcome measurements at the same times İn our department
2 Weeks durationPool-bath tub- exercises
Gönen Spa Hotel
n=24 Spa+exercise therapy
44 patient completed 3. month measurements
50 Patients randomized into two groups
Patient with chronic back pain Assesment in musculosceletal polyclinic
in our department
Study Groups
Balneotherapy group (n:20)
Stay atGönen Spa Hotel
Balneotherapy + exercise therapy group (n:24)
Stay atGönen Spa Hotel
PatientsBalneotherapy and exercise (n=24)
Balneotherapy only (n=20)
Female/Male 17/7 15/5
Age (year) (SD) 64,7 (±11,3) 61,7 (± 9,4)
Duration ofdisease(year)(SD)
9,9 (± 7,3) 11,6 (± 7,7)
Duration of pain (month) (SD)
2,3 (± 1,0) 2,4 (± 1,2)
ESR (mm/h) (SD)
19,2 (± 11,4) 16,8 (± 8,0)
Balneotherapy Group
Thermomineral water (Na, SO4, HCO3, Cl, Fl)
Once a day- in thermal pool
36-37ºC20 minutes duration
Once a day- in bath tub38ºC
20 minutes duration
Balneotherapy+Exercise Group
Once a day- in thermal pool 36-37ºC20 minutes duration
Once a day- in bath tub38ºC
20 minutes duration
Once a dayWilliams exercises15 minutes duration
Williams’ Flexion Exercises
Pelvic Tilt: lie on back with knees bent and feet flat. Flatten small of back against floor.
Single and Double Knee to Chest: lie on back with knees bent, slowly pull knees or knee toward the chest.
Partial sit-up: do pelvic tilt and slowly curl head an shoulders off the floor.
Hamstring Stretch: sitting with legs and toes forward, slowly lower trunk forward and over the legs.
Hip flexor stretch: place one foot in front of the other with knee flexed. Flex forward through the trunk until the opposite knee contracts the auxiliary fold.
Squat: stand with feet parallel maintaining trunk stabilization, lower the body by flexing the knees.
Uncontrolled Factors
Resting Regular daily rhythm Close contact with health
professionals Change of environment
Outcome measures Pain (VAS) Patient’s global assessment (VAS) Doctor’s global assessment (VAS) Health assessment questionnaire -
HAQ WOMAC OA index WADDELL Finger-floor distance Schober index
Outcome measures
Before spa therapy After spa therapy (within a week) Long term
– 3. month– 6. month
Pain-VAS
0
10
20
30
40
50
60
70
80
before after 3. month
baln+ exer baln
Significant Significant reduction was reduction was seen in Pain seen in Pain VAS scores in VAS scores in both groups.both groups.
P=0,000 P=0,000
P=0,000 P=0,001
Patient’s global assesment (VAS)
0
10
20
30
40
50
60
70
before after 3. month
baln+ exer baln
Significant Significant reduction was reduction was seen in both seen in both groups.groups.
P=0,001P=0,000
P=0,000 P=0,001
Doctor’s global assesment (VAS)
0
10
20
30
40
50
60
70
before after 3. month
baln+exer baln
Significant Significant reduction was reduction was seen in both seen in both groups.groups.
P=0,000
P=0,000 P=0,000
P=0,000
HAQ
0
0,2
0,4
0,6
0,8
1
1,2
before after 3. month
baln+ exer baln
Significant Significant reduction was reduction was seen in both seen in both groups.groups.
P=0,001
P=0,015P=0,006
P=0,014
WOMAC-total
0
5
10
15
20
25
30
35
40
45
50
before after 3. month
baln+ exer baln
Significant Significant reduction was reduction was seen in both seen in both groups.groups.
P=0,002
P=0,000
P=0,007P=0,001
Function WADDELL
0
1
2
3
4
5
6
7
before after 3. month
baln+ exer baln
Improvement (not significant) in balneotherapy+exercise group at the end of spa therapy and significant improvement at 3. month.
Significant improvement in balneotherapy group at the end of spa therapy and at 3. month.
P=0,128 P=0,02
P=0,000 P=0,000
Finger-Floor Distance(cm)
SignificantSignificant reduction was reduction was seen in both seen in both groups.groups.
0
2
4
6
8
10
12
14
before after 3.month
baln+ exer baln
P=0,007P=0,006
P=0,022
P=0,026
Schober (cm)
13,4
13,6
13,8
14
14,2
14,4
14,6
14,8
15
before after 3. month
baln+ exer baln
Improvement in both groups at the end of spa therapy and at 3. month, but significant only in balneotherapy + exercise group at 3. month.
P=0,092
P=0,218
P=0,081
P=0,024
Conclusion
In our trial, both 2 week-spa therapy regimens are effective in reducing pain and improving function and spinal mobility and flexibility.
The significant improvement in Schober Index seen at 3 month in balneotherapy + exercise group seems the only advantage of added exercise therapy.
Conclusion
Spa therapy combining balneotherapy and exercise therapy seems having advantage in improving mobility and flexibility in patient with chronic low back pain.
However, it is needed further well designed randomized controlled trials with a higher number of patients in both groups with a sufficient power to show the superiority of combined spa therapy.
Thank you !!Thank you !!