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 !!