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    Balneological outpatient treatment for patients with knee osteoarthritis; an effective non-drug therapy option in daily routine?
    (Springer, 2017) Ozkuk, Kagan; Gurdal, Hatice; Karagulle, Mine; Barut, Yasemin; Eroksuz, Riza; Karagulle, Mufit Zeki
    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 A degrees C were applied for 20 min, after a tap water (38 A degrees 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.
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    Evaluation of the therapeutic and the chemical effects of balneological treatment on clinical and laboratory parameters in knee osteoarthritis: a randomized, controlled, single-blinded trial
    (Springer, 2022) Adiguzel, Tuba; Arslan, Beyza; Gurdal, Hatice; Karagulle, M. Zeki
    The purpose of this study was to investigate the therapeutic and the chemical effects of balneological treatment (peloidotherapy + hydrotherapy), and its effects on serum levels of interleukin-lbeta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha), and insulin-like growth factor-1 (IGF-1) in patients with knee osteoarthritis (OA). Sixty-four (64) knee OA patients were randomly divided into study and control groups. Balneological treatment, consisting of hydrotherapy, and peloidotherapy were given to both groups. Unlike the study group, in the control group, the peloid was applied over a stretch film cover, preventing any contact between the skin and peloid. Clinical outcome measures of the study were pain degree, patient's and investigator's global assessment on visual analog scale (VAS-pain, VAS-PGA, VAS-IGA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (pain, stiffness, and physical function). Patients were evaluated at baseline, post-treatment (after 10th session), and 3 and 6 months after treatment. Blood samples were taken at baseline, post- treatment, and 6 months after treatment for analysis of IL-1 beta, TNF-alpha, and IGF-1 serum levels. When compared with the baseline, VAS measurements decreased significantly in almost all evaluation periods in both groups, and no difference was observed between the groups. In the study group, WOMAC scores showed significant improvement in all assessments. In the control group, pain and physical function subscores of WOMAC significantly decreased at post-treatment and 3 months after treatment. In group comparison, pain and stiffness subscores showed a significant difference in favor of the study group at 6 months after treatment. No clinically significant improvement was seen in levels of IL-1 beta and IGF-1 in both groups during the whole assessment period. Because of TNF-alpha kit failure, we could not evaluate the measurements. In conclusion, balneological treatment is an effective treatment option to improve the pain and functional capacity of patients with knee OA. The application of peloid by contact with the skin is superior in the long-term period, which means that in addition to the thermal effect, the chemical content of peloid can also contribute to the therapeutic effect.