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 Patient with chronic back pain Assesment in musculosceletal polyclinic in our department 50 Patients randomized into two groups 44 patient completed 3. month measurements n=20 Spa therapy(pool-bath tub) n=24 Spa+exercise therapy 2 weeks duration Pool-bath tub Gönen Spa Hotel 2 Weeks duration Pool-bath tub- exercises Gönen Spa Hotel outcome measurements Before therapy- end of therapy and 3. month outcome measurements at the same times İn our department 19 patient completed 3. month 1 patient didn’t come to 3rd.month measurement 24 patient completed 3. month
Balneotherapy group (n:20) Stay at Gönen Spa Hotel Balneotherapy + exercise therapy group (n:24) Stay at Gönen Spa Hotel Study Groups
Balneotherapy Group Thermomineral water (Na, SO4, HCO3, Cl, Fl) Once a day- in thermal pool 36-37ºC 20 minutes duration Once a day- in bath tub 38ºC 20 minutes duration
Balneotherapy+Exercise Group Once a day- in thermal pool 36-37ºC 20 minutes duration Once a day- in bath tub 38ºC 20 minutes duration Once a day Williams exercises 15 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. 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. Hamstring Stretch: sitting with legs and toes forward, slowly lower trunk forward and over the legs. 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 • Significant reduction was seen in Pain VAS scores in both groups. P=0,000 P=0,000 P=0,000 P=0,001
Patient’s global assesment (VAS) • Significant reduction was seen in both groups. P=0,000 P=0,001 P=0,000 P=0,001
Doctor’s global assesment (VAS) • Significant reduction was seen in both groups. P=0,000 P=0,000 P=0,000 P=0,000
HAQ • Significant reduction was seen in both groups. P=0,014 P=0,001 P=0,006 P=0,015
WOMAC-total • Significant reduction was seen in both groups. P=0,002 P=0,000 P=0,001 P=0,007
Function WADDELL • 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) • Significantreduction was seen in both groups. P=0,006 P=0,007 P=0,022 P=0,026
Schober (cm) • 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=0,024 P=0,218 P=0,081 P=0,092
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.