The efficacy of balneotherapy, mud therapy and spa therapy in patients with osteoarthritis: an overview of reviews

Association between sleep quality and serum biomarkers among long-term hot spring bathers: a cross-sectional study

Previous studies investigating the influence of hot spring bathing on sleep quality have predominantly focused on the short-term effects through questionnaire surveys without blood collection for biochemical tests. Here, we undertook a comprehensive investigation of the long-term health effects of hot spring bathing among the residents of Hot Spring Village. A total of 140 participants were enrolled, and their demographic characteristics and the patterns of hot spring bathing were obtained via face-to-face interview, and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Moreover, the blood samples of the participants were collected for biomarker detection with the ELISA assay. Logistic regression analysis was applied to evaluate the relationship between sleep quality and serum biomarkers among long-term hot spring bathers. In individuals aged 65 and older, the results demonstrated that hot spring bathing (OR = 0.18, 95%CI: 0.05-0.68), particularly with a length of ≥ 30 min (OR = 0.10, 95%CI: 0.02-0.53) and a frequency of ≥ 3 times/week (OR = 0.07, 95%CI: 0.01-0.32) were significant protective factors for good sleep quality (P < 0.05). Furthermore, reduced TNF-α (OR = 1.03, 95% CI: 1.01-1.06) and increased 5-HT levels (OR = 0.98, 95% CI: 0.97-0.99) were associated with good sleep quality. Interestingly, for the first time, we observed that the TNF-α significantly decreased (P < 0.05) in the bathing group, along with an increasing trend of 5-HT and BDNF. Moreover, among participants in this group who reported good sleep quality, there was a notably significant decrease in TNF-α and an increase in 5-HT levels as well. These findings suggested that long-term hot spring bathing is associated with good sleep quality through the alteration of TNF-α and 5-HT levels, which could be potential biomarkers for future investigation on the health-promoting effects of bathing.

Water-based interventions in rheumatic diseases: mechanisms, benefits, and clinical applications

Chronic pain and restricted mobility, hallmark features of rheumatic diseases, substantially affect patients' quality of life, often resulting in physical disability and emotional distress. Given the long-term nature of these conditions, there is a growing interest in complementary therapeutic approaches, emphasizing the need to explore non-pharmacological treatments. Hydrotherapy, balneotherapy, and mud therapy have emerged as effective interventions to alleviate pain, reduce inflammation, improve joint mobility, and enhance overall physical and mental well-being. These therapies utilize water's thermal, mechanical, and chemical properties to regulate blood circulation, metabolism, inflammatory processes, and patients' psycho-emotional states. This narrative review evaluates the multifaceted effects of water-based treatments on patients with rheumatic diseases, including rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and fibromyalgia syndrome. Special attention is given to these therapies' synergistic effects, underlying mechanisms, and impacts on patients' physical and emotional health. In conclusion, the integrated use of water-based therapies represents a promising adjunctive treatment for improving the quality of life in patients with rheumatic diseases. However, further research must refine and individualize these therapeutic approaches for optimal outcomes.

Developmental Psychology and Healthcare Professions: Autism Knowledge Among Nurses: An Observational Study

Background: One of the biggest limitations faced by autistic people is the lack of knowledge of their condition. Our study aims to evaluate and discuss the knowledge of autism among nurses, which is a social and health category often in close contact with autistic people. Objective: Given the limited exploration of awareness levels about autism among healthcare professionals, this study aims to investigate general and specific knowledge of autism within a group of nursing students enrolled in a master's degree. Methods: A total of 66 nurses completed the questionnaire. Descriptive analyses were conducted on the results for the four subcomponents of the questionnaire: (i) general knowledge, (ii) symptomatology, (iii) screening and diagnosis, and (iv) intervention and treatment. A correlation analysis was performed between the participants' demographic variables and questionnaire scores. Additionally, a multivariable logistic regression was conducted to analyze the association between the participants' basic demographic characteristics and questionnaire scores. Results: Results showed a good percentage of correct answers in the "general knowledge" category. Furthermore, a good level of knowledge regarding the fact that ASD is a developmental disorder and a congenital disease also emerged. Conclusions: Regarding the knowledge of typical autism symptoms, participants answered most of the questions correctly. Correct answers decreased for questions related to screening and diagnosis. In particular, participants had limited knowledge of the DSM-5 and the timing of ASD diagnosis. Similar levels of knowledge were observed for the fourth category, "intervention and treatment".

Effects on Physical Functioning and Fear of Falling of a 3-Week Balneotherapy Program Alone or Associated with a Physical Activity and Educational Program in Older Adult Fallers: A Randomized-Controlled Trial

Background

The effects on gait and posture of balneotherapy in fallers are unknown. We assessed the effects on physical functioning and fear of falling of a balneotherapy program alone or combined with a physical activity and educational program in older adult fallers.

Methods

A multicenter randomized controlled trial enrolled patients aged 65 or older referred to a 3-week balneotherapy program, and screened for risk of falling (a history of falls in the last year and a timed up and go test or a five chair rising test >12 sec or a 4-meter walk test >4 sec). In addition to balneotherapy, patients had either no intervention (controls) or twelve 60-minute sessions of physical activity including 15 minutes of health education and three 90-minute sessions of an educational program (intervention).

Results

There were 118 control and 105 intervention patients. The balneotherapy program alone had a clinically significant effect on (i) the grip strength, (ii) the five chair rising test, (iii) the 4-meter walk test, and (iv) the short physical performance battery (Cohen's d 0.29-0.46). It had no effect on (i) the maximum time stood on one foot, and (ii) the timed up and go test. Furthermore, it worsened the falls efficacy scale (d = 0.27). Adding a physical activity and educational program significantly improved (i) the time stood on one foot (Cohen's d =-0.34), and (ii) the timed up and go test (d=- 0.44), (iii) and reduced the concern about falling (Falls Efficacy scale, d=-0.25), and (iv) the fear of falling (d=-0.34).

Conclusion

Older patients referred to a balneotherapy program and at high risk of falling when screened at the entrance of the center should be offered an additional physical and educational program to further improve the functional effects of balneotherapy on the timed up and go test, balance, and the fear of falling.

Etodolac utility in osteoarthritis: drug delivery challenges, topical nanotherapeutic strategies and potential synergies

Osteoarthritis (OSA) is a prevalent joint disorder characterized by losing articular cartilage, primarily affecting the hip, knee and spine joints. The impact of OSA offers a major challenge to health systems globally. Therapeutic approaches encompass surgical interventions, non-pharmacological therapies (exercise, rehabilitation, behavioral interventions) and pharmacological treatments. Inflammatory processes within OSA joints are regulated by pro-inflammatory and anti-inflammatory cytokines. Etodolac, a COX-2-selective inhibitor, is the gold standard for OSA management and uniquely does not inhibit gastric prostaglandins. This comprehensive review offers insights into OSA's pathophysiology, genetic factors and biological determinants influencing disease progression. Emphasis is placed on the pivotal role of etodolac in OSA management, supported by both preclinical and clinical evidences in topical drug delivery. Notably, in-silico docking studies suggested potential synergies between etodolac and baicalein, considering ADAMTS-4, COX-2, MMP-3 and MMP-13 as essential therapeutic targets. Integration of artificial neural network (ANN) techniques with nanotechnology approaches emerges as a promising strategy for optimizing and personalizing topical etodolac delivery. Furthermore, the synergistic potential of etodolac and baicalein warrants in-depth exploration. Hence, by embracing cutting-edge technologies like ANN and nanomedicine, the optimization of topical etodolac delivery could guide a new era of OSA treatment.

Self-Perceived Competencies and Attitudes on Palliative Care in Undergraduate Nursing Students: A Multicenter Descriptive Study

Introduction: Caring for the dying can generate anxiety and emotional distress, particularly in nursing students, and perceived competence could play a crucial role in enabling nurses to perform their duties with greater confidence. Unfortunately, few studies describe the relationship between students' nursing attitudes and perceived self-efficacy in palliative care (PC). To overcome this gap, this survey aimed to assess the attitudes towards dying patients and the perceived competence of nursing students in palliative care at different universities in the south of Italy. Methods: A cross-sectional study was conducted from September 2022 to March 2023 involving nursing students from the three major Sicilian universities (Italy). The study included a survey investigating socio-demographic characteristics, palliative care training, knowledge about pain management, and previous experience with dying. Moreover, the Professional Competence of the Core Curriculum in Palliative Care Nursing (CCPCN) questionnaire and the Frommelt Attitudes Toward Care of the Dying-B Italian version (FATCOD-B-I) assessed competencies and emotional attitudes. Results: A total of 1913 nursing students were recruited, of which 71.3% were females, and 53.9% were in the age range of 18 to 21 years. In the multivariable analysis, practical PC training was a substantial factor in enhancing competencies (Adj-OR 2.78 [95% CI = 2.12-3.65]). Male students had higher competence odds (Adj-OR 1.38 [95% CI = 1.14-1.66]), and perceived knowledge strongly correlated with self-assessed competence. Advancement in academic years also positively influenced competence self-assessment (Adj-OR 1.98 [95% CI = 1.75-2.24]). Regarding emotional attitudes, a per-quartile increase in competence score was found to improve the attitude score (Adj-OR 1.24 [95% CI = 1.13-1.35]). Conclusions: Nursing students gain valuable experience during clinical experience. PC training and perceived knowledge of PC significantly increase nurses' competencies, and the latter seem to be strongly associated with attitudes. Thus, introducing palliative care education into nurses' core curricula could be a way to reduce anxiety and emotional distress in young students.

The Usefulness of Virtual Reality in Symptom Management during Chemotherapy in Lung Cancer Patients: A Quasi-Experimental Study

Background: Virtual reality (VR) emerges as a promising non-pharmacological intervention for managing symptoms and providing distraction during chemotherapy. This study aims to assess VR's effectiveness on cancer-related symptoms, vital signs, and the patients' perception of chemotherapy in lung cancer patients. Methods: A quasi-experimental study was conducted on 100 patients. Participants were allocated into an intervention group (n = 55), which experienced immersive VR, and a comparison group (n = 45), which received usual care. Data were collected through questionnaires and checklists, including feedback on the VR experience, pain, vital signs, and common cancer symptoms, assessed through the Edmonton Symptom Assessment Scale. Results: VR had a significant impact on reducing the perception of chemotherapy length. Patients reported high levels of satisfaction and tolerability. No adverse events were observed. VR did not have significant influence on pain intensity or vital signs. The only exceptions were oxygen saturation, where a significant difference (p = 0.02) was reported, and the perception of chemotherapy duration. Conclusions: As a non-pharmacological intervention, VR proves to be beneficial in minimizing the perceived length of chemotherapy sessions for lung cancer patients, enhancing their overall treatment experience. The intervention was found to be a safe, feasible, and well-accepted distraction technique. Future research should explore VR's potential effects on a wider range of symptoms and evaluate its impact on long-term outcomes.

Circulating serotonin and dopamine concentrations in osteoarthritis patients: a pilot study on the effect of pelotherapy

Balneotherapy has demonstrated clinical efficacy in the management of pathologies involving low-grade inflammation and stress. In rheumatic conditions such as osteoarthritis (OA), this therapy presents anti-inflammatory properties and potential to improve psychological well-being. Although the neurohormones serotonin and dopamine are known to be involved in these processes, surprisingly they have not been studied in this context. The objective was to evaluate the effect of a cycle of balneotherapy with peloids (pelotherapy) on circulating serotonin and dopamine concentrations in a group of aged individuals with OA, after comparing their basal state to that of an age-matched control group. In our pilot study, a pelotherapy program (10 days) was carried out in a group of 16 elderly patients with OA, evaluating its effects on circulating serotonin and dopamine concentrations (measured by ELISA). Individuals with OA showed higher levels of serotonin and lower dopamine levels, in line with the inflammatory roles of these mediators. After pelotherapy, serotonin concentrations significantly decreased, potentially contributing to the previously reported anti-inflammatory effects of balneotherapy.

Marked Reduction of Oxidant Species after Sulfureous Crenotherapy in Females with Joint Diseases and Psoriasis: A Retrospective Real-Life Study

Oxidative stress, a condition induced by an excessive amount of free radicals, such as reactive oxygen species (ROS), shows several gender-related differences in basal cellular redox state and antioxidant responses. Crenotherapy with sulfureous mineral water can improve the cellular redox state. In this retrospective observational study, gender-related differences in the efficacy of sulfureous crenotherapy in decreasing oxidant species were investigated. Seventy-eight patients, stratified by sex, with osteoarthritis or degenerative joint disease and Vulgar psoriasis who have received a cycle of sulfureous mud-bath therapy + sulfureous hydropinotherapy were enrolled. Plasma concentration of oxidant species and clinical outcomes were measured at baseline and at the end of treatment. After 2 weeks of sulfureous crenotherapy, a significant amelioration of clinical outcomes and a significant reduction of oxidant species were observed in both sexes, more marked in females than in males (p = 0.0001 and p = 0.04, respectively). For patients with high oxidant species at baseline, females showed a greater reduction in itching compared to males (-95% vs. -50%), while men had a higher amelioration in pain and morning stiffness (-45% vs. -32%, and -50% vs. -37%, respectively). In conclusion, sulfureous crenotherapy can be a valuable strategy to improve cellular redox state in both sexes.

The Potential Role of Spa Therapy in Managing Frailty in Rheumatic Patients: A Scoping Review

Frailty is not limited to the elderly, as patients with rheumatic diseases can also experience this condition. The present scoping review aimed to investigate the possibility of using the health resort setting as an alternative location for managing rheumatic patients with frailty. The research resulted in finding several in vitro, in vivo, and clinical studies, resulting in evidence supporting the effectiveness of spa treatments in reducing pain, improving function, and managing comorbidity in rheumatic diseases. Additionally, spa treatments were demonstrated to modulate the MAPK/ERK pathway and the NF-kB pathway's activation and to reduce proinflammatory molecules' secretion in rheumatic diseases, thus suggesting their potential effective role in the regulation of inflammaging in frailty. Moreover, the health resort setting may offer potential resources to reduce risk factors, such as drug consumption, inactivity, and disease severity, and may serve as a setting for developing prevention protocols for frailty. Future research should explore innovative approaches, such as exercise training and early diagnostics, for the overall management of frailty in rheumatic patients in the spa setting.

Osteoarthritis year in review 2022: rehabilitation

This year in review presents key highlights from research relating to osteoarthritis (OA) rehabilitation published from the 1^st April 2021 to the 18^th March 2022. To identify studies for inclusion in the review, an electronic database search was carried out in Medline, Embase and CINAHLplus. Following screening, included studies were grouped according to their predominant topic area, including core OA rehabilitation treatments (education, exercise, weight loss), adjunctive treatments, novel and emerging treatments or research methods, and translation of rehabilitation evidence into practice. Studies of perceived high clinical importance, quality, or controversy in the field were selected for inclusion in the review. Headline findings include: the positive role of technology to support remote delivery of core OA rehabilitation treatments, the importance of delivering educational interventions alongside exercise, the clinical and cost-effectiveness of a stepped approach to exercise, controversy around the potential mechanisms of action of exercise, mixed findings regarding the use of splinting for thumb base OA, increasing research on blood flow restriction training as a potential new intervention for OA, and evidence that the beneficial effects from core OA treatments seen in randomised controlled trials can be seen when implemented in clinical practice. A consistent finding across several recently published systematic reviews is that randomised controlled trials testing OA rehabilitation interventions are often small, with some risk of bias. Whilst future research is warranted, it needs to be large scale and robust, to enable definitive answers to important remaining questions in the field of OA rehabilitation.

Property of mud and its application in cosmetic and medical fields: a review

Mud is a semi-colloidal substance formed by the mixture of inorganic, organic and water under the influence of various physical and chemical factors through geological and biological processes. The chemical composition of mud is complex, rich in Ca²⁺, Zn²⁺, Mg²⁺, Na⁺ and other mineral elements, also contains organic matter such as humic acid, fulvic acid and acetic acid. In cosmetic field, mud can improve the activity of glutathione enzyme and superoxide dismutase in skin, which helps the skin anti-aging. Besides, it also can improve the skin microbial community, due to its distinctively physical properties, mineral ions, microorganisms, etc. In medical field, mud can treat osteoarthritis, especially knee osteoarthritis which has been studied extensively, and it can also increase the chemotaxis of macrophages. On the one hand, the use of clay (a kind of refined mud) can protect the gastrointestinal tract and treat some gastrointestinal diseases. On the other hand, clay is often used as carriers or composites in drug delivery, especially in skin drug delivery, showing very positive results. The purpose of this review is to present an overview of current knowledge about the application of mud in cosmetic and medical fields and to provide ideas for further research in mud.

Comparison of the efficacies of peloid therapy and paraffin treatment given as an adjuncts to exercise therapy in patients with hallux rigidus: a randomized, uncontrolled, prospective study

Although it is thought that peloid and paraffin treatments may have positive effect on pain, functional status, and quality of life in patients with hallux rigidus (HR), there are no comprehensive and comparative studies with a high level of evidence. We aimed to compare peloid and paraffin treatments in symptomatic hallux rigidus patients. A total of 113 patients diagnosed with HR between May 2019 and June 2021 were included in the study. After exclusion criteria, the remaining 90 patients were randomly divided into two groups: the peloid therapy group (peloid therapy + home exercise) and the paraffin therapy group (paraffin therapy + home exercise). Peloid and paraffin treatments were applied for 2 weeks (5 days a week for a total of 10 sessions). Patients were evaluated before treatment, at the end of treatment, and one month after treatment. The groups were compared in terms of pain, functional status, quality of life, and joint range of motion. In the final analysis, 40 patients in each treatment group were compared. Statistically significant improvements were achieved for all parameters at the end of treatment and at follow-up, and the treatments were found to be highly effective. As a result of the comparison, the methods were not found to be superior to each other. The present study is the first randomized study comparing peloid therapy and paraffin therapy given as an adjuncts to exercise therapy. Exercise therapy plus peloid and exercise therapy plus paraffin treatments seem to have similar effects on HR; however, controlled trials are necessary for confirmation of our results.

The therapeutic effect of Värska mud and Värska mineral water baths on the overuse pain and muscle tension syndromes in the working age population

The effects of bath therapy are complex and result from a unique interaction between the aquatic environment and the human body functions. The effect of bath therapy depends on both water temperature and chemical additives (mineral substances and humic substances). Värska Resort Centre, in south-eastern Estonia, uses for the balneotherapy the local curative mud and mineral water. The aim of the study was to evaluate and compare the effects of Värska's local mud bath and mineral water bath on moderate musculoskeletal pains in working-age people. The study involved 64 working-age subjects: within two weeks, 32 of them received five general mineral water baths, and another 32 received five general curative mud baths. Pain was assessed with the Nordic Musculosceletal Questionnaire, and muscle tension was measured with a myotonometer in m. erector spinae and m. trapezius. Measurements were performed three times: before the start of the study, immediately after the last procedure, and 2-3 weeks after the last procedure. Both the Värska curative mud bath and the Värska mineral water bath showed a positive effect on musculoskeletal pain and muscle tension. Both procedures can be recommended as drug-free interventions for mild to moderate musculoskeletal pain syndrome and muscle tensions, in both prevention and treatment.

Efficacy of Cabbage Leaf versus Cooling Gel Pad or Diclofenac Gel for Patients with Knee Osteoarthritis: A Randomized Open-Labeled Controlled Clinical Trial

Background

Osteoarthritis (OA) is one of the most common joint degeneration ailments adversely affecting the elderly population by impairing their physical movements and quality of life. This study aimed to establish the efficacy of cabbage leaf application in alleviating pain-related distress and positively improving OA conditions.

Materials and Methods

Patients with moderate to severe (grades 3-4) OA by the Kellgren and Lawrence grading system with a poor to good Oxford Knee Score were selected for enrollment in this clinical trial. The participants were divided into three intervention groups: the cooling gel pad group for 20 minutes duration once a day (n = 20), the diclofenac gel group for 4 times a day (n = 20) as the control group (total n = 40), and the cabbage leaf group for 1-hour duration once a day (n = 20) as the experimental group (total n = 20). All trial participants were trained to record their Numerical Rating Scale (NRS) pain score and Oxford Knee Score and were advised to undergo weekly follow-ups and assessment of the outcome at 4 weeks. Data were analyzed by the paired t-test and analysis of variance (ANOVA).

Results

The cabbage leaf group and cooling gel pad group showed a significant difference in both the Oxford Knee Score (p < 0.001 in both groups) and NRS score (p < 0.001 in both groups) before and after the intervention, by using the paired t-test. The three study procedures were found to be significantly different with respect to both the Oxford Knee Score (p=0.012) and NRS score (p < 0.001), by using ANOVA.

Conclusion

This study clinically demonstrated that cabbage leaf application and cooling gel pad application showed similar improvements in reducing OA symptoms in terms of the overall NRS score and Oxford Knee Score. Their therapeutic effectiveness was better than that of diclofenac gel.

Efficacy of mud plus bath therapy as compared to bath therapy in osteoarthritis of hands and knees: a pilot single-blinded randomized controlled trial

The primary objective of this study was to assess the efficacy of mud plus bath therapy in comparison to bath therapy alone in hand and knee osteoarthritis (HOA and KOA). We conducted a single-blinded randomized controlled trial (RCT). Patients were randomly assigned to either mud plus bath therapy (group 1) or balneotherapy (group 2). The primary outcome was a change in AUSCAN questionnaire for HOA and in WOMAC for KOA at month 12. Evaluations were performed at baseline (B), immediately after the interventions (week 2, W2) and after 3 (M3), 6 (M6), 9 (M9) and 12 (M12) months. 37 patients with KOA and 52 with HOA were randomized in the study. In HOA patients, AUSCAN pain improved more in group 1 compared to group 2 at M3, M6 and M12 (p<0.001, p=0.001 and p=0.038, respectively). AUSCAN stiffness improved more in group 1 at M3 (p=0.001). AUSCAN function improved more at M3, M6, M9 and M12 (p=0.001, p=0.001, p=0.014 and p=0.018, respectively). Regarding, KOA, WOMAC function decreased more prominently in group 1 compared to group 2 at M9 (p=0.007). The absolute values of WOMAC function at M6 and M9 were lower in group 1 compared to group 2 (p=0.029 and p=0.001, respectively). WOMAC pain absolute values were lower in group 1 at W2 (p=0.044) and at M9 (p=0.08). We conducted a RCT on the efficacy of mud plus balneotherapy over balneotherapy alone in HOA and KOA. We found that mud plus balneotherapy was more effective than balneotherapy alone on clinical outcomes of HOA. Differences in clinical outcomes of KOA were not significant, yet numerically higher.

Clinical efficacy of medical hydrology: an umbrella review

The aim of this research was to summarize available scientific evidence on the efficacy of medical hydrology for the management of any health condition. The search was conducted on 26th March 2021, in the following databases: Medline (via PubMed), EMBASE, Web of Science, Cochrane Library, and Google Scholar. All relevant literature reviews investigating the clinical efficacy of interventions characterized by the use of natural mineral waters and muds were included. The quality of studies was assessed with the "AMSTAR 2" tool. After article screening, 49 reviews were included in this work. Overall, retrieved scientific evidence suggests that spa therapy is beneficial for patients affected by some specific musculoskeletal conditions, with improvements potentially lasting up to 9 months. Moreover, balneotherapy can be an integrative support for the management of chronic venous insufficiency and some inflammatory skin diseases like psoriasis. The role of spa therapy in rehabilitation appears relevant as well. More limited, although interesting evidence exists for inhalation and hydropinic therapies. Globally, retrieved evidence suggests that, besides individual wellbeing, medical hydrology can be useful for public health. In particular, higher-quality studies seem to support the integrative use of spa-related interventions for conditions like osteoarthritis, fibromyalgia, low back pain of rheumatic origin, and chronic venous insufficiency. However, the body of evidence has some limitations and further clinical trials should be designed for each relevant application to consolidate and expand acquired knowledge.