FEATURES OF REHABILITATION OF PERSONS WITH KNEE OSTEOARTHRITIS IN THE SANATORIUM AND RESORT TREATMENT IN THE ROMAN BATHS IN SLOVENIA
DOI:
https://doi.org/10.32782/pub.health.2025.1.18Keywords:
osteoarthritis, balneotherapy, knee joint, rehabilitationAbstract
Topicality. Osteoarthritis (OA) most often affects the knee joint, and patients experience inflammation, pain, stiffness, muscle atrophy and functional disability. Modern methods of treating knee osteoarthritis are aimed atrelieving these symptoms by various methods, such as pharmacological and non-pharmacological ones. The main non- drug conservative treatment is balneotherapy.Aim. To evaluate the effects of balneotherapy of the springs in the Roman Baths as a therapy for the treatment ofsymptoms and signs of osteoarthritis, taking into account all possible anatomical localizations in adults and the elderly.Materials and methods. The study included adult patients of both sexes with an average age of 64.8 ± 8.9 years,diagnosed with OA of the knee joint according to the classification of the American College of Rheumatology. Patients received 30-minute thermal water treatment (36.3 °C) in a bath 5 times a week for 3 weeks and performed therapeutic exercises for 50 minutes, three times a week. All patients were randomly assigned to two groups: the tap water group and patients treated with thermal mineral water. The WOMAC index, the visual analog scale (VAS) for determining the severity of pain were determined, and the questionnaire “Your health and well-being: assessment of quality-of-life indicators” was offered.Results. In our study, no significant differences were found in the tap water group in VAS scores for pain at rest andduring movement at the end point of treatment (in 3 weeks), and in the extended period, i.e., in two months. However, themean VAS score was significantly lower (less pain) in the group of patients receiving thermal mineral water in 3 weeks and during the 2-month follow-up (P < 0.05). Patients were interviewed before and after the treatment. Our study found improvements in all parameters of the SF 36 questionnaire, both short-term and long-term. There was a significant decrease in the WOMAC scores for subscales of pain, stiffness and physical function from the baseline to three weeks and two months of the treatment (P = 0.000) in the mineral water group, as well as in comparison between groups (P = 0.000).Conclusions. The data obtained indicate that the thermal water in the Roman Baths in Slovenia leads to the treatment of symptoms and signs of OA, taking into account all possible anatomical localizations in adults and the elderly. It has also been confirmed that balneotherapy in the Roman Baths has a greater long-term impact on the quality of life of people with severe disabilities, reducing pain and stiffness in the joints and increasing mobility of the limbs.
References
Bijlsma J. W., Berenbaum F., Lafeber F. P. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011. Vol. 377. P. 2115–2216.
Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Annals of the Rheumatic Diseases. 2014. Vol.73. №. 7. P. 1323–30. DOI: 10.1136/annrheumdis-2013-204763.
Kim J.R., Kim H.A. Molecular mechanisms of sex-related differences in arthritis and associated pain. International Journal of Molecular Sciences. 2020. Vol. 21. № 21. P. 7938. DOI: 10.3390/ijms21217938.
Pereira D, Peleteiro B, Araújo J, Branco J, Santos RA, Ramos E. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis Cartilage. 2011 Vol. 19. № 11. Р. 1270–85. DOI: 10.1016/j.joca.2011.08.009.
Epidemiologia. OsteoArtrosi.eu. 2022. URL: http://www.osteoartrosi.eu/paz_epidemiologia.php
Man G.S., Mologhianu G. Osteoarthritis pathogenesis – a complex process that involves the entire joint. Journal of Medicine and Life. 2014. Vol. 7. P. 37–41.
Kraus V.B., Blanco F.J., Englund M., Karsdal M.A., Lohmander L.S. Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use. Osteoarthritis Cartilage. 2015. Vol. 23. № 8. Р. 1233–41. DOI: 10.1016/j.joca.2015.03.036.
Zhang Y., Jordan J. M. Epidemiology of osteoarthritis. Clinics in Geriatric Medicine. 2010. Vol. 26. P. 355–369.
Salaffi F., De Angelis R., Stancati A., Grassi W. MArche Pain; Prevalence INvestigation Group (MAPPING) study. Health-related quality of life in multiple musculoskeletal conditions: a cross-sectional population based epidemiological study. II. The MAPPING study. Clinical and Experimental Rheumatology. 2005. Vol. 23. № 6. Р. 829–39.
Hunter D.J., March L., Chew M. Osteoarthritis in 2020 and beyond: a Lancet Commission. Lancet. 2020. Vol. 396. P. 1711–1712. DOI: 10.1016/S0140-6736(20)32230-3.
Center for Disease Control and Prevention. Cost Statistics. URL: https://www.cdc.gov/arthritis/data_statistics/cost.htm#:~:text=Cost%20of%20Osteoarthritis&text=In%20that%20year%2C%20it%20accounted,combined%20costs%20for%20all%20hospitalizations.&text=OA%20was%20also%20the%20most,%246.2%20billion%20in%20hospital%20costs
Ofman J.J., MacLean C.H., Straus W.L., Morton S.C., Berger M.L., Roth E.A., Shekelle P. A metaanalysis of severe upper gastrointestinal complications of nonsteroidal antiinflammatory drugs. The Journal of Rheumatology. 2002. Vol. 29. № 4. Р. 804–812.
Bresalier R.S., Sandler R.S., Quan H., Bolognese J.A., Oxenius B., Horgan K., Lines C., Riddell R., Morton D., Lanas A., Konstam M.A., Baron J.A. Adenomatous Polyp Prevention on Vioxx (APPROVe) Trial Investigators. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. The New England Journal of Medicine. 2005. Vol. 17;352. № 11. Р. 1092–1102. DOI: 10.1056/NEJMoa050493.
Pincus T., Wang X., Chung C., Sokka T., Koch G.G. Patient preference in a crossover clinical trial of patients with osteoarthritis of the knee or hip: face validity of self-report questionnaire ratings. The Journal of Rheumatology. 2005. Vol. 32. № 3. Р. 533–539.
Skou St., Roos E.M. Physical therapy for patients with knee and hip osteoarthritis: supervised, active treatment is current best practice. Clinical and Experimental Rheumatology. 2019. Vol. 120. P. 112–117.
Bernetti A., Mangone M., Alviti F., Paolucci T., Attanasi C., Murgia M., Di Sante L., Agostini F., Vitale M., Paoloni M. Spa therapy and rehabilitation of musculoskeletal pathologies: a proposal for best practice in Italy. International Journal of Biometeorology. 2020. Vol. 64. № 6. Р. 905–914. DOI: 10.1007/s00484-019-01731-z.
Rocha T.C., Ramos P.DS., Dias A.G., Martins E.A. The Effects of Physical Exercise on Pain Management in Patients with Knee Osteoarthritis: A Systematic Review with Metanalysis. Revista Brasileira de Ortopedia. 2020. Vol. 55. № 5. Р. 509–517. DOI: 10.1055/s-0039-1696681.
Levinger P., Dunn J., Bifera N., Butson M., Elias G., Hill K.D. High-speed resistance training and balance training for people with knee osteoarthritis to reduce falls risk: study protocol for a pilot randomized controlled trial. Trials. 2017. Vol. 18;18. № 1. Р. 384. DOI: 10.1186/s13063-017-2129-7.
Protano C., Fontana M., De Giorgi A. et al. Balneotherapy for osteoarthritis: a systematic review. Rheumatology. 2023. Vol. 43. Р. 1597–1610. https://doi.org/10.1007/s00296-023-05358-7.
Paoloni M., Bernetti A., Brignoli O., Coclite D., et al. Appropriateness and efficacy of Spa therapy for musculoskeletal disorders. A Delphi method consensus initiative among experts in Italy. Annali dell’Istituto Superiore di Sanita. 2017. Vol. 53. № 1. Р. 70–76. DOI: 10.4415/ANN_17_01_13.
Bannuru R.R., Osani M.C., Vaysbrot E.E., Arden N.K., Bennell K. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019. Vol. 27. № 11. Р. 1578–1589. DOI: 10.1016/j.joca.2019.06.011.
Geenen R., Overman C.L., Christensen R., Åsenlöf P., et al. EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases. 2018. Vol. 77. № 6. Р. 797–807. DOI: 10.1136/annrheumdis-2017-212662.
Kolasinski S.L., Neogi T., Hochberg M.C., Oatis C., et al. American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology. 2020. Vol. 72. № 2. Р. 220–233. DOI: 10.1002/art.41142.
Protano C., Fontana M., De Giorgi A., Marotta D., et al. Balneotherapy for osteoarthritis: a systematic review. Rheumatology International. 2023. Vol. 43. № 9. Р. 1597–1610. DOI: 10.1007/s00296-023-05358-7.
Vaidya B., Nakarmi S. A qualitative study of patients’ beliefs and perception on medicinal properties of natural hot spring bath for musculoskeletal problems. Journal of Environmental and Public Health. 2020. Vol. 2020. P. 3694627.
Fioravanti A., Cantarini L., Guidelli G.M., Galeazzi M. Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there? Rheumatology International. 2011. Vol. 31. № 1. Р. 1–8. DOI: 10.1007/s00296-010-1628-6.
Prepustite se toku zdravja. Termalna voda. URL: https://www.rimske-terme.si/termalna-voda (Date of access: 20.01.2025).
Пате Ю., Таможанська Г. В. Курортне лікування з використанням мінеральної води Donat Mg у Словенії як засіб профілактики та реабілітації. Сучасні тенденції спрямовані на збереження здоров’я людини : зб. наук. пр., присвяч. пам’яті проф. О. В. Пєшкової, м. Харків, 23–24 квіт. 2020 р. Харків, 2020. Вип. 1. С. 27–29.
Пате Ю., Таможанська, Г. В. Аракелов, В. Любинский, Д. В. Особливості санаторно-курортного лікування на курорті Римські Терми Словенія. Сучасні тенденції спрямовані на збереження здоров’я людини : зб. наук. пр., при- свяч. пам’яті проф. О. В. Пєшкової, м. Харків, 22–23 квіт. 2021 р. Харків, 2021. Вип. 2. С. 71–73.
Bellamy N., Campbell J., Stevens J., Pilch L., Stewart C., Mahmood Z. Validation study of a computerized version of the Western Ontario and McMaster Universities VA3.0 Osteoarthritis Index. The Journal of Rheumatology. 1997. Vol. 24, № 12. Р. 2413–2415.
Gould D., Kelly D., Goldstone L., Gammon J. Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data. Journal of Clinical Nursing. 2001. Vol. 10. № 5. Р. 697–706. DOI: 10.1046/j.1365-2702.2001.00525.x.
Bató A., Brodszky V. Rencz F. Development of updated population norms for the SF-36 for Hungary and comparison with 1997–1998 norms. Health Qual Life Outcomes. 2025. Vol. 23. № 14. https://doi.org/10.1186/s12955-025-02343-5.
Доказова медицина та дизайн клінічних досліджень при остеоартрозі. URL: https://compendium.com.ua/uk/clinical- guidelines-uk/osteoartroz-praktichna-nastanova/glava-9-dokazova-meditsina-ta-dizajn-klinichnih-doslidzhen-pri-osteoartrozi/
Abramoff B., Caldera F.E. Osteoarthritis: pathology, diagnosis, and treatment options. Medical Clinics of North America. 2020. Vol. 104. P. 293–311.
Antonelli M., Donelli D., Fioravanti A. Effects of balneotherapy and spa therapy on quality of life of patients with knee osteoarthritis: a systematic review and meta-analysis. Rheumatology International. 2018. Vol. 38. P. 1807–1824.
Harzy T., Ghani N., Akasbi N., Bono W., Nejjari C. Short- and long-term therapeutic effects of thermal mineral waters in knee osteoarthritis: a systematic review of randomized controlled trials. Clinical Rheumatology. 2009. Vol. 28. № 5. Р. 501–507. DOI: 10.1007/s10067-009-1114-2.
Salaffi F., Di Carlo M., Carotti M., Farah S., Ciapetti A., Gutierrez M. The impact of different rheumatic diseases on health-related quality of life: a comparison with a selected sample of healthy individuals using SF-36 questionnaire, EQ-5D and SF-6D utility values. Acta Biomedica. 2019. Vol. 15;89. № 4. Р. 541–557. DOI: 10.23750/abm.v89i4.7298.
