The efficacy of health resort treatment and balneotherapy in patients with muskuloskeletal disorders - first results of a systematic review

Objective

To evaluate the clinical evidence of health resort treatment (HRT) and balneotherapy (BT)

Data sources

MEDLINE, EMBASE, MEDKUR search, review of articles’ bibliographies, personal communication with experts

Study selection

Randomized controlled trials (RCTs) of HRT and BT, exclusion of studies with only laboratory or physiological outcome measures. Twenty-three RCTs (3 HRT, 19 BT) could be retrieved.

Data analysis

Internal validity assessment by the Jadad Scale. Data from 9 studies could be combined for meta-analysis, effect size calculation by Cohen’s d, separate meta-analyses on therapy modality and outcome-criteria

Results

Twenty-one studies reported positive results. Mean internal validity was 56 %. Assessment of pain, disability, drug consumption and quality of life were reported in 22, 8, 5, respectively 2 studies. Eight studies used inadequate statistics. Only 4 studies involved a group sample size of more than 50 persons, 16 studies involved a follow-up, in none of the studies a sensitivity analysis was performed.

For HRT major effects (mean of immediate and prolonged effects) could be found for pain (d = 1.1) and drug consumption (d = 0.8), and moderate effects for disability (d = 0.7). Six studies of BT showed low to moderate immediate analgesic effects in comparison to placebo-baths (d = 0.4 for VAS, d = 0.8 for pressure algometry).

Conclusion

The low internal validity does not permit valid conclusions on efficacy of HRT or BT. There is a need for methodologically appropriate studies.