Evidence-based-balneotherapy-inHungary.pptx

1、EVIDENCE-BASED BALNEOTHERAPY IN HUNGARYKatalin Szendi M.D., Ph.D.Department of Public Health Medicine, Universitiy of Pcs, Pcs, HungaryIntroduction Balneotherapy: Ancient, traditional treatment Europe, other parts of the world Musculoskeletal Gynaecological Dermatological conditions (psoriasis) Peri

2、pheral vascular diseases, etc. Used empirically for centuries 18th century chemical analyses inorganic salts only Recent decades studies, clinical trialsIntroduction Balneotherapy defined as the use of: Natural mineral waters Natural peloids and mud Natural sources of different gases (CO2, H2S, Rn22

3、2) Implemented as/by: Head-out immersion in mineral water Mud- or peloid-packs to body regions Exposure to gases during bathing and by inhalation Drinking mineral waterIntroductionHungary: Rich in thermal-mineral waters 1300 thermal wells 270 qualified medicinal water, 275 qualified mineral water Ge

4、othermal conditions geothermal gradient Pannonian basin crust 10 km thinner 50 C / km (world average 26 C / km) Thermal water underground 70-80%Mechanism of action of balneotherapy Physical: Cardiovascular Pulmonal Renal Endocrine Neuromuscular Hematologic Water depth Posture Buoyancy Temperature Ch

5、emical: Absorption through the skin (limited data) Other: Antioxidant ImmunologicEvidence-based balneology research in HungaryEvidence-based balneology research in Hungary Started in the 19th century The Hungarian Balneological Society was founded in 1891Musculoskeletal conditionsKnee osteoarthritis

6、Trial Study design Treatment Follow-up periodResultsBalint et al. 2007Double blind RCTG1: mineral water, 34C, 30 min, 5 days a week for 4 weeksG2: heated tap water3 months WOMAC activity, pain improved sign. + follow-up sign.Same in tap water, no improvement end of follow-upSzucs et al. 1989Double b

7、lind RCTG1: thermal mineral water, 36C, daily 20 min, 18xG2: tap water3 weeks Pain, tenderness decreasedKovacs and Bender 2002Double blind RCTG1: thermal mineral water, 36C, daily 30 min, over 15 daysG2: mixture of tap and thermal15 weeks Greater improvement in thermal water group (in all parameters

8、)Gaal et al. 2008 Prospective study33C water, daily 30 min, 15x10-14 weeks All parameters improved sign. Effect prolonged for 3 months after treatmentMusculoskeletal conditionsHand osteoarthritisTrial Study design Treatment Follow-up periodResultsHorvath et al. 2012Randomised, single-blind, controll

9、ed trialG1: thermal mineral water, 38C, 20 min, 5x a week for 3 weeks + standard pulsed magnetic field therapy 3x a week, over 3 weeksG2: same, but 36C G3: pulsed magnetic field therapy13 weeks Stat. sign. improvement in several parameters + follow-upKovacs et al. 2012Randomised, double-blind, controlled trialG1: thermal mineral water, 37C, 20 min, 15x, over 3 weeksG2: tap water, same temperature6 months Improvement more pronounced in G1, sign. difference immediately and after 3 months: pain VAS, EQVAS. Same with AUSCAN after 3 months, HAQ after 3 and 6 months