Carla Morer

The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials

The aims of this study were to conduct a systematic literature review on balneotherapy about the specific therapeutic role of mineral elements and other chemical compounds of mineral waters and derivate peloids/muds and to discuss the study methods used to evaluate it (in musculoskeletal conditions). We searched Medline by PubMed using the following key words: “spa therapy” “balneotherapy” “mud” “peloid” “mud pack Therapy” in combination with “randomized controlled trial” “double blind trial.” We also reviewed the reference list of articles retrieved by the Medline search. We selected the double-blind randomized clinical trials that assessed the effects of mineral water or mud treatments compared to tap water, attenuated peloid/mud therapy or similar treatments without the specific minerals or chemical compounds of the treatment group (“non-mineral”). We evaluated the internal validity and the quality of the statistical analysis of these trials. The final selection comprised 27 double-blind randomized clinical trials, 20 related to rheumatology. A total of 1118 patients with rheumatological and other musculoskeletal diseases were evaluated in these studies: 552 of knee osteoarthritis, 47 of hand osteoarthritis, 147 chronic low back pain, 308 of reumathoid arthritis, and 64 of osteoporosis; 293 of these participants were assigned to the experimental groups of knee osteoarthritis, 24 in hand osteoarthritis, 82 of low back pain, 152 with reumathoid arthritis, and 32 with osteoporosis. They were treated with mineral water baths and/or mud/peloid (with or without other forms of treatment, like physical therapy, exercise…). The rest were allocated to the control groups; they received mainly tap water and/or “non-mineral” mud/peloid treatments. Mineral water or mud treatments had better and longer improvements in pain, function, quality of life, clinical parameters, and others in some rheumatologic diseases (knee and hand osteoarthritis, chronic low back pain, rheumatoid arthritis, and osteoporosis) compared to baseline and non-mineral similar treatments. Internal validity and other limitations of the study’s methodology impede causal relation of spa therapy on these improvements. Randomized clinical trials are very heterogeneous. Double-blind randomized clinical trials seem to be the key for studying the role of mineral elements and other chemical compounds, observing enough consistency to demonstrate better and longer improvements for mineral waters or derivate compared to tap water; but due to heterogeneity and gaps on study protocol and methodology, existing research is not sufficiently strong to draw firm conclusions. Well-designed studies in larger patients’ population are needed to establish the role of minerals and other chemical compounds in spa therapy.

Situación de la Medicina Termal en 2014

Los miembros del Grupo de Investigacion Complutense UCM-911757 HIDROLOGIA MEDICA han participado activamente desde el pasado Congreso de la Sociedad, entre otros, en los siguientes eventos cientificos:  2nd European Conference on Evidence Based Aquatic Therapy. AQUALEUVEN 2015. Lovaina (Belgica) 15-18/04/2015  VIII Congresso da Sociedade Portuguesa de Hidrologia Medica. Termas de S. Pedro do Sul (Portugal) 25-27/06/2015  IV Congreso Iberoamericano de Peloides. IV CIBAP BOI 2015. Caldes de Boi (Espana) 1-3/07/2015  40 World Congreso of the Internacional Society of Medical Hydrology and Climatology. Rio de Janeiro (Brasil) 26-28/08/2015  XXV Congress of the Polish Association of Balneology and Physical Medicine. Polanczyk (Polonia) 10-13/09/2015  I Congreso Internacional del Agua - Termalismo y Calidad de Vida. Ourense (Espana) 23-24/09/2015  Termatalia 2015 – X Encuentro Internacional sobre Agua y Termalismo. Ourense (Espana) 24-26/09/2015  68o General Assembly and International Scientific Congress of the World Federation of Hydrotherapya and Climatotherapy (FEMTEC). S. Margherita di Pula-Cagliari (Italia) 30-04/09-10/2015  I Congreso Internacional de Talaso. Salud y Bienestar. Baiona – Pontevedra (Espana) 22-25/11/2015  16th Post-Bachelos Aquatic Therapy Modular Course. KLINIKEN VALENS Study Centre - University of Applied Sciences and Arts of Southern Switzerland (SUPSI). Valens (Suiza) 01-13/05/2016.  41 World Congress of the Internacional Society of Medical Hydrology and Climatology. Bucharest (Rumania) 19-22/05/2016  21 Annual ESPA Congress. Vichy (Francia) 24-27/05/2016  8th Hydration for Health Annual Scientific Conference H4H. Evian-LesBains (Francia) 28-30/06/2016  Termatalia Mexico – XI Encuentro Internacional sobre Agua y Termalismo. Arteaga - Coahuila (Mexico) 29-01/09-10/2016  IX Congresso Internacional da Sociedade Portuguesa de Hidrologia Medica. Vidago (Portugal) 13-15/10/2016 A partir de la informacion obtenida se puede resumir la situacion actual de la Medicina Termal, haciendo hincapie en los siguientes aspectos:  Formacion Academica  Investigacion  Ejercicio Profesional  Sociedades Cientificas  Organizaciones Internacionales relacionadas con la Hidrologia Medica