title: Taking baths: the efficacy of balneotherapy in patients with arthritis. A systematic review.
abstract: OBJECTIVE
  To review English, French, German, and Dutch language studies of the effectiveness of balneotherapy. Balneotherapy (hydrotherapy or spa therapy) is one of the oldest forms of therapy for patients with arthritis. One of the aims of balneotherapy is to relieve pain.
  
  
  METHODS
  We performed a systematic review that included randomized and nonrandomized studies. Quality scores of the studies were determined using a criteria list.
  
  
  RESULTS
  Most studies report positive findings, but all studies showed methodological flaws. A quality of life measurement was never reported as an outcome measure. None of the randomized clinical trials included intention-to-treat analysis or comparison of effects between groups.
  
  
  CONCLUSIONS
  Because of the methodological flaws a conclusion about the efficacy of balneotherapy cannot be provided from studies we reviewed. We conclude that most flaws found could be avoidable in future research.
authors.affiliation: Department of Epidemiology, Maastricht University, The Netherlands.
authors.forename: A P
authors.initials: AP
authors.lastname: Verhagen
authors.forename: H C
authors.initials: HC
authors.lastname: de Vet
authors.forename: R A
authors.initials: RA
authors.lastname: de Bie
authors.forename: A G
authors.initials: AG
authors.lastname: Kessels
authors.forename: M
authors.initials: M
authors.lastname: Boers
authors.forename: P G
authors.initials: PG
authors.lastname: Knipschild
mesh_terms: D001168:Arthritis / Q000628:therapy*; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D001452:Balneology; D002986:Clinical Trials as Topic; D006801:Humans; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome