[Balneotherapy and spa therapy of rheumatic diseases in Turkey: a systematic review].
OBJECTIVE
Turkey has a lot of thermal and mineral springs and is looking back on a still vivid tradition of spa therapy and balneotherapy, applied especially for the treatment of rheumatic diseases. This tradition is predominantly empiric and intuitive, however, it has assumed some important aspects of modern balneotherapeutic methods as well. This article is aimed at presenting the characteristics of traditional and modern balneological and spa therapy forms in Turkey.


METHODS
The studies which have been conducted between 1990 and 2000 in different spas in Turkey on the efficacy and effectiveness of spa therapy and balneotherapy for rheumatic diseases have been searched and analyzed independent of their design. A descriptive evaluation of the studies was carried out.


RESULTS
A total of 15 published studies have been found and analyzed. The investigations have been carried out in 8 different spa resorts in Turkey. In these studies the effectiveness and efficacy of different balneological and spa therapies on a variety of rheumatic diseases (from osteoarthritis to fibromyalgia and from rheumatoid arthritis to low back pain) could be shown. Nearly all studied balneotherapeutic modalities were applied as bathing cures. Only in one study peloid therapy was applied. Balneotherapeutic therapy was applied in a modern and traditional way, and both open and stationary spa therapy forms were used at the same time.


CONCLUSIONS
The review has shown the effectiveness of the investigated spa therapy and balneotherapy forms. It could be concluded that nearly all forms of spa therapy and balneotherapy used for the treatment of rheumatic diseases in Turkey are effective. A definitive conclusion, however, is not possible because of the heterogeneity of the study designs, methodological flaws, and the publication bias. In future good quality randomized controlled trials are needed.
Medizinische Okologie und Hydroklimatologie, Medizinische Fakultät Istanbul der Universität Istanbul, Turkey. mzkaragulle@tnn.net
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D001452:Balneology; D002908:Chronic Disease; D006294:Health Resorts; D006801:Humans; D015201:Meta-Analysis as Topic; D026741:Physical Therapy Modalities / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012216:Rheumatic Diseases / Q000628:therapy*; D016896:Treatment Outcome; D014421:Turkey