title: Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials.
abstract: OBJECTIVE
  Low back pain is a major public health concern and complementary treatments are frequently used for this condition. The objective of this systematic review and meta-analysis was to assess the evidence for or against the effectiveness of spa therapy and balneotherapy for treating low back pain.
  
  
  METHODS
  Systematic searches were conducted on Medline, Embase, Amed Cochrane Central, the UK National Research Register and ClincalTrials.gov (all until July 2005). Hand searches were performed and experts contacted. Methodological quality was assessed using a standard scale.
  
  
  RESULTS
  Five randomized clinical trials met all inclusion criteria. Quantitative data synthesis was performed. The data for spa therapy, assessed on a 100 mm visual analogue scale (VAS), suggest significant beneficial effects compared with waiting list control groups (weighted mean difference 26.6 mm, 95% confidence interval 20.4-32.8, n=442) for patients with chronic low back pain. For balneotherapy the data, assessed on a 100 mm VAS, also suggest beneficial effects compared with control groups (weighted mean difference 18.8 mm, 95% confidence interval 10.3-27.3, n=138).
  
  
  CONCLUSIONS
  Even though the data are scarce, there is encouraging evidence suggesting that spa therapy and balneotherapy may be effective for treating patients with low back pain. These data are not compelling but warrant rigorous large-scale trials.
authors.affiliation: Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK. M.H.Pittler@exeter.ac.uk
authors.forename: M H
authors.initials: MH
authors.lastname: Pittler
authors.forename: M Z
authors.initials: MZ
authors.lastname: Karagülle
authors.forename: M
authors.initials: M
authors.lastname: Karagülle
authors.forename: E
authors.initials: E
authors.lastname: Ernst
mesh_terms: D000328:Adult; D001452:Balneology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome