title: The effect of balneotherapy on patients with ankylosing spondylitis.
abstract: OBJECTIVE
  To compare the effect of balneotherapy on physical activity and quality of life as well as the symptoms of pain and stiffness with exercise alone in ankylosing spondylitis (AS) patients.
  
  
  METHODS
  A total of 60 patients who had a diagnosis of AS according to the modified New York criteria were included in the study. The patients were randomly assigned to two groups. In Group I (n = 30) the patients received balneotherapy in a therapeutic pool for 30 min once a day for 3 weeks. All patients received instructions on the exercise programme, which they were requested to repeat once a day for 30 min during the study. The patients in this group continued the same exercise programme after the end of the balneotherapy protocol to complete a course of 6 months. In Group II the patients were given the same exercise protocol but did not receive balneotherapy. Patients were evaluated before the start of the study and at 3 weeks and 24 weeks. Evaluation parameters were daily and night pain, morning stiffness, the patient's global evaluation and the physician's global evaluation (according to a scoring system of 1 to 5), the Bath Ankylosing Spondilitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Dougados Functional Index (DFI), tragus-wall distance, chest expansion, modified Shober test (MST), fingertip-fibula head distance, and Nottingham Health Profile (NHP).
  
  
  RESULTS
  Evaluations were completed in 54 patients in the two groups. Comparison of the groups showed significantly superior results for Group I for parameters of BASDAI, NHP total, pain, physical activity, tiredness and sleep score, patient's global evaluation and the physician's global evaluation at 3 weeks, but only for the parameters of patient's global evaluation and MST at 24 weeks.
  
  
  CONCLUSIONS
  Balneotherapy has a supplementary effect on improvement in disease activity and functional parameters in AS patients immediately after the treatment period. However, in the light of our medium-term evaluation results, we suggest that further research is needed to assess the role of balneotherapy applied for longer durations in AS patients.
authors.affiliation: Uludağ University Medical Faculty, Rheumatic Disease and Hydrotherapy Section, Atatürk Rehabilitation Centre, Kükürtlü cad. No. 98, 16080 Cekirge, Bursa, Turkey. lalealtan@uludag.edu.tr
authors.forename: L
authors.initials: L
authors.lastname: Altan
authors.forename: U
authors.initials: U
authors.lastname: Bingöl
authors.forename: M
authors.initials: M
authors.lastname: Aslan
authors.forename: M
authors.initials: M
authors.lastname: Yurtkuran
mesh_terms: D001452:Balneology; D005081:Exercise Therapy; D006801:Humans; D009043:Motor Activity; D059408:Pain Management; D011788:Quality of Life; D013167:Spondylitis, Ankylosing / Q000628:therapy*