title: Randomized trial of balneotherapy associated with patient education in patients with advanced chronic venous insufficiency.
abstract: OBJECTIVE
  Except for compression therapy, physical therapy has scarcely been evaluated in the treatment of chronic venous disorders (CVD). Spa treatment is a popular way to administer physical therapy for CVD in France, but its efficacy has not been evaluated yet. This study aimed to assess the efficacy of balneotherapy associated with patient education, as performed in the spa resort of La Léchère, in patients with advanced chronic venous insufficiency (CEAP clinical classes C4/C5).
  
  
  METHODS
  The study was a randomized controlled trial, spa therapy being administered on top of the usual medical care. Evaluation was by a blinded independent investigator. Subjects were patients with primary or post-thrombotic CVD with skin changes but no active ulcer (C4a, C4b, or C5), living in Grenoble area, and willing to undergo a spa treatment course in La Léchère. The treated group had the three week spa treatment course in La Léchère, soon after randomization; the control group also had a spa treatment, but starting at day 365. The treatment consisted of four balneology sessions per day, six days a week during three weeks, and three educational workshops. An independent follow-up was performed in Grenoble hospital every three months for 15 months. The main outcome criterion was the severity of the skin changes, as evaluated by means of malleolar chromametry. Quality of life, as measured by the Chronic Venous Insufficiency Questionnaire 2 scale, a visual analog scale (VAS) for leg symptoms, and the occurrence of leg ulcers were used as secondary criteria. The year after spa treatment in the treated group was compared with the year before spa treatment in the control group.
  
  
  RESULTS
  Fifty-nine subjects were enrolled (29 in the treatment group and 30 in the control group). No statistically significant difference between groups was found at study onset regarding age, sex, etiology, CEAP "C" class, and the outcome variables. After treatment, chromametry showed significantly decreased pigmentation and erythema in the treatment group compared with the controls (P < .01). Quality of life (P < .01) and symptoms (P < .001) also improved significantly. These differences remained significant after one year follow-up. The control patients improved similarly after their own spa treatment (day 450).
  
  
  CONCLUSIONS
  This study shows that spa therapy, associating balneotherapy and patient education, is able to improve significantly the skin trophic changes of the CVD patients and their CVD related quality of life and symptoms. This effect is of large magnitude and remains significant one year after the treatment course.
authors.affiliation: Pôle Pluridisciplinaire de Médecine, Centre Hospitalier Universitaire de Grenoble, Clinique Universitaire de Médecine Vasculaire, Grenoble, France. patrick.carpentier@ujf-grenoble.fr
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Carpentier
authors.forename: Bernadette
authors.initials: B
authors.lastname: Satger
mesh_terms: D000368:Aged; D001452:Balneology; D002908:Chronic Disease; D004890:Erythema / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D005260:Female; D006294:Health Resorts; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D010353:Patient Education as Topic; D011788:Quality of Life; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012867:Skin / Q000473:pathology*; D012880:Skin Pigmentation; D013997:Time Factors; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D014689:Venous Insufficiency / Q000150:complications / Q000473:pathology / Q000628:therapy*