title: Effect of combined spa and physical therapy on pain in various chronic diseases.
abstract: OBJECTIVE
  The purpose of this study was to exhibit the effect of combined therapy (spa and physical therapy) on pain in various chronic diseases.
  
  
  METHODS
  Retrospectively, 472 (58.1% female and 41.9% male) spa and physical therapy patients with a mean age of 53.4 +/- 12.5 years were evaluated during 2001-2004 from the archives of Dumlupinar University TUTAV Thermal Cure Center. Before, after therapy and before discharging, visual analog scale (VAS) for pain, heart and respiratory rates, systolic and diastolic blood pressures were measured for hemodynamic evaluations.
  
  
  RESULTS
  Arthrosis (230 patient, 48.7%) was found to be the main problem in our patients. Ankle arthrosis, fibromyalgia and cervical disc herniation were found with the highest VAS values compared to other pathologies before spa therapy (p<0.05).  Immediately after spa therapy and before discharge, VAS values were lower than before treatment (p<0.05). Immediately after spa therapy, the highest decreases in VAS values were observed in coxarthrosis and gonarthrosis patients (p<0.05). Coxarthrosis and nonarticular patients had the lowest VAS values before discharge than other pathologies (p<0.05). No statistical differences were found between male and female VAS values in all stages of treatment (p>0.05). Heart and respiratory rate were statistically increased (p<0.01), diastolic blood pressure was decreased (p<0.01) but not changed in systolic blood pressure (p>0.05) immediately after spa therapy. Before discharging, all hemodynamic parameters were found statistically decreased before treatment and immediately after spa therapy (p<0.01).
  
  
  CONCLUSIONS
  A combination of spa and physical therapy decreases pain and improves functional capacity without any hemodynamic risk in rheumatological, neurological and cardiac patients.
authors.affiliation: Department of Physical Therapy and Rehabilitation, Dumlupinar University Health Institution of Higher Education, Kutahya, Turkey.  Tel. +90 535 3938164.  Fax. +90 274 2652191.  E-mail: alicimbiz@yahoo.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Cimbiz
authors.forename: Vahdettin
authors.initials: V
authors.lastname: Bayazit
authors.forename: Hasan
authors.initials: H
authors.lastname: Hallaceli
authors.forename: Ugur
authors.initials: U
authors.lastname: Cavlak