title: Crenobalneotherapy (spa therapy) in patients with knee and generalized osteoarthritis: a post-hoc subgroup analysis of a large multicentre randomized trial.
abstract: OBJECTIVE
  To determine whether the addition of spa therapy to home exercises provides any benefit over exercises and the usual treatment alone in the management of generalised osteoarthritis associated with knee osteoarthritis.
  
  
  METHODS
  This study was a post-hoc subgroup analysis of our randomised multicentre trial (www.clinicaltrial.gov: NCT00348777). Participants who met the inclusion criteria of generalized osteoarthritis (Kellgren, American College of Rheumatology, or Dougados criteria) were extracted from the original randomised controlled trial. They had been randomised using Zelen randomisation. The treatment group received 18days of spa treatment in addition to a home exercise programme. Main outcome was number of patients achieving minimal clinically important improvement at six months (MCII) (≥-19.9mm on the VAS pain scale and/or ≥-9.1 points in a WOMAC function subscale), and no knee surgery. Secondary outcomes included the "patient acceptable symptom state" (PASS) defined as VAS pain ≤32.3mm and/or WOMAC function subscale ≤31 points.
  
  
  RESULTS
  From the original 462 participants, 214 patients could be categorized as having generalised osteoarthritis. At sixth month, 182 (88 in control and 94 in SA group) patients, were analysed for the main criteria. MCII was observed more often in the spa group (n=52/94 vs. 38/88, P=0.010). There was no difference for the PASS (n=19/88 vs. 26/94, P=0.343).
  
  
  CONCLUSIONS
  This study indicates that spa therapy with home exercises may be superior to home exercise alone in the management of patients with GOA associated with knee OA.
authors.affiliation: Centre de recherche rhumatologique et thermal, 15, avenue Charles-de-Gaulle, 73100 Aix-les-Bains, France. Electronic address: romain.forestier@wanadoo.fr.
authors.forename: R
authors.initials: R
authors.lastname: Forestier
authors.affiliation: Inserm CIC03, centre for clinical investigation, 38000 Grenoble, France. Electronic address: celinegentyfr@yahoo.fr.
authors.forename: C
authors.initials: C
authors.lastname: Genty
authors.affiliation: University of Jyväskylä, Jyväskylä, Finland. Electronic address: ben.waller@likes.fi.
authors.forename: B
authors.initials: B
authors.lastname: Waller
authors.affiliation: Centre de recherche rhumatologique et thermal, 15, avenue Charles-de-Gaulle, 73100 Aix-les-Bains, France. Electronic address: alain-francon@wanaddoo.fr.
authors.forename: A
authors.initials: A
authors.lastname: Françon
authors.affiliation: 13, avenue des Thermes-Athéna, 34540 Balaruc-les-Bains, France. Electronic address: hugues.desfour@orange.fr.
authors.forename: H
authors.initials: H
authors.lastname: Desfour
authors.affiliation: Inserm CIC03, centre for clinical investigation, 38000 Grenoble, France.
authors.forename: C
authors.initials: C
authors.lastname: Rolland
authors.affiliation: Université de Toulouse, 31000 Toulouse, France. Electronic address: cf.roques@gmail.com.
authors.forename: C-F
authors.initials: CF
authors.lastname: Roques
authors.affiliation: Inserm CIC03, centre for clinical investigation, 38000 Grenoble, France. Electronic address: jlbosson@imag.fr.
authors.forename: J-L
authors.initials: JL
authors.lastname: Bosson
mesh_terms: D000368:Aged; D001452:Balneology; D005260:Female; D006801:Humans; D008297:Male; D008405:Massage; D008875:Middle Aged; D009094:Mud Therapy; D020370:Osteoarthritis, Knee / Q000628:therapy*; D016896:Treatment Outcome
keywords: Arthrose; Arthrose généralisée; Balneotherapy; Balnéothérapie; Crenobalneotherapy; Crénobalnéothérapie; Cure thermale; Generalized osteoarthritis; Gonarthrose; Knee osteoarthritis; Osteoarthritis; Spa therapy