title: Comparison of the clinical effectiveness of thermal cure and rehabilitation in knee osteoarthritis. A randomized therapeutic trial.
abstract: OBJECTIVE
  To compare the benefits of a thermal cure and non-thermal rehabilitation in treatment of knee osteoarthritis (KOA).
  
  
  METHODS
  Randomized therapeutic trial including patients with knee osteoarthritis (American College of Rheumatology criteria). Patients were randomly divided into two groups. Spa treatment consisted of underwater shower, massage-jet showers, hydromassage, pool rehabilitation and peloid therapy. Non-thermal rehabilitation consisted of analgesic physiotherapy, muscle strengthening and group physical rehabilitation. A blinded evaluation was carried out at day 21 and 12months following treatment. It was based on the visual analogic scale of pain (VAS), which represented the primary endpoint.
  
  
  RESULTS
  Two hundred and forty patients were included (February-June 2005). The spa treatment and non-thermal rehabilitation groups included 119 and 121 patients respectively. Two hundred and thirty-three patients completed their treatments. Significant improvement of the visual analogic scale of pain was noted in the thermal cure group (61.6±15 at day 0 versus 46.5±22.4 at 12months, P<0.001), but not in the non-thermal group (64.1±15 at day 0 versus 62±29 at 12months, P=0.68). At day 21, comparison of the two groups revealed no significant difference on the VAS (P=0.08). However, at 12months, the thermal cure group was significantly more improved (P=0.000).
  
  
  CONCLUSIONS
  In our study, crenobalneotherapy had resulted, at 12months, in more pronounced long-term improvement of the painful symptoms of KOA than had non-thermal rehabilitation.
authors.affiliation: Service de rhumatologie, hôpital MongiSlim, 2046 La Marsa, Tunisia; Faculté de médecine de Tunis, Tunis El Manar university, Tunis, Tunisia. Electronic address: f.alia@yahoo.fr.
authors.forename: A
authors.initials: A
authors.lastname: Fazaa
authors.affiliation: Service de rhumatologie, hôpital MongiSlim, 2046 La Marsa, Tunisia; Faculté de médecine de Tunis, Tunis El Manar university, Tunis, Tunisia.
authors.forename: L
authors.initials: L
authors.lastname: Souabni
authors.affiliation: Service de rhumatologie, hôpital MongiSlim, 2046 La Marsa, Tunisia; Faculté de médecine de Tunis, Tunis El Manar university, Tunis, Tunisia.
authors.forename: K
authors.initials: K
authors.lastname: Ben Abdelghani
authors.affiliation: Service de rhumatologie, hôpital MongiSlim, 2046 La Marsa, Tunisia; Faculté de médecine de Tunis, Tunis El Manar university, Tunis, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Kassab
authors.affiliation: Service de rhumatologie, hôpital MongiSlim, 2046 La Marsa, Tunisia; Faculté de médecine de Tunis, Tunis El Manar university, Tunis, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Chekili
authors.affiliation: Faculté de médecine de Tunis, Tunis El Manar university, Tunis, Tunisia.
authors.forename: B
authors.initials: B
authors.lastname: Zouari
authors.affiliation: Service de rhumatologie, hôpital MongiSlim, 2046 La Marsa, Tunisia; Faculté de médecine de Tunis, Tunis El Manar university, Tunis, Tunisia.
authors.forename: R
authors.initials: R
authors.lastname: Hajri
authors.affiliation: Service de rhumatologie, hôpital MongiSlim, 2046 La Marsa, Tunisia; Faculté de médecine de Tunis, Tunis El Manar university, Tunis, Tunisia.
authors.forename: A
authors.initials: A
authors.lastname: Laatar
authors.affiliation: Service de rhumatologie, hôpital MongiSlim, 2046 La Marsa, Tunisia; Faculté de médecine de Tunis, Tunis El Manar university, Tunis, Tunisia.
authors.forename: L
authors.initials: L
authors.lastname: Zakraoui
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D001452:Balneology; D005260:Female; D006801:Humans; D006875:Hydrotherapy; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology / Q000628:therapy; D020370:Osteoarthritis, Knee / Q000150:complications / Q000534:rehabilitation*; D010147:Pain Measurement; D055070:Resistance Training; D016037:Single-Blind Method
chemical_list: D000700:Analgesics
keywords: Controlled trial; Crenobalneotherapy; Crénobalnéothérapie; Cure thermale; Essai contrôlé; Gonarthrose; Knee osteoarthritis (KOA); Rehabilitation; Rééducation; Thermal cure