title: Spa therapy and knee osteoarthritis: A systematic review.
abstract: BACKGROUND
  Osteoarthritis (OA) is a public health problem that will probably increase in the future with the aging of the population. Crenobalneotherapy is commonly used to treat OA, but evidence from previous reviews was not sufficient. This systematic review aimed to identify the best evidence for the clinical effect of crenobalneotherapy for knee OA.
  
  
  METHODS
  We systematically searched MEDLINE via PubMed, PEDRO and the Cochrane Central Register of Controlled Trials for articles published up to September 2015. Articles were included if trials were comparative, if one or more of the subgroups had knee OA with separate data, and if spa therapy or any hydrotherapy techniques involving mineral water or mineral mud was compared to any other intervention or no treatment. Statistical validity, external validity and quality of side effects assessment were evaluated by personal checklists. Risk of bias was assessed by the CLEAR NTP.
  
  
  RESULTS
  Treatments (hot mineral water baths, mud therapy, hot showers, and sometimes massage and supervised water exercises) delivered in spa centers across Europe and the Middle East seem to improve symptoms in knee OA. They may be effective for pain and function. There are conflicting results about the effect on quality of life and drug consumption.
  
  
  CONCLUSIONS
  Improvements with spa therapy for knee OA appear to be clinically relevant until 3 to 6 months and sometimes 9 months.
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: Romain
authors.initials: R
authors.lastname: Forestier
authors.affiliation: Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey.
authors.forename: Fatma Begüm
authors.initials: FB
authors.lastname: Erol Forestier
authors.affiliation: Centre de Recherche Rhumatologique et Thermal, 15, avenue Charles-de-Gaulle, 73100 Aix-les-Bains, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Francon
mesh_terms: D001452:Balneology / Q000379:methods*; D005060:Europe; D005081:Exercise Therapy / Q000379:methods*; D006294:Health Resorts; D006801:Humans; D006875:Hydrotherapy / Q000379:methods*; D008405:Massage / Q000379:methods*; D008877:Middle East; D020370:Osteoarthritis, Knee / Q000628:therapy*; D016896:Treatment Outcome
keywords: Crenobalneotherapy; Hydrotherapy; Mud; Osteoarthritis; Radon; Spa therapy