Effectiveness of Balneotherapy versus Paraffin Wax Bath in Patients with Rheumatoid Arthritis: A Randomized Controlled Trial

Muhammad Safdar Hussain; Saad Saleem; Muhammad Sameet; Roha Farooqi; Aleeza Shuja; Sehrish Jabeen

doi:10.55735/ge5g2047

Authors

Muhammad Safdar Hussain Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan
Saad Saleem Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan
Muhammad Sameet University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
Roha Farooqi Faculty of Rehabilitation & Allied Health Sciences, Riphah International University, Islamabad, Pakistan
Aleeza Shuja Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan
Sehrish Jabeen Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan

DOI:

https://doi.org/10.55735/ge5g2047

Keywords:

Balneotherapy , Mobility , Paraffin wax bath , Rheumatoid arthritis

Abstract

Background: Rheumatoid arthritis refers to a chronic autoimmune disease that causes inflammation and dysfunctional joints. Balneotherapy and paraffin wax baths have gained attention due to their potential to reduce symptoms and enhance quality of life. Objective: To compare the effectiveness of balneotherapy and paraffin wax bath therapy among rheumatoid arthritis patients. Methodology: A single-blinded, randomized controlled trial that followed the guidelines of the CONSORT, which had received ethical approval from the Institutional Review Board. The trial was conducted in Sehat Medical Complex and Hamid Latif Hospital and took place. Out of 60 participants, 54 who met the inclusion criteria were randomly allocated to two groups on the basis of a concealed-envelope design. Group A was treated with balneotherapy along with standard physical therapy, and Group B was treated with paraffin wax baths and standard physical therapy. Participants included both males and females aged between 30 to 50 years, for at least three months and the ability to walk independently or with minimal assistance. Patients with severe cardiovascular, neurological, or dermatological conditions, as well as those with cognitive impairments or other contraindications to either intervention, were excluded. This treatment was administered five times per week over six weeks. Outcome evaluations were carried out at the baseline, 4^th and 8^th weeks. Pain severity was assessed with the visual analogue scale, functional mobility was assessed by the timed up and go, and disability by means of the health assessment questionnaire disability index. Mixed model and repeated measure ANOVA were used to detect the differences between the groups and within the groups, respectively. Results: Both groups showed significant improvements (p<0.001) in pain, mobility and functional scores. However, Group A showed greater improvement, with a mean pain score reduction of 4.6±1.0, mobility score improvement of 4.91±1.32 seconds, and functional improvement of 1.41±1.78. Conclusion: Balneotherapy is a more effective adjunctive intervention than paraffin wax bath in reducing pain, enhancing mobility, and improving functional outcomes in patients with rheumatoid arthritis.

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References

1. Almutairi K, Nossent J. The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review. 2021; 41(5): 863–77. DOI: https://doi.org/10.1007/s00296-020-04731-0

https://doi.org/10.1007/s00296-020-04731-0 DOI: https://doi.org/10.1007/s00296-020-04731-0

2. Cross M, Smith E, Hoy D, et al. The global burden of rheumatoid arthritis: estimates from the global burden of disease 2010 study. Annals of the Rheumatic Diseases 2014; 73(7): 1316–22. DOI: https://doi.org/10.1136/annrheumdis-2013-204627

https://doi.org/10.1136/annrheumdis-2013-204627 DOI: https://doi.org/10.1136/annrheumdis-2013-204627

3. Safiri S, Kolahi AA, Cross M, Hill C. Prevalence, Deaths, and Disability-Adjusted Life Years Due to Musculoskeletal Disorders for 195 Countries and Territories 1990-2017. 2021; 73(4): 702–14. DOI: https://doi.org/10.1002/art.41571

https://doi.org/10.1002/art.41571 DOI: https://doi.org/10.1002/art.41571

4. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bulletin of the World Health Organization 2003; 81(9): 646–56.

https://doi.org/10.1590/S0042-96862003000900007

5. Conforti A, Di Cola I, Pavlych V, et al. Beyond the joints, the extra-articular manifestations in rheumatoid arthritis. Autoimmunity Reviews 2021; 20(2): 102735. DOI: https://doi.org/10.1016/j.autrev.2020.102735

https://doi.org/10.1016/j.autrev.2020.102735 DOI: https://doi.org/10.1016/j.autrev.2020.102735

6. Radu A-F, Bungau SG. Management of rheumatoid arthritis: an overview. Cells 2021; 10(11): 2857. DOI: https://doi.org/10.3390/cells10112857

https://doi.org/10.3390/cells10112857 DOI: https://doi.org/10.3390/cells10112857

7. Bullock J, Rizvi SA, Saleh AM, et al. Rheumatoid arthritis: a brief overview of the treatment. Medical Principles and Practice 2019; 27(6): 501–7. DOI: https://doi.org/10.1159/000493390

https://doi.org/10.1159/000493390 DOI: https://doi.org/10.1159/000493390

8. Stanmore EK, Oldham J, Skelton DA, et al. Fall incidence and outcomes of falls in a prospective study of adults with rheumatoid arthritis. Arthritis Care & Research 2013; 65(5): 737–44. DOI: https://doi.org/10.1002/acr.21892

https://doi.org/10.1002/acr.21892 DOI: https://doi.org/10.1002/acr.21892

9. Radu AF, Bungau SG. Management of Rheumatoid Arthritis: An Overview. 2021; 10(11). DOI: https://doi.org/10.3390/cells10112857

https://doi.org/10.3390/cells1011285

10. Morer C, Roques C-F, Françon A, Forestier R, Maraver F. The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials. International Journal of Biometeorology 2017; 61(21): 2159–73. DOI: https://doi.org/10.1007/s00484-017-1421-2

https://doi.org/10.1007/s00484-017-1421-2 DOI: https://doi.org/10.1007/s00484-017-1421-2

11. Király M, Kővári E, Hodosi K, Bálint PV, Bender T. The effects of Tiszasüly and Kolop mud pack therapy on knee osteoarthritis: a double-blind, randomised, non-inferiority controlled study. International Journal of Biometeorology 2020; 64(6): 943–50. DOI: https://doi.org/10.1007/s00484-019-01764-4

https://doi.org/10.1007/s00484-019-01764-4 DOI: https://doi.org/10.1007/s00484-019-01764-4

12. Fioravanti A, Manica P, Bortolotti R, Cevenini G, Tenti S, Paolazzi G. Is balneotherapy effective for fibromyalgia? Results from a 6-month double-blind randomized clinical trial. Clinical Rheumatology 2018; 37(8): 2203–12. DOI: https://doi.org/10.1007/s10067-018-4117-z

https://doi.org/10.1007/s10067-018-4117-z DOI: https://doi.org/10.1007/s10067-018-4117-z

13. Fioravanti A, Karagülle M, Bender T, Karagülle MZ. Balneotherapy in osteoarthritis: facts, fiction and gaps in knowledge. European Journal of Integrative Medicine 2017; 9: 148–50. DOI: https://doi.org/10.1016/j.eujim.2017.01.001

https://doi.org/10.1016/j.eujim.2017.01.001 DOI: https://doi.org/10.1016/j.eujim.2017.01.001

14. Antonelli M, Donelli D, Fioravanti A. Effects of balneotherapy and spa therapy on quality of life of patients with knee osteoarthritis: a systematic review and meta-analysis. Rheumatology international 2018; 38(10): 1807–24. DOI: https://doi.org/10.1007/s00296-018-4081-6

https://doi.org/10.1007/s00296-018-4081-6 DOI: https://doi.org/10.1007/s00296-018-4081-6

15. Karagülle M, Karagülle MZ. Effectiveness of balneotherapy and spa therapy for the treatment of chronic low back pain: a review on latest evidence. Clinical Rheumatology 2015; 34(2): 207–14. DOI: https://doi.org/10.1007/s10067-014-2845-2

https://doi.org/10.1007/s10067-014-2845-2 DOI: https://doi.org/10.1007/s10067-014-2845-2

16. Verhagen AP, Bierma-Zeinstra SM, Boers M, et al. Balneotherapy (or spa therapy) for rheumatoid arthritis. Cochrane Database Systematic Review 2015; 2015(4): Cd000518. DOI: https://doi.org/10.1002/14651858.CD000518.pub2

https://doi.org/10.1002/14651858.CD000518.pub2 DOI: https://doi.org/10.1002/14651858.CD000518.pub2

17. Kim S-G, Kang JW, Boo JH, et al. Effectiveness of paraffin bath therapy for the symptoms and function of hand diseases: A systematic review and meta-analysis of randomized controlled trials. Journal of Hand Therapy 2023; 36(3): 706–12. DOI: https://doi.org/10.1016/j.jht.2022.10.005

https://doi.org/10.1016/j.jht.2022.10.005 DOI: https://doi.org/10.1016/j.jht.2022.10.005

18. Gebretsadik A, Taddesse F, Melaku N, Haji Y. Balneotherapy for Musculoskeletal Pain Management of Hot Spring Water in Southern Ethiopia: Perceived Improvements. Inquiry : A Journal of Medical Care Organization, Provision and Financing 2021; 58: 469580211049063. DOI: https://doi.org/10.1177/00469580211049063

https://doi.org/10.1177/00469580211049063 DOI: https://doi.org/10.1177/00469580211049063

19. Protano C, Fontana M. Balneotherapy for osteoarthritis: a systematic review. 2023; 43(9): 1597–610. DOI: https://doi.org/10.1007/s00296-023-05358-7

https://doi.org/10.1007/s00296-023-05358-7 DOI: https://doi.org/10.1007/s00296-023-05358-7

20. Bekaryssova D, Yessirkepov M. Water-based interventions in rheumatic diseases: mechanisms, benefits, and clinical applications. 2024; 45(1): 8. DOI: https://doi.org/10.1007/s00296-024-05770-7

https://doi.org/10.1007/s00296-024-05770-7 DOI: https://doi.org/10.1007/s00296-024-05770-7

21. Romay-Barrero H, Herrero-López J, Antonio Llorente-González J, Melgar-Del Corral G, Palomo-Carrión R, Martínez-Galán I. Balneotherapy and health-related quality of life in individuals with Rheumatoid arthritis: An observational study under real clinical practice conditions. Balneo & PRM Research Journal 2022; 13(4): 527. DOI: https://doi.org/10.12680/balneo.2022.527

https://doi.org/10.12680/balneo.2022.527 DOI: https://doi.org/10.12680/balneo.2022.527

22. Gáti T. Hydrotherapy and Balneotherapy methods in the treatment of chronic low back pain: University of Szeged (Hungary); 2021.

https://doi.org/10.14232/PHD.10878 DOI: https://doi.org/10.14232/phd.10878

23. Castelli L, Ciorciari AM, Galasso L, et al. Revitalizing your sleep: the impact of daytime physical activity and balneotherapy during a spa stay. Frontiers in Public Health 2024; 12: 1339689. DOI: https://doi.org/10.3389/fpubh.2024.1339689

https://doi.org/10.3389/fpubh.2024.1339689 DOI: https://doi.org/10.3389/fpubh.2024.1339689

24. Cheleschi S, Gallo I, Tenti S. A comprehensive analysis to understand the mechanism of action of balneotherapy: why, how, and where they can be used? Evidence from in vitro studies performed on human and animal samples. International Journal Biometeorol 2020; 64(7): 1247–61. DOI: https://doi.org/10.1007/s00484-020-01890-4

https://doi.org/10.1007/s00484-020-01890-4 DOI: https://doi.org/10.1007/s00484-020-01890-4

25. Bestaş E, Dündar Ü. The comparison of effects of balneotherapy, water-based and land-based exercises on disease activity, symptoms, sleep quality, quality of life and serum sclerostin level in patients with ankylosing spondylitis: A prospective, randomized study. Archives of Rheumatology 2022; 37(2): 159–68. DOI: https://doi.org/10.46497/ArchRheumatol.2022.9024

https://doi.org/10.46497/ArchRheumatol.2022.9024 DOI: https://doi.org/10.46497/ArchRheumatol.2022.9024