Identification of Responders to Balneotherapy among Adults over 60 Years of Age with Chronic Low Back Pain: A Pilot Study with Trajectory Model Analysis

Abstract

Balneotherapy may be a relevant treatment for chronic low back pain (LBP) in individuals > 60 years old. This pilot study aimed to determine the effectiveness of balneotherapy for chronic LBP in people > 60 years old and to determine profiles of responders with trajectory model analysis. This was a pilot prospective open cohort study, with repeated measurements using validated questionnaires; participants were their own controls. The primary endpoint was the proportion of participants with a change in pain intensity between the start of treatment and 3 months after treatment assessed with a numeric scale (NS) from 0 to 100 mm, with an effect size (ES) > 0.5. The assessments involved questionnaires that were self-administered on days (D) 1 and 21 and at months 3 and 6. The secondary objective was to determine the profile of responders to balneotherapy. We included 78 patients (69.2% women), mean age 68.3 ± 5.3 years. The mean pain score on the NS was 48.8 ± 19.9 at D1 and 39.1 ± 20.5 at 3 months (p < 0.001). The ES was 0.47 [95% confidence interval [CI] 0.25 to 0.69] for the whole sample; 36% (28/78) had an ES > 0.5; 23% (18/78) had a moderate ES (0 to 0.5); and 41% (32/78) had an ES of zero (14/78) or < 0 (18/78), corresponding to increased pain intensity. The pain trajectory model showed that the change in pain between D1 and D21 for trajectory A (larger reduction in pain intensity) was −50% [95% CI −60 to −27], and for trajectory B (smaller reduction in pain intensity), it was −13% [−33 to 0] (p < 0.001). Between Day 1 and month 3, the change for trajectory A was −33% [−54; 0] and for trajectory B was −13% [−40 to 0] (p = 0.14). Finally, between D1 and month 6, the change for trajectory A was −50% [−60 to 0] and for trajectory B was −6% [−33 to 17] (p = 0.007). The patients in trajectory A reported performing more physical activity than those in trajectory B (p = 0.04). They were also less disabled, with a mean Oswestry Disability Index of 40.4 versus 45.7 for those in trajectory A and B, respectively, (p = 0.03) and had a higher total Arthritis Self-Efficacy Scale score. This real-life study of the effectiveness of balneotherapy on chronic LBP identified distinct pain trajectories and predictive variables for responders. These criteria could be used in decision-making regarding the prescription of balneotherapy, to ensure personalized management of chronic LBP.

The Impact of Complex Rehabilitation Treatment on Sarcopenia—Pathology with an Endocrine Morphological Substrate and Musculoskeletal Implications

“…It was observed that evaluation of the Visual Analogue Scale (VAS) at discharge recorded improvements, with significant relief of the pain. Protocols that combine specific rehabilitation treatments with balneotherapy, including hydrotherapy, mud baths and exercise in hot thermal mud, could reduce pain and disability in patients identified as responders [ 21 ].…”

“…The tests indicated for the diagnosis of sarcopenia can be performed for all cooperative, conscious patients who have multiple associated diseases. Likewise, rehabilitation treatments that use artificial and natural physical agents can be recommended to patients with kidney, liver or heart damage, without determining the side effects of drug treatments [ 7 , 8 , 9 , 10 , 13 , 20 , 21 ] The physical factors recommended in physical and rehabilitation medicine are considered environmentally friendly alternatives compared to drugs for the treatment of various pathologies [ 7 , 10 ].…”

Efektivitas Intervensi Hidroterapi Terhadap Gangguan Muskuloskeletal: Systematic Review

“…Pada intervensi balneotherapy yang diberikan pada usia 18 tahun keatas dengan keluhan low back pain mampu memberikan efek perbaikan dari rasa nyeri dengan menggunakan air yang memiliki suhu 60,2°C serta peningkatan kandungan SO4 2-sulfat dan mineral lainnya (Haji et al, 2021). Namun, berbeda hasilnya dengan penelitian yang dilakukan oleh Raud et al (2022), balneotherapy yang diberikan kepada pasien usia 60 tahun keatas dengan chronic low back pain tidak cukup mampu dalam mengurangi rasa nyeri jika tidak diiringi dengan edukasi dan/atau latihan yang disarankan untuk mendukung keberhasilan program intervensi. Sementara pada latihan berupa moderate hiking (ketinggian pendakian maksimal 1.500m dari permukaan laut) yang dikombinasi dengan intervensi balneotherapy Mg-Ca-SO4 terbukti mampu memberikan manfaat pada penurunan nyeri, meningkatkan mobilitas tulang belakang, mengurangi tingkat depresi, hingga meningkatkan kualitas hidup (Huber et al, 2019).…”