The effecti̇veness of balneotheraphy wi̇th knee osteoarthri̇ti̇s on i̇soki̇neti̇c parametres and quali̇ty of li̇fe

Objective: This study aims to evaluate the efficacy of combined balneotherapy and physical therapy on pain, fonctional status and muscle strength of patients with knee osteoarthritis. Materials and Methods: A total of 60 patients diagnosed with knee osteoarthritis were included in the study and two groups were randomly assigned as balneotherapy group (n = 30) and control group (n = 30). Demographic data of the patients were recorded. A total of 15 sessions of hot pack, TENS, US and knee exercises were applied to symptomatic knees of both groups for 5 days a week a total of 3 weeks. Balneotheraphy group had bathing in thermal and mineral water, which were applied five times per week, total 15 sessions and for 20 minutes duration, conventional physical theraphy programme was also applied. The control group had only conventional physical therapy program. The patients were assessed before and after treatment, using VAS, knee range of motion(ROM), WOMAC , concentric knee flexor and knee extensor peak torque values at 90 degrees/second and 150 degrees/second angular speed with isokinetic dynamometer. Body fat percentage, body mass, body mass percentage and lean body mass were calculated by bioelectrical impedance analysis method before treatment. The statistical analysis was performed using SPSS 18 for Windows. The normal distribution was tested by Kolmogorov-Simirnov and Shapiro-Wilk tests to make test selection while comparing the mean of the groups in the evaluation of the data, descriptive statistics and the significance of the median difference between groups were tested using the Mann-Whitney U test, Wilcoxon test was used to evaluate recurrent measurements of the same group, Chi square test was used in evaluating two categorical data, Spearman test was used to assess the correlation between isokinetic datas and muscle mass. A value of P <0.05 was considered statistically significant. Results: Demographic characteristics, radiological stages, VAS, WOMAC, knee ROM and isokinetic muscle power measurement parameters of the groups before treatment were similar. After treatment these were statistically significant in both groups according to before treatment; a significant decrease in VAS and WOMAC scores, a significant increase in isokinetic muscle strength at all angles and speeds. After treatment, there was a significant increase only in the control group at the knee ROM according to before treatment. In comparing the values of the groups after treatment; There was a statistically significant decrease in VAS, WOMAC pain and WOMAC stiffness in favor of the balneotherapy group. In comparing the percent changes of the groups after treatment; VAS, WOMAC pain, WOMAC stiffness, WOMAC function and WOMAC total scores were statistically decreased in the balneotherapy group, but there was no significant difference in isokinetic muscle strength measurements. There was no significant correlation between isokinetic change values of the groups and measurements of body mass. Conclusion: Conventional physical therapy program combined with balneotherapy in patients with knee osteoarthritis is very effective in the early period compared with the conventional physical therapy program applied alone in reducing pain and increasing physical function.