International Journal of Biometeorology

, Volume 63, Issue 12, pp 1555–1568 | Cite as

Effect of balneotherapy on pain and fatigue in elderly with knee osteoarthritis receiving physical therapy: a randomized trial

  • Erdal Dilekçi
  • Kağan ÖzkukEmail author
  • Barış Kaki
Original Paper


This study aimed to investigate whether balneotherapy (BT) applied in combination with physical therapy (PT) has a more positive effect in patients aged 65 years and older with knee osteoarthritis (KOA) compared to PT alone. A total of 305 individuals were randomized into two groups. Group I was applied PT alone; group II was applied PT + BT. Assessments were made using the Pain (VAS), EQ-5D-3L Scale, Western Ontario And McMaster Universities Osteoarthritis Index (WOMAC), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Scale, Epworth Sleepiness scale (EPWORTH) and the Outcome Measures in Rheumatology-The Osteoarthritis Research Society International set of responder criteria for osteoarthritis (OMERACT-OARSI) at the beginning (T0) and at the end (T1) of treatment. Statistically significant interactions found between treatment (PT alone or PT + BT) and time (before treatment and after treatment) in terms of Pain-VAS, Pain-WOMAC, Stiffness-WOMAC, Physical Function-WOMAC, Total-WOMAC, EQ-5D, EQ-VAS, FACIT-F, and EPWORTH scores (p < 0.0001 for all). According to OMERACT-OARSI criteria, the responder rate was 89.04% in PT alone group and 98.74% in PT + BT group. Balneotherapy plus physical therapy was more effective than physical therapy alone in KOA patients aged over 65 years. Reducing pain, especially, positively contributes to functionality, quality of life, fatigue and sleepiness of KOA patients.


Knee osteoarthritis Balneotherapy Physical therapy Elderly Fatigue Sleepiness 



This research was not supported by any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Ethics Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all participants prior to being included in the study.

Conflict of interest

The authors declare that they have no no conflicts of interest.


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Copyright information

© ISB 2019

Authors and Affiliations

  1. 1.Department of Physical Medicine and RehabilitationIzzet Baysal Physical Medicine and Rehabilitation Training and Research HospitalBoluTurkey
  2. 2.Department of Medical Ecology and HydroclimatologyUsak University Faculty of MedicineUşakTurkey
  3. 3.Department of EconometricsUsak University Faculty Of Economics And Administrative SciencesUşakTurkey

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