Effect on Hip Osteoarthritis of Mud Bath and Underwater Exercises: A Randomized Controlled Trial

Objective: To compare the efficacy of an approach combining thermal therapy (mud pack and spa bath treatment) and underwater exercising (TT-UE) with conventional therapy, in patients with primary osteoarthritis (OA) of the hip. Design: Single-blind, randomized controlled trial. Setting: Thermal-rehabilitation center. Participants: 63 outpatients randomly assigned to the TT-UE (n= 34) and conventional therapy (n=29). Intervention: The TT-UE group underwent a 12-day cycle of mature mud pack application, bathing in natural mineral thermal water rich in bromine-iodine, massage therapy according to the standard protocol, and underwater exercises (eg, mobilization, hip traction, muscle strengthening), in a spa pool (≈50min/d), at a thermal facility of the Euganean Basin (Padua, Italy). The conventional therapy group was treated for the same number of sessions with traditional rehabilitation that included magnetotherapy, electrotherapy, and therapeutic exercises (mobilization, axial traction of the hip, functional re-education). During the treatment period, all patients stayed in the treatment center. Main Outcome Measures: Range of motion (ROM) (with IncliMed goniometer), Western Ontario and McMaster University Osteoarthritis (WOMAC) Index, and nonsteriodal anti-inflammatory drug (NSAID) consumption. Results: Findings were based on comparison of 2 groups matched for clinical and initial degree of impairment. In the TT-UE group, ROM significantly increased for flexion, abduction, and internal rotation (P range, .040−.011), WOMAC pain, stiffness, and physical function scores were significantly lower (P range, .001−.001) at the end of treatment, and the effects persisted at 3-month follow-up. In addition, analgesic and NSAID consumption during follow-up was higher in the TT-UE group, but not significantly so (P=.09). Conclusions: The patients with OA of the hip who received thermal therapy in combination with underwater exercising showed greater reductions in pain, motor impairment, and improvements in functional abilities, and these benefits persisted over time