Comparison of the clinical effectiveness of thermal cure and rehabilitation in knee osteoarthritis. A randomized therapeutic trial

To compare the benefits of a thermal cure and non-thermal rehabilitation in treatment of knee osteoarthritis (KOA). Methods: Randomized therapeutic trial including patients with knee osteoarthritis (American College of Rheumatology criteria). Patients were randomly divided into two groups. Spa treatment consisted of underwater shower, massage-jet showers, hydromassage, pool rehabilitation and peloid therapy. Non-thermal rehabilitation consisted of analgesic physiotherapy, muscle strengthening and group physical rehabilitation. A blinded evaluation was carried out at day 21 and 12. months following treatment. It was based on the visual analogic scale of pain (VAS), which represented the primary endpoint. Results: Two hundred and forty patients were included (February-June 2005). The spa treatment and non-thermal rehabilitation groups included 119 and 121patients respectively. Two hundred and thirty-three patients completed their treatments. Significant improvement of the visual analogic scale of pain was noted in the thermal cure group (61.6 ± 15 at day 0 versus 46.5 ± 22.4 at 12. months, P<. 0.001), but not in the non-thermal group (64.1 ± 15 at day 0 versus 62 ± 29 at 12. months, P= 0.68). At day 21, comparison of the two groups revealed no significant difference on the VAS (P= 0.08). However, at 12. months, the thermal cure group was significantly more improved (P= 0.000). Conclusion: In our study, crenobalneotherapy had resulted, at 12. months, in more pronounced long-term improvement of the painful symptoms of KOA than had non-thermal rehabilitation.