Rheumatol Int (2010) 30:739–747 DOI 10.1007/s00296-009-1054-9 123 ORIGINAL ARTICLE EVect of balneotherapy on temporospatial gait characteristics of patients with osteoarthritis of the knee Önder KÂlÂçoflu · Arif Dönmez · Zeki Karagülle · Nergis Erdofan · Ekin Akalan · Yener Temelli Received: 2 December 2008 / Accepted: 28 June 2009 / Published online: 9 July 2009  Springer-Verlag 2009 Abstract EVects of balneotherapy on gait properties of patients with osteoarthritis of the knee were investigated prospectively. A total of 30 patients with knee osteoarthritis received balneotherapy consisting of two daily thermomin- eral water baths for 2 weeks. Patients were evaluated using gait analysis and clinical scores, both within 2 weeks, before and after spa treatment. Patients were walking faster in their control analyses (0.81 § 0.21 to 0.89 § 0.19 m/s; P = 0.017), with a shorter mean stance time (63.0 § 3.3 to 61.8 § 2.5% stride; P = 0.007), an increased cadence (96 § 13.1 to 100 § 11.9 steps/min; P = 0.094) and stride length (996 § 174 to 1,058 § 142 mm; P = 0.017). Balneo- therapy also resulted in a signiWcant decrease in Lequesne knee osteoarthritis index (12.1 § 3.7 to 10.0 § 3.3 points; P = 0.003), VAS for pain (58 § 25 to 33 § 15; P = 0.0001), VAS for patients’ (56 § 24 to 29 § 19; P < 0.001) and investigator’s global assessment (55 § 20 to 26 § 15; P < 0.0001) and WOMAC score (2.1 § 0.7 to 1.6 § 0.8; P = 0.0004). Balneotherapy has positive eVects on gait properties and clinical health quality parameters of patients with knee osteoarthritis in short-term evaluations. Keywords Knee joint · Osteoarthritis · Balneology · Hydrotherapy · Spa therapy · Gait Introduction Osteoarthritis is a degenerative disorder of the synovial joints, characterized by irreversible loss of joint cartilage and hypertrophic bony changes [1, 2]. Its incidence increases with age, causing signiWcant loss in work hours and increase in health costs, especially when the hip and knee joints are involved [3]. While literature from various countries reports that knee joint involvement ranges between 20 and 70% [4], long-term studies demonstrate new-onset knee osteoarthritis in 2 out of every 100 individ- uals over 50 years of age [5]. None of the current treatment modalities can replace the damaged cartilage. Treatment generally aims to relieve pain and restore function, at least to some extent. Guidelines published by rheumatology and orthopedic societies recommend patient education, weight loss, activity modiWcation and use of canes as the Wrst line of conservative measures [6–8]. When these measures do not suYce, medications, intraarticular steroid injections and viscosupplementation may be used, before considering sur- gery [6–8]. Spa therapy is widely used for musculoskeletal system disorders, such as low back pain [9, 10] or Wbromyalgia [11, 12], in addition to osteoarthritis of various joints. Bal- neotherapy is the original form of treatment, which is the main, and usually the sole, intervention during the spa stay. Studies on the eYcacy of thermomineral water baths in osteoarthritis (OA), and various types of mineral water baths and treatment protocols, report Wndings consistent with an advantageous eVect in most cases [13–21]. Spa treatment is accepted as a valid option in the treatment Ö. KÂlÂçoflu (&) · Y. Temelli Department of Orthopedics and Traumatology, Istanbul University, Istanbul Medical School, Millet Cad. 118, Fatih, 34093 Istanbul, Turkey e-mail: kilicoglu@istanbul.edu.tr A. Dönmez · Z. Karagülle · N. Erdofan Department of Medical Ecology and Hydroclimatology, Istanbul University, Istanbul Medical School, Istanbul, Turkey E. Akalan Gait Analysis Laboratory, Istanbul University, Istanbul Medical School, Istanbul, Turkey