Efficacy of balneotherapy for osteoarthritis of the knee: a systematic review Brosseau L, MacLeay L, Robinson V, Casimiro L, Pelland L, Wells G, Tugwell P, McGowan J Authors' objectives To assess the efficacy of balneotherapy in patients with osteoarthritis (OA) of the knee. Searching MEDLINE, EMBASE, HeathSTAR, SPORTDiscus, CINAHL, the Cochrane Controlled Trials Register, PEDro, the specialised register of the Cochrane Musculoskeletal Group, and the Cochrane Field of Physical and Related Therapies until September 2002. In addition, reference lists of the included studies were screened and experts (including the co- ordinating offices of the aforementioned Cochrane Groups) were contacted. The search strategy was reported. Studies were included if they were reported in either French or English. Peer-reviewed abstracts were eligible. Study selection Study designs of evaluations included in the review Comparative controlled trials (including randomised controlled trials (RCTs), non-randomised studies, case-control and cohort studies) were eligible for inclusion if they included at least 5 patients in each treatment group. Studies in which the participants acted as their own control were excluded. Where reported, the duration of follow-up in the included studies was 12 weeks. Specific interventions included in the review Studies that compared any form or combination of balneotherapy applied to peripheral joints with placebo, no treatment, or other active treatment were eligible for inclusion. Any concurrent interventions had to be given to all treatment groups. The included studies compared different compositions of thermal water balneotherapy with placebo (tap water thermal bath or sweet-water outdoor pool) or compared various forms of balneotherapy (hot sulphur baths, Dead Sea water and combinations of these) with placebo (tap water bath) and each other. In some studies, concomitant treatment with standard anti-inflammatory drugs and pain-killers was permitted; one study did not allow other physical or drug treatments. The interventions lasted between 2 and 3 weeks; the frequency of bathing, where reported, was twice daily or 6 days per week. Participants included in the review Studies in adults (aged 18 years or over) with OA were eligible for inclusion. The participants in the included studies had mild to severe OA of the knee, as determined by radiographs. The mean age was approximately 62 years in one study with the age range reported as 40 to 70 years in another; one study did not report this information. Outcomes assessed in the review Studies that assessed rehabilitation outcomes were eligible for inclusion. All of the included studies assessed pain but used different measures: visual analogue scale, pain with movement, pressure or at rest, and a 10-point ordinal scale. Other outcomes assessed by the primary studies included range of movement (ROM) of flexion and extension, timed stair climbing and function (measured using the Lequesne index). How were decisions on the relevance of primary studies made? Two reviewers independently selected the studies. Assessment of study quality Validity was assessed and scored using the Jadad scale, which considers the reporting and handling of randomisation, blinding and handling of withdrawals. The maximum possible score was 5 points. In addition, the review reported whether or not the methods used to assess pain outcomes had been validated. Two reviewers independently assessed validity and resolved any disagreements through consensus or through recourse Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2020 University of York Page: 1 / 4