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Summary of Clinical Surveys from Piestany

Abstract 1.
Gašpar, R1., Rybár, I2., Zimanová, T1., Makovník, Pavel1:
Current status of balneo-rehabilitation as a non-pharmacological treatment of diseases of the musculoskeletal system in the Slovak Health Spa Piestany, Inc.

(1 Slovak Health Spa Piestany, Inc., 2 Clinic of  Rheumatology, Medical Faculty of Slovak Medical University Bratislava and National Institute of Rheumatologic Diseases, Piešťany).

Introduction: Health spa balneo-rehabilitation is an important component in comprehensively treating inflammatory, non-inflammatory and metabolic disorders of musculoskeletal system, as part of post-trauma treatment and the treatment of certain neurological diseases.

Objective: Survey of indications/diseases for non-pharmacological balneo-rehabilitation inpatients in Slovak Health Spa Piešťany.

Results: In 2012-2014, the balneo-rehabilitation in Slovak Health Spa Piešťany provided treatment for 26 064, 29 064 and 26 625 patients with musculoskeletal system diseases. Their geographical distribution is shown in Table 1.

Table 1 Geographical distribution of patients SLK Piešťany as in the years 2012-2014


2012
2013
2014

abs.
%
abs.
%
abs.
%
EU + Israel
22230
85
23977
82,4
21973
82,5
USA + Canada
405
1,5
487
1,7
466
1,8
Middle East + Egypt
1769
7
2284
7,9
2277
8,6
Australia
199
0,8
155
0,5
118
0,4
Russia + Ukraine
1186
4,6
1742
6
1604
6
Africa + South America
275
1,1
419
1,5
187
0,7
Total
26064
100
29064
100
26625100

The indication criteria for this spa balneo-rehabilitation treatment program was made up mainly of patients suffering from back pain resulting from vertebral diseases, intervertebral disc disorders and scoliosis. These represented up to 86.5% of all treated patients in 2013 and 81.75% in 2014. The second group were patients suffering from osteoarthritis, in particular osteoarthritis of the hip and knee joints (5.6% and 7,5%, respectively), and post injury conditions of the musculoskeletal system (5.1% and 7,3%, respectively). More detailed information is given in Table 2. The average time of balneo-rehabilitation was 11.54 days.

Table 2. Indications for balneo-rehabilitation treatment in Slovak Health Spa Piešťany


2013
2014
Indications
abs.
%
abs.
%
Back pain (vertebropathies, disc disorders, scoliosis)
25135
86,50
21767
81,75
Arthritis
1623
5,60
1994
7,50
Post trauma or post surgery conditions
1483
5,10
1944
7,30
Inflammatory rheumatic diseases
386
1,30
407
1,50
Neurological diseases
364
1,25
383
1,45
Kids, other diseases
73
0,25
130
0,50
Total
29064
100,00
26625100,00

Conclusion
. Among the indications in the health spa balneo-rehabilitation, back pain dominated - 86.5% in 2013 and 81.75% in 2014, followed by osteoarthritis and post-traumatic conditions. The high numbers of treated patients, with a predominance of non-inflammatory affections, indicate the high level of patient confidence for this type of therapy and treatment.

Abstract 2.
Rybár, Ivan1, Zimanová Tamara2, Saraková Johana2, Lulovič Tomáš2, Lulovič Peter2, Drličková Viera2, Richvaldská Daniela2, Drobná Eugénia2, Maceková Oľga2, Makovník Pavel2, Blahunka Rudolf2, Rohová Zlatica2, Korkošová Eva2, Gašpar Rastislav2:
Characteristics of patients with low back pain at the beginning of spa treatment in Slovak Health Spa Piešťany.
(1 Clinic of  Rheumatology, Medical Faculty of Slovak Medical University Bratislava and National Institute of Rheumatologic Diseases, Piešťany,2 Slovak Health Spa Piešťany,).

Back pain with mobility limitation represents the main indication for balneo-rehabilitation treatment in up to 88% of spa patients.

Objective: Further determination of the pain intensity, basic motoric functions findings, physical disability and quality of life evaluation in patients upon arrival to the health spa, before the start of balneo-rehabilitation therapy.

Patients and methods: The group included Slovak patients with lower back pain, who underwent a spa treatment program from 01.10.2014 to 15.01.2015 and signed informed consent.

Results: 126 patients were evaluated, 88 (70%) women and 38 (30%) men with average age of 56,86±13,04 (20-84) years, average Body Mass Index (BMI) 28,1±4,97 (17,3-42,5). Pain in the lower spine was caused by: disc disorders 52% (65/126), degenerative disease - osteoarthrosis 34% (43/126), inflammatory spine disease 4% (5/126), osteoporosis and metabolic bone diseases 2% (3/126) and other reasons 8% (10/126). Average pain intensity was evaluated by VAS (100mm). Values were: 46,63±17,84 mm, average range fingertip to floor distance: 15,31 cm, left lateroflexion: 19,47 cm and right lateroflexion 19,46 cm. Physical disability was evaluated by HAQ questionnaire was in standard value ( HAQ DI ≤0,500) 54% of evaluated patients (68/126), slight disability (HAQ DI > 0,500 a ≤ 1,000) had 27% of evaluated patients (34/126) and moderate disability (HAQ DI >1,000 a ≤ 2,000 19% of patients (24/126). Severe disability with HAQ DI > 2,000 was not found in any patient. Patients with low back pain were most significantly limited the following activities: daily activities average 0,97, attainment 0,87 and hygiene 0,79. Disability in patients with low back pain was quantified by Oswestry disability index: minimal disability (0-20%) 48 patients (38%), moderate disability  (21-40%) 54 patients (43%), severe disability (41 – 60%) 23 patients  (18%) and crippling back pain (61-80%) 1 patient (1%). Concerning individual activities, patients with low back pain had limitations in lifting, followed by standing limitations and limitations in social activities. The physical components of quality of life were assessed using SF-36 were reduced to 38.2 ± 9.48, and mental quality of life of the component was 45.7 ± 10.52.

Conclusion: Patients with low back pain at the beginning of the balneo-rehabilitation treatment in Slovak Health Spa Piešťany have a moderate to severe physical disability in 61% of cases. The most common cause of the low back pain in spa patients were intervertebral disc disorders and degenerative diseases of the spine.

Abstract 3.
Rybár Ivan1 , Zimanová Tamara2, Ivanková Renata1, Masaryk Pavol1, Gašpar Rastislav2:
Oswestry Disability Index correlates in patients with low back pain with pain intensity, physical disability and quality of life.
(1 Clinic of  Rheumatology, Medical Faculty of Slovak Medical University Bratislava and National Institute of Rheumatologic Diseases, Piešťany,2 Slovak Health Spa Piešťany,).

Back pain with limitation in mobility represents main indication in balneo-rehabilitation for up to 88%  of spa patients. Disability caused by low back pain is quantified by a patient questionnaire according to the Oswestry Disability Index, where the following functions are evaluated: pain, self-care, lifting, standing, sleeping, sexual functions, social activities and travel.

Objective: To compare disability results evaluated by the Oswestry Disability Index with pain intensity using the HAQ questionnaire and quality of life assessed by the SF-36 questionnaire.

Results: Table 1 shows increasing values of pain intensity assessed by VAS 100 mm and median HAQ simultaneously with decreasing values of physical and mental component quality of life (SF-36).

Oswestry Disability
Index score  %
No of patients
VAS (mm)
HAQ
SF-36
physical
component
SF-36
mental component
0 - 20
48
37,75±18,52
0,125
45,00±7,70
49,40±10,01
21 - 40
54
48,28±12,83
0,625
37,3±6,70
44,70±9,84
41 - 60
23
61,57±15,54
1,5
26,60±4,70
41,20±10,1
61 - 80
1
40,00
1,625
26,8
26,5
81 and more   
0
0
0
0
0

Table 2 shows positive correlation between Oswestry Disability Index, pain intensity and HAQ index (median) and negative correlation with physical and mental component quality of life SF-36.

n-126
Pain severity (VAS, mm)
HAQ DI
SF-36
physical component
SF-36
mental component
Oswestry
Disability
Index
0,501
0,769
-0,742
-0,407

Conclusion: In the spa patients with low back pain the Oswestry Disability index is positively correlated with pain severity (VAS), physical disability (HAQ) and negatively with the physical and mental components of quality of life SF-36.
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