Journal of Traditional Medical Complementary Therapies

.: ORIGINAL RESEARCH
Balneoterapi Uygulamasının Ağrı, Anksiyete ve Uyku Kalitesi Üzerindeki Etkisi: Yarı Deneysel Çalışma
The Effect of Balneotherapy Intervention on Pain, Anxiety and Sleep Quality: A Quasi-Experimental Study
Elif OK a, İnci KISA b
aSerbest Araştırmacı, Ankara, TÜRKİYE
bİlker Çelikcan Fizik Tedavi ve Rehabilitasyon Hastanesi, Bursa, TÜRKİYE
J Tradit Complem Med. 2021;4(3):336-42
doi: 10.5336/jtracom.2021-84301
Article Language: TR
Full Text
ÖZET
Amaç: Balneoterapi; doğal kaynaklardan oluşan, en az 20°C sıcaklıkta ve mineral içeriği en az 1 g/L olan termal mineral su içeren banyoların kullanılması olarak tanımlanır ve genellikle kür şeklinde uygulanır. Bu çalışmada, balneoterapi uygulamasının hastaların ağrı, anksiyete ve uyku kalitesi üzerindeki etkilerinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışma, yarı deneysel araştırma dizaynında gerçekleştirildi. Çalışma verileri, Ocak ve Mart 2020 tarihleri arasında, Bursa İlker Çelikcan Fizik Tedavi ve Rehabilitasyon Hastanesinde toplandı. Araştırmanın örneklemini kas-iskelet sistemi hastalıkları nedeniyle yatarak balneoterapi tedavisi alan 33 hasta oluşturdu. Araştırma verileri 'Tanıtıcı Özelliklere İlişkin Soru Formu', 'Beck Anksiyete Ölçeği', 'vizüel analog skala' ve 'Uyku Sonrası Değerlendirme Formu' ile toplandı. Değerlendirmeler balneoterapi öncesinde ve 12 günlük balneoterapi kürü sonrasında yapıldı. Hastalar gün aşırı ve her biri azami 10 dk olan toplam 6 kez balneoterapi tedavisi aldı. Bulgular: Çalışmaya katılan hastaların yaş medyanı 65 (65,5-70) yıldı. Balneoterapi sonrası yapılan değerlendirmelerde ağrı (p<0,001), anksiyete (p<0,001) ve uyku kalitesinin tüm alt boyutlarında (p<0,001) istatistiksel olarak anlamlı fark saptandı. Anksiyete ile ağrı ve uyku kalitesi puanları arasında pozitif yönde ve orta düzeyde anlamlı ilişki bulundu. Sonuç: Balneoterapinin kas-iskelet sistemi hastalıklarında tamamlayıcı tıp olarak uygulandığında ağrı ve anksiyete düzeyini anlamlı olarak azalttığı ve uyku kalitesini önemli oranda geliştirdiği gösterilmiştir. Ayrıca kronik ağrı şikâyeti olan hastalarda anksiyetenin ağrı algısı ve uyku sürecini etkileyebileceği düşünülmeli ve bu hastalarda anksiyete ve uyku değerlendirmeleri yapılmalıdır.

Anahtar Kelimeler: Balneoterapi; kronik ağrı; anksiyete; uyku
ABSTRACT
Objective: Balneotherapy is defined as the use of baths consisting of natural resources, containing thermal mineral water at a temperature of at least 20 °C and a mineral content of at least 1 g/L. The aim of the study is to determine the effect of balneotherapy on pain, anxiety and sleep quality. Material and Methods: This study was carried out a quasiexperimental research design. Research data were collected at Bursa İlker Çelikcan Physical Therapy and Rehabilitation Hospital between January and March 2020. The sample of the study consisted of 33 patients who received inpatient balneotherapy treatment for musculoskeletal diseases. The research data were collected using the 'Patient Information Form', 'Beck Anxiety Scale', 'visual analogue scale' and 'Post-Sleep Assessment Form'. Evaluations were made before balneotherapy and after a 12- day balneotherapy cure. The patients received balneotherapy every other day for a maximum of 10 minutes each, a total of 6 times. Results: The median age of the patients participating in the study was 65 (65.5-70) years. In the post-balneotherapy evaluations, a statistically significant difference was found in all sub-dimensions of sleep quality (p<0.001), anxiety (p<0.001) and pain (p<0.001). In addition, a positive and moderately significant correlation was found between anxiety and pain and sleep quality scores. Conclusion: Balneotherapy has been shown to significantly reduce pain and anxiety levels and significantly improve sleep quality. In addition, it should be considered that anxiety may affect the perception of pain and sleep process in patients with chronic pain and anxiety and sleep assessments should be made in these patients.

Keywords: Balneotherapy; chronic pain; anxiety; sleep
REFERENCES:
  1. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26(3):355-69. Erratum in: Clin Geriatr Med. 2013; 29(2):ix. [Crossref]  [PubMed]  [PMC] 
  2. Atalay SG, Alkan BM, Aytekin MN. Osteoartrite güncel yaklaşım [Current approach to osteoarthritis]. Ankara Med J. 2013;13(1):26-32. [Link] 
  3. Fioravanti A, Karagülle M, Bender T, Karagülle MZ. Balneotherapy in osteoarthritis: Facts, fiction and gaps in knowledge. European Journal of Integrative Medicine. 2017;1(9):148-50. [Crossref] 
  4. Perrucio AV, Chandran V. Safety profile of current OA therapies: evidence from clinical trials. In: Kapoor M, Mahomed NN, eds. Osteoarthritis. Pathogenesis, Diagnosis, Available Treatments, Drug Safety, Regenerative and Precision Medicine. 1st ed. Switzerland: Springer; 2015. p.211-34. [Crossref] 
  5. Dilekçi E, Özkuk K, Kaki B. Effect of balneotherapy on pain and fatigue in elderly with knee osteoarthritis receiving physical therapy: A randomized trial. Int J Biometeorol. 2019; 63(12):1555-68. [Crossref]  [PubMed] 
  6. Özkuk K, Uysal B, Ateş Z, Ökmen BM, Sezer R, Dilek G. The effects of inpatient versus outpatient spa therapy on pain, anxiety, and quality of life in elderly patients with generalized osteoarthritis: a pilot study. Int J Biometeorol. 2018;62(10):1823-32. [Crossref]  [PubMed] 
  7. Karagülle M, Karagülle MZ. Effectiveness of balneotherapy and spa therapy for the treatment of chronic low back pain: a review on latest evidence. Clin Rheumatol. 2015;34(2): 207-14. [Crossref]  [PubMed] 
  8. Bair MJ, Wu J, Damush TM, Sutherland JM, Kroenke K. Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med. 2008;70(8):890-7. [Crossref]  [PubMed]  [PMC] 
  9. Resmî Gazete [24.07.2001, Sayı:24472] sayılı Kaplıcalar Yönetmeliği; 2001. Erişim tarihi: 01 Temmuz 2021. Erişim linki: [Link] 
  10. Ulusoy M, Şahin NH, Erkmen H. Turkish version of the Beck Anxiety Inventory: Psychometric properties. J Cognit Psychother. 1996;12:163-72. [Link] 
  11. Jones KR, Vojir CP, Hutt E, Fink R. Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents. J Rehabil Res Dev. 2007;44(2):305-14. [Crossref]  [PubMed] 
  12. Çınar Menteş S, Sezerli M, Dinçer F, Yeşilbilek A. [Sleep disorders in chronic Hemodialysis patients]. Hemşirelik Formu. 1998;1(4):166-71.
  13. Özkuk K, Gürdal H, Karagülle M, Karagülle MZ. Diz osteoartritli hastaların balneolojik tedavilerinde süreye alternatif bir yaklaşım [An alternative approach to the duration of balneological treatment of knee osteoarthritis patients]. Aegean J Med Sci. 2018;1(1):1-6. [Link] 
  14. Bender T, Bálint G, Prohászka Z, Géher P, Tefner IK. Evidence-based hydro- and balneotherapy in Hungary--a systematic review and meta-analysis. Int J Biometeorol. 2014; 58(3):311-23. [Crossref]  [PubMed]  [PMC] 
  15. Kısa İ, Ok E, Er F. Osteoartrit tanılı hastalarda balneoterapinin ağrı, depresyon belirtileri, uyku ve yaşam kalitesi üzerine etkisi [The effect of balneotherapy on pain, depression symptoms, sleep and quality of life in patients with osteoarthritis]. J Tradit Complem Med. 2020;3(1):27-31. [Crossref] 
  16. Takinacı ZD, Karagülle M, İşsever H, Karagülle MZ. Clinical efficacy of spa therapy (balneotherapy) for chronic low back pain: a randomized single-blind trial. European Journal of Integrative Medicine. 2019;29:100928. [Crossref] 
  17. Pittler MH, Karagülle MZ, Karagülle M, Ernst E. Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials. Rheumatology (Oxford). 2006;45(7): 880-4. [Crossref]  [PubMed] 
  18. Ozkurt S, Dönmez A, Zeki Karagülle M, Uzunoğlu E, Turan M, Erdoğan N. Balneotherapy in fibromyalgia: a single blind randomized controlled clinical study. Rheumatol Int. 2012;32(7):1949-54. [Crossref]  [PubMed] 
  19. Fioravanti A, Manica P, Bortolotti R, Cevenini G, Tenti S, Paolazzi G. Is balneotherapy effective for fibromyalgia? Results from a 6-month double-blind randomized clinical trial. Clin Rheumatol. 2018;37(8):2203-12. [Crossref]  [PubMed] 
  20. Latorre-Román PÁ, Rentero-Blanco M, Laredo-Aguilera JA, García-Pinillos F. Effect of a 12-day balneotherapy programme on pain, mood, sleep, and depression in healthy elderly people. Psychogeriatrics. 2015; 15(1):14-9. [Crossref]  [PubMed] 
  21. Falagas ME, Zarkadoulia E, Rafailidis PI. The therapeutic effect of balneotherapy: evaluation of the evidence from randomised controlled trials. Int J Clin Pract. 2009;63(7):1068-84. [Crossref]  [PubMed] 
  22. Foley D, Ancoli-Israel S, Britz P, Walsh J. Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res. 2004;56(5):497-502. [Crossref]  [PubMed] 
  23. Kaya E, Kaplan C, Çarli AB, Güzelküçük Ü. Effects of balneotherapy and physical therapy on sleep quality in patients with osteoarthritis aged 50 to 85 years. Arch Rheumatol. 2015;31(1):1-5. [Crossref]  [PubMed]  [PMC] 
  24. Yang B, Qin QZ, Han LL, Lin J, Chen Y. Spa therapy (balneotherapy) relieves mental stress, sleep disorder, and general health problems in sub-healthy people. Int J Biometeorol. 2018;62(2):261-72. [Crossref]  [PubMed] 
  25. Dubois O, Salamon R, Germain C, Poirier MF, Vaugeois C, Banwarth B, et al. Balneotherapy versus paroxetine in the treatment of generalized anxiety disorder. Complement Ther Med. 2010;18(1):1-7. [Crossref]  [PubMed] 
  26. Antonelli M, Donelli D. Effects of balneotherapy and spa therapy on levels of cortisol as a stress biomarker: a systematic review. Int J Biometeorol. 2018;62(6):913-24. [Crossref]  [PubMed] 
  27. Means-Christensen AJ, Roy-Byrne PP, Sherbourne CD, Craske MG, Stein MB. Relationships among pain, anxiety, and depression in primary care. Depress Anxiety. 2008;25(7): 593-600. [Crossref]  [PubMed] 
  28. Alvaro PK, Roberts RM, Harris JK. A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep. 2013;36(7):1059-68. [Crossref]  [PubMed]  [PMC] 

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