Balneotherapie bei Arthrose

Zusammenfassung

Aufgrund systematischer Reviews und Metaanalysen randomisierter, kontrollierter, teils doppelblinder Studien ergibt sich eine relativ gute Evidenz für einzelne balneotherapeutische Verfahren (Bäder, Peloide) und komplexe balneotherapeutische Verfahren (Kurortmedizin, spa therapy) zur Behandlung von Arthrosen der Hüfte, Knie, Hände oder generalisiert. Es gibt Hinweise auf mögliche spezifische Wirkmechanismen der Balneotherapie, besonders für Mooranwendungen und Schwefel- und Hydrogenkarbonatbäder. Prospektive Kohortenstudien lassen einen positiven Einfluss auf Arbeitsunfähigkeit und Krankenhausaufenthalte vermuten. Damit stellt die Balneotherapie eine gute Ergänzung, gegebenenfalls auch eine Alternative zu den übrigen konservativen Therapien der Arthrose dar, die auch nach endoprothetischem Ersatz und in Kombination mit Gymnastik gerade für Ältere mit Fallneigung zum Einsatz kommen kann und sollte. Unverständlicherweise führt die vorhandene Evidenz der Balneotherapie bei Arthrose nicht zu einer Aufnahme in alle entsprechenden Leitlinien, was in zukünftigen Versionen optimiert werden sollte. Dies insbesondere, da die Erstattungsfähigkeit von Therapien häufig an Leitlinien geknüpft ist, und damit eine wirksame und gut verträgliche Therapie mit hoher Akzeptanz wie die Balneotherapie aus dem Leistungs katalog der gesetzlichen Krankenkassen und der Medizin in Deutschland zu verschwinden droht.

Summary

Due to systematic reviews and meta-analyses of randomized controlled partly doubleblind trials, there is a relatively good evidence for balneotherapeutic procedures (baths, peloids) and complex balneotherapy procedures (spa medicine, spa therapy) in the treatment of osteoarthritis of the hip, knee, hands or generalized. There are possible specific mechanisms of action of balneotherapy, especially for mud applications and sulfur and hydrogencarbonate baths. Prospective cohort studies suggest a positive impact on disability and hospitalization. Thus balneotherapy provides a good complementary or even alternative conservative therapy for osteoarthritis, including recuperation after joint replacement or and in combination with exercise for elderly with a tendency to fall. Incomprehensibly, the existing evidence of balneotherapy in osteoarthritis does not lead to an entry in all relevant guidelines, which should be optimized in future guideline editions. Moreover, because the reimbursability of therapies is often linked to guidelines, balneotherapy as an effective and well tolerated therapy with high acceptance may dissappear from the service catalogue of the statutory health insurances and even the medicine in Germany.

Schlüsselwörter

Balneotherapie - Kurortmedizin - Peloid - Arthrose

Keywords

Balneotherapy - spa therapy - peloids - osteoarthritis

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