Clinical Impact of Balneotherapy and Therapeutic Exercise in Rheumatic Diseases: A Lexical Analysis and Scoping Review

Objective: To review the evidence regarding the clinical effect of spa therapy for rheumatic diseases, with particular attention given to association protocols between balneotherapy and rehabilitation interventions, and to support the literature research and studies' selection with lexical analysis. Methods: A lexical analysis was performed considering a list of words representing diseases and outcome measures linked to the theme studied in our review. Then, two independent researchers conducted a literature search on PubMed using the string employed for lexical analysis, including Randomized Controlled Trials regarding spa therapy's clinical effects on patients affected by rheumatic diseases published in the last 30 years. After the exclusion of works that did not meet the eligibility criteria, 14 studies were included in the final scoping review. Results: Spa therapy has shown a favourable effect on pain, function and quality of life in patients with Osteoarthritis, Fibromyalgia and Rheumatoid Arthritis. Different treatment modalities and types of water have demonstrated beneficial long-term clinical improvement. Furthermore, the association between thermal therapy and rehabilitation treatments has shown better clinical outcomes, probably due to the synergistic effect between the peculiar properties of the thermal waters and the therapeutic exercise program, if conducted in the same context. Conclusions: The combination of balneotherapy and rehabilitative interventions seems to be effective in ameliorating several outcomes in patients with rheumatic diseases. However, due to the wide variety of methodologies and interventions employed, these findings need to be further investigated. The lexical analysis should represent an auxiliary support for an extensive evaluation of scientific literature.