Article Text

Extended report
Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial
  1. R Forestier1,
  2. H Desfour2,
  3. J-M Tessier3,
  4. A Françon1,
  5. A M Foote4,
  6. C Genty4,
  7. C Rolland4,
  8. C-F Roques5,
  9. J-L Bosson4
  1. 1Centre for Rheumatology and Balneotherapy Research, Aix Les Bains, France
  2. 2Private Practice, 13 Av des Thermes Athéna, Balaruc les Bains, France
  3. 3Spa Hospital, Dax, France
  4. 4Clinical Research Centre, INSERM CIC03, Grenoble, France
  5. 5University of Toulouse, Toulouse, France
  1. Correspondence to Professor Jean-Luc Bosson, Clinical Research Centre, CHU de Grenoble BP 217, Grenoble 38043, France; jlbosson{at}


Objective To determine whether spa therapy, plus home exercises and usual medical treatment provides any benefit over exercises and usual treatment, in the management of knee osteoarthritis.

Methods Large multicentre randomised prospective clinical trial of patients with knee osteoarthritis according to the American College of Rheumatology criteria, attending French spa resorts as outpatients between June 2006 and April 2007. Zelen randomisation was used so patients were ignorant of the other group and spa personnel were not told which patients were participating. The main endpoint criteria were patient self-assessed. All patients continued usual treatments and performed daily standardised home exercises. The spa therapy group also received 18 days of spa therapy (massages, showers, mud and pool sessions).

Main Endpoint The number of patients achieving minimal clinically important improvement (MCII) at 6 months, defined as ≥19.9 mm on the visual analogue pain scale and/or ≥9.1 points in a normalised Western Ontario and McMaster Universities osteoarthritis index function score and no knee surgery.

Results The intention to treat analysis included 187 controls and 195 spa therapy patients. At 6 months, 99/195 (50.8%) spa group patients had MCII and 68/187 (36.4%) controls (χ2=8.05; df=1; p=0.005). However, no improvement in quality of life (Short Form 36) or patient acceptable symptom state was observed at 6 months.

Conclusion For patients with knee osteoarthritis a 3-week course of spa therapy together with home exercises and usual pharmacological treatments offers benefit after 6 months compared with exercises and usual treatment alone, and is well tolerated.

Trial registration number NCT00348777.

This paper is freely available online under the BMJ Journals unlocked scheme, see

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Supplementary materials


  • Funding This study was funded by the French Society for Spa Research (Association Française pour la Recherche Thermale, AFRETH) a non-profit organisation, the Rhone-Alpes Regional Council and the County Council of Savoie.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ethics Committee Lyon A, Lyon, France.

  • Provenance and peer review Not commissioned; externally peer reviewed.