Hydrotherapy, Balneotherapy - Index Of Alternative Therapies And Modalities - Complementary & Alternative Medicine

Anorectal lesions (hemorrhoids, anal fissures)

There is early evidence that sitz baths may help relieve symptoms of anorectal conditions, although research is not definitive. Sitz baths are often available in hospitals.

Arthritis

Hydrotherapy is traditionally used to treat symptoms of rheumatoid arthritis and osteoarthritis. There is evidence that hydrotherapy may reduce pain and increase functional activity. Several studies have been published, but because of design flaws, the benefits remain unclear.

Atopic dermatitis

Research is limited, and no clear conclusions can be drawn.

Blood flow in patients with post-traumatic gonarthritis

Early studies suggest a potential benefit for hydrotherapy in this condition; more studies are needed.

Bluebottle stings

Early studies suggest a potential benefit for hydrotherapy in bluebottle stings; more studies are needed.

Bone density in menopause

There is preliminary evidence suggesting that aquatic exercises, like other forms of weight-bearing exercises, may help increase bone mass.

Bronchial asthma

Early studies in children with mild asthma suggest a potential benefit of hydrotherapy; more studies are needed.

Burns

Research is limited, and no clear conclusions can be drawn.

Chronic obstructive pulmonary disease (COPD)

It is not clear if deep breathing exercises in heated pools are beneficial in people with COPD. There is evidence that suggests water training may improve overall physical fitness, but additional research is needed to confirm these results.

Chronic venous insufficiency

Hydrotherapy is used in Europe for chronic venous insufficiency, a syndrome that may include leg swelling, varicose veins, leg pain, itching and skin ulcers. A few studies report benefits of leg stimulation with cold water alone, or in combination with warm water. However, this research is only preliminary, and additional study is necessary to make a firm conclusion.

Claudication (painful legs from clogged arteries)

Research is limited, and no clear conclusions can be drawn.

Common cold

Research is limited, and no clear conclusions can be drawn.

Craniocerebral trauma

Early studies do not show a benefit of hydrotherapy in this condition.

Delayed-onset muscle soreness

Early studies do not show a benefit of hydrotherapy in this condition.

Diabetes mellitus

Research is limited, and no clear conclusions can be drawn.

Endurance performance

Early studies in athletes suggest a potential benefit of hydrotherapy in endurance running performance; more studies are needed.

Fibromyalgia

Research results are mixed. Further well-designed trials are needed to make a recommendation.

Heart failure

Study results are mixed in this area. For example, one randomized controlled trial suggests repeated sauna treatment may reduce the risk of arrhythmias. Another randomized trial suggests this therapy may improve heart failure-related symptoms and heart rate response to exercise. However, some studies report no benefits. Further well-designed research is needed before firm conclusions can be drawn.

High cholesterol

One randomized controlled trial suggests that repeated sauna therapy may protect against oxidative stress, which leads to the prevention of atherosclerosis. Further research is needed before firm conclusions can be made.

Hyperthermia

Early studies did not find clear evidence of a benefit in this condition; more studies are needed.

Insomnia

Preliminary study of hydrotherapy for insomnia shows inconclusive results.

Knee rehabilitation

Limited research is available. Further study is needed to make a conclusion.

Labial edema during pregnancy

Limited research is available. Further studies are needed.

Labor, childbirth

There is preliminary research examining whether giving birth in water reduces labor pain, the duration of labor, perineal damage to the mother and birth complications. However, this research is not reliable enough to form clear conclusions about safety or benefits.

Low back pain

Several small studies in humans report that regular use of hot whirlpool baths with massaging jets reduces the duration and severity of back pain when used with standard medical care. Additional research is needed to make a strong conclusion.

Neonatal hypothermia

Early studies did not find clear evidence of a benefit in this condition; more studies are needed.

Pain

Hydrotherapy has been studied for various types of pain, with inconclusive results.

Pelvic inflammatory disease

Research is limited, and no clear conclusions can be drawn.

Photodynamic therapy side effects

Early studies suggest a potential benefit of hydrotherapy in treatment of the inflammation that results from photodynamic therapy; more studies are needed.

Pressure ulcers, wound care

Research is limited, and no clear conclusions can be drawn.

Psoriasis

Evidence regarding hydrotherapy for psoriasis is varied. There is not enough research available to make a recommendation.

Quality of life (ankylosing spondylitis, rheumatoid arthritis, fibromyalgia)

Early human studies and anecdotal evidence suggest that hydrotherapy may improve measures of quality of life in a variety of conditions; more studies are needed.

Rhinogenous deafness

Early studies suggest a potential benefit of hydrotherapy in the prevention of rhinogenous deafness; more studies are needed.

Skin bacteria

There is not enough research to determine if hydrotherapy reduces bacteria on the skin, or if hydrotherapy offers any benefit.

Spinal muscular atrophy

There is not enough research available to make a recommendation.

Varicose veins

There is not enough research available to make a recommendation.

Hydrotherapy has been suggested for many uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using hydrotherapy for any use.

Acute tubular necrosis (a kidney disorder)
Allergies
Angina pectoris (chest pain)
Animal bites
Anxiety
Arthrosis of hand and finger joints
Ascites (abdominal fluid)
Attention-deficit hyperactivity disorder
Back muscle strengthening
Balance disorders
Bladder infection
Blood clot prevention
Blood detoxification
Body tone
Bowel movement disorders
Bronchitis
Cancer
Candidiasis (a fungal disease)
Catarrh in nose and throat
Childhood diseases
Chronic pain
Colitis
Complex regional pain syndrome
Constipation
Contusions
Cough
Coxarthritis
Cramps
Crohn's disease
Crural paralysis
Cystitis
Dental surgery
Depression
Digestion disorders
Ear infection (otitis media)
Eczema
Edema
End-stage peripheral artery disease
Enhanced blood flow
Enhanced energy level
Enhanced mucus production
Enhanced sleep
Epidermolysis
Fatigue
Fever
Flu
Food poisoning
Fractures
Gallbladder disorders
Gastric acid reduction
Gastric and duodenal ulcers
Glomerulonephritis
Headache
Heart disease
Herpes zoster
High blood pressure
Hormonal disorders
Huntington's disease
Immune system stimulation
Improved body tone
Improved bowel function
Inflammation

Insect bites
Intellectual disabilities
Kidney infection (pyelonephritis)
Kidney stones
Laryngitis
Legionnaires disease
Leukemia
Levator ani syndrome
Liver disorders
Low blood pressure
Lung diseases
Lymphatic disorders
Menopause
Menstrual cramps
Mental outlook
Meteorism
Mucositis
Multiple sclerosis
Muscular rheumatism
Muscle atrophy
Musculoskeletal injuries
Neurologic disorders
Paralysis
Parasitic infections
Peptic ulcer disease
Peripheral blood flow
Peripheral edema (leg swelling from fluid accumulation)
Peripheral neuropathy
Peritonitis (abdominal wall irritation)
Phlebitis polios
Pleurisy (a lung disorder)
Pneumonia with pleural effusion
Polio
Postoperative recovery
Pregnancy
Premenstrual syndrome
Prostatitis
Prostate swelling
Psychiatric disorders
Rash
Relaxation
Rett's syndrome
Sciatica
Scleroderma
Sepsis
Sinus pain
Sjogren sydrome
Soft tissue injuries
Sore throat
Sprains
Stiff muscles
Stone formation
Stress
Sweaty feet
Tinnitus
Tired eyes
Toothache
Trigeminal neuralgia (a nerve disorder)
Tuberculosis
Urinary tract infection
Vaginitis
Viral infections
Vocal cord disorders
Well-being

The safety of some hydrotherapy techniques is not well studied.

Sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas or other types of hydrotherapy should be avoided, particularly by patients with heart disease or lung disease or by pregnant women. Warm temperatures can lead to dehydration or low blood sodium levels, and hydration and electrolyte intake should be maintained. Cold temperatures may worsen symptoms in people with circulatory disorders, such as acrocyanosis, chilblains, erythrocyanosis or Raynaud's disease.

Water temperature should be carefully monitored, particularly for patients with temperature-sensitivity disorders, such as neuropathy. People with implanted medical devices such as pacemakers, defibrillators or liver infusion pumps should avoid high temperatures or therapies that involve electrical currents.

Contact with contaminants or additives in water (such as essential oils or chlorine) can irritate the skin. Skin infections may occur if water is not sanitary, particularly in patients with open wounds. There are several reported cases of dermatitis and bacterial skin infections after hot tub or whirlpool use.

People with fractures, blood clots, bleeding disorders, severe osteoporosis or open wounds and pregnant women should avoid vigorous therapy with water jets in. Although water births are popular, safety is not well studied. The effects of prolonged labor in hot or cold water are not known.

Hydrotherapy should not delay the time it takes to see a health care provider for diagnosis or treatment with more proven techniques or therapies. And hydrotherapy should not be used as the sole approach to illness. Consult with your primary health care provider before starting hydrotherapy.

There are many hydrotherapy techniques used for a wide variety of health conditions. Early evidence suggests that regular use of hot whirlpool baths with massaging jets improves the duration and severity of low back pain. Additional research is necessary to make a strong recommendation. There is no conclusive evidence for any other condition.

Prolonged treatments, particularly in extreme temperatures, should be avoided. Skin irritation or bacterial infections may result from additives or contaminants in the water. People with fractures, blood clots, bleeding disorders, severe osteoporosis or open wounds and pregnant women should avoid vigorous therapy with water jets. Although water births are popular, safety has not been well studied. Hydrotherapy should not be used as the sole approach to any illness. Consult with your primary health care provider before starting hydrotherapy.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research

Natural Standard has reviewed all of the currently available medical literature to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

Altan L, Bingol U, Aslan M, et al. The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol 2006; Jul-Aug, 35(4):283-289.
Altan L, Bingol U, Aykac M, et al. Investigation of the effects of pool-based exercise on fibromyalgia syndrome. Rheumatol Int 2003;Sep 24.
Ay A, Yurtkuran M. Influence of aquatic and weight-bearing exercises on quantitative ultrasound variables in postmenopausal women. Am J Phys Med Rehabil 2005;84(1):52-61.
Balint GP, Buchanan WW, Adam A, et al. The effect of the thermal mineral water of Nagybaracska on patients with knee joint osteoarthritis: a double blind study. Clin Rheumatol 2007;Jun, 26(6):890-894.
Barsevick A, Llewellyn J. A comparison of the anxiety-reducing potential of two techniques of bathing. Nurs Res 1982;Jan-Feb, 31(1):22-27.
Beamon S, Falkenbach A, Jobst K. Hydrotherapy for asthma. Cochrane Database Syst Rev 2001;(2):CD001741.
Benfield RD. Hydrotherapy in labor. J Nurs Scholarsh 2002;34(4):347-352.
Bergstram A, Byaruhanga R, Okong P. The impact of newborn bathing on the prevalence of neonatal hypothermia in Uganda: a randomized, controlled trial. Acta Paediatr 2005;Oct, 94(10):1462-1467.
Blazickova S, Rovensky J, Koska J, et al. Effect of hyperthermic water bath on parameters of cellular immunity. Int J Clin Pharmacol Res 200;20(1-2):41-46.
Bodner K, Bodner-Adler B, Wierrani F, et al. Effects of water birth on maternal and neonatal outcomes. Wien Klin Wochenschr 2002;Jun 14, 114(10-11):391-395.
Brucker MC. Management of the third stage of labor: an evidence-based approach. J Midwifery Womens Health 2001;Nov-Dec, 46(6):381-392.
Buman G, Uyanik M, Yilmaz I, et al. Hydrotherapy for Rett syndrome. J Rehabil Med 2003;Jan, 35(1):44-45.
Buskila D, Abu-Shakra M, Neumann L, et al. Balneotherapy for fibromyalgia at the Dead Sea. Rheumot Intl 2001;Apr, 20(3):105-108.
Cantarini L, Leo G, Giannitti C, et al. Therapeutic effect of spa therapy and short wave therapy in knee osteoarthritis: a randomized, single blind, controlled trial. Rheumatol Int 2007;Apr, 27(6):523-529.
Cider A, Schaufelberger M, Sunnerhagen KS, et al. Hydrotherapy: a new approach to improve function in the older patient with chronic heart failure. Eur J Heart Fail 2003;Aug, 5(4):527-535.
Coccheri S, Nappi G, Valenti M, et al. Changes in the use of health resources by patients with chronic phlebopathies after thermal hydrotherapy: report from the Naiade project, a nation-wide survey on thermal therapies in Italy. Int Angiol 2002;Jun, 21(2):196-200.
Cohen AD, Van-Dijk D, Naggan L, et al. Effectiveness of climatotherapy at the Dead Sea for psoriasis vulgaris: a community-oriented study introducing the 'Beer Sheva Psoriasis Severity Score'. J Dermatolog Treat 2005;16(5-6):308-313.
Crevenna R, Schneider B, Mittermaier C, et al. Implementation of the Vienna hydrotherapy group for laryngectomees: a pilot study. Support Care Cancer 2003;Nov, 11(11):735-738. Epub 2003;Sep 13.
da Silva FM, de Oliveira SM. The effect of immersion baths on the length of childbirth labor . Rev Esc Enferm USP 2006;Mar, 40(1):57-63.
DiPasquale LR, Lynett K. The use of water immersion for treatment of massive labial edema during pregnancy. MCN Am J Matern Child Nurs 2003;Jul-Aug, 28(4):242-245.
Driver S, Rees K, O'Connor J, et al. Aquatics, health-promoting self-care behaviours and adults with brain injuries. Brain Inj 2006;Feb, 20(2):133-141.
Eckert K, Turnbull D, MacLennan A. Immersion in water in the first stage of labor: a randomized controlled trial. Birth 2001;28(2):84-93.
Ekmekcioglu C, Strauss-Blasche G, Holzer F, et al. Effect of sulfur baths on antioxidative defense systems, peroxide concentrations and lipid levels in patients with degenerative osteoarthritis. Forsch Komplementarmed Klass Naturheilkd 2002;Aug, (4):216-220.
Eksioglu E, Yazar D, Bal A, et al. Effects of Stanger bath therapy on fibromyalgia. Clin Rheumatol 2007;May, 26(5):691-694.
Embil JM, McLeod JA, Al Barrak AM, et al. An outbreak of methicillin resistant Staphylococcus aureus on a burn unit: potential role of contaminated hydrotherapy equipment. Burns 2001;27(7):681-688.
Erler K, Anders C, Fehlberg G, et al. [Objective assessment of results of special hydrotherapy in inpatient rehabilitation following knee prosthesis implantation]. Z Orthop Ihre Grenzgeb 2001;Jul-Aug, 139(4):352-358.
Evcik D, Kizilay B, Gokcen E. The effects of balneotherapy on fibromyalgia patients. Rheumatol Int 2002;Jun, 22(2):56-59.
Evcik D, Kavuncu V, Yeter A, et al. The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. Joint Bone Spine 2007;Jan, 74(1):60-65.
Eversden L, Maggs F, Nightingale P, et al. A pragmatic randomised controlled trial of hydrotherapy and land exercises on overall well being and quality of life in rheumatoid arthritis. BMC Musculoskelet Disord 2007;Mar 1, 8:23. Comment in: Aust J Physiother 2007;53(2):130.
Foley A, Halbert J, Hewitt T, et al. Does hydrotherapy improve strength and physical function in patients with osteoarthritis: a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. Ann Rheum Dis 2003;Dec, 62(12):1162-1167.
Forestier R, Franason A, Saint Arroman F, et al. Are SPA therapy and pulsed electromagnetic field therapy effective for chronic neck pain? Randomised clinical trial: second part. Medicoeconomic approach Ann Readapt Med Phys 2007;Apr, 50(3):148-153.
Forestier R, Franason A, Saint-Arromand F, et al. Are SPA therapy and pulsed electromagnetic field therapy effective for chronic neck pain? Randomised clinical trial First part: clinical evaluation Ann Readapt Med Phys 2007;Apr, 50(3):140-147.
Fransen M, Nairn L, Winstanley J, et al. Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Rheum 2007;Apr 15, 57(3):407-414.
Giesbrecht GG, Jamieson C, Cahill F. Cooling hyperthermic firefighters by immersing forearms and hands in 10 degrees C and 20 degrees C water. Aviat Space Environ Med 2007;Jun, 78(6):561-567.
Goldman MP, Merial-Kieny C, Nocera T, et al. Comparative benefit of two thermal spring waters after photodynamic therapy procedure. J Cosmet Dermatol 2007;Mar, 6(1):31-35.
Gusi N, Tomas-Carus P, Hakkinen A, et al. Exercise in waist-high warm water decreases pain and improves health-related quality of life and strength in the lower extremities in women with fibromyalgia. Arthritis Rheum 2006;Feb 15, 55(1):66-73. Comment in: Aust J Physiother 2007;53(1):64.
Gotz HM, Tegnell A, De Jong B, et al. A whirlpool associated outbreak of Pontiac fever at a hotel in Northern Sweden. Epidemiol Infect 2001;Apr, 126(2):241-247.
Green JJ. Localized whirlpool folliculitis in a football player. Cutis 2000;Jun, 65(6):359-362.
Gupta P. Randomized, controlled study comparing sitz-bath and no-sitz-bath treatments in patients with acute anal fissures. ANZ J Surg 2006;Aug, 76(8):718-721.
Haskes PJ. Beneficial effect of climatic therapy on inflammatory arthritis at Tiberias Hot Springs. Scand J Rheumatol 2002;31(3):172-177.
Inston N, Lake S. Pneumoperitoneum following Jacuzzi usage. Ann R Coll Surg Engl 2000;Sep, 82(5):350-351.
Kihara T, Biro S, Ikeda Y, et al. Effects of repeated sauna treatment on ventricular arrhythmias in patients with chronic heart failure. Circ J 2004;68(12):1146-1151.
Kovacs I, Bender T. The therapeutic effects of Cserkeszolo thermal water in osteoarthritis of the knee: a do Kniazeva TA, Trukhacheva NV, Elizarov NA. Reparative effect of siliceous baths and their combination with laser and magnet therapies for trophic ulcers of venous etiology. Vopr Kurortol Fizioter Lech Fiz Kult 2007;Jan-Feb, (1):14-19.
Li DK, Janevic T, Odouli R, Lui L. Hot tub use during pregnancy and the risk of miscarriage. Am J Epidemiol 2003;Nov 15, 158(10):931-937.
Loten C, Stokes B, Worsley D, et al. A randomised controlled trial of hot water (45 degrees C) immersion versus ice packs for pain relief in bluebottle stings. Med J Aust 2006;Apr 3, 184(7):329-333.
Malarewicz A, Wydrzynski G, Szymkiewicz J, et al. The influence of water immersion on the course of first stage of parturition in primiparous women. Med Wieku Rozwoj 2005;Oct-Dec, 9(4):773-780.
Mancini S Jr, Piccinetti A, Nappi G, et al. Clinical, functional and quality of life changes after balneokinesis with sulphurous water in patients with varicose veins. Vasa 2003;Feb, 32(1):26-30.
Masuda A, Miyata M, Kihara T, et al. Repeated sauna therapy reduces urinary 8-epi-prostaglandin F (2alpha). Jpn Heart J 2004;45(2):297-303.
Meldrum R. Survey of Staphylococcus aureus contamination in a hospital's spa and hydrotherapy pools. Commun Dis Public Health 2001;4(3):205-208.
Michalsen A, Ludtke R, Buhring M, Spahn G, et al. Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure. Am Heart J 2003;Oct, 146(4):E11.
Miller MS. Pharmacotherapy as adjunctive treatment for serious foot wounds in the patient with diabetes: a case study. Ostomy Wound Manage 2003;Apr, 49(4):52-55.
Moliavchikova OV, Cherevashchenko LA, Grinzaa�d IuM, et al. Effects of combined action of radon baths and transcranial magnetotherapy on cerebral circulation in patients in an intermediate period of a mild craniocerebral trauma. Vopr Kurortol Fizioter Lech Fiz Kult 2007;May-Jun, (3):19-22.
Moore JE, Heaney N, Millar BC, et al. Incidence of Pseudomonas aeruginosa in recreational and hydrotherapy pools. Commun Dis Public Health 2002;Mar, 5(1):23-26.
Nagai T, Sobajima H, Iwasa M, et al. Neonatal sudden death due to Legionella pneumonia associated with water birth in a domestic spa bath. J Clin Microbiol 2003;May, 41(5):2227-2229.
Nagiev IuK, Davydova OB, Zhavoronkova EA, et al. Effects of underwater massage douche on left ventricular diastolic function in patients with chronic cardiac failure and postinfarction cardiosclerosis. Vopr Kurortol Fizioter Lech Fiz Kult 2002;Jul-Aug, (4):11-15.
Neumann L, Sukenik S, Bolotin A, et al. The effect of balneotherapy at the Dead Sea on the quality of life of patients with fibromyalgia syndrome. Clin Rheumatol 2001;20(1):15-19.
Nikonorov MV, Boriak VP. Updated assessment of efficacy of dry air radon baths of different concentrations at the stage of medical rehabilitation of patients with bronchial asthma Vopr Kurortol Fizioter Lech Fiz Kult 2006;Jul-Aug, (4):15-18.
Nikodem VC. Immersion in water in pregnancy, labour and birth. Cochrane Database Syst Rev 2000;(2):CD000111.
Pittler MH, Karagalle MZ, Karagalle M, et al. Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials. Rheumatology (Oxford) 2006;Jul, 45(7):880-884.
Raspopova EA, Udartsev EIu. Effects of therapeutic complexes including balneoradonokinesitherapy, electromyostimulation and low-frequency magnetotherapy on regional blood flow in patients with postrraumatic gonarthritis. Vopr Kurortol Fizioter Lech Fiz Kult 2006;Sep-Oct, (5):14-16.
Schiener R, Brockow T, Franke A, et al. Bath PUVA and saltwater baths followed by UV-B phototherapy as treatments for psoriasis: a randomized controlled trial. Arch Dermatol 2007;May, 143(5):586-596. Comment in: Arch Dermatol 2007;May, 143(5):647-175192189.
Scoon GS, Hopkins WG, Mayhew S, et al. Effect of post-exercise sauna bathing on the endurance performance of competitive male runners. J Sci Med Sport 2007;Aug, 10(4):259-262.
Shutov AA, Panasiuk IIa. Efficacy of rehabilitation of patients with chronic primary low back pain at the spa Klyuchi using balneopelotherapy and transcranial electrostimulation. Vopr Kurortol Fizioter Lech Fiz Kult 2007;Mar-Apr, (2):16-18.
Sokolova MIu, Ivanova NA, Shabalov NP. Optimal therapy of children with bronchial asthma at Pyatigorsk spa. Vopr Kurortol Fizioter Lech Fiz Kult 2007;May-Jun, (3):8-12.
Stener-Victorin E, Kruse-Smidje C, Jung K. Comparison between electro-acupuncture and hydrotherapy, both in combination with patient education and patient education alone, on the symptomatic treatment of osteoarthritis of the hip. Clin J Pain 2004;20(3):179-185.
Tozzi A, Blancasio AC, Basagni C, et al. Prevention and cure of rhinogenous deafness at the Thermal Baths "Bagni delle Galleraie". J Prev Med Hyg 2006;Dec, 47(4):146-150.
Sellwood KL, Brukner P, Williams D, et al. Ice-water immersion and delayed-onset muscle soreness: a randomised controlled trial. Br J Sports Med 2007;Jun, 41(6):392-397.
Verhagen AP, de Vet HC, de Bie RA, et al. Balneotherapy for rheumatoid arthritis and osteoarthritis. Cochrane Database Syst Rev 2000;(2):CD000518.
Vitorino DF, Carvalho LB, Prado GF. Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: randomized clinical trial. Sleep Med 2006;Apr, 7(3):293-296.
Wadell K, Sundelin G, Henriksson-Larsen K, et al. High intensity physical group training in water�an effective training modality for patients with COPD. Respir Med 2004;98(5):428-438.
Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev 2007;Apr 18, (2):CD004985. Update of: Cochrane Database Syst Rev 2006;(2):CD004985.
Winthrop KL, Abrams M, Yakrus M, et al. An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. N Engl J Med 2002;May 2, 346(18):1366-1371.
Yilmaz B, Goktepe SAS, Alaca R, et al. Comparison of a generic and a disease specific quality of life scale to assess a comprehensive spa therapy program for knee osteoarthritis. Joint Bone Spine 2004;71(6):563-566.