1. Innovation in balneotherapy – challenge of new target diseases and conditions National Institute of Rheumatology and Physiotherapy, Budapest, Hungary National Institute of Rheumatology and Physiotherapy, Budapest, Hungary László Hodinka and Ildikó Tefner

3. Traditional balneotherapy is usually disease orienteddisease oriented applying mostly conventional treatment modalities and combinationsapplying mostly conventional treatment modalities and combinations based on community groupsbased on community groups advertising effectivity more empirically than evidence- basedadvertising effectivity more empirically than evidence- based Using more damage-specific, less functional and psychosocial evidencesUsing more damage-specific, less functional and psychosocial evidences

4. Things for consideration Phisical medicine tools - including balneotherapy - rarely have specific but produce mostly of symptomatic or physiological effects (as used for ill or healthy persons). Clients of physical medicine tools represent a continuum of people with symptoms, or discomfort or intending to prevent something or simply improving the quality of their life. Pysical medicine tools also represent a continuum –from medicinal use to spa and wellnes –from approved to hypothetic –from usual triggers e.g. (thermomineral waters) to unusual ones (light, colours, touch schents, sounds etc.) Approved methods have also placebo effects and alternative tools may produce objective (e.g. mental or QoL) changes. Combination of tools are more effective than single use.

6. Challenge for traditional balneotherapy Recently people (ill and healthy) prefer –an action targeted to their specific needs an individual programmean individual programme –a combination of different triggers –an attractive and prestigious surrounding and climate –a short and effective package

8. Search for new applications Keyword „balneotherapy”: 1725 abstracts in English Excluded primary targets: rheumatic diseases pulmonary diseases dermatologyurologygynecology cerebrovascular conditions cardiovascular conditions metabolic conditions Analyzed: 7 pulications

9. PublicationDiseaseTreatmentControlTargetIndicatorChange Psychiatry R. Rastelli et al 1985 anxiety syndromes balneoth. 3 WK yes, without balneoth. anxiety, somatisation, drug need Zung and Crown quest. Improvement in treated Strauss-Blasche et al 2000 pain and discomfort balneoth.gymn. education 3 wk no General well-being pain, mood, fatigue Improvement in younger Yokota et al 1997 Psychiatric complicatious of bronchial festhma balneoth., inhalation swimming, mud pack no depression, motivation, frustration CMI (Cornell, Med Ind), SDS (Self-r Depr Sc.) CAI (Compr.Asthma Inst.) improvement in psychosocial scales Kamioka et al 2003 Psychologial tension balneoth. ow/3 mo. exercise, education yes, without balneoth. anxyety, tension Questionnaire on stress Improvement in treated Kamioka et al 2004 Depression and vigorousness balneoth. ow/ 6 mo. exercise education yes, without balneoth. Depression vigorousness BDI, self rated qu vest Improvement in treated Neurology Brefel-Courbon et al 2003 Parkinson's disease spa.th (?) yes, crossover QoL motor function, psychic state, direct costs PDQ, SF-36 UPDR Scale GHQ-28 Improvement short term, lower costs Oncology Strauss-Blasche Breast cancer postoperative CO 2 bath, mud pack, exercise lymph dr. psych/relax no QoL, anxiety, depression, CA 15-3 tumor marker EORTC QLQ-C30 HADS laboratory QoL, mood, tumor marker improved

10. Attempt to identify target oriented modalities for balneotherapy alone or in combination CO2pain/spasticityanxiety/panicdepression/fatiguefunctions/self-esteem thermomineral+ + + + hydrotherapy + ? ??+ turkish bath/hammum + ? + ? mud, oil, plant, etc., packs +??+ aromatics ? + ? light/colour?++? sound?++? gymnastics and kinesis + ? + + massages+??+ location/climate?+++ Not evaluated and not recommended: soft laser, polarized light, magnetic field, acupuncture, reflexology, homeopathy, bioresonance, ayurveda, neural therapy

11. Comments on new target balneotherapy applications Weaknesses ( of some protocols): Unclear target definition Traditional treatment panels, short term trial settings. Little effort to identify the supposed effective factors The effects of balneotherapy cannot be investigated independently from the other physical medicine components, lack of adequate controls Strength Intention of objectivity, use of validated measures

12. Conclusion and suggestions Symptoms caused by somatic and psychic interactions (pain, anxiety, depression) seem to be promising targets for balneotherapy. It is advisable to investigate the effects of balneotherapy combined with different other triggers in the above conditions. Development and use of objective indicators in recommended