Cost-effectiveness of Spa treatment for fibromyalgia: general health improvement is not for free

Objectives: To estimate the cost-effectiveness of an adjuvant treatment course of spa treatment compared with usual care only in patients with fibromyalgia syndrome (FM). - \ud Methods: 134 patients with FM, selected from a rheumatology outpatient department and from members of the Dutch FM patient association were randomly assigned to a 2½ week spa treatment course in Tunisia or to usual care only. Results are expressed as quality-adjusted life years (QALYs) for a 6-month as well as a 12-month time horizon. Utilities were derived form the Short Form 6D (SF-6D) scores and the visual analogue scale (VAS) rating general health. Costs were reported from societal perspective. Mean incremental cost per patient and the incremental cost utility ratio (ICER) were calculated; 95% confidence intervals (CIs) were estimated using double-sided bootstrapping. -\ud Results: The data of 128 (55 spa and 73 controls) of the 134 patients (96%) could be used for analysis. Improvement in general health was found in the spa group until 6 months of follow-up by both the SF-6D (AUC 0.32 vs 0.30, P<0.05) and the VAS (AUC 0.23 vs 0.19, P<0.01). After 1yr no significant between-group differences were found. Mean incremental cost of spa treatment was E1311 per patient (95% CI 369–2439), equalling the cost of the intervention (thalassotherapy including airfare and lodging), or E885 per patient based on a more realistic cost estimate. -\ud Conclusions: The temporary improvement in quality of life due to an adjuvant treatment course of spa therapy for patients with FM is associated with limited incremental costs per patient

A Standard Operating Procedure Video for Dauni Spa and Beauty House to Standardize Its Therapists' Service Qualities

Dauni Spa, the company where I did my internship, provides spa treatment, sauna, and salon service. During my internship at Dauni Spa, I found there are various practices of massage techniques performed by the therapists that lead to inconsistency in the service qualities. This problem certainly resulted in unsatisfactory treatment because the customers would not be satisfied to receive inconsistent service quality. Aside from this problem, many newly-recruited therapists did not know the standard procedures of massage in Dauni Spa while they needed to start working very soon. Therefore, I intend to make a standard operating procedure (SOP) video as a solution to the problems. For the newly recruited therapists, the SOP video can give effective and efficient instructions of the standard procedures in Dauni Spa. For the old therapists, this video works as a standard service quality that should be put into practice by all therapists. The basic content of this video is the procedures of the massage and a little background information about Dauni Spa. From this video, there are some benefits that Dauni Spa can get. It can complete the written SOP that they have, cut down the cost of a trainer, and bring a good impact to the customers' satisfaction

Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force

Background: Therapeutic targets have been defined for diseases like diabetes, hypertension or rheumatoid arthritis and adhering to them has improved outcomes. Such targets are just emerging for spondyloarthritis (SpA). Objective: To define the treatment target for SpA including ankylosing spondylitis and psoriatic arthritis (PsA) and develop recommendations for achieving the target, including a treat-to-target management strategy. Methods: Based on results of a systematic literature review and expert opinion, a task force of expert physicians and patients developed recommendations which were broadly discussed and voted upon in a Delphi-like process. Level of evidence, grade and strength of the recommendations were derived by respective means. The commonalities between axial SpA, peripheral SpA and PsA were discussed in detail. Results: Although the literature review did not reveal trials comparing a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated the development of recommendations. The group agreed on 5 overarching principles and 11 recommendations; 9 of these recommendations related commonly to the whole spectrum of SpA and PsA, and only 2 were designed separately for axial SpA, peripheral SpA and PsA. The main treatment target, which should be based on a shared decision with the patient, was defined as remission, with the alternative target of low disease activity. Follow-up examinations at regular intervals that depend on the patient's status should safeguard the evolution of disease activity towards the targeted goal. Additional recommendations relate to extra-articular and extramusculoskeletal aspects and other important factors, such as comorbidity. While the level of evidence was generally quite low, the mean strength of recommendation was 9-10 (10: maximum agreement) for all recommendations. A research agenda was formulated. Conclusions: The task force defined the treatment target as remission or, alternatively, low disease activity, being aware that the evidence base is not strong and needs to be expanded by future research. These recommendations can inform the various stakeholders about expert opinion that aims for reaching optimal outcomes of SpA

Appropriateness and efficacy of Spa therapy for musculoskeletal disorders. A Delphi method consensus initiative among experts in Italy.

OBJECTIVE: The aim of the study was to identify the main aspects concerning appropriateness and efficacy of Spa therapy for musculoskeletal pathologies. METHODS: A committee of 8 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Clinicians from Italian medical centers specialized in rheumatology, rehabilitation and thermal medicine took part in a Delphi process aimed at obtaining consensus statements among the participants. RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; choice of treatment modality and treatment efficacy. CONCLUSIONS: The experts developed a number of consensus statements which may be used as a practical reference to guide the choice of physicians to treat musculoskeletal diseases with Spa therapy

Understanding the concept of muslimah spa among the workers of spa at bandar Puncak Alam / Azizah Mohd Zan

Muslim spa is a spa that adheres to Islamic shariah. Another term for spa is the beautification industry, beauty center, wellness and care spa and Islamic spa practices. Spa is the form or term from Latin which is “Solus Per Aqua” that means healing with water in Latin and that the concept of treatment. Issues that arise in the beauty industry are often consumer doubts in the use of products in spa treatments. Issues related to care genitalia also applies when receiving treatment at the spa. Muslim spas are created for Islamic consumers of Islam and especially for women. Women and beauty are inseparable. Therefore, this study is designed to explain the concept of Muslim spa in terms of treatment offered and the types of spa. Among the treatments provided at the spa are generally massage, body bathing, body scrub, sauna, facial and hair treatment. The spa also has many types, including hotel spa, medical spa, and day spa. In addition, this study also examines the elements involved in spa activities such as the use of halal products, genital care and the treatment activities involved. This study is focused on a Muslim spa in the Puncak Alam area. The purpose of this study is to gain an understanding of the concept of the Muslim spa in Puncak Alam area. Explanations are supported by previous studies and several articles of relevance. Then the researcher used the arguments from the Qur'anic verse as supporting arguments. This research use the qualitative methodology which is based on interviews and internet search. Most Muslim women in Malaysia will seek Muslim spas for beauty and health care as they keep their genitals closed while receiving treatment

Spondyloarthritis: Matrix Metalloproteinasesas Biomarkers of Pathogenesis and Response to Tumor Necrosis Factor (TNF) Inhibitors

The term spondyloarthritis (SpA) is used to describe a group of multifactorial chronic inflammatory diseases characterized by a predisposing genetic background and clinical manifestations typically involving the sacroiliac joint. The absence of pathognomonic clinical and/or laboratory findings generally results in a delay in diagnosis and, consequently, in treatment. In addition, 20-40% of SpA patients are non-responders to tumor necrosis factor (TNF) inhibitor therapies. Given these considerations, it is important to identify biomarkers that can facilitate the diagnosis and assessment of disease activity. As inflammation plays a key role in the pathogenesis of SpA, inflammatory mediators have been investigated as potential biomarkers for diagnosing the disease and predicting response to therapy. Some investigators have focused their attention on the role of matrix metalloproteinases (MMPs), which are known to be markers of synovial inflammation that is generated in the joint in reaction to inflammatory stimuli. Several studies have been carried out to verify if serum MMPs levels could be useful to diagnose SpA, to assess disease severity, and to predict response to TNF inhibitor therapy. The current review focuses on MMPs' role in SpA pathogenesis, diagnosis and therapeutic implications

Randomized controlled trial of adalimumab in patients with nonpsoriatic peripheral spondyloarthritis

Objective. To evaluate the efficacy and safety of adalimumab in patients with active nonpsoriatic peripheral spondyloarthritis (SpA). Methods. ABILITY-2 is an ongoing phase III, multicenter study of adalimumab treatment. Eligible patients age 18 years fulfilled the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for peripheral SpA, did not have a prior diagnosis of psoriasis, psoriatic arthritis (PsA), or ankylosing spondylitis (AS), and had an inadequate response or intolerance to nonsteroidal antiinflammatory drugs (NSAIDs). Patients were randomized 1:1 to receive adalimumab 40 mg every other week or matching placebo for 12 weeks, followed by a 144-week open-label period. The primary end point was the proportion of patients achieving 40% improvement in disease activity according to the Peripheral SpA Response Criteria (PSpARC40) at week 12. This was defined as 40% improvement from baseline (20-mm absolute improvement on a visual analog scale) in patient's global assessments of disease activity and pain, and 40% improvement in at least one of the following features: swollen joint and tender joint counts, total enthesitis count, or dactylitis count. Adverse events were recorded throughout the study. Results. In total, 165 patients were randomized to a treatment group, of whom 81 were randomized to receive placebo and 84 to receive adalimumab. Baseline demographics and disease characteristics were generally similar between the 2 groups. At week 12, a greater proportion of patients receiving adalimumab achieved a PSpARC40 response compared to patients receiving placebo (39% versus 20%; P = 0.006). Overall, improvement in other outcomes was greater in the adalimumab group compared to the placebo group. The rates of adverse events were similar in both treatment groups. Conclusion. Treatment with adalimumab ameliorated the signs and symptoms of disease and improved physical function in patients with active nonpsoriatic peripheral SpA who exhibited an inadequate response or intolerance to NSAIDs, with a safety profile consistent with that observed in patients with AS, PsA, or other immune-mediated diseases

Analyzing The Effect Of Increasing Growth And Motoric Development Of Infants Aged 6-11 Months Who Are At Risk Of Stunting With Baby Spa Treatment

Optimal growth and development of baby can be carried out by stimulation. Stimulation can be given through active tactile stimulation to baby, one of which is with massage, solus per aqua (SPA). This study was to analyze the improvement of growth and motoric development of infants aged 6-11 months who are at risk of stunting with Baby SPA Treatment. Research method with Quasi-experimental quantitative research, pre and posttest approach with two group intervention design with a total sample of 30 respondents. Statistical test using Paired Sample t-test. The results showed an average change in the baby SPA group before 8,413 grams and after treatment 8,930 grams, while in the baby massage group before 8,260 grams and after treatment 8,460 grams. The difference in average body weight in the baby SPA group was 517 grams, the baby massage group was 200 grams (p=&lt;0.001). The average height of the baby SPA group before the treatment were 73.7cm and after the treatment 75cm, while in the baby massage group before the treatment 71.7cm and after the treatment 72.9cm. The difference in the average height of the baby SPA group was 1.36 cm, while the baby massage group was 1.2 cm (p = &lt;0.001). Changes in the average motoric development of the baby SPA group before 9.07 and after treatment 9.93, while in the baby massage group before 9.00 and after treatment 9.87. The difference in the average motoric development the baby SPA group was 0.86, while the baby massage group was 0.87 (p=0.55). In conclusion, there are differences in the average value of weight and height gain before and after treatment, there is a difference in the mean difference in weight and height between baby SPA group and baby massage, there is no difference in the average difference in motoric development between baby SPA group and baby massage. Suggestions for baby SPA treatment as one of complementary care

PENGGUNAAN BATU BASALT SEBAGAI HOT STONE MASSAGE DALAM BODYSPA DI WOMAN &amp; WOMAN SPA DAN PUTRI KEDATON SPA

Abstrak: Cara menjaga kesehatan tubuh, pikiran, serta jiwa secara maksimal ada bermacam-macam, salah satunya adalah dengan melakukan perawatan badan atau solus per aqua (spa). Inti dari perawatan spa adalah memperoleh ketenangan pikiran, tubuh, serta jiwa secara maksimal.Ada bermacam-macam jenis spa dengan berbagai macam metode yang juga berbeda-beda, salah satunya adalah hot stone massage spa.Hot stone massage merupakan perawatan hydroterapi dengan pemijatan menggunakan batu untuk relaksasi mendalam dan dapat juga sebagai pengobatan. Batu yang digunakan sebagai hot stone spa adalah batu basalt, termasuk dalam jenis batuan beku. Tujuan penelitian ini adalah untuk mengetahui tentang (1) bentuk, ukuran, dan jumlah batu basalt yang digunakan sebagai hot stone massage spa. (2) prosedur penggunaan batu basalt untuk hot stone massage spa di Women &amp; Women Spa dan Putri Kedaton Spa. (3) tanggapan konsumen setelah melakukan hot stone massage spa. Metode penelitian ini adalah deskriptif kualitatif. Data dikumpulkan melalui obsefrvasi dan wawancara menggunakan instrument berupa lembar observasi dan pedoman wawancara. Hasil penelitian menunjukan bahwa bentuk, ukuran, dan jumlah batu basalt yang digunakan sebagai hot stone massage spa ialah batu basalt yang sudah dibentuk menjadi berbagai macam tipe, prosedur penggunaan batu basalt sebagai hot stone massage spa pada kedua salon spa tersebut berbeda, dan perawatan ini dianggap sebagai tindakan menjaga kesehatan oleh konsumen. Kata kunci: Batu basalt, Hot stone massage. &nbsp; &nbsp; Abstract: There&rsquo;s so many method to keep the body, mind, and soul in maximal healthiness, one of them is with doing body treatment or spa. The point of spa treatment is to get a composure of mind, body, and soul maximally. There&rsquo;s so many type of spa with many difference methods, and hot stone massage spa is one of spa method.Hot stone massage is a hydrotherapy wich is using a stone to run massage activity to reach the deep relax and also as a healing treatment. The stones that used as a hot stone massage spa is basalt stone, basalt is one of an extrusive rocks type. The aim of this research is to find out about (1) the shapes, sizes, and numbers of basalt stones that used as a hot stone massage spa. (2) the using of basalt stones procedure as hot stone massage spa in Women &amp; Women Spa and Putri Kedaton Spa. (3) the customers conceptions after having a hot stone massage spa experience.The research method of this research is descriptive qualitative. Datas was collected from observation and interviews using observation sheet and interviews directive as an instrument. The result of this research, indicate that the shapes, sizes, and numbers of basalt stones that used as a hot stone massage spa is a basalt stones wich is shapped in many types. There&rsquo;s a differences of&nbsp; the using of basalt stones procedure as hot stone massage spa between Women &amp; Women Spa and Putri Kedaton Spa. The custumers believed that this treatment is a kind of&nbsp; healhness maintain&nbsp; measurement. Key Word: Basalt stone, Hot stone massage