Taking baths: The efficacy of balneotherapy in patients with arthritis. A systematic review

Objective. To review English, French, German, and Dutch language studies of the effectiveness of balneotherapy. Balneotherapy (hydrotherapy or spa therapy) is one of the oldest forms of therapy for patients with arthritis. One of the aims of balneotherapy is to relieve pain. Methods. We performed a systematic review that included randomized and nonrandomized studies. Quality scores of the studies were determined using a criteria list. Results. Most studies report positive findings, but all studies showed methodological flaws. A quality of life measurement was never reported as an outcome measure. None of the randomized clinical trials included intention-to-treat analysis or comparison of effects between groups. Conclusion. Because of the methodological flaws a conclusion about the efficacy of balneotherapy cannot be provided from studies we reviewed. We conclude that most flaws found could be avoidable in future research

Balneotherapy and quality assessment: Interobserver reliability of the Maastricht criteria list and the need for blinded quality assessment

This study investigates aspects of the reliability of the Maastricht criteria list for quality assessment in systematic reviews, and whether blinded reviewing is necessary to prevent review bias. We used the data set of 12 articles from a systematic review concerning the efficacy of balneotherapy in patients with arthritis. Twenty reviewers participated of which two reviewers, who have been involved in developing the Maastricht criteria list, acted as reference standard. Half of all assessments were performed blindly. A high level of agreement was found between the reviewers and a high level of correlation with the reference standard. The quality scores between the blinded and unblinded assessment did not differ much. Based on the results we conclude that the Maastricht criteria list is a reliable instrument in duality assessment of clinical trials. Within the limits of this study we found no evidence that blinding is necessary to prevent review bias

Systematic reviews on the basis of methodological criteria

This paper describes a method of systematic reviewing. This method puts much emphasis on the methodological quality of the randomised clinical trials involved. Various items concerning the internal validity, precision and relevance of the studies are scored in such a way that next to the methodological quality the amount of uncertainty about it also becomes visible. These quality assessments are not only useful for systematic reviews, but also have an educational function for researchers with respect to the design and publication of a clinical trial

Efficacy of 904 nm laser therapy in the management of musculoskeletal disorders: a systematic review

This systematic review was undertaken to assess the effectiveness of 904nm low level laser therapy (LT) in musculoskeletal disorders. In order to retrieve randomized trials, computer-aided searches of databases and of bibliographic indexes were performed. Furthermore, congress reports, reviews and handbooks were all checked for relevant citations. Subsequently, all retrieved studies were scored on methodological quality. This review found 25 studies that investigated the effects of 904nm LT versus placebo or any other intervention, in subjects with a condition for which LT was thought a feasible intervention. Of these, 21 fulfilled the entry criteria for this review, and were assessed in a blinded manner on methodological criteria. Overall, study quality ranged from ‘poor’ to ‘reasonable’. In a classification of the material into diseases studied, no clear evidence was found for the effectiveness of LT, except perhaps for knee problems and myofascial pain. It is concluded that 904nm LTdoes not seem to be effective in the treatment of musculoskeletal disorders, but that further and improved research is needed to shed more light on its effectiveness