Efficacy of spa-therapy, mud-pack therapy, balneotherapy and mud-bath therapy in the management of knee osteoarthritis. A systematic review

Background: Osteoarthritis (OA) is the most common musculoskeletal disease in the world. OA is the result of an inflammatory and degenerative process affecting the entire joint. Osteoarthritis, especially involving the knee, has a relevant socio-economic impact in terms of drugs, hospital admissions, work absences and temporary or permanent invalidity. Therapy of knee osteoarthritis is based on pharmacological and non-pharmacological measures. Methods: We conducted a systematic review of the studies published between 2002 and 2017 on spa-therapy, mud-pack therapy, balneotherapy and mud-bath therapy in the treatment of knee osteoarthritis in order to investigate the evidence of the efficacy of such treatment on pain, functional limitation, drug use and quality of life. Overall, 35 studies were examined among which 12 were selected and included in the review if trial comparative. Each report was reviewed to identify the criteria used for study enrolment and for assignment to experimental vs control groups, sample size, type and characteristics of treatment, features of mineral water, control intervention, assessment point, endpoints, outcome measures, tests used for statistical analysis of the results. We have been able to illustrate the main results obtained in the individual studies and to elaborate these results in order to allow as much a unitary presentation as possible, and hence an overall judgment. Results: Because the studies we reviewed differed markedly from one another in terms of the methods used, we were unable to conduct a quantitative analysis (meta-analysis) of pooled data from the 12 studies. For the purposes of the present review, we re-evaluated the results of the different studies using the same statistical method, the Student’s t test, which is used to compare the means of two frequency distributions. Among all the studies, the most relevant indexes used to measure effectiveness of spa therapy were improved including VAS, Lequesne’s and WOMAC Score. Conclusions: The mud-pack therapy, balneotherapy, mud-bath therapy and spa therapy has proved to be effective in the treatment and in the secondary prevention of knee osteoarthritis, by reducing pain, non-steroidal antiinflammatory drug consumption, functional limitation and improving quality of life of affected patients. Is a noninvasive, complication-free, and cost-effective alternative modality for the conservative treatment of knee osteoarthritis

Uno studio sulla “dissenting opinion” con particolare riguardo all’esperienza del diritto inglese

The essay explores the many means through which judicial dissent has traditionally made its way into the English legal system in order to be finally accepted as an ineliminable instrument that the minority has availed itself of to air its differing opinion, mostly in matters of general, public importance. So, the research is in the first place directed towards the identification of the different types of dissent and of the forms (even concurring) in which it may be shaped. Furthermore, the study involves the attempt to find out what reasons may underlie the expression of dissent and whether they may conceal some kind of idyiosincratic state of mind on the part of the dissenters. A view is also taken of a number of famous, even for their strong tones, dissenting opinions in the courts of last instance. The general, and reassuring, impression is that such dissents not only reflect issues and values which reasonably may split the public opinion as well as the courts. They are also expressed with the clear perspective of contributing, although adopting a different point of view, to a better development of the domestic legal system. And not infrequently dissents have over an adequate span of time converted themselves into majority views once their intrinsic force has come to be accepted. Which brings us to conclude that dissent in itself does not constitute a menace to the coherence and credibility of a legal system, is well embedded in the English legal tradition and is not likely to be abandoned in the foreseeable future. Conversely, it gives rise to a positive example that could be fruitfully followed, without any fear, by continental systems, such as the Italian, so sweeping away the unjustified diffidence and suspicion that dissent might shake its stability