human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of the study was to demonstrate the effectiveness of sulphurous water in patients with osteoarthritis of the h and . Forty-seven patients with osteoarthritis of the h and were enrolled into the double-blind , r and omized , controlled study , satisfying ACR criteria . One group of the patients ( n = 24 ) received balneotherapy , bathing in sulphurous thermal water for 20 min per occasion , 15 times in all during a period of 3 weeks . The control group ( n = 21 ) had a bath exclusively in warm tap water . Assessment s were carried out in both groups on four occasions : at the beginning and at the end of the treatment , and 3 and 6 months after the beginning of the treatment . The parameters studied were the following : pain in the h and , morning stiffness in the joints , grip strength of both h and s , and Health Assessment Question naire Disability Index ( HAQ ) and AUSCAN H and Osteoarthritis Index and EuroQol quality of life question naire . At the end of treatment , the improvement was more pronounced in the patient group treated with the sulphurous water . After 3 months , significant improvement could be detected in all parameters , except the morning stiffness and EQ5D . After 6 months , the values of pain , HAQ and AUSCAN continued to be significantly better in comparison with the baseline values . The improvement in quality of life was significant only at the end of the treatment , 6 months later not any longer . The difference between the two groups was significant after 3 months in point of pain and EQVAS .  Balneotherapy and within this the sulphurous spa water alone may be effective for the attenuation of pain in patients with h and osteoarthrosis An increasing body of evidence substantiating the effectiveness of balneotherapy has accumulated during recent decades . In the present study , 42 ambulatory patients ( 23 males and 19 females , mean age 59.5 years ) with degenerative musculoskeletal disease were r and omised into one of two groups — bathing in tap water or in mineral water at the same temperature— and subjected to 30-min balneotherapy sessions on 15 occasions . Study parameters comprised serum levels of sensitised C-reactive protein ( CRP ) , plasma lipids , heat shock protein ( HSP-60 ) and total antioxidant status ( TAS ) . In both groups , CRP levels followed a decreasing tendency , which still persisted 3 months later . At 3 months after balneotherapy , serum cholesterol levels were still decreasing in patients who had used medicinal water , but exhibited a trend towards an increase in the control group . Triglyceride levels followed a decreasing trend in both patient groups . TAS showed a declining tendency in both groups . No changes of HSP-60 levels were observed in either group . Balneotherapy with the thermal water from Hajdúszoboszló spa had a more pronounced physiological effect compared to that seen in the control group treated with tap water in a 3 month period Effect of thermal water with high mineral content on clinical parameters and quality of life of patients with chronic low back pain was studied . In this r and omized controlled , single-blind , follow-up study , 60 patients with chronic low back pain were r and omized into two groups . The treatment group received balneotherapy with thermal-mineral water , and the control group bathed in tap water . Changes of the followings were evaluated : visual analogue scale ( VAS ) for pain , range of motion for the lumbar spine , Oswestry index , EuroQol-5D and Short Form-36 question naires . In the treatment group , the mobility of the lumbar spine , the Oswestry index , the VAS scores and the EuroQoL-5D index improved significantly . SF-36 items improved significantly in the treated group compared with baseline except for two parameters . Our study demonstrated the beneficial effect of balneotherapy with thermal mineral versus tap water on clinical parameters , along with improvements in quality of life Three treatments for non-specific lumbar pain -- balneotherapy , underwater traction bath , and underwater massage -- were assessed in a r and omised prospect i ve controlled trial in 158 out patients . Each group was treated for four weeks and patients were review ed at the end of this period and at 12 months after entry to the trial . The prescription of analgesics and the pain score were significantly reduced in all three treated groups , but there was no difference between the three groups . No significant change occurred in spinal motion and the straight leg raising test . After one year only the analgesic consumption was significantly lower than in the control group Objective : Balneotherapy , a domain of medical science , focuses on utilizing the beneficial effects of medicinal waters . Low back pain is among the most prevalent musculoskeletal disorders affecting a large proportion of the population during their lifetime . Although small in number , all controlled studies published on this subject have demonstrated the benefits of balneotherapy . This present study was undertaken to compare the effects of hydrotherapy with mineral water vs. tap water on low back pain . Patients and Methods : A single-blind clinical study was carried out to appraise the therapeutic efficacy of reduced sulphurous water on 60 patients with low back pain . 30 subjects took baths in reduced sulphurous mineral water  , whereas the other 30 patients used modified tap water of matching odor . Parameters determined at baseline , after balneo-/hydrotherapy , and at the end of the 3-month follow-up period included the results of the Visual Analogue Scale ( VAS ) score , the modified Oswestry index , mobility of the spine , antalgic posture , tenderness of the paravertebral muscles on palpation , the dose requirements for analgesics , and the efficacy assessed by the investigators and by the patients . Results : Bathing in mineral water result ed in a statistically significant improvement . This was reflected by the VAS ( p < 0.01 ) and manifested by the mitigation of muscle spasm ( p < 0.01 ) , the alleviation of local tenderness ( p < 0.01 ) , the enhanced flexion-extension and rotation of the spine ( p < 0.01 ) as well as by the improvement of the Schober ’s index ( p < 0.01 ) . All these beneficial changes persisted as long as 3 months after the completion of balneotherapy . By contrast , hydrotherapy with tap water result ed only in the temporary improvement of just a single parameter : the VAS score improved significantly ( p < 0.01 ) . Conclusions : Balneotherapy in itself can alleviate  low back pain . As demonstrated by this study , the analgesic efficacy and improvement of mobility accomplished by the use of mineral water is significantly superior to that afforded by hydrotherapy with tap water . Our results clearly establish the beneficial effects of mineral water . Moreover , it is a valuable adjunct to other forms of physical treatment as well as to pharmacotherapy To study the effect of thermal mineral water of Nagybaracska ( Hungary ) on patients with primary knee osteoarthritis in a r and omized , double-blind clinical trial , 64 patients with nonsurgical knee joint osteoarthritis were r and omly selected either into the thermal mineral water or into the tap water group in a non-spa resort village . The patients of both groups received 30-min sessions of bathing , 5 days a week for four consecutive weeks . The patients were evaluated by a blind observer immediately before and at the end of the trial using Western Ontario and McMaster Osteoarthritis ( WOMAC ) indices and follow-up assessment 3 months later . Twenty-seven patients of the 32 patients who received thermal mineral water and 25 of the 32 of those treated with tap water completed the trial . The WOMAC activity , pain , and total scores improved significantly in the thermal mineral-water-treated group . The improvement remained also at the end of the 3-month follow-up . The WOMAC activity , pain , and total scores improved significantly also in the tap water group at the end of the treatment course , but no improvement was detected at the end of the 3-month follow-up period . The treatment with the thermal mineral water of Nagybaracska significantly improved activity , pain , and total WOMAC scores of patients with nonsurgical OA of the knee . Even after 3 months , significant improvement was observed compared to the scores before the treatment or to tap water treatment Objective To determine whether spa therapy , plus home exercises and usual medical treatment provides any benefit over exercises and usual treatment , in the management of knee osteoarthritis . Methods Large multicentre r and omised prospect i ve clinical trial of patients with knee osteoarthritis according to the American College of Rheumatology criteria , attending French spa resorts as out patients between June 2006 and April 2007 . Zelen r and omisation was used so patients were ignorant of the other group and spa personnel were not told which patients were participating . The main endpoint criteria were patient self-assessed . All patients continued usual treatments and performed daily st and ardised home exercises . The spa therapy group also received 18 days of spa therapy ( massages , showers , mud and pool sessions ) . Main Endpoint The number of patients achieving minimal clinical ly important improvement ( MCII ) at 6 months , defined as ≥19.9 mm on the visual analogue pain scale and /or ≥9.1 points in a normalised Western Ontario and McMaster Universities osteoarthritis index function score and no knee surgery . Results The intention to treat analysis included 187 controls and 195 spa therapy patients . At 6 months , 99/195 ( 50.8 % ) spa group patients had MCII and 68/187 ( 36.4 % ) controls ( χ2=8.05 ; df=1 ; p=0.005 ) . However , no improvement in quality of life ( Short Form 36 ) or patient acceptable symptom state was observed at 6 months . Conclusion For patients with knee osteoarthritis a 3-week course of spa therapy together with home exercises and usual pharmacological treatments offers benefit after 6 months compared with exercises and usual treatment alone , and is well tolerated . Trial registration number NCT00348777 BACKGROUND Balneotherapy is an established treatment modality for musculoskeletal disease , but few studies have examined the efficacy of spa therapy in elderly patients with degenerative spine and joint diseases . OBJECTIVES To assess the effects of balneotherapy on chronic musculoskeletal pain , functional capacity , and quality of life in elderly patients with osteoarthritis of the knee or with chronic low back pain . METHODS The 81 patients in the study group underwent a 1 day course of 30 minute daily baths in mineral water . Changes were evaluated in the following parameters : pain intensity , functional capacity , quality of life , use of non-steroidal anti-inflammatory or analgesic drugs , subjective disease severity perceived by the patients , investigator-rated disease severity , and severity of pain perceived by the patients . We analyzed the results of 76 subjects as 5 did not complete the study . RESULTS Compared to baseline , all monitored parameters were significantly improved by balneotherapy in both investigated groups . Moreover , the favorable effect was prolonged for 3 months after treatment . CONCLUSIONS This study showed that balneotherapy is an effective treatment modality in elderly patients with osteoarthritis of the knee or with chronic low back pain , and its benefits last for at least 3 months after treatment Objective : To evaluate the effectiveness of thermal mineral water compared with magnetotherapy without balneotherapy as control , in the treatment of h and osteoarthritis . Design : R and omized controlled single-blind follow-up study . Setting : Rheumatology specialist clinic of Gunaras Health Spa . Subjects : Patients between 50 and 70 years of age with h and osteoarthritis , r and omly assigned into three groups . Interventions : The subjects in the first two groups bathed in thermal mineral water of two different temperatures ( 36 ° C and 38 ° C ) for three weeks five times a week for 20 minutes a day and received magnetotherapy to their h and s three times weekly . The third group received only magnetotherapy . Outcome measures : Visual analogue scale scores , h and grip strength , pinchgrip strength , the number of swollen and tender joints of the h and , the duration of morning joint stiffness , Health Assessment Question naire , and Short Form-36 question naire . The study parameters were administered at baseline , immediately after treatment and after 13 weeks . Results : The study included 63 patients . Statistically significant improvement was observed in several studied parameters after the treatment and during the follow-up study in the thermal water groups versus the control group . The 38 ° C thermal water treatment significantly improved the pinch strength of the right h and ( 0.6 ( 95 % confidence interval ( CI ) 0.2 to 1.1 ) vs. 0.03 ( 95 % CI −0.3 to 0.4 ) , P < 0.05 ) and the Health Assessment Question naire parameters ( −0.4 ( 95 % CI −0.6 to −0.2 ) vs. −0.1 ( 95 % CI −0.2 to 0.1 ) , P < 0.01 ) even in the long term . Conclusions : Balneotherapy combined with magnetotherapy  improved the pain and function as well as the quality of life in patients with h and osteoarthritis The therapeutic modalities available for the conservative management of chronic cervical and lumbar pain include underwater traction , the usefulness of which is not universally acknowledged . No reports have been published on clinical trials evaluating underwater traction . This study was intended to ascertain any beneficial impact of weightbath therapy on the clinical parameters and quality of life of patients with cervical/lumbar discopathy . The study population comprised 72 subjects . Two groups of 18 patients each received underwater traction therapy of the cervical or lumbar spine with add-on McKenzie exercises and iontophoresis . The remaining two groups , treated with exercises and iontophoresis , served as controls . VAS and SF36 scores 
    Output:
    
agent
A similar effect has been found in chronic pelvic inflammatory disease .
The review also revealed that  balneotherapy has some beneficial effects on antioxidant status , and on metabolic and inflammatory parameters .
Based on the results , we conclude that balneotherapy with Hungarian thermal-mineral waters is an effective remedy for  lower back pain  , as well as for knee and h and osteoarthritis
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of the study was to demonstrate the effectiveness of sulphurous water in patients with osteoarthritis of the h and . Forty-seven patients with osteoarthritis of the h and were enrolled into the double-blind , r and omized , controlled study , satisfying ACR criteria . One group of the patients ( n = 24 ) received balneotherapy , bathing in sulphurous thermal water for 20 min per occasion , 15 times in all during a period of 3 weeks . The control group ( n = 21 ) had a bath exclusively in warm tap water . Assessment s were carried out in both groups on four occasions : at the beginning and at the end of the treatment , and 3 and 6 months after the beginning of the treatment . The parameters studied were the following : pain in the h and , morning stiffness in the joints , grip strength of both h and s , and Health Assessment Question naire Disability Index ( HAQ ) and AUSCAN H and Osteoarthritis Index and EuroQol quality of life question naire . At the end of treatment , the improvement was more pronounced in the patient group treated with the sulphurous water . After 3 months , significant improvement could be detected in all parameters , except the morning stiffness and EQ5D . After 6 months , the values of pain , HAQ and AUSCAN continued to be significantly better in comparison with the baseline values . The improvement in quality of life was significant only at the end of the treatment , 6 months later not any longer . The difference between the two groups was significant after 3 months in point of pain and EQVAS .  Balneotherapy and within this the sulphurous spa water alone may be effective for the attenuation of pain in patients with h and osteoarthrosis An increasing body of evidence substantiating the effectiveness of balneotherapy has accumulated during recent decades . In the present study , 42 ambulatory patients ( 23 males and 19 females , mean age 59.5 years ) with degenerative musculoskeletal disease were r and omised into one of two groups — bathing in tap water or in mineral water at the same temperature— and subjected to 30-min balneotherapy sessions on 15 occasions . Study parameters comprised serum levels of sensitised C-reactive protein ( CRP ) , plasma lipids , heat shock protein ( HSP-60 ) and total antioxidant status ( TAS ) . In both groups , CRP levels followed a decreasing tendency , which still persisted 3 months later . At 3 months after balneotherapy , serum cholesterol levels were still decreasing in patients who had used medicinal water , but exhibited a trend towards an increase in the control group . Triglyceride levels followed a decreasing trend in both patient groups . TAS showed a declining tendency in both groups . No changes of HSP-60 levels were observed in either group . Balneotherapy with the thermal water from Hajdúszoboszló spa had a more pronounced physiological effect compared to that seen in the control group treated with tap water in a 3 month period Effect of thermal water with high mineral content on clinical parameters and quality of life of patients with chronic low back pain was studied . In this r and omized controlled , single-blind , follow-up study , 60 patients with chronic low back pain were r and omized into two groups . The treatment group received balneotherapy with thermal-mineral water , and the control group bathed in tap water . Changes of the followings were evaluated : visual analogue scale ( VAS ) for pain , range of motion for the lumbar spine , Oswestry index , EuroQol-5D and Short Form-36 question naires . In the treatment group , the mobility of the lumbar spine , the Oswestry index , the VAS scores and the EuroQoL-5D index improved significantly . SF-36 items improved significantly in the treated group compared with baseline except for two parameters . Our study demonstrated the beneficial effect of balneotherapy with thermal mineral versus tap water on clinical parameters , along with improvements in quality of life Three treatments for non-specific lumbar pain -- balneotherapy , underwater traction bath , and underwater massage -- were assessed in a r and omised prospect i ve controlled trial in 158 out patients . Each group was treated for four weeks and patients were review ed at the end of this period and at 12 months after entry to the trial . The prescription of analgesics and the pain score were significantly reduced in all three treated groups , but there was no difference between the three groups . No significant change occurred in spinal motion and the straight leg raising test . After one year only the analgesic consumption was significantly lower than in the control group Objective : Balneotherapy , a domain of medical science , focuses on utilizing the beneficial effects of medicinal waters . Low back pain is among the most prevalent musculoskeletal disorders affecting a large proportion of the population during their lifetime . Although small in number , all controlled studies published on this subject have demonstrated the benefits of balneotherapy . This present study was undertaken to compare the effects of hydrotherapy with mineral water vs. tap water on low back pain . Patients and Methods : A single-blind clinical study was carried out to appraise the therapeutic efficacy of reduced sulphurous water on 60 patients with low back pain . 30 subjects took baths in reduced sulphurous mineral water  , whereas the other 30 patients used modified tap water of matching odor . Parameters determined at baseline , after balneo-/hydrotherapy , and at the end of the 3-month follow-up period included the results of the Visual Analogue Scale ( VAS ) score , the modified Oswestry index , mobility of the spine , antalgic posture , tenderness of the paravertebral muscles on palpation , the dose requirements for analgesics , and the efficacy assessed by the investigators and by the patients . Results : Bathing in mineral water result ed in a statistically significant improvement . This was reflected by the VAS ( p < 0.01 ) and manifested by the mitigation of muscle spasm ( p < 0.01 ) , the alleviation of local tenderness ( p < 0.01 ) , the enhanced flexion-extension and rotation of the spine ( p < 0.01 ) as well as by the improvement of the Schober ’s index ( p < 0.01 ) . All these beneficial changes persisted as long as 3 months after the completion of balneotherapy . By contrast , hydrotherapy with tap water result ed only in the temporary improvement of just a single parameter : the VAS score improved significantly ( p < 0.01 ) . Conclusions : Balneotherapy in itself can alleviate  low back pain . As demonstrated by this study , the analgesic efficacy and improvement of mobility accomplished by the use of mineral water is significantly superior to that afforded by hydrotherapy with tap water . Our results clearly establish the beneficial effects of mineral water . Moreover , it is a valuable adjunct to other forms of physical treatment as well as to pharmacotherapy To study the effect of thermal mineral water of Nagybaracska ( Hungary ) on patients with primary knee osteoarthritis in a r and omized , double-blind clinical trial , 64 patients with nonsurgical knee joint osteoarthritis were r and omly selected either into the thermal mineral water or into the tap water group in a non-spa resort village . The patients of both groups received 30-min sessions of bathing , 5 days a week for four consecutive weeks . The patients were evaluated by a blind observer immediately before and at the end of the trial using Western Ontario and McMaster Osteoarthritis ( WOMAC ) indices and follow-up assessment 3 months later . Twenty-seven patients of the 32 patients who received thermal mineral water and 25 of the 32 of those treated with tap water completed the trial . The WOMAC activity , pain , and total scores improved significantly in the thermal mineral-water-treated group . The improvement remained also at the end of the 3-month follow-up . The WOMAC activity , pain , and total scores improved significantly also in the tap water group at the end of the treatment course , but no improvement was detected at the end of the 3-month follow-up period . The treatment with the thermal mineral water of Nagybaracska significantly improved activity , pain , and total WOMAC scores of patients with nonsurgical OA of the knee . Even after 3 months , significant improvement was observed compared to the scores before the treatment or to tap water treatment Objective To determine whether spa therapy , plus home exercises and usual medical treatment provides any benefit over exercises and usual treatment , in the management of knee osteoarthritis . Methods Large multicentre r and omised prospect i ve clinical trial of patients with knee osteoarthritis according to the American College of Rheumatology criteria , attending French spa resorts as out patients between June 2006 and April 2007 . Zelen r and omisation was used so patients were ignorant of the other group and spa personnel were not told which patients were participating . The main endpoint criteria were patient self-assessed . All patients continued usual treatments and performed daily st and ardised home exercises . The spa therapy group also received 18 days of spa therapy ( massages , showers , mud and pool sessions ) . Main Endpoint The number of patients achieving minimal clinical ly important improvement ( MCII ) at 6 months , defined as ≥19.9 mm on the visual analogue pain scale and /or ≥9.1 points in a normalised Western Ontario and McMaster Universities osteoarthritis index function score and no knee surgery . Results The intention to treat analysis included 187 controls and 195 spa therapy patients . At 6 months , 99/195 ( 50.8 % ) spa group patients had MCII and 68/187 ( 36.4 % ) controls ( χ2=8.05 ; df=1 ; p=0.005 ) . However , no improvement in quality of life ( Short Form 36 ) or patient acceptable symptom state was observed at 6 months . Conclusion For patients with knee osteoarthritis a 3-week course of spa therapy together with home exercises and usual pharmacological treatments offers benefit after 6 months compared with exercises and usual treatment alone , and is well tolerated . Trial registration number NCT00348777 BACKGROUND Balneotherapy is an established treatment modality for musculoskeletal disease , but few studies have examined the efficacy of spa therapy in elderly patients with degenerative spine and joint diseases . OBJECTIVES To assess the effects of balneotherapy on chronic musculoskeletal pain , functional capacity , and quality of life in elderly patients with osteoarthritis of the knee or with chronic low back pain . METHODS The 81 patients in the study group underwent a 1 day course of 30 minute daily baths in mineral water . Changes were evaluated in the following parameters : pain intensity , functional capacity , quality of life , use of non-steroidal anti-inflammatory or analgesic drugs , subjective disease severity perceived by the patients , investigator-rated disease severity , and severity of pain perceived by the patients . We analyzed the results of 76 subjects as 5 did not complete the study . RESULTS Compared to baseline , all monitored parameters were significantly improved by balneotherapy in both investigated groups . Moreover , the favorable effect was prolonged for 3 months after treatment . CONCLUSIONS This study showed that balneotherapy is an effective treatment modality in elderly patients with osteoarthritis of the knee or with chronic low back pain , and its benefits last for at least 3 months after treatment Objective : To evaluate the effectiveness of thermal mineral water compared with magnetotherapy without balneotherapy as control , in the treatment of h and osteoarthritis . Design : R and omized controlled single-blind follow-up study . Setting : Rheumatology specialist clinic of Gunaras Health Spa . Subjects : Patients between 50 and 70 years of age with h and osteoarthritis , r and omly assigned into three groups . Interventions : The subjects in the first two groups bathed in thermal mineral water of two different temperatures ( 36 ° C and 38 ° C ) for three weeks five times a week for 20 minutes a day and received magnetotherapy to their h and s three times weekly . The third group received only magnetotherapy . Outcome measures : Visual analogue scale scores , h and grip strength , pinchgrip strength , the number of swollen and tender joints of the h and , the duration of morning joint stiffness , Health Assessment Question naire , and Short Form-36 question naire . The study parameters were administered at baseline , immediately after treatment and after 13 weeks . Results : The study included 63 patients . Statistically significant improvement was observed in several studied parameters after the treatment and during the follow-up study in the thermal water groups versus the control group . The 38 ° C thermal water treatment significantly improved the pinch strength of the right h and ( 0.6 ( 95 % confidence interval ( CI ) 0.2 to 1.1 ) vs. 0.03 ( 95 % CI −0.3 to 0.4 ) , P < 0.05 ) and the Health Assessment Question naire parameters ( −0.4 ( 95 % CI −0.6 to −0.2 ) vs. −0.1 ( 95 % CI −0.2 to 0.1 ) , P < 0.01 ) even in the long term . Conclusions : Balneotherapy combined with magnetotherapy  improved the pain and function as well as the quality of life in patients with h and osteoarthritis The therapeutic modalities available for the conservative management of chronic cervical and lumbar pain include underwater traction , the usefulness of which is not universally acknowledged . No reports have been published on clinical trials evaluating underwater traction . This study was intended to ascertain any beneficial impact of weightbath therapy on the clinical parameters and quality of life of patients with cervical/lumbar discopathy . The study population comprised 72 subjects . Two groups of 18 patients each received underwater traction therapy of the cervical or lumbar spine with add-on McKenzie exercises and iontophoresis . The remaining two groups , treated with exercises and iontophoresis , served as controls . VAS and SF36 scores 
    Output:
    