OBJECTIVE: To compare the benefits of a thermal cure and non-thermal rehabilitation in treatment of knee osteoarthritis (KOA). METHODS: Randomized therapeutic trial including patients with knee osteoarthritis (American College of Rheumatology criteria). Patients were randomly divided into two groups. Spa treatment consisted of underwater shower, massage-jet showers, hydromassage, pool rehabilitation and peloid therapy. Non-thermal rehabilitation consisted of analgesic physiotherapy, muscle strengthening and group physical rehabilitation. A blinded evaluation was carried out at day 21 and 12 months following treatment. It was based on the visual analogic scale of pain (VAS), which represented the primary endpoint. RESULTS: Two hundred and forty patients were included (February to June 2005). The spa treatment and non-thermal rehabilitation groups included 119 and 121 patients respectively. Two hundred and thirty-three patients completed their treatments. Significant improvement of the visual analogic scale of pain was noted in the thermal cure group (61.6 +/- 15 at day 0 versus 46.5 +/- 22.4 at 12 months, p < 0.001), but not in the non-thermal group (64.1 +/- 15 at day 0 versus 62 +/- 29 at 12 months, p = 0.68). At day 21, comparison of the two groups revealed no significant difference on the VAS (p = 0.08). However, at 12 months, the thermal cure group was significantly more improved (p = 0.000). CONCLUSION: In our study, crenobalneotherapy had resulted, at 12 months, in more pronounced long-term improvement of the painful symptoms of KOA than had non-thermal rehabilitation.

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