Balneotherapy for chronic venous insufficiency

Detalhes bibliográficos
Autor(a) principal: Melissa Andreia de Moraes Silva
Data de Publicação: 2019
Outros Autores: Luis Carlos Uta Nakano, Ligia de Loiola Cisneros, Fausto Miranda Júnior
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UFMG
Texto Completo: https://doi.org/10.1002/14651858.CD013085.pub2
http://hdl.handle.net/1843/42622
https://orcid.org/ 0000-0001-8773-3095
https://orcid.org/0000-0002-7996-3269
https://orcid.org/0000-0002-9940-2119
https://orcid.org/0000-0003-2954-8638
Resumo: Outra Agência
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spelling 2022-06-23T16:42:56Z2022-06-23T16:42:56Z2019-088153https://doi.org/10.1002/14651858.CD013085.pub21465-1858http://hdl.handle.net/1843/42622https://orcid.org/ 0000-0001-8773-3095https://orcid.org/0000-0002-7996-3269https://orcid.org/0000-0002-9940-2119https://orcid.org/0000-0003-2954-8638Outra AgênciaBackground: Chronic venous insufficiency (CVI) is a progressive and common disease that affects the superficial and deep venous systems of the lower limbs. CVI is characterised by valvular incompetence, reflux, venous obstruction, or a combination of these with consequent distal venous hypertension. Clinical manifestations of CVI include oedema, pain, skin changes, ulcerations and dilated skin veins in the lower limbs. It can result in a large financial burden on health systems. There is a wide variety of treatment options or therapies for CVI, ranging from surgery and medication to compression and physiotherapy. Balneotherapy (treatments involving water) is a relatively cheap option and potentially efficient way to deliver physical therapy for people with CVI. Objectives: To assess the efficacy and safety of balneotherapy for the treatment of people with chronic venous insufficiency (CVI). Search methods: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, AMED and CINAHL databases, the World Health Organization International Clinical Trials Registry Platform and the Clinical Trials.gov trials register to August 2018. We searched the LILACS and IBECS databases. We also checked references, searched citations and contacted study authors to identify additional studies. Selection criteria: We included randomised and quasi‐randomised controlled trials comparing balneotherapy with no treatment or other types of treatment for CVI. We also included studies that used a combination of treatments. Data collection and analysis: Two review authors independently reviewed studies retrieved by the search strategies. Both review authors independently assessed selected studies for complete analysis. We resolved conflicts through discussion. We attempted to contact trial authors for missing data, obtaining additional information. For binary outcomes (leg ulcer incidence and adverse events), we presented the results using odds ratio (OR) with 95% confidence intervals (CI). For continuous outcomes (disease severity, health‐related quality of life (HRQoL), pain, oedema, skin pigmentation), we presented the results as a mean difference (MD) with 95% CI. Main results: We included seven randomised controlled trials with 891 participants (outpatients in secondary care). We found no quasi‐randomised controlled trials. Six studies (836 participants) evaluated balneotherapy versus no treatment. One study evaluated balneotherapy versus a phlebotonic drug (melilotus officinalis) (55 participants). There was a lack of blinding of participants and investigators, imprecision and inconsistency, which downgraded the certainty of the evidence. For the balneotherapy versus no treatment comparison, there probably was no improvement in favour of balneotherapy in disease severity signs and symptom score as assessed using the Venous Clinical Severity Score (VCSS) (MD –1.66, 95% CI –4.14 to 0.83; 2 studies, 484 participants; moderate‐certainty evidence). Balneotherapy probably resulted in a moderate improvement in HRQoL as assessed by the Chronic Venous Insufficiency Questionnaire 2 (CVIQ2) at three months (MD –9.38, 95% CI –18.18 to –0.57; 2 studies, 149 participants; moderate‐certainty evidence), nine months (MD –10.46, 95% CI –11.81 to –9.11; 1 study; 55 participants; moderate‐certainty evidence), and 12 months (MD –4.99, 95% CI –9.19 to –0.78; 2 studies, 455 participants; moderate‐certainty evidence). There was no clear difference in HRQoL between balneotherapy and no treatment at six months (MD –1.64, 95% CI –9.18 to 5.89; 2 studies, 445 participants; moderate‐certainty evidence). Balneotherapy probably slightly improved pain compared with no treatment (MD –1.23, 95% CI –1.33 to –1.13; 1 study; 390 participants; moderate‐certainty evidence). There was no clear effect related to oedema between the two groups at 24 days (MD 43.28 mL, 95% CI –102.74 to 189.30; 2 studies, 153 participants; very‐low certainty evidence). There probably was no improvement in favour of balneotherapy in the incidence of leg ulcers (OR 1.69, 95% CI 0.82 to 3.48; 2 studies, 449 participants; moderate‐certainty evidence). There was probably a reduction in incidence of skin pigmentation changes in favour of balneotherapy at 12 months (pigmentation index: MD –3.59, 95% CI –4.02 to –3.16; 1 study; 59 participants; low‐certainty evidence). The main complications reported included erysipelas (OR 2.58, 95% CI 0.65 to 10.22; 2 studies, 519 participants; moderate‐certainty evidence), thromboembolic events (OR 0.35, 95% CI 0.09 to 1.42; 3 studies, 584 participants; moderate‐certainty evidence) and palpitations (OR 0.33, 95% CI 0.01 to 8.52; 1 study; 59 participants; low‐certainty evidence), with no clear evidence of an increase in reported adverse effects with balneotherapy. There were no serious adverse events reported in any of the studies. For the balneotherapy versus a phlebotonic drug (melilotus officinalis) comparison, we observed no clear difference in pain symptoms (OR 0.29, 95% CI 0.03 to 2.87; 1 study; 35 participants; very low‐certainty evidence) and oedema (OR 0.21, 95% CI 0.02 to 2.27; 1 study; 35 participants; very low‐certainty evidence). This single study did not report on the other outcomes of interest. Authors' conclusions: We identified moderate‐ to low‐certainty evidence that suggests that balneotherapy may result in a moderate improvement in pain, quality of life and skin pigmentation changes and has no clear effect on disease severity signs and symptoms score, adverse effects, leg ulcers and oedema when compared with no treatment. For future studies, measurements of outcomes such as disease severity sign and symptom score, quality of life, pain and oedema and choice of time points during follow‐up must be standardised for adequate comparison between trials.engUniversidade Federal de Minas GeraisUFMGBrasilEEF - DEPARTAMENTO DE FISIOTERAPIACochrane LibraryBalneologiaInsuficiência venosa - TratamentoFisioterapiaBalneotherapy for chronic venous insufficiencyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013085.pub2/fullMelissa Andreia de Moraes SilvaLuis Carlos Uta NakanoLigia de Loiola CisnerosFausto Miranda Júniorapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/42622/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALBalneotherapy for chronic venous insufficiency.pdfBalneotherapy for chronic venous insufficiency.pdfapplication/pdf599370https://repositorio.ufmg.br/bitstream/1843/42622/2/Balneotherapy%20for%20chronic%20venous%20insufficiency.pdfe30cac2aa93479776a66f4a9de3a2d0aMD521843/426222022-06-23 13:42:57.093oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2022-06-23T16:42:57Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
dc.title.pt_BR.fl_str_mv Balneotherapy for chronic venous insufficiency
title Balneotherapy for chronic venous insufficiency
spellingShingle Balneotherapy for chronic venous insufficiency
Melissa Andreia de Moraes Silva
Balneologia
Insuficiência venosa - Tratamento
Fisioterapia
title_short Balneotherapy for chronic venous insufficiency
title_full Balneotherapy for chronic venous insufficiency
title_fullStr Balneotherapy for chronic venous insufficiency
title_full_unstemmed Balneotherapy for chronic venous insufficiency
title_sort Balneotherapy for chronic venous insufficiency
author Melissa Andreia de Moraes Silva
author_facet Melissa Andreia de Moraes Silva
Luis Carlos Uta Nakano
Ligia de Loiola Cisneros
Fausto Miranda Júnior
author_role author
author2 Luis Carlos Uta Nakano
Ligia de Loiola Cisneros
Fausto Miranda Júnior
author2_role author
author
author
dc.contributor.author.fl_str_mv Melissa Andreia de Moraes Silva
Luis Carlos Uta Nakano
Ligia de Loiola Cisneros
Fausto Miranda Júnior
dc.subject.other.pt_BR.fl_str_mv Balneologia
Insuficiência venosa - Tratamento
Fisioterapia
topic Balneologia
Insuficiência venosa - Tratamento
Fisioterapia
description Outra Agência
publishDate 2019
dc.date.issued.fl_str_mv 2019-08
dc.date.accessioned.fl_str_mv 2022-06-23T16:42:56Z
dc.date.available.fl_str_mv 2022-06-23T16:42:56Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/1843/42622
dc.identifier.doi.pt_BR.fl_str_mv https://doi.org/10.1002/14651858.CD013085.pub2
dc.identifier.issn.pt_BR.fl_str_mv 1465-1858
dc.identifier.orcid.pt_BR.fl_str_mv https://orcid.org/ 0000-0001-8773-3095
https://orcid.org/0000-0002-7996-3269
https://orcid.org/0000-0002-9940-2119
https://orcid.org/0000-0003-2954-8638
url https://doi.org/10.1002/14651858.CD013085.pub2
http://hdl.handle.net/1843/42622
https://orcid.org/ 0000-0001-8773-3095
https://orcid.org/0000-0002-7996-3269
https://orcid.org/0000-0002-9940-2119
https://orcid.org/0000-0003-2954-8638
identifier_str_mv 1465-1858
dc.language.iso.fl_str_mv eng
language eng
dc.relation.ispartof.pt_BR.fl_str_mv Cochrane Library
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidade Federal de Minas Gerais
dc.publisher.initials.fl_str_mv UFMG
dc.publisher.country.fl_str_mv Brasil
dc.publisher.department.fl_str_mv EEF - DEPARTAMENTO DE FISIOTERAPIA
publisher.none.fl_str_mv Universidade Federal de Minas Gerais
dc.source.none.fl_str_mv reponame:Repositório Institucional da UFMG
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collection Repositório Institucional da UFMG
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