Balneotherapy for the treatment of post-COVID syndrome: a randomized controlled trial

Abstract Background Post-Acute COVID Syndrome (PACS) is a complex disorder that currently lacks effective evidenced-based therapies to manage it. This randomized controlled trial aims to evaluate the effects of balneotherapy (BT) on PACS symptomatology. Methods Ninety-eight adults with PACS visited...

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Main Authors: Diana Ovejero, Anna Ribes, Judit Villar-García, Marta Trenchs-Rodriguez, Daniel Lopez, Xavier Nogués, Robert Güerri-Fernandez, Natalia Garcia-Giralt
Format: Article
Language:English
Published: BMC 2025-02-01
Series:BMC Complementary Medicine and Therapies
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Online Access:https://doi.org/10.1186/s12906-025-04784-3
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author Diana Ovejero
Anna Ribes
Judit Villar-García
Marta Trenchs-Rodriguez
Daniel Lopez
Xavier Nogués
Robert Güerri-Fernandez
Natalia Garcia-Giralt
author_facet Diana Ovejero
Anna Ribes
Judit Villar-García
Marta Trenchs-Rodriguez
Daniel Lopez
Xavier Nogués
Robert Güerri-Fernandez
Natalia Garcia-Giralt
author_sort Diana Ovejero
collection DOAJ
description Abstract Background Post-Acute COVID Syndrome (PACS) is a complex disorder that currently lacks effective evidenced-based therapies to manage it. This randomized controlled trial aims to evaluate the effects of balneotherapy (BT) on PACS symptomatology. Methods Ninety-eight adults with PACS visited at Hospital del Mar Research Institute, Barcelona (Spain) were included to the study. Participants in the intervention group (n = 51) were allocated to 12 sessions of BT and aquatic exercises delivered in one month while the control group (n = 47) did not. The primary outcome was to evaluate the absolute change in questionnaire scores between baseline and two follow-up points: immediately after balneotherapy (or one-month post-baseline for the control group) and 2 months post-baseline. The following scales/questionnaires were employed: Post-COVID-19 functional status scale, mMRC dyspnea Scale, SF-36, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Memory failures in everyday life following severe head injury, and Visual Analogic Scale (VAS). Results Forty-seven patients in the BT group and 43 in the control group completed the study. The majority of participants were middle-aged women (> 84%; mean age 48 years), and the most prevalent symptoms were fatigue, musculoskeletal pain, and neurocognitive impairment (> 88%). Noteworthy, the vast majority did not undergo a severe primary infection (ICU admissions < 3%). After BT, significant improvement was detected in the BT group vs. the control group in various SF-36 domains, PSQI total score (Beta-coefficient [95%CI] 2.641 [1.15;4.12]; p -value = 0.003), HAD’s anxiety subscale (Beta-coefficient [95%CI] 1.72 [0.40;3.03;p-value = 0.023), and VAS (Beta-coefficient [95%CI] 1.625 [0.32;2.96]; p-value = 0.026). Among these, SF-36’s energy/fatigue and pain subscales exhibited the most prominent changes with a Beta-coefficient [95%CI] of -17.45 [-24.23;-10.66] and − 21.634 [-30.48;-12.78], respectively (p-value < 0.0001). No severe adverse effects were reported during BT although seventeen patients reported mild and transient worsening of preexisting symptoms, particularly fatigue/post-exertional malaise mainly in the first sessions of BT. Conclusion Balneotherapy comprise an effective therapeutic modality that can alleviate several symptoms that characterize PACS, particularly musculoskeletal pain and fatigue. However, the sustainability of these effects over time remains uncertain, as evidenced by the loss of some between-group differences at the one-month follow-up. Trial registration ClinicalTrials.gov NCT05765591 (13/03/2023).
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spelling doaj-art-c99190d5e4c34ab4ab143b749e50b1f82025-02-09T12:12:03ZengBMCBMC Complementary Medicine and Therapies2662-76712025-02-0125111310.1186/s12906-025-04784-3Balneotherapy for the treatment of post-COVID syndrome: a randomized controlled trialDiana Ovejero0Anna Ribes1Judit Villar-García2Marta Trenchs-Rodriguez3Daniel Lopez4Xavier Nogués5Robert Güerri-Fernandez6Natalia Garcia-Giralt7Hospital del Mar Research Institute, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)Hospital del Mar Research Institute, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)Hospital del Mar Research Institute, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)EAP Passeig de Sant Joan, Institut Català de la Salut (ICS)Department of Physics, Universitat Politècnica de CatalunyaHospital del Mar Research Institute, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)Hospital del Mar Research Institute, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)Hospital del Mar Research Institute, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)Abstract Background Post-Acute COVID Syndrome (PACS) is a complex disorder that currently lacks effective evidenced-based therapies to manage it. This randomized controlled trial aims to evaluate the effects of balneotherapy (BT) on PACS symptomatology. Methods Ninety-eight adults with PACS visited at Hospital del Mar Research Institute, Barcelona (Spain) were included to the study. Participants in the intervention group (n = 51) were allocated to 12 sessions of BT and aquatic exercises delivered in one month while the control group (n = 47) did not. The primary outcome was to evaluate the absolute change in questionnaire scores between baseline and two follow-up points: immediately after balneotherapy (or one-month post-baseline for the control group) and 2 months post-baseline. The following scales/questionnaires were employed: Post-COVID-19 functional status scale, mMRC dyspnea Scale, SF-36, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Memory failures in everyday life following severe head injury, and Visual Analogic Scale (VAS). Results Forty-seven patients in the BT group and 43 in the control group completed the study. The majority of participants were middle-aged women (> 84%; mean age 48 years), and the most prevalent symptoms were fatigue, musculoskeletal pain, and neurocognitive impairment (> 88%). Noteworthy, the vast majority did not undergo a severe primary infection (ICU admissions < 3%). After BT, significant improvement was detected in the BT group vs. the control group in various SF-36 domains, PSQI total score (Beta-coefficient [95%CI] 2.641 [1.15;4.12]; p -value = 0.003), HAD’s anxiety subscale (Beta-coefficient [95%CI] 1.72 [0.40;3.03;p-value = 0.023), and VAS (Beta-coefficient [95%CI] 1.625 [0.32;2.96]; p-value = 0.026). Among these, SF-36’s energy/fatigue and pain subscales exhibited the most prominent changes with a Beta-coefficient [95%CI] of -17.45 [-24.23;-10.66] and − 21.634 [-30.48;-12.78], respectively (p-value < 0.0001). No severe adverse effects were reported during BT although seventeen patients reported mild and transient worsening of preexisting symptoms, particularly fatigue/post-exertional malaise mainly in the first sessions of BT. Conclusion Balneotherapy comprise an effective therapeutic modality that can alleviate several symptoms that characterize PACS, particularly musculoskeletal pain and fatigue. However, the sustainability of these effects over time remains uncertain, as evidenced by the loss of some between-group differences at the one-month follow-up. Trial registration ClinicalTrials.gov NCT05765591 (13/03/2023).https://doi.org/10.1186/s12906-025-04784-3BalneotherapyPost-COVID-19 syndromePatient reported outcome measures
spellingShingle Diana Ovejero
Anna Ribes
Judit Villar-García
Marta Trenchs-Rodriguez
Daniel Lopez
Xavier Nogués
Robert Güerri-Fernandez
Natalia Garcia-Giralt
Balneotherapy for the treatment of post-COVID syndrome: a randomized controlled trial
BMC Complementary Medicine and Therapies
Balneotherapy
Post-COVID-19 syndrome
Patient reported outcome measures
title Balneotherapy for the treatment of post-COVID syndrome: a randomized controlled trial
title_full Balneotherapy for the treatment of post-COVID syndrome: a randomized controlled trial
title_fullStr Balneotherapy for the treatment of post-COVID syndrome: a randomized controlled trial
title_full_unstemmed Balneotherapy for the treatment of post-COVID syndrome: a randomized controlled trial
title_short Balneotherapy for the treatment of post-COVID syndrome: a randomized controlled trial
title_sort balneotherapy for the treatment of post covid syndrome a randomized controlled trial
topic Balneotherapy
Post-COVID-19 syndrome
Patient reported outcome measures
url https://doi.org/10.1186/s12906-025-04784-3
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