Bath Group Research Articles

Efficacy of Dilute Hypochlorite Solutions and an Electrochemically Activated Saline Solution Containing Hypochlorous Acid for Disinfection of Methicillin-Resistant Staphylococcus aureus in a Pig Skin Model

Recurrent skin and soft-tissue infections (SSTIs) due to Staphylococcus aureus are a common problem in children and adults. Many of these SSTIs are caused by a community-associated methicillin-resistant S. aureus (MRSA) strain designated USA300. Dilute bleach baths are commonly used as part of decolonization regimens for recurrent SSTI, particularly in children. However, limited data are available on the microbiological efficacy of dilute bleach on skin, and optimal concentrations are unknown. Recent practice guidelines for MRSA from the Infectious Diseases Society of America recommend a teaspoon of household bleach per gallon of bath water (1.3 μL/mL or a quarter cup per quarter tub of water) for 15 minutes twice weekly. On the basis of in vitro data, Fisher et al suggested that a higher concentration (2.5 μL/mL or a half cup per quarter tub of water) might be more effective (more than a 3-log reduction in MRSA in 5 minutes versus a 2-log reduction for a 1.2-μL/mL concentration). In contrast, more dilute bleach solutions (eg, a quarter cup of 6% sodium hypochlorite per bathtub full of water) for 5 days in combination with intranasal mupirocin were effective for eradication of colonization in a recent randomized trial, but 29% of patients in the mupirocin/bleach bath group developed recurrent colonization within 4 months. Here, we used a pig skin model to examine the effectiveness of various concentrations of dilute bleach solution and an electrochemically activated saline solution containing 0.025% hypochlorous acid (Vashe; PuriCore) for disinfection of MRSA on skin. Vashe is safe for use on skin and is commercially available as a wound care product.

Acute Response to Hydrotherapy After a Simulated Game of Rugby

Despite lacking clear scientific evidence, hydrotherapies (water treatments) are accepted techniques to help team sport athletes recover from the physical effects of games. The purpose of this study was to assess the comparative effectiveness of cold water immersions (CWIs) and hot-and-cold contrast baths on athletes' recovery after a simulated game of rugby union. Twenty-four experienced, well-trained, male rugby union players were divided into 3 groups to receive recovery interventions: CWI for 1 group, contrast baths for a second group, and passive recovery for a third (control) group. Pregame and postgame measurements included a countermovement jump (normalized as a ratio to body weight), a sit-and-stretch flexibility test (centimeters), thigh circumference (to detect swelling; centimeters), and participants' perception of delayed-onset muscular soreness (DOMS, 100-mm visual analog scale). Statistical analysis included analysis of variance, and the calculation of omnibus effect sizes for each group ((Equation is included in full-text article.)) and the magnitudes of change within and between groups (Cohen's d). The participants in the contrast bath group reported statistically significantly greater measures of DOMS than participants in the control group did at 1 hour postintervention (p = 0.05, control group: d = 1.80; contrast bath: d = 4.75), and than participants in the CWI group did at 48 hours postintervention (p = 0.02, CWI: d = 1.17; contrast bath: d = 1.97). These findings provide modest evidence that contrast baths are a less effective strategy for recovery from rugby union than are CWI or passive recovery. Specifically, 2 × 5-minute CWI is superior to both contrasts baths and passive recovery in alleviating DOMS after exercise-induced muscle damage. Our recommendation for rugby union players aiming to attenuate the effects of DOMS postgames is to take 2 × 5-minute CWIs baths immediately after the game.

Evaluation of Hydrotherapy, Using Passive Tests and Power Tests, for Recovery Across a Cyclic Week of Competitive Rugby Union

In team sports, a cycle of training, competition, and recovery occurs weekly during the competitive season. In this research, we evaluated hydrotherapy for recovery from a simulated game of rugby union tracked over a week of training. Twenty-four experienced male rugby union players (mean ± SD age 19.46 ± 0.82 years, weight 82.38 ± 11.12 kg, height 178.54 ± 5.75 cm) were randomly divided into 3 groups: cold water immersion (n = 8), contrast bath therapy (n = 8), and a control group (n = 8). The 2 forms of hydrotherapy were administered immediately after a simulated rugby game. Testing was conducted 1 hour before the game and at 5 intervals postgame: 1, 48, 72, 96, and 144 hours. Dependent variables included countermovement jump, 10- and 40-m sprints, sessional rating of perceived exertion (RPE), flexibility, thigh circumference, and self-reported delayed onset muscle soreness (DOMS). Significant differences in DOMS were found between the cold water immersion and contrast bath groups at 48 hours post intervention (p = 0.02), and between the control and contrast bath groups at 72 (p = 0.03) and 96 (p = 0.04) hours post intervention. Cold water immersion and contrast bath groups reported significantly different RPE at 72 hours (p = ?) and 96 hours post (p = 0.05) intervention. Athletes' perceptions of muscle soreness and sessional RPE scores for training were greater in the contrast bath group (20%) after the simulated game and throughout the training week. Although results from passive and power tests were inconclusive in determining whether cold water immersion or passive recovery was more effective in attenuating fatigue, results indicated contrast baths had little benefit in enhancing recovery during a cyclic week of rugby union.

The balneotherapy effect of hydrogen reduced water on UVB-mediated skin injury in hairless mice

Exposure to UVB radiation induced skin damage that results to increase risk of skin cancer. Despite the clinical importance of skin-induced damage, antioxidants imposed limited therapeutic success. Hydrogen molecule (H2) has been known as a safe antioxidant in the prevention and therapeutic approach towards several diseases. Drinking hydrogen reduced water (HRW), inhalation of hydrogen gas, and injecting H2-dissolved saline are widely accepted to incorporate H2 in the body. However, there is no document about the beneficial effect of hydrogen water bath. Here, we investigated the effect of hydrogen bathing on the UVB-induced skin damage in hairless mice. For this, mice of the bathing group are allowed to freely swim on HRW, and let the HRW penetrate for 60 mins. Scoring of skin injury, reactive oxygen species (ROS) enzyme activity quantification, cytokine analysis, and ultrastructural change of corneocytes were measured after exposure to UVB radiation of 360–540 mJ/cm2. In summary, the bathing with HRW significantly reduced the levels of skin damage, as well as increased activity of glutathione peroxidase. Further, the effect of HRW on cytokine network in the skin after UVB exposure revealed that HRW significantly decreased the level of inflammatory cytokines such as IL-1β, IL-6, TNF-α and IFN-γ. Finally, scanning electron microscopy data revealed low number of defected corneocytes and ultrastructural changes, suggesting that HRW bathing would protect UV-induced cell damage.

Influences of Aerobic Exercise Training and Half Bath on Blood Component, Cardiorespiratory Function, and Vascular Compliance of Middle-aged Obese Men

Abstract The purpose of this study was to investigate the effect of aerobic exercise training and half bath on blood component, cardiorespiratory function, and vascular compliance of middle-aged obese men. The subjects were 3 groups; aerobic exercise(n=10), half bath(n=10), and controlled group(n=10). They were tested on their blood component, cardiorespiratory function, and vascular compliance at the beginning and at the end of the 12-week study(pre-post test). For data analysis, mean and standard deviation scores were calculated, and repeated measure two-way ANOVA and Scheffe were used. The results of this study are as follows. First, aerobic exercise group was significantly improved on all blood component after the 12-weeks, and showed significant difference among groups. Half bath group was better than control groups on Triglyceride, LDL-C, and HDL-C levels. Second, aerobic exercise group was significantly improved on maximum oxygen uptake, maximum heart rate, and maximum ventilation after the 12-weeks. Third, in vascular compliance measured in both hands and both feet, the half bath group and aerobic exercise training group were significantly increases the control group.Therefore, these results imply that aerobic exercise and half bath can be helpful for better blood component, cardiorespiratory function, and vascular compliance in middle-aged obese men.

Evaluation of head-only electrical stunning for practical application: Assessment of neural and meat quality parameters

Behavioral and neural responses of 47 broilers to head-only single-bird electrical stunning were evaluated using cone-shaped restrainers in which the broilers were suspended by their feet. Meat quality assessment was performed on 2 groups of 25 broilers stunned using the head-only method or a conventional water bath method. Hemorrhages were quantified by a visual grading system. On electroencephalogram recordings, a general epileptiform insult was observed when a set current of at least 190 mA (˜100 V, 50 Hz) was applied for a duration of 0.5, 3, or 5 s. This insult showed a tonic phase, followed by a clonic phase and an exhaustion phase, after which the birds recovered. On the basis of visual observation, these birds may have been unconscious for approximately 30, 44, or 65 s. According to correlation dimension analysis scores, these durations were 18, 12, and 16 s, respectively. Within a confidence limit of 95%, taking into account the number of birds with a reliable electroencephalogram, the chance of an effective stun lies between 0.95 and 1.00 with an average current of 190 ± 30 mA. After stunning, the electrocardiogram revealed fibrillation. The heart rate decreased significantly (P < 0.05) after stunning but recovered thereafter. The pH after chilling was (P < 0.05) lower in the group stunned head only compared with the water bath group. The percentages of fillets free of blood splashes were 80% in carcasses of head-only-stunned birds and 16% in carcasses from broilers stunned in the commercial water bath. It was concluded that broilers were insensible and unconscious after head-only electrical stunning using pin-electrodes. Because of the risk that broilers can rapidly regain consciousness after stunning, cutting the neck immediately after stunning is recommended. It is also recommended that the head-only equipment be developed further for practical application and commercial use.

Bathing in a bathtub and health status: A cross-sectional study

Bathing, or soaking, in a bathtub is a popular and often habitual pastime that has its roots in the culture of the Japanese people. The purpose of this study was to examine the effects of such bathing on health status. We conducted a population-based cross-sectional study involving 617 Japanese participants who took routine medical checkups. The frequency of bathing in a bathtub was categorized into two levels: "less than seven times a week" (less frequent bathing group) and "seven or more times a week" (frequent bathing group). We compared the following characteristics between the two groups: age, body mass index, blood pressure, blood chemistry findings, self-rated health, and sleep quality. The frequent bathing group reported better self-rated health and sleep quality than the less frequent bathing group, with age- and sex-adjusted odds ratios (95% confidence interval) of 2.11 (1.28-3.48) for self-rated health and 1.55 (0.98-2.44) for sleep quality. Other survey items were similar between the two groups. The findings of this study suggested that bathing in a bathtub every day or more frequently was associated with a good state of self-rated health and sleep quality.

족욕이 수험생의 스트레스 및 피로에 미치는 효과 -아로마 오일과 발효추출물의 비교연구-

21세기에, 사람들은 심리적, 사회적, 환경적 자극에 의해 많은 스트레스를 경험한다. 스트레스가 지나치면 문제가 될 수 있고 결국 질병을 불러오게 된다. 족욕은 발부터 몸을 따뜻하게 해주고 혈액순환과 자율신경계를 조절한다. 이 연구는 아로마 오일과 발효추출물과 함께 족욕이 입시를 준비하는 수험생의 스트레스와 피로에 미치는 영향을 알아보기 위한 것이다. 실험기간은 2009년 3월 30일부터 4월 18일까지 20일간 천안 C여고 고3 수험생을 대상으로 싸주아리쑥 발효추출물 입욕제를 넣은 족욕 그룹 실험군 1과 아로마 오일 중 그레이프프루트, 사이프러스, 시더우드를 블렌딩한 족욕 그룹 실험군 2, 무 처치를 한 족욕 그룹 대조군으로 나누워 각각 7명씩 연구 대상자로 선정하였다. 신체적, 심리적 스트레스의 차이는 발효추출물군의 경우 1.23, 1.09의 감소효과가 있었고, 아로마군의 경우 0.71, 0.63의 감소효과가 있었으나 대조군의 경우 0.03, 0.02의 감소효과를 나타내어 발효추출물이나 아로마를 통한 족욕이 대조군에 비해 신체적 스트레스가 낮게 나타났다(p<.01). 피로도의 차이는 발효추출물군의 경우 1.27의 감소효과가 있었고, 아로마군의 경우 0.77의 감소효과가 있었으나 대조군의 경우 0.03의 감소효과를 나타내어 본 연구에서 적용한 발효추출물이나 아로마를 통한 족욕이 대조군에 비해 피로도가 낮게 나타났다(p<.01). 발효추출물군(M=3.71)의 경우 족욕 후 만족도가 가장 높은 것으로 나타났고, 아로마군(M=3.28), 대조군(M=2.22)순으로 나타났으며, Duncan의 사후검정결과 실험군과 대조군간 통계적으로 유의한 차이가 있는 것으로 볼 수 있다(p<.01). 이상의 연구결과를 통해 볼 때, 입욕제에 따른 족욕이 입시로 인한 스트레스, 피로도 감소에 매우 효과적인 것으로 사료된다. In the twenty first century, people experience a lot of stresses by psychological, social and environmental impetus. If the stress is excessive, it can become a problem and finally lead to diseases. Foot bath makes the body warm starting with the feet, controls the blood circulations and autonomic nervous systems. This study aims at examining the effects of stress and fatigue of senior students preparing for college entrance examination by foot bath with the aroma essential oil and the fermentation extracts. The experimental period was from March 30 to April 18, 2009. The study objects were 21 senior students of C Girls' High School in Cheonan. They were divided into 3 groups and treated 20 times. The first group was a foot bath group with Artemisia Herbal fermentation extracts. The second group was a foot bath group with the blending aroma essential oil of grapefruit, cypress and cedarwood. The third group was not treated. In the case of difference of physical and psychological stress, there was a reduction of 18.43 and 16.71 for the fermented extract group and 10.71 and 9.43 for the aroma group, while a reduction of 0.43 and 0.29 for the control group, respectively. This shows that foot baths using fermented extracts and aroma had lower physical stress compared to the control group (p<.01). For the difference of fatigue, there was a reduction of 19.14 for the fermented extract group, 11.57 for the aroma group and 0.07 for the control group, showing that foot baths accompanied by fermented extracts and aroma used in this study having lower fatigue compared to the control group (p<.01). The fermented extract group (M=55.71) had the highest level of satisfaction after foot baths, followed by the aroma group (M=49.14) and the control group (M=33.29). Duncan's post hoc test showed that there was a statistically considerable difference between the tests groups and control groups (p<.01). Through the results of this study, it was found that foot baths using bathing supplements were very effective for reducing stress and fatigue.

Influence of wanning traditional Chinese medicine dipping for newborns on their sleeping quality and appetite

Objective To know the influence of wanning traditional Chinese medicine dipping for newborns on their sleeping quality and appetite. Methods Divided 600 newborns into the traditional Chinese medicine dipping group, swimming group and the single bath group according to their sequence of birth, there were 200 cases in each group. Different nursing cares were used in the different group sepa-rately. Compared the condition of sleep quality and appetite among the three groups. Results The condi-tion of sleep quality and appetite in the traditional Chinese medicine dipping group was significant better than those in the other groups with few cry and scream. Conclusions Wanning traditional Chinese medicine dipping for newborns can ameliorate their quality of sleep and improve their aapetite. Key words: Newborn; Traditional Chinesemedicine; Swimming; Sleep; Appetite

成人の血液培養由来β 溶血性レンサ球菌の疫学的性状と発症例における背景因子の特徴

We studied the relationship between features of beta-hemolytic streptococci (n = 45) isolated from blood in adult invasive infection and the clinical background factors observed from January 2001 through August at a hospital for the elderly. The meanage of subjects having invasive streptococcal infection with 22 invasive Streptococcus dysgalactiae subspecies equisimilis (SDSE) strains, 2 S. pyogenes isolates, and 21 S. agalactiae (GBS) was 80 years, and 85.7% and 86.4% had underly diseases in the GBS and SDSE infections. SDSE-infected were mainly emergency woman outpatients and GBS infected were mainly man inpatients. The clinical syndrome involved pneumonia, urosepsis, and cellulitis. GBS mortality was 14.3% and SDSE mortality 27.3%. Compared to survivors, nonsurvivors had more thrombocytopenia and marked serum C-reactive protein elevation when blood culture were performed. No difference was seen in white blood cell count between bath groups. Our observations suggest that blood culture should be obtained before antimicrobials administration in elderly individuals with underlying illness who are seen at the emergency department and have laboratory blood data suggestive of infectious disease.

Warm Sitz Bath: Are There Benefits after Transurethral Resection of the Prostate?

PurposeWe aimed to evaluate the efficacy of warm water sitz baths in patients who have undergone transurethral resection of the prostate (TURP) owing to lower urinary tract symptoms secondary to benign prostatic hyperplasia.Materials and MethodsWe reviewed the records of 1,783 patients who had undergone TURP between 2001 and 2009. In the warm water sitz bath group, patients were instructed to sit in a tub containing lukewarm water at 40-45℃ for 10 minutes each time. Patients were advised to perform the procedure for at least 5 days immediately after the removal of a Foley urethral catheter. The differences in post-TURP complications between the warm water sitz bath group and the no sitz bath group were compared.ResultsAfter TURP, 359 of the 1,561 patients performed a warm water sitz bath. Complications after TURP, such as hemorrhage, urinary tract infection, urethral stricture, and acute urinary retention were found in 19 (5.3%) and 75 (6.2%) patients in the sitz bath and no sitz bath groups, respectively (p=0.09). There was a significant difference in postoperative complications such as urethral stricture between the warm sitz bath group and the no sitz bath group (p=0.04). The group that did not undergo warm water sitz bath treatment showed a 1.13-fold increased risk of rehospitalization within 1 month after TURP due to postoperative complications compared with the warm water sitz bath group (odds ratio [OR]=1.134; 95% confidence interval [CI], 1.022 to 1.193; p=0.06).ConclusionsWarm water sitz bath treatment reduced postoperative complications such as urethral stricture. These results suggest that large-scale prospective studies are needed to establish an ideal method and optimal duration of sitz baths.

A randomized controlled study to evaluate the cost-effectiveness in sperm extraction using carbon dioxide and carbon dioxide free system in relation to intrauterine insemination pregnancy

OBJECTIVES:To evaluate the effectiveness of two different systems i.e. circulating water bath and carbon dioxide (CO2) incubator in extracting motile sperm for IUI programme and their effect on pregnancy outcome.METHODS:The study was performed on sixty-two patients recruited for ovulation induction followed by intrauterine insemination (IUI) in University fertility clinic. The patients were randomly divided into two groups and sperm preparation was performed with either water bath or CO2 incubator system. The efficiency of the two systems was analyzed in relation to pregnancy outcome.RESULTS:There was no significant difference in the efficacy of water bath and CO2 system with respect to the quality of sperm extracted and pregnancy outcome. Although pregnancy rate was marginally higher in water bath group, it was not statistically significant.CONCLUSION:CO2-free system can be a cost-effective approach in IUI programme which does not compromise with pregnancy rate.

Influence of Bathing or Washing on Skin Barrier Function in Newborns during the First Four Weeks of Life

Background and Objectives: After birth, skin barrier function is in state of flux and at risk of dysfunction. In a prospective clinical study, we compared the effects of 2 standard cleansing procedures on skin barrier function in newborns. Methods: Fifty-seven healthy full-term neonates aged ≤48 h were randomly assigned to either a bathing group (group B; n = 29), who were bathed with clear water twice weekly, or to a washing group (group W; n = 28), who were washed with a washcloth moistened with clear water twice weekly. Transepidermal water loss (TEWL), skin pH, stratum corneum hydration (SCH) and sebum production were measured at days 2, 7 and 28 of life on the forehead, abdomen, upper leg and buttock. Results: Group B showed significantly lower TEWL on the buttock and higher SCH on the abdomen and forehead compared to group W at day 28. Conclusions: Both skin care regimens do not harm the adaptation of the skin barrier in healthy neonates within the first 4 weeks of life. Skin barrier function differentiates after birth in a regionally specific fashion.

Comparison of Clinical Effects Between Warm Water Spray and Sitz Bath in Post-hemorrhoidectomy Period

BackgroundWarm water sitz bath is advised for a variety of anorectal disorders. However, preparation of the sitz bath is sometimes difficult for patients. As an alternative to the sitz bath, we have adapted a water spray method. A randomized, controlled study was conducted to determine if the water spray method has similar effects to the sitz bath in the post-hemorrhoidectomy period and it is easy to carry out. MethodsA total of 120 patients were randomly assigned to water spray or sitz bath groups. All patients received analgesics and a fiber-rich diet after hemorrhoidectomy. Clinical parameters including pain, irritation (burning or itching sensations), hygiene, convenience, and overall satisfaction were evaluated by a visual analog scale to assess treatment outcome in both groups. ResultsThere was no obvious difference in age, gender distribution, body mass index, or duration of disease between groups. There were no significant difference in scores for postoperative pain (p = 0.23), irritation (p = 0.48), or hygiene (p = 0.725) between groups. However, the water spray group reported significantly greater convenience (p < 0.05) and higher overall satisfaction (p < 0.05) compared with the sitz bath group. At the end of the 4-week postoperative follow-up period, 90% of patients in the watery spray group and 93% of patients in the sitz bath group showed complete wound healing. There were no significant differences in postoperative complications between groups. ConclusionOur results demonstrate that the water spray method could provide a safe and reliable alternative to the sitz bath for post-hemorrhoidectomy care. Furthermore, the water spray method could be used instead of the sitz bath as a more convenient and satisfactory form of treatment.

Comparison of Three Protocols for Tight Glycemic Control in Cardiac Surgery Patients

OBJECTIVEWe performed a randomized trial to compare three insulin-titration protocols for tight glycemic control (TGC) in a surgical intensive care unit: an absolute glucose (Matias) protocol, a relative glucose change (Bath) protocol, and an enhanced model predictive control (eMPC) algorithm.RESEARCH DESIGN AND METHODSA total of 120 consecutive patients after cardiac surgery were randomly assigned to the three protocols with a target glycemia range from 4.4 to 6.1 mmol/l. Intravenous insulin was administered continuously or in combination with insulin boluses (Matias protocol). Blood glucose was measured in 1- to 4-h intervals as requested by the protocols.RESULTSThe eMPC algorithm gave the best performance as assessed by time to target (8.8 ± 2.2 vs. 10.9 ± 1.0 vs. 12.3 ± 1.9 h; eMPC vs. Matias vs. Bath, respectively; P < 0.05), average blood glucose after reaching the target (5.2 ± 0.1 vs. 6.2 ± 0.1 vs. 5.8 ± 0.1 mmol/l; P < 0.01), time in target (62.8 ± 4.4 vs. 48.4 ± 3.28 vs. 55.5 ± 3.2%; P < 0.05), time in hyperglycemia >8.3 mmol/l (1.3 ± 1.2 vs. 12.8 ± 2.2 vs. 6.5 ± 2.0%; P < 0.05), and sampling interval (2.3 ± 0.1 vs. 2.1 ± 0.1 vs. 1.8 ± 0.1 h; P < 0.05). However, time in hypoglycemia risk range (2.9–4.3 mmol/l) in the eMPC group was the longest (22.2 ± 1.9 vs. 10.9 ± 1.5 vs. 13.1 ± 1.6; P < 0.05). No severe hypoglycemic episode (<2.3 mmol/l) occurred in the eMPC group compared with one in the Matias group and two in the Bath group.CONCLUSIONSThe eMPC algorithm provided the best TGC without increasing the risk of severe hypoglycemia while requiring the fewest glucose measurements. Overall, all protocols were safe and effective in the maintenance of TGC in cardiac surgery patients.

WARM SITZ BATH DOES NOT REDUCE SYMPTOMS IN POSTHAEMORRHOIDECTOMY PERIOD: A RANDOMIZED, CONTROLLED STUDY

Warm water sitz bath is routinely recommended after anal surgery. The aim of this study was to determine the influence of sitz bath with regards to pain scores, analgesic requirements and patient satisfaction ratings after haemorrhoidectomy. Fifty patients were randomly assigned to receive antibiotics and analgesics alone (control patients) or a twice-daily sitz bath along with identical antibiotics and analgesics (sitz bath group). Weekly pain score and patient satisfaction score were evaluated on visual analogue scores. The number of analgesic tablets consumed in each week was also assessed. There was no significant difference in age, gender distribution and the number of excised haemorrhoid piles between the two groups. No significant difference in postoperative mean pain score between groups (P = 0.234) was noticed. Likewise, no relevant differences in analgesic requirements between sitz bath and no sitz bath group (P = 0.435) were seen. The satisfaction score was higher in the sitz bath group when compared with the control group; however, it did not reach a statistically significant level. This study shows that sitz bath does not offer pain relief, wound healing or reduction in consumption of analgesics and thus there is no evidence to prescribe sitz bath in the post-haemorrhoidectomy period.

Rehabilitation in ankylosing spondylitis

Medical therapy of ankylosing spondylitis has improved dramatically with the advent of anti-tumor necrosis factor therapy, but nonpharmacologic therapies have long been employed to treat the condition. The purpose of this review is to summarize the most recent data to assess the role of exercise and nonpharmacologic therapies in ankylosing spondylitis. We review six articles published since 2005. The most common outcome measures (validated scores from Bath group) were only formally utilized in two studies. Four of the six studies were randomized controlled trials. One study using balneotherapy did not reveal any significant improvement in the medium term. One study used a multimodal exercise program, which revealed some benefit. Two studies assessed short and long-term efficacy of an experimental exercise protocol and suggested a prolonged benefit. Two small studies looking at biologic markers suggested that exercise may impact cytokine production. All studies we reviewed had small numbers of participants without a standardized control group and each study used different outcome measures. This review demonstrates the importance of continued emphasis on exercise therapy, the need for a standardized approach to exercise therapy, and a potential biologic effect. Exercise therapy should remain a mainstay of ankylosing spondylitis treatment complementing medical therapy.

Effects of Warm Water Sitz Bath on Symptoms in Post‐anal Sphincterotomy in Chronic Anal Fissure—A Randomized and Controlled Study

Sitz bath is frequently recommended by physicians for a variety of anal disorders including anal fissure. The aim of the present study was to determine whether sitz bath does have any therapeutic properties improving upon a patient's postoperative symptoms after a closed lateral sphincterotomy. Forty-six patients were randomly assigned to receive analgesics and fiber supplement alone (control patients) or a twice-daily sitz bath along with identical fiber and analgesics (sitz bath group). A 24-h pain score--post-defecation anal burning and symptom improvement--was evaluated on a visual analog scale (VAS). The groups were equally matched for age, gender distribution, and duration of disease. No significant difference in mean pain score between groups (p = 0.284) was noticed after one week. However, the patients from the control group experienced significant anal burning compared with patients from sitz bath group (p < 0.0001). The improvement score was higher in the sitz bath group when compared with the control group; however, it did not reached a statistically significant level. Patients after sphincterotomy for anal fissure receiving sitz bath experienced similar levels of pain when compared with those not receiving sitz bath. However, they reported a significant relief in anal burning and a marginally better satisfaction score and no reported adverse side effects.

RANDOMIZED, CONTROLLED STUDY COMPARING SITZ‐BATH AND NO‐SITZ‐BATH TREATMENTS IN PATIENTS WITH ACUTE ANAL FISSURES

To determine the efficacy and safety of sitz baths in the management of acute anal fissures. Individual patients were randomized to either receive sitz baths or no sitz baths for 4 weeks in addition to oral psyllium husk. Patients were asked to soak their hips and buttocks in a tub containing plain lukewarm water for 10 min, once after defecation in the morning and again at bedtime. Each week, the patients were called to assess pain scores and healing of fissures, whereas the level of satisfaction was recorded at the end of 4 weeks. Main outcome measures were validated pain scores and levels of satisfaction. Fifty-eight subjects were recruited for this study. In all, 52 of them completed the trial (27 in the sitz bath group and 25 in the control group). Although the pain score was lesser in the sitz bath group than in the control group, it failed to reach statistical significance. There were no significant differences in fissure healing between the two groups over the 4-week study period. However, patients in the sitz bath group reported better satisfaction levels than the control group (P < 0.01). Although no serious adverse effects were observed, two patients from sitz bath group developed perianal skin rash. This study suggests that sitz baths improve patient satisfaction in acute anal fissures. However, the healing and overall pain relief was not significant enough to attract attention. It was also found to be associated with adverse effects in few patients.

Effects of Stanger bath therapy on fibromyalgia

The purpose of this study was to assess the effectiveness of Stanger bath on the treatment of fibromyalgia (FM). Fifty women with FM were randomly divided into two groups. The first group (n=25) was treated with amitriptyline, 10 mg/day for 8 weeks, and Stanger bath, 20 min daily for ten sessions. The second group (n=25) only had amitriptyline, 10 mg/day for 8 weeks. In the first group the assessment parameters were measured before (t1), at the end (t2), and 2 months after the hydrotherapy (t3). In the second group these parameters were examined before (T1) and 2 months after the treatment (T2). Patients were evaluated by number of tender points and Fibromyalgia Impact Questionnaire (FIQ) scores. There was significant improvement in number of tender points between t1 and t2 (P<0.01) and t1 and t3 (P<0.001) in the Stanger bath group. In addition, there was significant improvement in FIQ scores between t1 and t2 (P<0.001) and t1 and t3 (P<0.01) in the Stanger bath group. In the second group we observed significant improvement in FIQ scores and tender point numbers between T1 and T2 (P=0.00). We did not find any difference between groups in tender point number percent change (p=0.074). However, we observed statistically significant improvement in percent change of FIQ scores in Stanger bath group (-30+/-16.7) when compared to group 2 (-19.3+/-13) (p=0.016). We conclude that Stanger bath therapy when combined with amitriptyline has a long lasting effect and better outcome in FM patients.