BALÇOVA THERMAL İZMİR-TÜRKİYE
Balรงova Thermal Physical Therapy & Rehabilitation Center Izmir, Turkey Dr. Aral HAKGร DER Physical & Rehabilitation Medicine, MD
BALÇOVA
THERMAL
BALÇOVA
THERMAL
BALÇOVA
THERMAL
UNDERGROUND
BALÇOVA THERMAL HISTORY From 1200 BC - To 1891
BALÇOVA THERMAL
Year: 1902
BALÇOVA THERMAL
Year: 1932
BALÇOVA THERMAL
Year: 1960
BALÇOVA THERMAL
Year: 1970
BALÇOVA THERMAL
Year: 1980 +
Balcova Thermal Water Thermal Production Sources-Balรงova Well BD-7 BD-6 BD-4 BD-2 BD-3 B-11 B-10 B-4 N-1 Total
Depth (m) Flow (L/sec) Temp. (ยบC) 702 605 624 677 750 125 125 125 150
35-40 35-40 40-45 35-40 35-40 10 25 20 2-3 260 L/sec
135-140 135-140 140 140 135 102-105 95-105 95-105 100 129 ยบC
ANALYSIS OF THERMOMINERAL WATERS OF BALÇOVA THERMAL CENTER (2005) (Result of State Mine Investigation and Research Institute & Istanbul University Medical Ecology and Hydroclimatology Department )
Na+ Ca++ K+ Mg++ Fe++ Other Total
mg / L : 305,8 : 62,0 : 30,5 : 10,9 : 7,9 : 0,6 : 417,7
HCO3SO4ClFOther Total
: : : : : :
616,1 177,6 156,3 4,6 1,3 955,9
milival/L 13,30 3,10 0,78 0,90 0,28 0,02 18,39 10,10 3,70 4,41 0,24 0,04 18,49
Total Mineralization:
1440,3 mg/L
% milival 72,3 16,8 4,2 4,9 1,5 0,3 100,0 54,6 20,0 23,8 1,3 0,3 100,0
WATER PROPERTY
Sodium
Bicarbonate Chlor Fluor
Treatment Center Health Team 7 Doctors 20 Physiotherapists 8 Nurses & Hydrotherapists 17 Masseurs ve Masseuses 1 Laboratory Technician 1 X-ray Technician 2 Translators
TOTAL 70
COMBINED THERAPY • • • • • • • • • •
Physical Therapy Balneotherapy Hydrotherapy Electrotherapy Paraffin Massage Exercises, kinesiotherapy Medical Therapy Diet Patient Education
THERMAL POOLS • In different sizes and
temperatures, 3 exercise pools for group and individual activities
ELECTROTHERAPY Diadynamic,
Interferential currents TENS Shortwave diathermy
Galvanic-Farady current Exponantial currents Infrared light Ultrasound therapy Laser Fluidotherapy
KINEZIOTHERAPY ď‚Ž 3 halls for group and
individual exercises with physiotherapists Rehabilitation, manuel therapy, physical training
HYDROTHERAPY UNIT 4-Cell, Jet-Dush Mani-Jet, Pedi-Jet Whirlpool Vichy Shower Underwater massage Aromatherapy Baths
X-RAY & ECG SECTION
LABORATORY
Heamogram Sedimentation Urine test ASO, CRP, RF Blood sugar Liver, Kidney func. tests Lipid profile etc.
DENTAL CLINIC
FIRST AID • 24 hours • Doctor on duty
• Ambulance
UNIVERSITY HOSPITAL • 500 meters
• All departments • Full equipment
THERMAL PROGRAM ENVIRONMENTAL FACTORS CLIMATIC PSCHYOLOGICAL SOCIOLOGICAL
Monthly Mean Temperature and Humidity of Izmir (2000-2005)
Month
1
2
3
Temp(oC)
8,7
9,6 10,6 15,7 21,7 26,5 29,0 28,1 23,4 18,7 15,1 11,6
Hum. (%)
70
68
63
4
63
5
60
6
53
7
50
8
54
9
59
10
65
11
69
12
72
HOBBY ROOM
SPORTS ACTIVITIES Fitness center Jogging-Walking Paths Cycling Tennis courts Basketball Volleyball (beachsand ground) Mini-Golf Aqua City
SOCIAL ACTIVITIES • Welcome Party • Turkish Nights • Fashion, art and •
folkdance exhibitions Excursions, tours
GARDEN 176,000 quadrmeters garden
GREENHOUSE • 14,000 quadrmeters greenhouse
• We are using our natural vegetables in our kitchen.
Diseases that can be treated at
Balçova Thermal Inflammatory Rheumatic Diseases ( Rheumatoid Arthritis, Ankylosing Spondylitis, Psoriatic Arthritis etc.) Rheumatic and mechanic Muscle and Soft Tissue Diseases (Fibromyalgia, Periarthritis, Tendinitis, Burcytis, Epicondylitis ) Cervical, low back pain syndromes Degenerative Joint Diseases (Osteoarthrosis, Calcinosis etc) Bone Metabolism Diseases (Osteoporosis, Gout Disease, Paget's Disease etc.) Orthopedic and Neurological Rehabilitation (Discopathy, Stenosis, Fractures, Paralysis, peripheric nerve lesion, RSDsudeck, stroke, CP, Parkinson, Post-Polio Syndrome etc.) Post Traumatic - Operative Sequela Geriatric Training and Rehabilitation Programs Physiological Motivation and Body Health Exercise Programs
CAPACITY Physiotherapy & Balneotherapy 5000 patients / year Total Patient 45-50,000 / year
STATISTICS OF THE PATIENTS Distribution of Patients and Nationality According to Years 2003
2004
2005
2006
2007
Turkish Patients
3148
3130
3025
3566
3608
Norwegian Patients
1044
1115
1120
1102
1114
Other(Swe,Dan,Ger,Hol,Rus) 227
445
437
129
321
4582
4797
5043
Total
4419
4690
TURK 68%
NOR % 24 Oth 8%
STATISTICS OF THE PATIENTS Distribution of Norwegian Patients and Diagnosis
According to Years 2003
2004
2005
2006
2007
373
455
417
434
445
Rheumatoid Arthritis 391
433
450
437
429
Psoriatik Arthritis
240
195
217
206
208
40
32
36
25
32
1044 1115
1120
1102
1114
Bechterew (AS)
Others Total
DIFFERENCE OF MS (Morning Stiffness) AT POSTTREATMENT MS1- MS2 RA-PA
MS1-MS2 AS
Dec 512
Dec 359
% 82,6
Inc 13
MEAN
MS1
MS2
RA-PA
54,4
20,6
% 86,3
Inc 17
MEAN
MS1
MS2
AS
59,0
21,7
% 2,1
Same 95
% 15, 3
% 4,1
Same 40
% 9,6
DIFFERENCE OF VAS ( PAIN ) AT POSTTREATMENT VAS1-VAS2 (pain) RA-PA
VAS1-VAS2 (pain) AS
Dec
%
Inc
%
Same
%
573
92,4
40
6,5
7
1,1
MEAN
VAS1
VAS2
RA-PA
47,9
18,1
Dec
%
Inc
%
Same
%
378
90,9
34
8,1
4
1
MEAN
VAS1
VAS2
AS
47,4
18,3
DIFFERENCE OF DRUG USAGE AT POSTTREATMENT (RA-PA) Analgesics Same
RA-PA
89
NSAIDs Same
RA-PA
243
Steroids Same RA-PA
110
%
Dec
%
Inc
%
Sep
%
42,9
71
34,3
8
3,8
39
18,8
%
Dec
%
Inc
%
Sep
%
66,2
64
17,4
7
1,9
53
14,5
%
Dec
%
Inc
%
Sep
%
80,9
14
10,3
4
2,9
8
5,9
Staalesen Strumse YA, Nordvag BY, Stanhelle JK et al: J Rehabil Med 2011 May; 43(6):534-42
‘Efficacy of Rehabilitation for Patients with Ankylosing Spondylitis: Comparison of a Four-Week Rehabilitation Programme in a Mediterranean and a Norwegian Setting’ Section for Climate Therapy, Dept of Rheumatology, Oslo University Hospital, Rikshospitelat and other centers in Norway Balcova Thermal Center in Turkey and Instute Igalo in Montenegro
Staalesen Strumse YA, Nordvag BY, Stanhelle JK et al: J Rehabil Med 2011 May; 43(6):534-42
Active physiotherapy: Individual exercisetraining, group exercise, pool exercise Passive therapy: Paraffin, massage, whirlpool, balneotherapy Patient education: Disease specific lectures, diet, daily life, physical activity 5 days/ week; 4 weeks totally 107 patients; 0-4-16 weeks control
Staalesen Strumse YA, Nordvag BY, Stanhelle JK et al: J Rehabil Med 2011 May; 43(6):534-42 Parameters: Spinal mobility- Schoeber test, lateral lumbar flexions, chest expansion Physical capacity tests- 6 min. Walking test Patients’ global well-being, spinal pain, morning stiffness BASDAI, BASFI Fatigue
Staalesen Strumse YA, Nordvag BY, Stanhelle JK et al: J Rehabil Med 2011 May; 43(6):534-42
Conclusions  Ankylosing Spondylitis patients had sustained positive effect of a 4-week rehabilitation program both in a Mediterranean and a Norwegian setting  The improvements in health status scales and spinal mobility measures were larger and better maintained at least 3 months later in Mediterranean setting.  Significantly better results in Mediterranean spa centers at 16. weeks