BALÇOVA THERMALİZMİR-TÜRKİYE

Balçova Thermal Physical Therapy & Rehabilitation CenterIzmir, Turkey

Dr. Aral HAKGÜDERPhysical & Rehabilitation Medicine, MD

B A L Ç O V A T H E R M A L

B A L Ç O V A T H E R M A L

B A L Ç O V A T H E R M A L

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

Well Depth (m) Flow (L/sec) Temp. (ºC)

BD-7 702 35-40 135-140

BD-6 605 35-40 135-140

BD-4 624 40-45 140

BD-2 677 35-40 140

BD-3 750 35-40 135

B-11 125 10 102-105

B-10 125 25 95-105

B-4 125 20 95-105

N-1 150 2-3 100

Total 260 L/sec 129 ºC

Thermal Production Sources-Balçova

ANALYSIS OF THERMOMINERAL WATERS OF

BALÇOVA THERMAL CENTER (2005)(Result of State Mine Investigation and Research Institute &

Istanbul University Medical Ecology and Hydroclimatology Department )

mg / L milival/L % milival

Na+ : 305,8 13,30 72,3

Ca++ : 62,0 3,10 16,8

K+ : 30,5 0,78 4,2

Mg++ : 10,9 0,90 4,9

Fe++ : 7,9 0,28 1,5

Other : 0,6 0,02 0,3

Total : 417,7 18,39 100,0

HCO3- : 616,1 10,10 54,6

SO4- : 177,6 3,70 20,0

Cl- : 156,3 4,41 23,8

F- : 4,6 0,24 1,3

Other : 1,3 0,04 0,3

Total : 955,9 18,49 100,0

Total Mineralization:

1440,3 mg/L

Sodium

Bicarbonate

Chlor

Fluor

WATER PROPERTY

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

3 halls for group andindividual exercises withphysiotherapistsRehabilitation, manueltherapy, physical training

HYDROTHERAPY UNIT

4-Cell, Jet-Dush

Mani-Jet, Pedi-Jet

Whirlpool

Vichy Shower

Underwater massage

Aromatherapy Baths

LABORATORY

Heamogram

Sedimentation

Urine test

ASO, CRP, RF

Blood sugar

Liver, Kidney func. tests

Lipid profile etc.

X-RAY & ECG SECTION

DENTAL CLINIC

FIRST AID

• 24 hours

• Doctor on duty

• Ambulance

• 500 meters

• All departments

• Full equipment

UNIVERSITY HOSPITAL

THERMAL PROGRAM

ENVIRONMENTAL FACTORS CLIMATICPSCHYOLOGICALSOCIOLOGICAL

Monthly Mean Temperature and Humidity of Izmir (2000-2005)

Month 1 2 3 4 5 6 7 8 9 10 11 12

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 63 60 53 50 54 59 65 69 72

HOBBYROOM

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, RSD-

sudeck, 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

Total 4419 4690 4582 4797 5043

TURK

68%

NOR

% 24

Oth

8%

STATISTICS OF THE PATIENTS

Distribution of Norwegian Patients and Diagnosis

According to Years

2003 2004 2005 2006 2007

Bechterew (AS) 373 455 417 434 445

Rheumatoid Arthritis 391 433 450 437 429

Psoriatik Arthritis 240 195 217 206 208

Others 40 32 36 25 32

Total 1044 1115 1120 1102 1114

DIFFERENCE OF

MS (Morning Stiffness)

AT POSTTREATMENT

MS1-MS2 Dec % Inc % Same %

AS 359 86,3 17 4,1 40 9,6

MS1- MS2 Dec % Inc % Same %

RA-PA 512 82,6 13 2,1 95 15, 3

MEAN MS1 MS2

RA-PA 54,4 20,6

MEAN MS1 MS2

AS 59,0 21,7

DIFFERENCE OF VAS ( PAIN )

AT POSTTREATMENT

VAS1-VAS2

(pain)

Dec % Inc % Same %

AS 378 90,9 34 8,1 4 1

MEAN VAS1 VAS2

AS 47,4 18,3

VAS1-VAS2

(pain)

Dec % Inc % Same %

RA-PA 573 92,4 40 6,5 7 1,1

MEAN VAS1 VAS2

RA-PA 47,9 18,1

DIFFERENCE OF DRUG USAGE

AT POSTTREATMENT (RA-PA)

Analgesics Same % Dec % Inc % Sep %

RA-PA 89 42,9 71 34,3 8 3,8 39 18,8

NSAIDs Same % Dec % Inc % Sep %

RA-PA 243 66,2 64 17,4 7 1,9 53 14,5

Steroids Same % Dec % Inc % Sep %

RA-PA 110 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 exercise-

training, 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 lumbarflexions, chest expansion

Physical capacity tests- 6 min. Walking test

Patients’ global well-being, spinal pain, morningstiffness

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-weekrehabilitation program both in a Mediterranean and a Norwegian setting

The improvements in health status scalesand spinal mobility measures were largerand better maintained at least 3 monthslater in Mediterranean setting.

Significantly better results in Mediterraneanspa centers at 16. weeks