Supplementary Material for: Effectiveness of mud-pack therapy and mud-bath therapy in osteoarthritis. A systematic review.

Background
Osteoarthritis has a tremendous socioeconomic impact in terms of drug spending, hospital admissions, work productivity and temporary or permanent incapacity. Mud therapy has been discussed as a potential conservative treatment options for osteoarthritis. However, findings from several trials still remain controversial.

Methods
We conducted a systematic review of the literature on mud-therapy in the treatment of osteoarthritis in order to investigate the evidence of efficiency of this treatment.

Results
Of the 19 studies included, 15 examined the effects of mud-bath therapy in knee osteoarthritis treatment. We finally systematically reviewed the data obtained from literature and summarized the results on the basis of the main outcomes. The results show significant improvements in function, quality of life and perceived pain for patients with osteoarthritis.

Conclusion
Results of randomized controlled trials suggest that mud therapy is part of a promising integrated and synergistic multidisciplinary approach in combination with other treatment forms like pharmacotherapy or physiotherapy. Impressing drug- reduction of conventional treatment dosage was reported, possibly resulting in lesser costs and drug-related adverse events.