The Benefits of an Integral HAMMAM Experience Combining Hydrotherapy and Swedish Massage on Pain, Subjective Well-Being and Quality of Life in Women with Endometriosis-Related Chronic Pelvic Pain: A Randomized Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Randomization
2.3. Intervention
2.4. Outcome Measures
2.4.1. Primary Endpoint
2.4.2. Secondary Endpoints
2.5. Statistical Analysis
3. Results
3.1. Primary Outcome: Pain Intensity
3.2. Secondary Outcomes
3.2.1. Other Pain-Related Outcomes
3.2.2. Subjective Well-Being, Functional Capacity and QoL
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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HAMMAM Group (n = 21) | Control Group (n = 23) | p-Value 1 | |
---|---|---|---|
Mean ± SD | Mean ± SD | ||
Age (yr) | 35.33 ± 6.65 | 35.26 ± 5.77 | 0.971 |
Height (m) | 1.64 ± 0.05 | 1.64 ± 0.06 | 0.777 |
Weight (kg) | 70.93 ± 10.40 | 71.72 ± 16.11 | 0.733 |
Body mass index (kg/m2) | 26.30 ± 3.93 | 26.83 ± 6.41 | 0.832 |
Marital status | 0.541 | ||
Single | 12 (57.1%) | 11 (47.8%) | |
Married/Divorced | 9 (42.9%) | 12 (52.2%) | |
Employment status | 0.176 | ||
Employed | 14 (66.7%) | 20 (87.0%) | |
Unemployed | 2 (9.5%) | 0 (0.0%) | |
Medical leave | 5 (23.8%) | 3 (13.0%) | |
Educational level | 0.592 | ||
Less than university | 8 (38.1%) | 7 (30.4%) | |
University | 13 (61.9%) | 16 (69.6%) | |
Smoking habits | 0.870 | ||
No/Former smoker | 18 (76.2%) | 16 (78.3%) | |
Yes | 5 (23.8%) | 5 (21.7%) | |
Endometriosis diagnosis | 0.741 | ||
Laparoscopy | 12 (57.1%) | 12 (52.2%) | |
Imaging (MRI, US) | 9 (42.9%) | 11 (47.8%) | |
Time since diagnosis (yr) | 5.12 ± 3.67 | 4.63 ± 4.30 | 0.397 |
Number of endometriosis-related surgeries | 0.820 | ||
0 | 9 (42.9%) | 12 (52.2%) | |
1 | 9 (42.9%) | 8 (34.8%) | |
≥2 | 3 (14.3%) | 3 (13.0%) | |
Oral contraceptives | 0.598 | ||
No | 5 (23.8%) | 4 (17.4%) | |
Yes | 16 (76.2%) | 19 (82.6%) | |
Parity | 0.598 | ||
Nulliparous | 16 (76.2%) | 19 (82.6%) | |
Primiparous/multiparous | 5 (23.8%) | 4 (17.4%) |
HAMMAM Group (n = 21) | Control Group (n = 23) | p-Value | |
---|---|---|---|
Mean ± SD | Mean ± SD | ||
Primary outcome | |||
Pain intensity—NRS | |||
Current pelvic pain | 5.41 ± 2.15 | 5.06 ± 1.71 | 0.469 |
Dysmenorrhea | 7.24 ± 2.93 | 7.65 ± 1.17 | 0.660 |
Dyspareunia | 6.71 ± 1.79 | 6.18±2.40 | 0.637 |
Dyschezia | 5.65 ± 2.32 | 5.29 ± 2.44 | 0.499 |
Dysuria | 3.82 ± 2.90 | 3.82 ± 2.53 | 0.981 |
Secondary outcomes | |||
Pressure pain threshold—Algometry | |||
Supraumbilical, right side | 1.54 ± 0.69 | 1.55 ± 0.91 | 0.405 |
Infraumbilical, right side | 1.27 ± 0.70 | 1.17 ± 0.75 | 0.440 |
Supraumbilical, left side | 1.45 ± 0.73 | 1.50 ± 0.87 | 0.356 |
Infraumbilical, left side | 1.31 ± 0.72 | 1.03 ± 0.64 | 0.126 |
Pubis symphysis | 1.22 ± 0.62 | 1.10 ± 0.82 | 0.301 |
Inguinal ligament, right side | 1.26 ± 0.83 | 1.06 ± 0.87 | 0.466 |
Inguinal ligament, left side | 0.97 ± 0.52 | 1.00 ± 0.75 | 0.565 |
Lumbar, right side | 2.01 ± 1.26 | 2.23 ± 1.47 | 0.630 |
Lumbar, left side | 1.85 ± 1.28 | 2.30 ± 1.64 | 0.533 |
Second metacarpal, right side | 2.17 ± 1.13 | 2.16 ± 1.12 | 0.396 |
Second metacarpal, left side | 2.09 ± 1.29 | 2.21 ± 1.23 | 0.622 |
Umbilical region | 1.39 ± 0.65 | 1.32 ± 0.72 | 0.304 |
Pelvic region | 1.15 ± 0.67 | 1.05 ± 0.79 | 0.455 |
Lumbar region | 1.93 ± 1.23 | 2.27 ± 1.54 | 0.565 |
Metacarpals | 2.13 ± 1.17 | 2.19 ± 1.16 | 0.647 |
Pain interference—BPI | |||
General activity | 4.76 ± 1.99 | 5.82 ± 2.68 | 0.344 |
Mood | 5.59 ± 2.27 | 6.53 ± 1.97 | 0.305 |
Walking ability | 4.00 ± 2.62 | 4.41 ± 2.98 | 0.501 |
Normal work | 4.35 ± 2.57 | 4.82 ± 2.43 | 0.497 |
Relationships with other people | 4.65 ± 2.69 | 4.35 ± 2.40 | 0.215 |
Sleep | 5.41 ± 2.94 | 4.24 ± 2.41 | 0.105 |
Enjoyment of life | 4.88 ± 2.85 | 5.71 ± 2.02 | 0.216 |
Total | 5.15 ± 2.17 | 5.16 ± 2.13 | 0.497 |
Pain catastrophizing thoughts—PCS | |||
Total | 27.62 ± 10.41 | 27.91 ± 11.33 | 0.888 |
Subjective well-being—EBS-20 | |||
Satisfaction with life | 3.30 ± 1.16 | 3.25 ± 1.00 | 0.436 |
Positive affect | 3.79 ± 0.71 | 3.70 ± 0.78 | 0.345 |
Total | 3.55 ± 0.85 | 3.48 ± 0.82 | 0.389 |
Functioning—PROMIS-29 | |||
Physical function | 16.00 ± 4.29 | 16.09 ± 3.36 | 0.905 |
Pain intensity | 5.86 ± 2.15 | 5.96 ± 1.66 | 0.981 |
Pain interference | 11.90 ± 3.55 | 11.96 ± 3.75 | 0.915 |
Fatigue | 14.71 ± 3.54 | 15.00 ± 4.05 | 0.645 |
Sleep disturbance | 13.57 ± 3.60 | 12.22 ± 3.25 | 0.098 |
Anxiety | 11.95 ± 2.85 | 12.65 ± 3.42 | 0.234 |
Depression | 10.81 ± 3.89 | 11.78 ± 3.42 | 0.191 |
Ability to participate in social roles and activities | 11.24 ± 3.58 | 11.65 ± 3.50 | 0.350 |
Quality of life—EHP-30 | |||
Pain | 52.81 ± 19.75 | 57.61 ± 15.35 | 0.186 |
Control and powerlessness | 59.72 ± 22.10 | 69.57 ± 18.18 | 0.056 |
Emotional well-being | 55.75 ± 15.95 | 60.69 ± 15.93 | 0.155 |
Social support | 59.23 ± 19.53 | 65.85 ± 18.89 | 0.130 |
Self-image | 59.13 ± 19.53 | 67.75 ± 22.23 | 0.090 |
Total | 56.27 ± 14.83 | 62.73 ± 12.60 | 0.063 |
HAMMAM Group (n = 21) | Control Group (n = 23) | Between-Group Effects | |
---|---|---|---|
Mean [CI(95%)] | Mean [CI(95%)] | ||
Pain intensity—NRSW | |||
Current pelvic pain | |||
Baseline | 5.60 [4.38, 6.82] | 5.06 [4.18, 5.94] | |
Post-intervention | 4.33 [2.74, 5.92] | 4.88 [3.75, 6.02] | |
Within-group score change | −1.27 [−2.77, 0.23] | −0.18 [−1.21, 0.86] | −1.20 [−2.70, 0.30] |
Dysmenorrhea | |||
Baseline | 7.13 [5.42, 8.84] | 7.65 [7.05, 8.25] | |
Post-intervention | 5.87 [4.22, 7.51] | 7.59 [6.88, 8.29] | |
Within-group score change | −1.27 [−2.32, −0.21] | −0.29 [−0.65, 0.53] | −1.21 [−2.33, −0.09] *b |
Dyspareunia | |||
Baseline | 6.80 [5.77, 7.83] | 6.18 [4.94, 7.41] | |
Post-intervention | 5.27 [3.71, 6.83] | 5.88 [4.61, 7.15] | |
Within-group score change | −1.53 [−2.97, −0.10] | −0.29 [−0.99, 0.40] | −1.24 [−2.71, −0.23] *a |
Dyschezia | |||
Baseline | 5.67 [4.33, 7.00] | 5.29 [4.04, 6.55] | |
Post-intervention | 4.33 [2.61, 6.06] | 5.00 [3.84, 6.16] | |
Within-group score change | −1.33 [−2.85, 0.19] | −0.29 [−1.99, 1.40] | −1.27 [−2.88, 0.34] |
Dysuria | |||
Baseline | 4.27 [2.72, 5.81] | 3.82 [2.52, 5.12] | |
Post-intervention | 3.20 [1.52, 4.88] | 3.82 [2.48, 5.16] | |
Within-group score change | −1.07 [−2.51, 0.38] | 0.00 [−1.45, 1.45] | −0.81 [−2.30, 0.67] |
HAMMAM Group (n = 21) | Control Group (n = 23) | Between-Group Effects | |
---|---|---|---|
Mean [CI(95%)] | Mean [CI(95%)] | ||
Pain interference—BPI | |||
Baseline | 5.08 [3.90, 6.25] | 5.13 [4.16, 6.09] | |
Post-intervention | 3.94 [2.37, 5.51] | 4.80 [3.46, 6.13] | |
Within-group score change | −1.13 [−2.08, −0.18] | −0.33 [−1.58, 0.93] | −0.44 [−1.68, 0.80] |
Pain catastrophizing thoughts—PCS | |||
Baseline | 27.62 [22.88, 32.56] | 28.17 [22.84, 33.51] | |
Post-intervention | 24.52 [18.92, 30.12] | 25.61 [20.58, 30.64] | |
Within-group score change | −3.10 [−7.81, 1.62] | −2.57 [−6.51, 1.38] | −0.56 [−7.54, 6.43] |
Pressure pain thresholds—Algometry | |||
Umbilical region | |||
Baseline | 1.41 [1.03, 1.79] | 1.32 [0.95, 1.69] | |
Post-intervention | 1.51 [1.01, 2.01] | 1.15 [0.78, 1.53] | |
Within-group score change | 0.10 [−0.31, 0.51] | −0.16 [−0.56, 0.23] | 0.27 [−0.16, 0.71] |
Pelvic region | |||
Baseline | 1.10 [0.71, 1.49] | 1.05 [0.65, 1.46] | |
Post-intervention | 1.49 [1.06, 1.92] | 1.00 [0.61, 1.38] | |
Within-group score change | 0.39 [0.01, 0.77] | −0.06 [−0.38, 0.27] | 0.42 [0.05, 0.80] *a |
Lumbar region | |||
Baseline | 1.92 [1.20, 2.64] | 2.27 [1.48, 3.06] | |
Post-intervention | 2.40 [1.66, 3.14] | 2.56 [1.46, 3.65] | |
Within-group score change | 0.48 [−0.14, 1.10] | 0.29 [−0.39, 0.97] | 0.30 [−0.47, 1.06] |
Metacarpals | |||
Baseline | 2.16 [1.47, 2.85] | 2.19 [1.59, 2.78] | |
Post-intervention | 2.20 [1.45, 2.95] | 2.16 [1.34, 2.98] | |
Within-group score change | 0.04 [−0.44, 0.52] | −0.03 [−0.48, 0.42] | 0.34 [−0.20, 0.88] |
HAMMAM Group (n = 21) | Control Group (n = 23) | Between-Group Effects | |
---|---|---|---|
Mean [CI(95%)] | Mean [CI(95%)] | ||
Subjective well-being—EBS-20 | |||
Satisfaction with life | |||
Baseline | 3.30 [2.78, 3.83] | 3.25 [2.82, 3.69] | |
Post-intervention | 3.37 [2.87, 3.88] | 3.38 [2.90, 3.86] | |
Within-group score change | 0.07 [−0.23, 0.37] | 0.13 [−0.15, 0.40] | −0.06 [−0.45, 0.34] |
Positive affect | |||
Baseline | 3.79 [3.47, 4.11] | 3.70 [3.36, 4.04] | |
Post-intervention | 3.63 [3.29, 3.97] | 3.70 [3.33, 4.07] | |
Within-group score change | −0.16 [−0.44, 0.12] | 0.00 [−0.18, 0.17] | −0.16 [−0.47, 0.16] |
Total | |||
Baseline | 3.55 [3.16, 3.94] | 3.48 [3.12, 3.83] | |
Post-intervention | 3.50 [3.11, 3.89] | 3.54 [3.15, 3.93] | |
Within-group score change | −0.05 [−0.20, 0.11] | 0.06 [−0.13, 0.26] | −0.11 [−0.35, 0.14] |
Functioning—PROMIS-29 | |||
Physical function | |||
Baseline | 16.00 [14.05, 17.95] | 16.09 [14.64, 17.54] | |
Post-intervention | 15.90 [13.92, 17.89] | 16.13 [14.74, 17.52] | |
Within-group score change | −0.10 [−0.67, 0.48] | 0.04 [−0.42, 0.50] | −0.14 [−0.85, 0.57] |
Pain intensity | |||
Baseline | 5.86 [4.88, 6.84] | 5.96 [5.24, 6.68] | |
Post-intervention | 4.95 [3.69, 6.21] | 6.09 [5.23, 6.94] | |
Within-group score change | −0.90 [−2.03, 0.22] | 0.13 [−0.60, 0.86] | −1.04 [−2.31, 0.24] |
Pain interference | |||
Baseline | 11.90 [10.29, 13.52] | 11.96 [10.34, 13.58] | |
Post-intervention | 10.00 [7.75, 12.25] | 12.30 [10.39, 14.22] | |
Within-group score change | −1.90 [−3.51, −0.30] | 0.35 [−0.74, 1.44] | −2.25 [−4.11, −0.40] *a |
Fatigue | |||
Baseline | 14.71 [13.10, 16.32] | 15.00 [13.25, 16.75] | |
Post-intervention | 13.52 [11.79, 15.26] | 14.22 [12.43, 16.01] | |
Within-group score change | −1.19 [−2.75, 0.37] | −0.78 [−1.94, 0.38] | −0.41 [−2.27, 1.46] |
Sleep disturbance | |||
Baseline | 13.57 [11.93, 15.21] | 12.22 [10.81, 13.62] | |
Post-intervention | 12.00 [10.62, 13.38] | 12.30 [10.61, 14.00] | |
Within-group score change | −1.57 [−3.39, 0.25] | 0.09 [−1.14, 1.31] | −1.66 [−3.75, 0.43] |
Anxiety | |||
Baseline | 11.95 [10.65, 13.25] | 12.65 [11.17, 14.13] | |
Post-intervention | 11.43 [9.58, 13.28] | 12.48 [10.90, 14.05] | |
Within-group score change | −0.52 [−1.80, 0.75] | −0.17 [−0.96, 0.62] | −0.35 [−1.78, 1.08] |
Depression | |||
Baseline | 10.81 [9.04, 12.58] | 11.78 [10.30, 13.26] | |
Post-intervention | 9.52 [7.81, 12.24] | 11.48 [9.64, 13.31] | |
Within-group score change | −1.29 [−2.81, 0.24] | −0.30 [−1.55, 0.94] | −0.98 [−2.88, 0.92] |
Ability to participate in social roles and activities | |||
Baseline | 11.24 [9.61, 12.87] | 11.65 [10.14, 13.16] | |
Post-intervention | 12.95 [11.19, 14.71] | 12.09 [10.51, 13.66] | |
Within-group score change | 1.71 [0.40, 2.64] | 0.43 [−0.45, 1.32] | 1.09 [−0.28, 2.46] |
Quality of life—EHP-30 | |||
Pain | |||
Baseline | 52.81 [43.83, 61.80] | 57.61 [50.97, 64.25] | |
Post-intervention | 43.40 [32.88, 53.91] | 50.40 [44.15, 56.64] | |
Within-group score change | −9.42 [−16.44, −2.40] | −7.21 [−11.99, −2.44] | −2.20 [−10.31, 5.90] |
Control and powerlessness | |||
Baseline | 59.72 [49.66, 69.78] | 69.57 [61.70, 77.43] | |
Post-intervention | 45.63 [34.39, 56.88] | 55.80 [48.43, 63.16] | |
Within-group score change | −14.07 [−22.84, −5.29] | −13.77 [−20.36, −7.17] | −0.30 [−10.83, 10.23] |
Emotional well-being | |||
Baseline | 55.75 [48.49, 63.01] | 60.69 [53.80, 67.58] | |
Post-intervention | 50.40 [42.29, 58.51] | 52.72 [47.06, 58.38] | |
Within-group score change | −5.35 [−10.95, 0.25] | −7.97 [−13.87, −2.07] | 2.62 [−5.32, 10.55] |
Social support | |||
Baseline | 59.23 [50.34, 68.12] | 65.85 [57.68, 74.01] | |
Post-intervention | 53.87 [43.24, 64.49] | 64.41 [57.53, 71.30] | |
Within-group score change | −5.36 [−15.51, 4.79] | −1.43 [−10.46, 7.59] | −3.92 [−17.06, 9.21] |
Self-image | |||
Baseline | 59.13 [50.24, 68.02] | 67.75 [58.14, 77.37] | |
Post-intervention | 52.78 [40.94, 64.61] | 62.33 [53.64, 71.01] | |
Within-group score change | −6.35 [−12.57, −0.13] | −5.43 [−12.60, 1.74] | −0.92 [−10.22, 8.38] |
Total | |||
Baseline | 56.27 [49.52, 63.02] | 62.73 [57.28, 68.18] | |
Post-intervention | 47.58 [39.09, 56.07] | 55.00 [50.09, 59.92] | |
Within-group score change | −8.69 [−14.47, −2.91] | −7.73 [−12.17, −3.29] | −0.96 [−7.96, 6.03] |
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© 2024 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Rodríguez-Ruiz, Á.; Arcos-Azubel, C.; Ruiz-Pérez, M.; Peinado, F.M.; Mundo-López, A.; Lara-Ramos, A.; Salinas-Asensio, M.d.M.; Artacho-Cordón, F. The Benefits of an Integral HAMMAM Experience Combining Hydrotherapy and Swedish Massage on Pain, Subjective Well-Being and Quality of Life in Women with Endometriosis-Related Chronic Pelvic Pain: A Randomized Controlled Trial. Medicina 2024, 60, 1677. https://doi.org/10.3390/medicina60101677
Rodríguez-Ruiz Á, Arcos-Azubel C, Ruiz-Pérez M, Peinado FM, Mundo-López A, Lara-Ramos A, Salinas-Asensio MdM, Artacho-Cordón F. The Benefits of an Integral HAMMAM Experience Combining Hydrotherapy and Swedish Massage on Pain, Subjective Well-Being and Quality of Life in Women with Endometriosis-Related Chronic Pelvic Pain: A Randomized Controlled Trial. Medicina. 2024; 60(10):1677. https://doi.org/10.3390/medicina60101677
Chicago/Turabian StyleRodríguez-Ruiz, Ángel, Camila Arcos-Azubel, Manuel Ruiz-Pérez, Francisco Manuel Peinado, Antonio Mundo-López, Ana Lara-Ramos, María del Mar Salinas-Asensio, and Francisco Artacho-Cordón. 2024. "The Benefits of an Integral HAMMAM Experience Combining Hydrotherapy and Swedish Massage on Pain, Subjective Well-Being and Quality of Life in Women with Endometriosis-Related Chronic Pelvic Pain: A Randomized Controlled Trial" Medicina 60, no. 10: 1677. https://doi.org/10.3390/medicina60101677
APA StyleRodríguez-Ruiz, Á., Arcos-Azubel, C., Ruiz-Pérez, M., Peinado, F. M., Mundo-López, A., Lara-Ramos, A., Salinas-Asensio, M. d. M., & Artacho-Cordón, F. (2024). The Benefits of an Integral HAMMAM Experience Combining Hydrotherapy and Swedish Massage on Pain, Subjective Well-Being and Quality of Life in Women with Endometriosis-Related Chronic Pelvic Pain: A Randomized Controlled Trial. Medicina, 60(10), 1677. https://doi.org/10.3390/medicina60101677