Background: Physical therapy has not been evaluated much for the treatment of chronic venous insufficiency before. The question is whether balneohydrotherapy and usual care combined is superior to usual care alone.

Patients and methods: In a randomized trial comparing spa therapy versus waiting list patients were treated on an out-patient basis in a private spa center. Patients had to be between 18 and 80 years old, with chronic venous insufficiency (stage 3 or 4 according to the CEAP classification). The balneohydrotherapy group received 18 days of treatment in Aix-Les-Bains spa center continuing their usual care. The control group continued their usual care as well during the study. The balneohydrotherapy program consisted of Kneipp therapy (10 minutes), walking 10 minutes in a special mineral water pool with underwater jets at 23 °C, massage and bathing in a mineral water tub at 34 °C. The main outcome criterion was the number of patients with 20 % self assessed improvement on the Chronic Venous Insufficiency Questionnaire at three months after therapy.

Results: 192 patients were assessed for eligibility, 99 were randomized 5 retired drew back their consent and were not included in the intention to treat analysis. None were lost to follow up. After three months 32 (66 %) patients improved in the balneohydrotherapy group and 13 (28 %) in the control group. The difference between groups was significant (odd ratio 5.08 [1.94 - 13.55], relative risk reduction 2.33 [1.42 - 3.84]).There were no serious side effects.

Conclusions: Balneohydrotherapy seems to improve quality of life of patients with chronic venous insufficiency.