Issue 25-4, 2026

Review

https://doi.org/10.38025/2078-1962-2026-25-4-96-104

Natural Healing Factors: A Systematic Analysis of the Evidence Base and Prospects for Application in Pediatric Practice

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ORCIDNina S. Prilipko1, ORCIDNatalia A. Mokina1,*, ORCIDMikhail V. Nikitin2, ORCIDNatalia V. Machula2, ORCIDAnfisa M. Nikitina1

1Federal Scientific and Clinical Center for Medical Rehabilitation and Balneology of the Federal Medical and Biological Agency of Russia, Moscow, Russia
2National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia


ABSTRACT

INTRODUCTION. Natural healing factors (NHF) — mineral waters, therapeutic mud, climate, and saline solutions — have a centuries-long history of use in pediatrics. However, to date, there is no systematic analysis of the evidence base for the effectiveness of NHF for various childhood diseases, with a gradation of levels of evidence according to GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.

AIM. To conduct a systematic analysis of modern scientific data on the effectiveness of natural healing factors in children, structure the evidence base by nosological groups, and identify promising areas for the development of pediatric balneology.

MAIN CONTENT OF THE REVIEW. A search of publications was performed in PubMed, Cochrane Library, Embase, and eLIBRARY.RU databases for the period 2000–2025. Systematic reviews, meta-analyses, randomized controlled trials, and cohort studies were included. Evidence was assessed using the GRADE criteria. The analysis included 42 studies, including 8 systematic reviews with meta-analysis, 12 randomized controlled trials, and 22 observational studies. The strongest evidence base (levels A–B) was found for the use of mineral waters and salt baths in respiratory diseases (asthma, recurrent respiratory infections), skin diseases (atopic dermatitis, psoriasis), and musculoskeletal disorders (juvenile arthritis). Level C–B evidence was established for the use of therapeutic mud and climatotherapy in diseases of the nervous system, digestive organs, and genitourinary system. High potential for extrapolation of these studies to pediatric practice was identified, consistent with modern approaches to developing medicines for children.

CONCLUSION. Natural therapeutic factors have proven efficacy in a wide range of childhood diseases. The highest level of evidence has been established for balneotherapy for respiratory, dermatological, and rheumatological pathologies. Key limitations of the evidence base include heterogeneity of treatment protocols, small sample sizes in some studies, and insufficient validation of pediatric efficacy assessment scales. Further randomized controlled trials with standardized protocols are needed to improve the level of evidence and expand the indications for the use of NHF in pediatrics.


KEYWORDS: natural therapeutic factors, balneotherapy, children, pediatrics, mineral waters, therapeutic mud, climatotherapy, evidence-based medicine, spa treatment, GRADE, data extrapolation

FOR CITATION: Prilipko N.S., Mokina N.A., Nikitin M.V., Machula N.V., Nikitina A.M. Natural Healing Factors: A Systematic Analysis of the Evidence Base and Prospects for Application in Pediatric Practice. Bulletin of Rehabilitation Medicine. 2026; 25(4):96–104. https://doi.org/10.38025/2078-1962-2026-25-4-96-104 (In Russ.).

FOR CORRESPONDENCE:

Natalia A. Mokina, E-mail: mokinana@mrik-fmba.ru


References:

  1. Fieten K.B., Weststrate A.C., van Zuuren E.J., et al. Alpine climate treatment of atopic dermatitis: a systematic review. Allergy. 2015; 70(1): 12–25. https://doi.org/10.1111/all.12514
  2. Peinemann F., Harari M., Peternel S., et al. Indoor salt water baths followed by artificial ultraviolet B light for chronic plaque psoriasis. Cochrane Database Syst Rev. 2020; 5(5): CD011941. https://doi.org/10.1002/14651858.cd011941.pub2
  3. Golusin Z., Jovanović M., Magda N., et al. Effects of Rusanda Spa balneotherapy combined with calcipotriol on plaque psoriasis. Vojnosanit Pregl. 2015; 72(11): 1010–1017. https://doi.org/10.2298/vsp130309095g
  4. Dawe R.S., Yule S., Cameron H., et al. A randomized controlled comparison of the efficacy of Dead Sea salt balneophototherapy vs. narrowband ultraviolet B monotherapy for chronic plaque psoriasis. Br J Dermatol. 2005; 153(3): 613–619. https://doi.org/10.1111/j.1365-2133.2005.06663.x
  5. Proksch E., Nissen H.P., Bremgartner M., Urquhart C. Bathing in a magnesium-rich Dead Sea salt solution improves skin barrier function, enhances skin hydration, and reduces inflammation in atopic dry skin. Int J Dermatol. 2005; 44(2): 151–157. https://doi.org/10.1111/j.1365-4632.2005.02079.x
  6. Dunn J., Rodriguez W.J., Murphy M.D., et al. Extrapolation of adult data and other data in pediatric drug development programs. Pediatrics. 2011; 128(5): e1242–e1249.
  7. Massimo T., Blank C., Strasser B., Schobersberger W. Does climate therapy at moderate altitudes improve pulmonary function in asthma patients? A systematic review. Sleep Breath. 2014; 18(1): 195–206. https://doi.org/10.1007/s11325-013-0870-z
  8. Beamon S., Falkenbach A., Fainburg G., Linde K. Speleotherapy for asthma. Cochrane Database Syst Rev. 2001; (2): CD001741. https://doi.org/10.1002/14651858.cd001741
  9. Varricchio A., Giuliano M., Capasso M., et al. Salso-sulphide thermal water in the prevention of recurrent respiratory infections in children. Int J Immunopathol Pharmacol. 2013; 26(4): 941–952. https://doi.org/10.1177/039463201302600412
  10. Baldi S., Pinna G.D., Bruschi C., et al. Medicinal clays improve the endurance of loaded inspiratory muscles in COPD: a randomized clinical trial of nonpharmacological treatment. Int J Chron Obstruct Pulmon Dis. 2015; 10: 2235–2248. https://doi.org/10.2147/copd.s87999
  11. Rassulova M.A., Siziakova L.A., Aĭrapetova N.S. Effect of naphthalan and therapeutic mud applications on clinical and roentgenological characteristics in patients with protracted pneumonia. Vopr Kurortol Fizioter Lech Fiz Kult. 2009; 3: 16–19.
  12. Aĭrapetova N.S., Uianaeva M.A., Pershin S.B. The approaches to realization of the therapeutic action of gas-air carbonate baths and lysozyme inhalation during their combined application for the treatment of patients presenting with chronic obstructive pulmonary disease. Vopr Kurortol Fizioter Lech Fiz Kult. 2013; 2: 8–13.
  13. Fernandez-Gonzalez M., Fernandez-Lao C., Martin-Martin L., et al. Therapeutic Benefits of Balneotherapy on Quality of Life of Patients with Rheumatoid Arthritis: A Systematic Review. Int J Environ Res Public Health. 2021; 18(24): 13216. https://doi.org/10.3390/ijerph182413216
  14. Cantista P., Maraver F. Balneotherapy for knee osteoarthritis in S. Jorge: a randomized controlled trial. Int J Biometeorol. 2020; 64(6): 1027–1038. https://doi.org/10.1007/s00484-020-01911-2
  15. Rapolienė L., Razbadauskas A., Mockevičienė D., et al. Balneotherapy for musculoskeletal pain: does the mineral content matter? Int J Biometeorol. 2020; 64(6): 965–979. https://doi.org/10.1007/s00484-019-01800-3
  16. Huber D., Grafetstätter C., Proßegger J., et al. Green exercise and mg-ca-SO(4) thermal balneotherapy for the treatment of non-specific chronic low back pain: a randomized controlled clinical trial. BMC Musculoskelet Disord. 2019; 20(1): 221. https://doi.org/10.1186/s12891-019-2582-4
  17. Morer C., Roques C.F., Françon A., et al. Role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials. Int J Biometeorol. 2017; 61(12): 2159–2173. https://doi.org/10.1007/s00484-017-1421-2
  18. Kovács C., Bozsik Á., Pecze M., et al. Effects of sulfur bath on hip osteoarthritis: a randomized, controlled, single-blind, follow-up trial: a pilot study. Int J Biometeorol. 2016; 60(11): 1675–1680. https://doi.org/10.1007/s00484-016-1158-3
  19. Branco M., Rêgo N.N., Silva P.H., et al. Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial. Eur J Phys Rehabil Med. 2016; 52(4): 422–430.
  20. Mel’nichuk L.P., Khodasevich L.S. The external application of “Plastunskaya” fluoride-containing mineral water in the course of the combined spa and health resort-based treatment of deforming osteoarthritis. Vopr Kurortol Fizioter Lech Fiz Kult. 2015; 92(6): 48–50. https://doi.org/10.17116/kurort2015648-50
  21. Santos I., Cantista P., Vasconcelos C. Balneotherapy in rheumatoid arthritis-a systematic review. Int J Biometeorol. 2016; 60(8): 1287–1301. https://doi.org/10.1007/s00484-015-1108-5
  22. Verhagen A.P., Bierma-Zeinstra S.M., Boers M., et al. Balneotherapy (or spa therapy) for rheumatoid arthritis. An abridged version of Cochrane Systematic Review. Eur J Phys Rehabil Med. 2015; 51(6): 833–847.
  23. Kulisch Á., Benkö Á., Bergmann A., et al. Evaluation of the effect of Lake Hévíz thermal mineral water in patients with osteoarthritis of the knee: a randomized, controlled, single-blind, follow-up study. Eur J Phys Rehabil Med. 2014; 50(4): 373–381.
  24. Bazzichi L., Da Valle Y., Rossi A., et al. A multidisciplinary approach to study the effects of balneotherapy and mud-bath therapy treatments on fibromyalgia. Clin Exp Rheumatol. 2013; 31(6 Suppl 79): S111–S120.
  25. Fioravanti A., Tenti S., Giannitti C., et al. Short- and long-term effects of mud-bath treatment on hand osteoarthritis: a randomized clinical trial. Int J Biometeorol. 2014; 58(1): 79–86. https://doi.org/10.1007/s00484-012-0627-6
  26. Kovács C., Pecze M., Tihanyi Á., et al. The effect of sulphurous water in patients with osteoarthritis of hand. Double-blind, randomized, controlled follow-up study. Clin Rheumatol. 2012; 31(10): 1437–1442. https://doi.org/10.1007/s10067-012-2026-0
  27. Fraioli A., Serio A., Mennuni G., et al. A study on the efficacy of treatment with mud packs and baths with Sillene mineral water (Chianciano Spa Italy) in patients suffering from knee osteoarthritis. Rheumatol Int. 2011; 31(10): 1333–1340. https://doi.org/10.1007/s00296-010-1475-5
  28. Maeda T., Kudo Y., Horiuchi T., Makino N. Clinical and anti-aging effect of mud-bathing therapy for patients with fibromyalgia. Mol Cell Biochem. 2018; 444(1–2): 87–92. https://doi.org/10.1007/s11010-017-3233-4
  29. Baroni S., Marazziti D., Consoli G., et al. Modulation of the platelet serotonin transporter by thermal balneotherapy: a study in healthy subjects. Eur Rev Med Pharmacol Sci. 2012; 16(5): 589–593.
  30. Tefner I.K., Németh A., Lászlófi A., et al. The effect of spa therapy in chronic low back pain: a randomized controlled, single-blind, follow-up study. Rheumatol Int. 2012; 32(10): 3163–3169. https://doi.org/10.1007/s00296-011-2145-y
  31. Mayerová M., Hlavácek A. Structure and dynamics of the mental status during spa therapy for degenerative disorders of the spine. Fysiatr Revmatol Vestn. 1982; 60(3): 161–167.
  32. Fraioli A., Grassi M., Mennuni G., et al. Clinical researches on the efficacy of spa therapy in fibromyalgia. A systematic review. Ann Ist Super Sanita. 2013; 49(2): 219–229. https://doi.org/10.4415/ann_13_02_13
  33. Pérez-Fernández M.R., Calvo-Ayuso N., Martínez-Reglero C., et al. Efficacy of baths with mineral-medicinal water in patients with fibromyalgia: a randomized clinical trial. Int J Biometeorol. 2019; 63(9): 1161–1170. https://doi.org/10.1007/s00484-019-01729-7
  34. Metin Ökmen B., Kasapoğlu Aksoy M., Güneş A., et al. Effectiveness of PELOID therapy in carpal tunnel syndrome: A randomized controlled single blind study. Int J Biometeorol. 2017; 61(8): 1403–1410. https://doi.org/10.1007/s00484-017-1317-1
  35. Yang B., Qin Q.Z., Han L.L., et al. Spa therapy (balneotherapy) relieves mental stress, sleep disorder, and general health problems in sub-healthy people. Int J Biometeorol. 2018; 62(2): 261–272. https://doi.org/10.1007/s00484-017-1447-5
  36. Adams J.B., Audhya T., Geis E., et al. Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder-A Randomized, Controlled 12-Month Trial. Nutrients. 2018; 10(3): 369. https://doi.org/10.3390/nu10030369
  37. Kradinova E.A., Moshkova E.D., Nazarova E.V. Efficiency of the differentiated use of physiobalneotherapy for borderline mental disorders in mothers of children with cerebral palsy. Vopr Kurortol Fizioter Lech Fiz Kult. 2019; 96(3): 16–24. https://doi.org/10.17116/kurort20199603116



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This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.