Mud therapy and rehabilitation - scientific relevance in the last six years (2015-2020): Systematic literature review and meta-analysis based on the PRISMA paradigm
Key Findings
- PRISMA-based systematic review of mud/pelotherapy literature 2015–2020: 394 articles identified, 68 retained after PEDro-based quality filtering, plus a meta-analysis of 26 studies covering 15,123 patients
- Pathology breakdown of the pooled meta-analysis cohort: osteoarthritis 48.75%, low back pain/algic symptoms ~29%, rheumatoid arthritis 2.20%, other musculoskeletal disorders 0.33%, osteoporosis 0.42%
- Peat mud specifically: classified among the organic peloids (alongside sapropel/bitumen mud), with the highest water-retention capacity and lowest specific weight of the peloid types compared
- Standard mud-bath protocol documented across pooled studies: 10–25% mud concentration, up to 42°C (37°C max for cardiovascular patients), 20–40 minutes, 12–15 sessions per course
- Documented mechanisms beyond direct anti-inflammatory chemistry: peripheral mechanoreceptor stimulation, skin vasodilation, thermoregulatory/skin-repair stimulation, and endocrine effects including hypothalamic-pituitary-adrenal axis activation with optimized plasma beta-endorphin levels
- A Techirghiol (Romania) sapropelic-mud study found warm mud application significantly decreased plasma leptin, correlating with reduced inflammation/rheumatic pain
- Overall meta-analytic proportion estimate across the 26 pooled studies: 0.544 (95% CI 0.400–0.687), with very high heterogeneity (I² = 99.99%) — reflecting how diverse the pooled pathologies and outcome measures were, not a single uniform effect size
A 2021 PRISMA-based systematic review and meta-analysis surveying six years (2015–2020) of mud and pelotherapy research — 68 primary studies reviewed in full, with a meta-analysis pooling 26 studies and 15,123 patients. It’s the largest-scale evidence synthesis in this site’s balneotherapy library by patient count, and one of the few sources here that performs actual statistical pooling rather than a narrative or systematic summary.
Scope and Method
394 articles were identified, filtered down to 68 using PEDro-based quality screening, with a further 26 studies (15,123 patients total, ranging from n=32 to n=6,281 per study) entering the quantitative meta-analysis. Osteoarthritis dominates the pooled cohort at 48.75% of patients, with low back pain the second-largest category at roughly 29% — directly overlapping this site’s two strongest musculoskeletal claims.
What It Found
The review confirms the standard mud-bath protocol used across the field (10–25% concentration, up to 42°C, 20–40 minute sessions, 12–15 sessions per course) and adds mechanistic detail not previously captured on this site: endocrine effects (HPA-axis activation, beta-endorphin), and a Romanian sapropelic-mud study linking warm mud application to reduced plasma leptin, a plausible anti-inflammatory pathway. The pooled proportion estimate carries very high heterogeneity (I² = 99.99%), which is expected and stated plainly by the authors — it reflects pooling many different pathologies and outcome measures together, not a single clean effect size, and shouldn’t be read as a single “peat works X% of the time” number.
Why It Matters Now
This is the one genuine meta-analysis in this site’s peat/pelotherapy evidence base — most other osteoarthritis and back-pain references here (Keilani 2025, Raza 2021, Crevenna 2025) are systematic reviews without quantitative pooling. Munteanu 2021 doesn’t replace those — it’s not peat-specific and pools mud/pelotherapy broadly — but it’s the correct citation whenever this site says “meta-analysis” for musculoskeletal balneotherapy evidence, and the two should not be conflated.