## 3 Results  
### Clinical Outcome: Function, Pain, Stiffness, and Quality of Life  
Figure 2 illustrates the results of knee functional mobility in elderly OA patients undergoing mud therapy. Following the interventions, both the CMT and CMRT groups showed a significant increase in knee flexion (\(p<0.001\) and \(p<0.05\), respectively; Figure 2A)  
and extension (\(p<0.05\) and \(p<0.001\), respectively; Figure 2B) compared to baseline values. No significant differences were observed between the two intervention groups.  
After the mud therapy cycle, perceived pain (assessed using the VAS questionnaire) significantly improved (\(p<0.001\)) in both intervention groups compared to baseline values, i.e., with the peloid without RosA and with the biologically fortified peloid containing RosA. No significant differences were observed between the two intervention groups (Figure 3).  
Figure 3: Perceived pain in OA patients after the mud therapy intervention. VAS = visual analogue scale; CMT = group of patients receiving controlled mud therapy; CMRT = group of patients receiving controlled mud therapy fortified with RosA. ***\(p<0.001\), compared to the corresponding baseline values.  
Figure 2: Knee flexion (**A**) and extension (**B**) in OA patients after the mud therapy intervention. CMT = Group of patients receiving controlled mud therapy; CMRT = group of patients receiving controlled mud therapy fortified with RosA. *\(p<0.05\), ***\(p<0.01\), and ***\(p<0.001\), compared to the corresponding baseline values.  
The results for pain, stiffness, and physical function related to OA (WOMAC indices) are shown in Figure 4. No differences were found between the two intervention groups in the total WOMAC scores, with a clear significant improvement (\(p<0.001\)) observed in both the CMT and CMRT groups following mud therapy (Figure 4A). Additionally, all evaluated dimensions showed significant improvement after mud therapy with both peloids, with no significant differences between the two groups: Pain (Figure 4B; \(p<0.001\) post-intervention values vs. baseline in both CMT and CMRT), morning stiffness (Figure 4C; \(p<0.001\) post-intervention values vs. baseline in both CMT and CMRT), stiffness later in the day (Figure 4D; \(p<0.001\) and \(p<0.01\) post-intervention values vs. baseline in CMT and CMRT, respectively), and difficulty in performing daily activities or physical function (Figure 4E; \(p<0.001\) post-intervention values vs. baseline in both CMT and CMRT).  
Health-related quality of life (EQ-5D) also improved (\(p<0.001\)) following the mud therapy intervention with both peloids (Figure 5A). Dimensions such as mobility (\(p<0.001\) and \(p<0.01\) in CMT and CMRT, respectively; Figure 5B), usual activities (\(p<0.01\) and \(p<0.001\) in CMT and CMRT, respectively; Figure 5D), and pain (\(p<0.001\) in both CMT and CMRT; Figure 5E) contributed to the improvement in health-related quality of life after the mud therapy with both peloids. In contrast, anxiety (\(p<0.01\) post-intervention values vs. baseline in the CMRT group; Figure 5F) and self-care (\(p<0.05\) post-intervention values vs. baseline in the CMRT group; Figure 5C) improved only with the peloid fortified with RosA. Nevertheless, no significant differences were observed between the two intervention groups as evaluated by two-way ANOVA.  
Figure 4: Pain (**B**), stiffness (**C**,**D**), and physical function (**E**) (WOMAC indices and total scores in **(**A**)) in OA patients after the mud therapy intervention. CMT = group of patients receiving controlled mud therapy; CMRT = group of patients receiving controlled mud therapy fortified with RosA. \(*p<0.01\), \(***p<0.001\), compared to the corresponding baseline values.