## 3 Results  
In the initial search, 5544 manuscripts were identified. The total number of papers found on PubMed was 32, on Google Scholar 5480, and on Web of Science 89. Following the selection criteria, seven studies were finally chosen for further analysis (Figure 1). In a randomized, controlled, single-blind pilot study, [PERSON] et al. considered 33 HOA patients who underwent peloid therapy covering 10 sessions across 2 weeks, coupled with a home exercise regimen. Meanwhile, the control group of 30 other HOA patients only underwent the home exercise program. The majority of the considered patients  
Figure 1: PRISMA flow diagram of selection for review. had mild HOA with a Kellgren and Lawrence score ranging from I to II. In each treatment session for the experimental group, the peloid was heated to a temperature of 47 \({}^{\circ}\)C and administered to the hands. The hands were then wrapped in the first layer of stretch film and covered with a towel for a duration of 30 min. Subsequently, the wrap was removed, and the peloid was thoroughly washed off. The peloid used in these treatments fell into the category of parapeloids, primarily composed of clay-like materials. At both 2-week and 6-week follow-up evaluations, peloid therapy was demonstrated to facilitate pain mitigation, enhance hand functionality, elevate quality of life, and increase grip strength. No complications during the treatment were observed [20]. In a recent study by [PERSON] et al., a group of 80 female patients diagnosed with HOA were included. These participants were randomly divided into two groups: one receiving peloid therapy combined with home exercises, and the other receiving paraffin therapy combined with home exercises. Across a 3-week period, each group underwent a total of 15 sessions involving either peloid or paraffin application. The exercise regimen provided to both groups comprised two daily sessions, each consisting of 10 repetitions of finger stretching, finger spreading, finger extension, lateral finger movements, making large and small lists, extending and relaxing all fingers while they were open on a table, and forming the \"OK\" sign. These exercises were practically demonstrated by the physician prior to the treatment, and all patients were provided with a printed document detailing the exercises. Both groups displayed positive effects in terms of pain reduction, functional status improvement, and hand grip strength enhancement over the course of 1 month. Nevertheless, in the short term, the peloid therapy group exhibited superior effects on physical activity and overall quality of life. Notably, no adverse effects were reported in either of the two groups [21]. [PERSON] et al., conducted a study with the aim of evaluating the short-term and long-term effectiveness of BT in individuals with primary HOA. The study involved 60 patients diagnosed with bilateral HOA, each assigned [PERSON] and [PERSON] radiological scores ranging from I to III, with the majority falling within the I and II grade range. These patients were divided into two groups. One group received treatment consisting of 12 daily sessions of local mud packs and mineral-rich baths, while the other group continued with their regular care routine. Patients in the control group were offered the BT treatment at the study's conclusion to ensure ethical considerations and prevent withdrawal. The BT treatment plan for the experimental group involved the placement of mud packs on both hands for a duration of 20 min, starting at an initial temperature of 43 \({}^{\circ}\)C. This was followed by immersing the hands in a bathtub filled with sulfate-calcium-magnesium-fluorides water at a temperature of 38 \({}^{\circ}\)C for 15 min. This cycle was repeated 12 times over a span of 2 weeks. The results of the study revealed that mud-bath therapy led to a significant and more pronounced improvement in the assessed parameters compared to usual care alone.