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Documente Cultură
1093/rheumatology/kep182
Advance Access publication 16 July 2009
Concise Report
KEY WORDS: Fibromyalgia syndrome, Hydrotherapy, Spa therapy, Balneotherapy, Systematic review, Meta-analysis.
socio-demographic and medical data of the study samples, the (only women vs mixed sample). These subgroup analyses were
settings and referrals of the RCTs and the side effects reported. also used to examine potential sources of clinical heterogeneity.
Diagnosis of FMS
Methodological Inclusion
quality criteria Study population Treatment group Control group
Type of treatment
Reference No. of patients Total number/ Total number/ Duration of treatment
Country Mean age, years Comorbidities screened/ no. of patients no. of patients Type of treatment Total number/ Co-medication allowed Outcomes usable
Setting Women, % Van Tulder assessed randomized, completing, completing, Duration of no. of patients Other co-therapies for meta-analysis
Referral Race, % score Exclusion criteria and reported % n/n, % n/n, % treatment completing, n/n, % reported side effects Follow-up
Ammer and 54 1 NR Yunus [32] NR 39/30, 76.9 26/19, 73.1 Whirl bath with pine Whirl bath with plain NR Pain VAS 0100a
Melnizky [21] 97 w or valerian 368 water of 368 Fatigue NA
Austria NR NR Min NR 3 week, 10 times, NR Sleep NA
City hospital 3 week, 10 times Min NR Depression NA
NR 13/11, 84.6 NR HRQOL NA
No
Ardic et al. [22] 43 2 Other disease ACR NR 24/21, 87.5 12/12, 100 Thermal pool 378C No therapy Co-medication not Pain VAS 010a
Turkey 100 w allowed Fatigue NP
University NR NR 5 week for 12/9, 75 NR Sleep NP
NR 20 min, 3 weeks Depression BDIa
NR HRQOL FIQ totala
No
Buskila et al. [23] 54 3 NR ACR NR 48/NR 24/NR Sulphur pool at Therapy as usual Continuation of regular Pain VAS 010b
Israel 100 378C medication Fatigue VAS 010 NP
University NR NR 24/NR Sleep NA
10 days for NR Depression VAS 010 NP
20 min HRQOL NA
2/24 slight flush Yes
Donmez et al. [24] 43 5 Any other ACR NR 28/27, 96.4 16/16, 100 Thermal pool bath Therapy as usual Continuation of Pain VAS 010c
Turkey 100 w condition that 378C medication with Fatigue VAS 010c
University NR might effect NR 14/13, 92.9 NSAIDs and Sleep VAS 010c
University study results 6 week for antidepressants Depression BDIc
outpatient 20 min, 2 weeks NR HRQOL FIQ totalc
department Yes
Evcik et al. [25] 42 3 Internal diseases ACR NR 42/NR 22/NR Thermal pool bath Therapy as usual NSAIDs Pain VAS 010a
Turkey 73 w Anti- 368C Fatigue NP
University NR depressants NR 20/NR NR Sleep NP
NR or other 5 week for Depression BDIa
physical 20 min, 3 weeks NR HRQOL FIQ totala
Hydrotherapy in fibromyalgia syndrome
treatment Yes
Eksioglu et al. [26] 45 6 Internal diseases ACR NR 50/50, 100 25/25, 100 Stanger bath 378C Amitriptyline, No other interventions Pain VAS 010 NP
Turkey 100 w Psychiatric and amitriptyline Fatigue NP
University NR disorder NR 10 mg/day 10 mg/day NR Sleep NP
Social security Anti- 25/25, 100 Depression NP
insurance depressant 5 week for No side effects HRQOL FIQa
therapy 20 min, 2 weeks Yes
Fioravanti et al. 46 5 Internal diseases ACR NR 80/80, 100 40/40, 100 Usual medication Usual medication Anti-depressants, Pain VAS 0100a
[27] 98 w and generalized tranquilizers, Fatigue NP
Italy NR NR mud bath muscle relaxants Sleep NP
University 40458C 40/40, 100 allowed Depression NP
Rheumatology followed by NR HRQOL FIQ total scorea
Divisions immersion in No side effects Yes
thermal water of
37388C
6 week for
25 min, 2 weeks
Gunther et al. [28] 45 2 NR ACR NR 29/25, 86.2 14/12, 85.7 Hygrogalvanic bath Jacobson relaxation No medication Pain VAS 0100a
Austria 100 w 8C NR Fatigue NA
University NR NR Four sessions of NR Sleep NA
NR 2 week for 3 weeks plus Depressed mood NA
20 min, 5 weeks audio casette NR HRQOL NA
No
1157
15/13, 86.7
(continued)
Downloaded from http://rheumatology.oxfordjournals.org/ by guest on December 26, 2012
1158 Jost Langhorst et al.
Used for meta-analysis; means and S.D. included in publication. bUsed for meta-analysis; means included in publication; S.D. not provided on request, calculated from S.D. of other studies. cUsed for meta-analysis; means included in publication; S.D. provided on request.
publication of the data [20]. Finally 10 studies met our selection
Outcomes usable
for meta-analysis
Depressed mood NA
criteria and were included for meta-analysis [2130].
Follow-up
Pain VAS 010a
Depression NA
External validity
HRQOL NA
HRQOL NA
Fatigue NA
Fatigue NA
Sleep NA
Sleep NA
Some characteristics of the studies and the patients are presented
in Table 1. Details are presented in supplementary material 1
Yes
(available as supplementary data at Rheumatology Online). Side
No
effects or adverse events were explicitely mentioned by four
Co-medication allowed
studies: three reported no side effects [26, 27, 30] and one study
analgesic allowed
No other medical or
Control group: 9/20
No adverse effects
depressants and
physical therapy
Both groups same
multicomponent
reported slight flashes in 10% of the patients [23].
NSAIDs anti-
therapy
Methodological quality
NR: not reported; ACR: American College of Rheumatology [31]; BDI: Beck Depression Inventory; FIQ: Fibromyalgia Impact Questionnaire; NA: not assessed; NP: not provided on request; VAS: visual analogue scale.
Three studies had a moderate quality (van Tulder score 57)
NR
[24, 25, 27], and the other ones had had a low quality (van
Tulder score <5). Only two studies [24, 25] reported adequate
Duration of treatment
cryocabin, 1108C
no. of patients
Total number/
Control group
5 week 13 min,
analysis.
intensity NR
38/18, 47.4
34 weeks
20 min, 2 weeks
5 week for
relaxation
exercises
378C and
20 min,
28/28, 100
n/n, %
significant.
There was moderate evidence for a reduction of pain (SMD
20/NR
66/48, 69.7
n/n, %
effect sizes, the effects of hydrotherapy were large for pain and
40/NR
Publication bias
screened/
The small number of studies included in the funnel plot limited the
meaningful interpretation. The fail-safe-Ns calculations indicated
NR
NR
that a publication bias was not evident for the data of this meta-
Comorbidities
ACR
Subgroup analyses
NR
NR
score
2
Sensitivity analyses
The sensitivity analyses did not change the results (for details see
supplementary material 3, available as supplementary data at
Mean age, years
Rheumatology Online).
Women, %
Race, %
Discussion
92 w
95 w
NR
NR
50
37
Celiktas [30]
Yurtkuran and
Referral
Country
Rehabilitation
Setting
Turkey
NR
NR
a
Hydrotherapy in fibromyalgia syndrome 1159
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