Hydrotherapy for fibromyalgia
Clinical bottom line
The evidence is limited. Some better quality trials hold out some promise, but are indufficiently strong not to be overturned by better quality and larger trials with sensible control groups.
Reference
McVeigh et al. The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review. Rheumatol Int. 2008 Aug 27. [Epub ahead of print]
Study
- Date review completed: 2006
- Number of trials included: 10
- Number of patients: 406
- Control group: usually no treatment
- Main outcomes: various
Results
The 10m included trials involved any type of hydrotherapy, including spas, power showers, with or without massage, or balneotherapy, or exercise in water. Most trials were small, with almost half the patients in a single trial. Most trials were of a reasonable duration. Six trials used no treatment as a control.
Only three of the trials gave a method of randomisation, one was not randomised, and in six randomisation was uncertain. Only four of the trials used an assessor blind to treatment allocation.
Nine of the trials has some positive result at some point, including all three with satisfactory randomisation, two of which involved spa plus exercise, or massage.
Comment
The authors concluded that the evidence for hydrotherapy was strong. There is too little good quality evidence to make that judgement, especially since we know that, with pain, no treatment is less good than placebo, and that this was the control in some of the studies. Given the positive result in three randomised trials, and the reasonable duration of some of the studies, it is possible to say that the limited evidence looks promising.