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2017 ; 6
(1
): 97
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An overview of systematic reviews of complementary and alternative therapies for
fibromyalgia using both AMSTAR and ROBIS as quality assessment tools
#MMPMID28506257
Perry R
; Leach V
; Davies P
; Penfold C
; Ness A
; Churchill R
Syst Rev
2017[May]; 6
(1
): 97
PMID28506257
show ga
BACKGROUND: Fibromyalgia (FM) is a chronic, debilitating pain disorder.
Dissatisfaction with conventional medicine can lead people with FM to turn to
complementary and alternative medicine (CAM). Two previous overviews of
systematic reviews of CAM for FM have been published, but they did not assessed
for risk of bias in the review process. METHODS: Five databases Medline, Embase,
AMED (via OVID), Web of Science and Central were searched from their inception to
December 2015. Reference lists were hand-searched. We had two aims: the first was
to provide an up-to-date and rigorously conducted synthesis of systematic reviews
of CAM literature on FM; the second was to evaluate the quality of the available
systematic review evidence using two different tools: AMSTAR (Shea et al. BMC Med
Res Methodol 15; 7:10, 2007) and a more recently developed tool ROBIS (Whiting et
al. J Clin Epidemiol 69:225-34, 2016) specifically designed to assess risk of
bias in systematic reviews. Any review that assessed one of eight CAM therapies
for participants diagnosed with FM was considered. The individual studies had to
be randomised controlled trials where the intervention was compared to placebo,
treatment as usual or waitlist controls to be included. The primary outcome
measure was pain, and the secondary outcome measure was adverse events. RESULTS:
We identified 15 reviews that met inclusion criteria. There was low-quality
evidence that acupuncture improves pain compared to no treatment or standard
treatment, but good evidence that it is no better than sham acupuncture. The
evidence for homoeopathy, spinal manipulation and herbal medicine was limited.
CONCLUSIONS: Overall, five reviews scored 6 or above using the AMSTAR scale and
the inter-rater agreement was good (83.6%), whereas seven reviews achieved a low
risk of bias rating using ROBIS and the inter-rater agreement was fair (60.0%).
No firm conclusions were drawn for efficacy of either spinal manipulation or
homoeopathy for FM. There is limited evidence for topical Capsicum, but further
research is required. There is some evidence to support the effectiveness of
acupuncture for FM, but further high-quality trials are needed to investigate its
benefits, harms and mechanisms of action, compared with no or standard treatment.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016035846 .
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