Conclusions
In summary, based on the limited number of studies analyzed, small sample sizes and risk of bias attributed to the studies, it appears difficult to determine the overall benefit of BT and HT. There is a risk of overestimating the evidence on the efficacy of HT and even more so BT. However, although evidence is limited, recommendations in recent evidence-based interdisciplinary guidelines emphasize a patient-tailored approach with aerobic exercises, CBT and MCT according to the key symptoms of FMS.[4] In this context, BT and HT offer a wide variety of treatment opportunities, which can be perfectly adapted to the patients' abilities and preferences. Unlike pharmacological treatments with questionable clinical relevance and frequent side effects,[12] the results of this review underline the potential value of BT and HT as supplementary therapy in the management of major symptoms of FMS.
In order to provide a better database for meta-analyses (internal validity), the use of a core set of outcome measures (outcome measures in rheumatology (OMERACT)[85]) including response rates is desirable. Future authors should use the consolidated standards of reporting trials (CONSORT) checklist[86] to report study results. Major interest should focus on long-term results and maintenance of beneficial effects. Given the popularity of BT and HT among patients with FMS, further studies with robust methodology are warranted to demonstrate and confirm the therapeutic benefits.
Abbreviations ACR: American College of Rheumatology; BDI: Beck depression inventory; BT: balneotherapy; CBT: cognitive behavioral therapy; CWP: chronic widespread pain; DWR: deep-water-running; FIQ: fibromyalgia impact questionnaire; FMS: fibromyalgia syndrome; HRQOL: health-related quality of life; HT: hydrotherapy; LBE: land-based exercise; MCT: multicomponent treatment; MW: mineral water; PBE: pool-based exercise; RCT: randomized controlled trial; SB: sulfur bath; SMD: standardized mean difference; SPA: spa center; TPC: tender point count; TT: thalassotherapy; VAS: visual analog scale.
Competing interests
JN receives support from balneology organisations such as Deutscher Heilbäderverband and Heilbäderverband Baden-Württemberg, and is member of these organisations. None of these organisations financed this work. The authors declare that they have no competing interests.
Authors' contributions
JN carried out the study concept and design, participated in the interpretation of the data, and helped draft the manuscript. CS carried out the statistical analysis, participated in drafting of the manuscript and interpretation of the data. Both authors read and approved the final manuscript.
Acknowledgements
The article processing charge was funded by the German Research Foundation (DFG) and the Albert Ludwigs University Freiburg in the funding programme Open Access Publishing.
Arthritis Res Ther. 2014;16(R141) © 2014 BioMed Central, Ltd.
Copyright to this article is held by the author(s), licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original citation.
Comments