THU0461 THE COMPARATIVE EFFICACY OF NON-PHARMACOLOGICAL INTERVENTIONS FOR FIBROMYALGIA: A SYSTEMATIC REVIEW WITH BAYESIAN NETWORK META-ANALYSIS
Authors: B. Kundakci, J. Kaur, S. R. Shim, M. Hall, M. Doherty, W. Zhang, A. Abhishek
Journal: Annals of the Rheumatic Diseases (2020)

Background: Non-pharmacological interventions are recommended as first-line treatment options in the management of fibromyalgia (FM) 1 . However, whether one intervention is more effective than another for specific patient-centred outcomes in FM is unknown. Objectives: To compare the relative efficacy of non-pharmacological interventions on FM impact questionnaire (FIQ), pain, fatigue, sleep and depression in people with FM. Methods: A Bayesian network meta-analysis was conducted. Randomised controlled trials (RCTs) assessing any non-pharmacological intervention versus usual care, placebo or active controls in patients with FM aged &gt;16 years were searched for in seven databases. A common comparator was identified between interventions to develop a network (Figure 1). Standardised mean difference (SMD) and 95% credible interval (CrI) was estimated between interventions. Direct and indirect evidence were pooled using the random effect model. Modified Cochrane‘s tool was used to assess risk of bias. Figure 1. Network map of different interventions evaluating FIQ Results: 78 studies (n = 5,639 participants) met the inclusion criteria. There was a high risk of bias on blinding and most trials had small sample size (n&lt;50). While multidisciplinary treatment (MDT) was the best for improving pain [-1.28 (-1.84, -0.72)], sleep [-1.14 (-2.38, 0.07)] and depression [-1.20 (-1.99, -0.46)], balneotherapy and exercise were the most effective treatments for FIQ [-1.06 (1.51, -0.61)] and fatigue [-0.75 (-1.35, -0.25)], respectively (Figure 2). Figure 2. Standardised mean difference (SMD) versus usual care in descending order for different outcomes Data from 47 exercise trials (n = 3,271 participants) were analysed to examine comparative efficacy of different exercise types. Strengthening showed the greatest benefits for FIQ [-0.76 (-1.39, -0.15)], pain [-0.94 (-1.58, -0.29)] and depression [-0.83 (-1.53, -0.14)], whereas aerobic exercise was the best for fatigue [-0.98 (-2.33, 0.18)] and sleep [-0.96 (-2.08, 0.13)] (Table 1). Table 1. Relative effect size between types of exercises FIQ Aerobic -0.58 (-1.13, -0.03 ) -0.09 (-0.55, 0.36) 0.18 (-0.44, 0.80) 0.12 (-0.36, 0.57) -0.57 (-0.95, -0.24 ) -0.60 (-1.36, 0.18) Flexibility 0.49 (-0.23, 1.20) 0.76 (-0.07, 1.58) 0.70 (-0.04, 1.41) 0.004 (-0.67, 0.64) -0.10 (-0.74, 0.53) 0.49 (-0.50, 1.49) Mind-body 0.27 (-0.37, 0.91) 0.20 (-0.24, 0.65) -0.49 (-0.85, -0.15 ) 0.05 (-0.59, 0.70) 0.65 (-0.35, 1.63) 0.16 (-0.53, 0.85) Mixed -0.06 (-0.73, 0.59) -0.69 (-1.06, -0.34 ) 0.21 (-0.42, 0.84) 0.80 (-0.19, 1.79) 0.31 (-0.41, 1.02) -0.06 (-0.73, 0.59) Strengthening -0.76 (-1.39, -0.15 ) -0.73 (-1.16, -0.30 ) -0.13 (-1.02, 0.74) -0.62 (-1.15, -0.11 ) -0.78 (-1.31, -0.26 ) -0.94 (-1.58, -0.29 ) Usual care Pain Data are standard mean difference (95% credible intervel) between exercises, pairwised from the top left to the bottom right. The negative value indicates that the first exercise is more effective than the second exercise. For example, aerobic is better than flexibility for FIQ -0.58 (-1.13, -0.13), but not pain -0.60 (-1.36, 0.18). Conclusion: Several non-pharmacological interventions are beneficial for FM. However, the effect size varies between interventions and outcomes. All types of exercises are effective for FIQ and pain apart from flexibility exercise. The results of this study may be used to guide the selection of the most effective non-pharmacological interventions according to the predominant symptom in individual patients. References: [1]Macfarlane GJ et al. Ann Rheum Dis 2017;76(2):3-8-28. Disclosure of Interests: : None declared