Background: Myofascial mobilization has been used as an intervention for patients with
fibromyalgia (FM) for acting on ascending nociceptive pathways possibly involved in the central
sensitization process, modulating the pain experience. However, there is still a gap in its efficacy
compared with another hands-on approach because manual therapy has nonspecific effects, such
as placebo.
Objectives: This systematic review aims to review the scientific literature for an overview of the
efficacy of manual therapy in pain, disease impact, and quality of life in patients with FM compared
with control or other treatments through randomized clinical trials.
Study Design: This study involved systematic review of published randomized controlled trials
(RCTs).
Setting: This study examined all RCTs evaluating the effect of manual therapy on pain, impact of
disease, and quality of life for patients with FM.
Methods: Systematic review. The research was performed in 9 databases: MEDLINE/PubMed,
CINAHL, Web of Science, Scopus, ScienceDirect, Lilacs, SciELO, PEDro, and Cochrane. Searches
were carried out from the end of the project until September 2019, with no language and year
restrictions. Randomized controlled clinical trials that used the following outcome measures
were included: Visual Analog Scale, Fibromyalgia Impact Questionnaire, and SF-36 Quality of Life
Questionnaire. The risk of bias and quality of studies was assessed using the PEDro scale; the
Cochrane risk-of-bias tool; and Grading of Recommendations Assessment, Development, and
Evaluation System.
Results: Seven studies were included (368 patients). The quantitative analysis was performed on
4 studies because of the lack of data in the others. Myofascial release was the most used modality.
The level of evidence ranged from very low to moderate, mainly because of the inconsistency and
inaccuracy of results.
Limitations: The present systematic review presented limitations because of the heterogeneity
of the included studies and only a short-term analysis of the intervention results. It was observed
that other information, such as pressure, repetition, and/or sustaining manual therapy techniques,
could be better described in future protocols, aiming at a better comparison between the
techniques and their subsequent reproducibility.
Conclusions: Current evidence of manual therapy in patients with FM, based on a very low to
moderate quality of evidence, was inconclusive and insufficient to support and recommend the
use of manual therapy in this population. To date, only general osteopathic treatment has achieved
clinically relevant pain improvement when compared with control.
Key words: Fibromyalgia, manual therapy, pain, quality of life, impact of disease, physiotherapy,
manipulation techniques, mobilization
Overview of Registered Clinical Trials on Manual Therapy: Possible Implications of Genetic Testing for Personalized Treatment
