title: Systematic review and network meta-analysis of interventions for fibromyalgia: a protocol.
abstract: BACKGROUND
  Fibromyalgia is associated with substantial socioeconomic loss and, despite considerable research including numerous randomized controlled trials (RCTs) and systematic reviews, there exists uncertainty regarding what treatments are effective. No review has evaluated all interventional studies for fibromyalgia, which limits attempts to make inferences regarding the relative effectiveness of treatments.
  
  
  METHODS
  We will conduct a network meta-analysis of all RCTs evaluating therapies for fibromyalgia to determine which therapies show evidence of effectiveness, and the relative effectiveness of these treatments. We will acquire eligible studies through a systematic search of CINAHL, EMBASE, MEDLINE, AMED, HealthSTAR, PsychINFO, PapersFirst, ProceedingsFirst, and the Cochrane Central Registry of Controlled Trials. Eligible studies will randomly allocate patients presenting with fibromyalgia or a related condition to an intervention or a control. Teams of reviewers will, independently and in duplicate, screen titles and abstracts and complete full text reviews to determine eligibility, and subsequently perform data abstraction and assess risk of bias of eligible trials. We will conduct meta-analyses to establish the effect of all reported therapies on patient-important outcomes when possible. To assess relative effects of treatments, we will construct a random effects model within the Bayesian framework using Markov chain Monte Carlo methods.
  
  
  CONCLUSIONS
  Our review will be the first to evaluate all treatments for fibromyalgia, provide relative effectiveness of treatments, and prioritize patient-important outcomes with a focus on functional gains. Our review will facilitate evidence-based management of patients with fibromyalgia, identify key areas for future research, and provide a framework for conducting large systematic reviews involving indirect comparisons.
authors.affiliation: Department of Anesthesia, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8S 4K1, Canada. bussejw@mcmaster.ca
authors.forename: Jason W
authors.initials: JW
authors.lastname: Busse
authors.forename: Shanil
authors.initials: S
authors.lastname: Ebrahim
authors.forename: Gaelan
authors.initials: G
authors.lastname: Connell
authors.forename: Eric A
authors.initials: EA
authors.lastname: Coomes
authors.forename: Paul
authors.initials: P
authors.lastname: Bruno
authors.forename: Keshena
authors.initials: K
authors.lastname: Malik
authors.forename: David
authors.initials: D
authors.lastname: Torrance
authors.forename: Trung
authors.initials: T
authors.lastname: Ngo
authors.forename: Karin
authors.initials: K
authors.lastname: Kirmayr
authors.forename: Daniel
authors.initials: D
authors.lastname: Avrahami
authors.forename: John J
authors.initials: JJ
authors.lastname: Riva
authors.forename: Peter
authors.initials: P
authors.lastname: Struijs
authors.forename: David
authors.initials: D
authors.lastname: Brunarski
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Burnie
authors.forename: Frances
authors.initials: F
authors.lastname: LeBlanc
authors.forename: Ivan A
authors.initials: IA
authors.lastname: Steenstra
authors.forename: Quenby
authors.initials: Q
authors.lastname: Mahood
authors.forename: Kristian
authors.initials: K
authors.lastname: Thorlund
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Vishalini
authors.initials: V
authors.lastname: Sivarajah
authors.forename: Paul
authors.initials: P
authors.lastname: Alexander
authors.forename: Milosz
authors.initials: M
authors.lastname: Jankowski
authors.forename: Wiktoria
authors.initials: W
authors.lastname: Lesniak
authors.forename: Markus
authors.initials: M
authors.lastname: Faulhaber
authors.forename: Małgorzata M
authors.initials: MM
authors.lastname: Bała
authors.forename: Stefan
authors.initials: S
authors.lastname: Schandelmaier
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
mesh_terms: D000041:Absenteeism; D002985:Clinical Protocols; D004651:Employment / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005356:Fibromyalgia / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007182:Income; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012959:Socioeconomic Factors; D000078202:Systematic Reviews as Topic; D016896:Treatment Outcome; D014481:United States; D015201:Meta-Analysis as Topic