title: Therapeutic benefit of balneotherapy and hydrotherapy in the management of fibromyalgia syndrome: a qualitative systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  In the present systematic review and meta-analysis, we assessed the effectiveness of different forms of balneotherapy (BT) and hydrotherapy (HT) in the management of fibromyalgia syndrome (FMS).
  
  
  METHODS
  A systematic literature search was conducted through April 2013 (Medline via Pubmed, Cochrane Central Register of Controlled Trials, EMBASE, and CAMBASE). Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model.
  
  
  RESULTS
  Meta-analysis showed moderate-to-strong evidence for a small reduction in pain (SMD -0.42; 95% CI [-0.61, -0.24]; P < 0.00001; I2 = 0%) with regard to HT (8 studies, 462 participants; 3 low-risk studies, 223 participants), and moderate-to-strong evidence for a small improvement in health-related quality of life (HRQOL; 7 studies, 398 participants; 3 low-risk studies, 223 participants) at the end of treatment (SMD -0.40; 95% CI [-0.62, -0.18]; P = 0.0004; I2 = 15%). No effect was seen at the end of treatment for depressive symptoms and tender point count (TPC).
  
  
  CONCLUSIONS
  High-quality studies with larger sample sizes are needed to confirm the therapeutic benefit of BT and HT, with focus on long-term results and maintenance of the beneficial effects.
authors.forename: Johannes
authors.initials: J
authors.lastname: Naumann
authors.forename: Catharina
authors.initials: C
authors.lastname: Sadaghiani
mesh_terms: D000328:Adult; D001452:Balneology / Q000379:methods*; D005260:Female; D005356:Fibromyalgia / Q000628:therapy*; D006801:Humans; D006875:Hydrotherapy / Q000379:methods*; D008297:Male; D016032:Randomized Controlled Trials as Topic