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Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions

Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions
Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions

OBJECTIVE: To identify potentially effective complementary approaches for musculoskeletal (MSK)-mental health (MH) comorbidity, by synthesising evidence on effectiveness, cost-effectiveness and safety from systematic reviews (SRs).

DESIGN: Scoping review of SRs.

METHODS: We searched literature databases, registries and reference lists, and contacted key authors and professional organisations to identify SRs of randomised controlled trials for complementary medicine for MSK or MH. Inclusion criteria were: published after 2004, studying adults, in English and scoring >50% on Assessing the Methodological Quality of Systematic Reviews (AMSTAR); quality appraisal checklist). SRs were synthesised to identify research priorities, based on moderate/good quality evidence, sample size and indication of cost-effectiveness and safety.

RESULTS: We included 84 MSK SRs and 27 MH SRs. Only one focused on MSK-MH comorbidity. Meditative approaches and yoga may improve MH outcomes in MSK populations. Yoga and tai chi had moderate/good evidence for MSK and MH conditions. SRs reported moderate/good quality evidence (any comparator) in a moderate/large population for: low back pain (LBP) (yoga, acupuncture, spinal manipulation/mobilisation, osteopathy), osteoarthritis (OA) (acupuncture, tai chi), neck pain (acupuncture, manipulation/manual therapy), myofascial trigger point pain (acupuncture), depression (mindfulness-based stress reduction (MBSR), meditation, tai chi, relaxation), anxiety (meditation/MBSR, moving meditation, yoga), sleep disorders (meditative/mind-body movement) and stress/distress (mindfulness). The majority of these complementary approaches had some evidence of safety-only three had evidence of harm. There was some evidence of cost-effectiveness for spinal manipulation/mobilisation and acupuncture for LBP, and manual therapy/manipulation for neck pain, but few SRs reviewed cost-effectiveness and many found no data.

CONCLUSIONS: Only one SR studied MSK-MH comorbidity. Research priorities for complementary medicine for both MSK and MH (LBP, OA, depression, anxiety and sleep problems) are yoga, mindfulness and tai chi. Despite the large number of SRs and the prevalence of comorbidity, more high-quality, large randomised controlled trials in comorbid populations are needed.

complementary medicine, mental health, musculoskeletal disorders, primary care
2044-6055
e020222
Lorenc, Ava
08d9d6c2-99d6-4409-9577-c792c7d41751
Feder, Gene
0fba983e-5a70-4280-99af-69811d2d6a56
MacPherson, Hugh
6485cd22-1dc3-4600-9e00-d3187e981663
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Mercer, Stewart W.
66234c9c-400d-4e2d-bf01-151d1a33b762
Sharp, Deborah
5be021f2-ec75-4317-bf7d-f02328a50107
Lorenc, Ava
08d9d6c2-99d6-4409-9577-c792c7d41751
Feder, Gene
0fba983e-5a70-4280-99af-69811d2d6a56
MacPherson, Hugh
6485cd22-1dc3-4600-9e00-d3187e981663
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Mercer, Stewart W.
66234c9c-400d-4e2d-bf01-151d1a33b762
Sharp, Deborah
5be021f2-ec75-4317-bf7d-f02328a50107

Lorenc, Ava, Feder, Gene, MacPherson, Hugh, Little, Paul, Mercer, Stewart W. and Sharp, Deborah (2018) Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions. BMJ Open, 8 (10), e020222. (doi:10.1136/bmjopen-2017-020222).

Record type: Article

Abstract

OBJECTIVE: To identify potentially effective complementary approaches for musculoskeletal (MSK)-mental health (MH) comorbidity, by synthesising evidence on effectiveness, cost-effectiveness and safety from systematic reviews (SRs).

DESIGN: Scoping review of SRs.

METHODS: We searched literature databases, registries and reference lists, and contacted key authors and professional organisations to identify SRs of randomised controlled trials for complementary medicine for MSK or MH. Inclusion criteria were: published after 2004, studying adults, in English and scoring >50% on Assessing the Methodological Quality of Systematic Reviews (AMSTAR); quality appraisal checklist). SRs were synthesised to identify research priorities, based on moderate/good quality evidence, sample size and indication of cost-effectiveness and safety.

RESULTS: We included 84 MSK SRs and 27 MH SRs. Only one focused on MSK-MH comorbidity. Meditative approaches and yoga may improve MH outcomes in MSK populations. Yoga and tai chi had moderate/good evidence for MSK and MH conditions. SRs reported moderate/good quality evidence (any comparator) in a moderate/large population for: low back pain (LBP) (yoga, acupuncture, spinal manipulation/mobilisation, osteopathy), osteoarthritis (OA) (acupuncture, tai chi), neck pain (acupuncture, manipulation/manual therapy), myofascial trigger point pain (acupuncture), depression (mindfulness-based stress reduction (MBSR), meditation, tai chi, relaxation), anxiety (meditation/MBSR, moving meditation, yoga), sleep disorders (meditative/mind-body movement) and stress/distress (mindfulness). The majority of these complementary approaches had some evidence of safety-only three had evidence of harm. There was some evidence of cost-effectiveness for spinal manipulation/mobilisation and acupuncture for LBP, and manual therapy/manipulation for neck pain, but few SRs reviewed cost-effectiveness and many found no data.

CONCLUSIONS: Only one SR studied MSK-MH comorbidity. Research priorities for complementary medicine for both MSK and MH (LBP, OA, depression, anxiety and sleep problems) are yoga, mindfulness and tai chi. Despite the large number of SRs and the prevalence of comorbidity, more high-quality, large randomised controlled trials in comorbid populations are needed.

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More information

Accepted/In Press date: 1 August 2018
e-pub ahead of print date: 15 October 2018
Keywords: complementary medicine, mental health, musculoskeletal disorders, primary care

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Local EPrints ID: 425637
URI: http://eprints.soton.ac.uk/id/eprint/425637
ISSN: 2044-6055
PURE UUID: 56a2750d-7bce-4237-8c19-719b70faeb9d

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Date deposited: 30 Oct 2018 17:30
Last modified: 06 Oct 2020 17:36

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Contributors

Author: Ava Lorenc
Author: Gene Feder
Author: Hugh MacPherson
Author: Paul Little
Author: Stewart W. Mercer
Author: Deborah Sharp

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