The impact of community-based, non-pharmaceutical interventions on anxiety and depression in fibromyalgia: A systematic review and network meta-analysis

Background: Fibromyalgia syndrome (FMS) is often accompanied by anxiety and depression, seriously affecting the prognosis of patients. Active non-pharmacological therapies are the mainstay of treatment, but the optimal choice is still contentious. Methods: We did a network meta-analysis(NMA) of RCTs and compared 7 community-based non-pharmacological interventions based on 29 studies. We searched Embase, MEDLINE, PubMed, Scopus, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) from the database inception to March 2022. Results: The NMA demonstrated that five out of six (83.34%) non-pharmacological interventions were associated with significant improvement in anxiety compared with usual care, with a standardized mean difference (SMD) ranging from -1.14 (95% CI: -1.76 to -0.51) for aquatic exercise to -0.39 (95% CI: 073-0.05) for meditation; six of the seven non-pharmacological interventions (85.71%) were associated with significant improvement in depression, with SMD ranged from -1.18 (95% CI: -1.68 to -0.68) for aquatic exercise to -0.46 (95% CI: -0.86 to -0.05) for education therapy. Limitation: First of all, there were scale translation biases in this study caused by the different languages of the original study. In addition, there was a lack of direct comparison between the aquatic exercise group and the routine care group, and the third included intervention measures lacked unified implementation standards. Conclusion: Aquatic exercise exhibited distinct advantages compared with other community-based non-pharmacological interventions and is likely to have optimal efficacy in improving anxiety and depression. The study protocol is registered with the Prospective Register of Systematic Reviews (PROSPERO, CRD 42022338406).