Ten RCTs (n=571) were included in the review. The mean methodological quality was 4.5 (range 3 to 6). Four studies were deemed high quality with regard to randomisation, use of cointerventions and long-term follow up. Six studies were deemed low quality. Few studies reported intention-to-treat analysis, method of allocation or concealment of allocation. Follow up ranged from six weeks to 24 months.
Balneotherapy (four RCTs): There was moderate evidence for use of balneotherapy as treatment of fibromyalgia syndrome. Two low-quality RCTs reported significant improvements for pain, fatigue and anxiety (p<0.05) for the treatment group compared to control group for up to three months. One high-quality RCT reported improvements in depression score, tender point count, pain and total fibromyalgia impact questionnaire score for up to six months. No between-group analysis was conducted for one RCT. Reductions in pain were reported in both groups.
Pool-based exercise (four RCTs): There was moderate evidence for the use of pool-based exercise as treatment for fibromyalgia syndrome. Two low-quality RCTs reported significant improvements in fibromyalgia impact questionnaire subscales for pool-based exercise groups compared to control groups (p<0.05). One high-quality RCT reported significant improvements in pain for pool-based exercise compared to control group. One high-quality RCT reported conflicting results for outcomes that compared pool-based exercise with land-based exercise, where the only significant difference reported was for improvement in grip strength for the control group (p<0.05).
Spa therapy (two RCTs): There was moderate evidence for use of spa therapy as treatment for fibromyalgia syndrome. One high-quality and one low-quality RCT reported significant improvements in Fibromyalgia Impact Questionnaire total score, tender point count, fatigue and general well being for treatment group compared to control (p<0.05).