Nine RCTs (n=1,119) were included in the review. Six RCTs were of moderate quality and three RCTs were low quality.
Post-treatment: There was strong evidence to show that compared to control, multicomponent treatment reduced: post-treatment pain (SMD -0.37, 95% CI -0.62 to -0.13; five RCTs); fatigue (WMD -0.85, 95% CI -1.50 to -0.20; three RCTs); depressive symptoms (SMD -0.67, 95% CI -1.08 to -0.26; four RCTs); limitations in health-related quality of life (SMD -0.59, 95% CI -0.90 to -0.27; three RCTs). There was also strong evidence that multicomponent treatment improved self-efficacy pain (SMD 0.54, 95% CI 0.26 to 0.82) and physical fitness (SMD 0.30, 95% CI 0.02 to 0.57; four RCTs) post-treatment compared to control. There was no evidence of statistical heterogeneity for these analyses.
Three to four months follow-up: There was strong evidence that multicomponent therapy improved self-efficacy pain (SMD 0.47, 95% CI 0.14 to 0.80; two RCTs) at three to four month follow-up, but no evidence of efficacy on pain, sleep disturbances, depressive symptoms, health-related quality of life or self-efficacy pain.
Six to 12 months follow-up: At six to 12 month follow-up, there was no evidence of effect for multicomponent therapy compared to control for pain, fatigue, sleep disturbances, depressed mood, health-related quality of life, or self-efficacy pain. There was strong evidence that positive effects on physical fitness (SMD 0.30, 95% CI 0.09 to 0.51; two RCTs) can be maintained in the long term (median follow-up seven months).
There was no evidence of publication bias. Results of sensitivity analysis were also reported.