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Is there a dose response relationship between soft tissue manual therapy and clinical outcomes in fibromyalgia?

Sturman, Sarah; Killingback, Clare


Sarah Sturman


Current clinical guidelines do not support the use of manual therapy (MT) interventions for Fibromyalgia (FM) patients, despite evidence of positive biochemical, mechanical and psychological effects, and the popularity of hands-on treatments amongst patients. An optimal dose for MT has not been established; this may explain the discrepancies found within the published literature. The aim of this systematic review was to determine whether there is a dose response relationship for MT leading to improvements in core domains of FM symptomology; Pain, Mood, Sleep, Global Measure of Impact (Functional Status & Quality of Life).
We searched six databases from 1990 to January 2018; studies were evaluated using the PEDro scale. Within-group (ES d) and between-group (ES g) Effect Sizes were calculated.
We identified and screened 4012 articles, 12 articles were critically appraised. Overall, there is moderate evidence that MT has positive effects on the four clinical outcomes investigated. However, there was no consistent dose response relationship observed across all studies.
A dose of approximately 45 min MT, three to five times per week, for three to five weeks, totalling 11 h 15 min, should be considered a baseline generic protocol for treatment delivery and research trials. Further research is necessary to confirm domain specific, or patient specific optimal doses. Moderator variables such as treatment time, frequency, duration; and MT type also need to be explored to ensure optimal delivery of MT in future research and clinical care provision.


Sturman, S., & Killingback, C. (2020). Is there a dose response relationship between soft tissue manual therapy and clinical outcomes in fibromyalgia?. Journal of Bodywork and Movement Therapies, 24(3), 141-153.

Journal Article Type Article
Acceptance Date Feb 17, 2020
Online Publication Date Feb 28, 2020
Publication Date 2020-07
Deposit Date Dec 3, 2020
Publicly Available Date Mar 1, 2021
Journal Journal of Bodywork and Movement Therapies
Print ISSN 1360-8592
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 24
Issue 3
Pages 141-153
Keywords Physical Therapy, Sports Therapy and Rehabilitation; Complementary and alternative medicine; Rehabilitation; Complementary and Manual Therapy
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Additional Information This article is maintained by: Elsevier; Article Title: Is there a dose response relationship between soft tissue manual therapy and clinical outcomes in fibromyalgia?; Journal Title: Journal of Bodywork and Movement Therapies; CrossRef DOI link to publisher maintained version:; Content Type: article; Copyright: © 2020 Elsevier Ltd. All rights reserved.


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