Fulvio Dal Farra1,2, Alessandro Aquino3,4,5, Andrea Gianmaria Tarantino6,7, Daniele Origo1. 1. SOMA Istituto Osteopatia Milano, Research Department, Viale Sarca 336 F, 20126, Milan, Italy. 2. Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy. 3. Department of Health Science, University of Milan, Milan, Italy. 4. Clinical-based Human Research Department, C.O.ME. Collaboration, Pescara, Italy. 5. Italian Pelvic Floor Center, Bergamo, Italy. 6. SOMA Istituto Osteopatia Milano, Research Department, Viale Sarca 336 F, 20126, Milan, Italy. andreagtarantino@gmail.com. 7. Manima Not-for-Profit Healthcare and Assistance, Milan, Italy. andreagtarantino@gmail.com.
Abstract
INTRODUCTION AND HYPOTHESIS: Chronic pelvic pain syndrome (CPPS) is defined as the occurrence of chronic pelvic pain (CPP) in the absence of a specific cause. People typically refer to pain associated with urological, gynaecological, and sexual dysfunction, affecting the quality of life. Therefore, we assessed the effectiveness of myofascial manual therapies (MMT) for pain and symptom impact. METHODS: A systematic review and meta-analysis were conducted. Findings were reported following the 2020 PRISMA statement. Five databases were searched for RCTs. Studies were independently assessed through a standardized form, and their internal validity was evaluated using the Cochrane risk of bias (RoB) tool. Effect sizes (ES) were calculated post-treatment, and the quality of evidence was assessed through GRADE criteria. RESULTS: Seven articles were included in the review, five of these in the meta-analysis. None of these studies were completely judged at low RoB. MMT was revealed to be not significantly superior for pain reduction [ES: -0.54 (-1.16; 0.08); p = 0.09], for symptom impact [ES: -0.37 (-0.87; 0.13); p = 0.15], and for quality of life [ES: -0.44 (-1.22, 0.33), p = 0.26] compared to standard care. The quality of evidence was "very low". Other results were presented in a qualitative synthesis. CONCLUSIONS: In patients with CPP/CPPS, MMT is not considered superior to other interventions for pain reduction and symptom impact improvements. However, a positive trend was detected, and we should find confirmation in the future. Further high-quality, double-blinded, sham-controlled RCTs are first necessary to confirm these positive effects and to improve the quality of evidence.
INTRODUCTION AND HYPOTHESIS: Chronic pelvic pain syndrome (CPPS) is defined as the occurrence of chronic pelvic pain (CPP) in the absence of a specific cause. People typically refer to pain associated with urological, gynaecological, and sexual dysfunction, affecting the quality of life. Therefore, we assessed the effectiveness of myofascial manual therapies (MMT) for pain and symptom impact. METHODS: A systematic review and meta-analysis were conducted. Findings were reported following the 2020 PRISMA statement. Five databases were searched for RCTs. Studies were independently assessed through a standardized form, and their internal validity was evaluated using the Cochrane risk of bias (RoB) tool. Effect sizes (ES) were calculated post-treatment, and the quality of evidence was assessed through GRADE criteria. RESULTS: Seven articles were included in the review, five of these in the meta-analysis. None of these studies were completely judged at low RoB. MMT was revealed to be not significantly superior for pain reduction [ES: -0.54 (-1.16; 0.08); p = 0.09], for symptom impact [ES: -0.37 (-0.87; 0.13); p = 0.15], and for quality of life [ES: -0.44 (-1.22, 0.33), p = 0.26] compared to standard care. The quality of evidence was "very low". Other results were presented in a qualitative synthesis. CONCLUSIONS: In patients with CPP/CPPS, MMT is not considered superior to other interventions for pain reduction and symptom impact improvements. However, a positive trend was detected, and we should find confirmation in the future. Further high-quality, double-blinded, sham-controlled RCTs are first necessary to confirm these positive effects and to improve the quality of evidence.
Authors: Gordon H Guyatt; Andrew D Oxman; Gunn E Vist; Regina Kunz; Yngve Falck-Ytter; Pablo Alonso-Coello; Holger J Schünemann Journal: BMJ Date: 2008-04-26
Authors: Matthew J Page; Joanne E McKenzie; Patrick M Bossuyt; Isabelle Boutron; Tammy C Hoffmann; Cynthia D Mulrow; Larissa Shamseer; Jennifer M Tetzlaff; Elie A Akl; Sue E Brennan; Roger Chou; Julie Glanville; Jeremy M Grimshaw; Asbjørn Hróbjartsson; Manoj M Lalu; Tianjing Li; Elizabeth W Loder; Evan Mayo-Wilson; Steve McDonald; Luke A McGuinness; Lesley A Stewart; James Thomas; Andrea C Tricco; Vivian A Welch; Penny Whiting; David Moher Journal: J Clin Epidemiol Date: 2021-03-29 Impact factor: 6.437
Authors: Ma José Ariza-Mateos; Irene Cabrera-Martos; Araceli Ortiz-Rubio; Irene Torres-Sánchez; Janet Rodríguez-Torres; Marie Carmen Valenza Journal: Arch Phys Med Rehabil Date: 2018-10-09 Impact factor: 3.966
Authors: M P FitzGerald; C K Payne; E S Lukacz; C C Yang; K M Peters; T C Chai; J C Nickel; P M Hanno; K J Kreder; D A Burks; R Mayer; R Kotarinos; C Fortman; T M Allen; L Fraser; M Mason-Cover; C Furey; L Odabachian; A Sanfield; J Chu; K Huestis; G E Tata; N Dugan; H Sheth; K Bewyer; A Anaeme; K Newton; W Featherstone; R Halle-Podell; L Cen; J R Landis; K J Propert; H E Foster; J W Kusek; L M Nyberg Journal: J Urol Date: 2012-04-12 Impact factor: 7.450
Authors: Julian P T Higgins; Douglas G Altman; Peter C Gøtzsche; Peter Jüni; David Moher; Andrew D Oxman; Jelena Savovic; Kenneth F Schulz; Laura Weeks; Jonathan A C Sterne Journal: BMJ Date: 2011-10-18
Authors: Mary P Fitzgerald; Rodney U Anderson; Jeannette Potts; Christopher K Payne; Kenneth M Peters; J Quentin Clemens; Rhonda Kotarinos; Laura Fraser; Annemarie Cosby; Carole Fortman; Cynthia Neville; Suzanne Badillo; Lisa Odabachian; Andrea Sanfield; Betsy O'Dougherty; Rick Halle-Podell; Liyi Cen; Shannon Chuai; J Richard Landis; Keith Mickelberg; Ted Barrell; John W Kusek; Leroy M Nyberg Journal: J Urol Date: 2013-01 Impact factor: 7.600
Authors: Mary L L S Montenegro; Carolina A Braz; Julio C Rosa-e-Silva; Francisco J Candido-dos-Reis; Antonio A Nogueira; Omero B Poli-Neto Journal: BMC Anesthesiol Date: 2015-12-01 Impact factor: 2.217