Table 2.
GRADE assessment.
| Certainty Assessment | Impact | Certainty | ||||||
|---|---|---|---|---|---|---|---|---|
| № of Studies | Study Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | Other Considerations | ||
| Fibromyalgia Impact Questionnaire (FIQ) Score | ||||||||
| 4 | 2 RCTs and 3 observational studies | Not serious | Serious a | Not serious | Not serious | Three out of the four studies reported reductions in FIQ score. Average score reductions ranged from −12.07 to −45 points. | ⨁⨁◯◯ Low |
|
| Visual Analog Scale (VAS) for Acute and Chronic Pain | ||||||||
| 2 | 2 RCTs and 2 observational studies | Not serious | Not serious | Not serious | Not serious | Dose–response b | All four studies reported a reduction in pain score ranging from −2.04 to −4.8 cm. | ⨁⨁⨁◯ Moderate |
| Lower-Back Pain | ||||||||
| 1 | RCT | Not serious | Serious c | Not serious | Not serious | Strong association | Greater decrease in lower-back pain | ⨁⨁⨁◯ Moderate |
| Number of Tender Points | ||||||||
| 1 | RCT | Not serious | Not serious | Not serious | Not serious | Strong association | No significant decrease in number of tender points | ⨁⨁⨁⨁ High |
Explanations: a. Two studies employed the Fibromyalgia Impact Questionnaire Revised (FIQR), which places more weight on dysfunction and less on symptoms compared to the previous version of the questionnaire. b. Magnitude of reduction in VAS score was correlated with drug high for Bedrocan and Bediol (van de Donk et al.). c. Lack of standardization of intervention.