Fibromyalgia is a highly heterogeneous condition, but the most common symptoms are widespread pain, fatigue, poor sleep, and low mood. Nonpharmacological interventions are recommended as first-line treatment of fibromyalgia. However which interventions are effective for the different symptoms is not well understood. The objective of this study was to assess the efficacy of nonpharmacological interventions on symptoms and disease-specific quality of life. Seven databases were searched from their inception until June 1, 2020. Randomised controlled trials comparing any nonpharmacological intervention to usual care, waiting list, or placebo in people with fibromyalgia aged >16 years were included without language restriction. Fibromyalgia Impact Questionnaire (FIQ) was the primary outcome measure. Standardised mean difference and 95% confidence interval were calculated using random effects model. The risk of bias was evaluated using the modified Cochrane tool. Of the 16,251 studies identified, 167 randomised controlled trials (n = 11,012) assessing 22 nonpharmacological interventions were included. Exercise, psychological treatments, multidisciplinary modality, balneotherapy, and massage improved FIQ. Subgroup analysis of different exercise interventions found that all forms of exercise improved pain (effect size [ES] −0.72 to −0.96) and depression (ES −0.35 to −1.22) except for flexibility exercise. Mind–body and strengthening exercises improved fatigue (ES −0.77 to −1.00), whereas aerobic and strengthening exercises improved sleep (ES −0.74 to −1.33). Psychological treatments including cognitive behavioural therapy and mindfulness improved FIQ, pain, sleep, and depression (ES −0.35 to −0.55) but not fatigue. The findings of this study suggest that nonpharmacological interventions for fibromyalgia should be individualised according to the predominant symptom.

纤维肌痛是一种高度异质性的疾病，但最常见的症状是广泛的疼痛、疲劳、睡眠质量差和情绪低落。建议将非药物干预作为纤维肌痛的一线治疗方法。然而，哪些干预措施对不同症状有效尚不清楚。本研究的目的是评估非药物干预措施对症状和疾病特定生活质量的功效。检索了 7 个数据库，从数据库成立到 2020 年 6 月 1 日。纳入了针对年龄 > 16 岁纤维肌痛患者的任何非药物干预与常规护理、候补名单或安慰剂进行比较的随机对照试验，不受语言限制。纤维肌痛影响问卷（FIQ）是主要结果指标。使用随机效应模型计算标准化平均差和 95% 置信区间。使用改良的 Cochrane 工具评估偏倚风险。在确定的 16,251 项研究中，纳入了 167 项评估 22 种非药物干预措施的随机对照试验（n = 11,012）。运动、心理治疗、多学科治疗、浴疗法和按摩可改善 FIQ。对不同运动干预措施的亚组分析发现，除灵活性运动外，所有形式的运动均可改善疼痛（效应值[ES] -0.72 至 -0.96）和抑郁症（ES -0.35 至 -1.22）。身心和强化运动改善疲劳（ES -0.77 至 -1.00），而有氧运动和强化运动改善睡眠（ES -0.74 至 -1.33）。包括认知行为疗法和正念疗法在内的心理治疗改善了 FIQ、疼痛、睡眠和抑郁（ES -0.35 至 -0.55），但没有改善疲劳。这项研究的结果表明，纤维肌痛的非药物干预措施应根据主要症状进行个体化。