Review Finds Combination of Hands-on and Hands-off Treatment Improves Fibromyalgia Sleep Quality

A combination of “hands-off” and “hands-on” treatment for fibromyalgia (FM) may lead to better sleep quality, according to a recent review of FM treatment strategies.¹

“The presence of different approaches, both active and passive, is challenging for fibromyalgia patients and the clinicians in charge of them, with a likely risk of wasting resources and time. From this perspective, it is crucial to define which is the best treatment modality. In more detail, there is a compelling need to clarify whether active treatments, also called “hands-off”, are more effective as a standalone intervention or, instead, whether the patient has more benefit from the combination of “hands-off” and “hands-on” therapies (i.e., passive treatments in which patients do not actively contribute to the therapy),” lead investigator Riccardo Buraschi, DPT, IRCCS Fondazione Don Carlo Gnocchi, and colleagues wrote.¹

Buraschi and colleagues compared 7 English-language randomized controlled trials involving people with FM assessing “hands-off” treatments alone versus the combination of “hands-off” and “hands-on” therapies on MEDLINE (PubMed), CENTRAL, and Embase. They noted that the literature is not consistent in terms of defining these kinds of treatment but for this analysis defined “hands-off” treatments as actively performed tasks, exercises, and activities with verbal and eventual haptic help or guidance with little-to-no contact with the therapist. “Hands-on” treatments are given with hands, tools or devices directly in contact with the patient while the patient does not actively contribute to the therapy but passively receives it.

The investigators calculated and used the risk ratio for dichotomous data of the drop-out rate of the studies. They found no significant differences in the outcomes, pain, quality of life, health status, and drop-out rate between “hands-off” alone and “hands-off” and “hands-on” treatments combined. Combining “hands-off” and “hands-on” treatments did significantly show better rest quality than “hands-off” treatments alone (standardized mean difference, 0.72 [95% CI, 0.35-1.09]; P <.001).¹

“This review opens interesting possibilities for managing fibromyalgia. It not only shows that “hands-off” treatments seem to be effective, but that the combination of “hands-off” and “hands-on” treatments shows a similar effect, although the application of this approach should be carefully evaluated according to the available resources. Moreover, the combined treatment provides small but significant improvements in sleep quality, while the adherence (drop-out rate) of the 2 groups did not produce significant differences. Further studies should consider the comparison of other interventions to increase the knowledge about the different treatment choices,” Buraschi and colleagues concluded.1

Other similar research into exercise for FM, which counts as a “hands-off” treatment, found that functional exercise training was more effective at reducing pain and improving quality of life than stretching exercises.²

After 14 weeks, the function exercise group had a statistically significant reduction in pain (interaction P = .002), improvement in health-related quality of life as measured by FIQ (interaction P < .001), and improvement in general health state domain of SF-36 (interaction P = .043) compared to the stretching exercise group. The investigators did not find any significant differences in functional capacity, muscle strength, flexibility or balance improvements between the functional exercise and the stretching exercise groups.²

REFERENCES

1. Buraschi R, Ranica G, Villafañe JH, Pullara R, Gobbo M, Pollet J. “Hands-On” and “Hands-Off” Physiotherapy Treatments in Fibromyalgia Patients: A Systematic Review and Meta-Analysis. Biomedicines. 2024; 12(10):2412. https://doi.org/10.3390/biomedicines12102412

2. Fernandes, G., Nery, M., Meireles, S.M. et al. A functional exercise program improves pain and health related quality of life in patients with fibromyalgia: a randomized controlled trial. Adv Rheumatol 64, 81 (2024). https://doi.org/10.1186/s42358-024-00422-7