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Publication - Professor Debbie Sharp

    Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions


    Lorenc, A, Feder, G, MacPherson, H, Little, P, Stewart, M & Sharp, D, 2018, ‘Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions’. BMJ Open, vol 8.


    To identify potentially effective complementary approaches for
    musculoskeletal (MSK)–mental health (MH) comorbidity, by synthesising
    evidence on effectiveness, cost-effectiveness and safety from systematic
    reviews (SRs).

    Design Scoping review of SRs.

    We searched literature databases, registries and reference lists, and
    contacted key authors and professional organisations to identify SRs of
    randomised controlled trials for complementary medicine for MSK or MH.
    Inclusion criteria were: published after 2004, studying adults, in
    English and scoring >50% on Assessing the Methodological Quality of
    Systematic Reviews (AMSTAR); quality appraisal checklist). SRs were
    synthesised to identify research priorities, based on moderate/good
    quality evidence, sample size and indication of cost-effectiveness and

    We included 84 MSK SRs and 27 MH SRs. Only one focused on MSK–MH
    comorbidity. Meditative approaches and yoga may improve MH outcomes in
    MSK populations. Yoga and tai chi had moderate/good evidence for MSK and
    MH conditions. SRs reported moderate/good quality evidence (any
    comparator) in a moderate/large population for: low back pain (LBP)
    (yoga, acupuncture, spinal manipulation/mobilisation, osteopathy),
    osteoarthritis (OA) (acupuncture, tai chi), neck pain (acupuncture,
    manipulation/manual therapy), myofascial trigger point pain
    (acupuncture), depression (mindfulness-based stress reduction (MBSR),
    meditation, tai chi, relaxation), anxiety (meditation/MBSR, moving
    meditation, yoga), sleep disorders (meditative/mind–body movement) and
    stress/distress (mindfulness). The majority of these complementary
    approaches had some evidence of safety—only three had evidence of harm.
    There was some evidence of cost-effectiveness for spinal
    manipulation/mobilisation and acupuncture for LBP, and manual
    therapy/manipulation for neck pain, but few SRs reviewed
    cost-effectiveness and many found no data.

    Only one SR studied MSK–MH comorbidity. Research priorities for
    complementary medicine for both MSK and MH (LBP, OA, depression, anxiety
    and sleep problems) are yoga, mindfulness and tai chi. Despite the
    large number of SRs and the prevalence of comorbidity, more
    high-quality, large randomised controlled trials in comorbid populations
    are needed.

    Full details in the University publications repository