{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T12:50:30Z","timestamp":1782391830307,"version":"3.54.5"},"reference-count":37,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Back and Musculoskeletal Rehabilitation"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intermittent Hypoxia-Hyperoxia Therapy (IHHT) is a recent, non-invasive method proposed to enhance physiological adaptations and promote recovery in musculoskeletal dysfunctions. However, evidence to guide practice remains limited. This systematic review aims to evaluate the therapeutic effects of IHHT on pain and health outcomes in patients with musculoskeletal dysfunctions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search was conducted following PRISMA guidelines across MEDLINE, EMCARE, CINAHL, Embase, Scopus, Google Scholar, and Semantic Scholar. Eligible studies included patients with musculoskeletal disorders receiving IHHT compared to usual care or no intervention, with outcomes assessing pain and general health. Cochrane RoB 2.0 tool and the PEDro scale evaluated methodological quality, while certainty of the evidence was assessed using the GRADE criteria and review quality with AMSTAR tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In seven trials, recruiting 321 participants, IHHT demonstrated significant improvements in pain (SMD\u2009=\u2009\u22120.5, 95% CI\u2009=\u2009\u22121.14 to \u22120.13, p\u2009&lt;\u20090.0001), and general health (MD\u2009=\u2009\u221212.06, 95% CI\u2009=\u2009\u221216.73 to \u22127.39, p\u2009&lt;\u20090.00001), reduction in psychological parameters (p\u2009&lt;\u20090.00001), and improved functional mobility (p\u2009&lt;\u20090.006). Moderate heterogeneity was reported across outcomes. Sensitivity and subgroup analysis clarified effect directions. Limitations included small sample size, short follow-up durations, and moderate to high methodological quality across included trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IHHT appears to be well-tolerated and effective intervention for improving pain, general health, severity of dysfunction, and psychological parameters, with no major adverse events reported in the included trials. However, overall certainty remains moderate, highlighting the need for future trials to monitor and report safety outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10538127251409591","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T18:08:02Z","timestamp":1771438082000},"page":"1306-1317","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of intermittent hypoxia-hyperoxia therapy for pain and general health in adults with musculoskeletal dysfunctions: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"39","author":[{"given":"Rida","family":"Shabbir","sequence":"first","affiliation":[{"name":"Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aatik","family":"Arsh","sequence":"additional","affiliation":[{"name":"Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zara","family":"Batool","sequence":"additional","affiliation":[{"name":"Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haider","family":"Darain","sequence":"additional","affiliation":[{"name":"Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32340-0"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-018-1151-2"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2023.100661"},{"key":"e_1_3_2_5_2","first-page":"1","article-title":"Musculoskeletal health systematic review: clinical and pharmacological, organizational and legal, administration and pharmaceutical management aspects","volume":"4","author":"Shapovalova V","year":"2024","unstructured":"Shapovalova V. Musculoskeletal health systematic review: clinical and pharmacological, organizational and legal, administration and pharmaceutical management aspects. SSP Mod Pharm Med 2024; 4: 1\u201312.","journal-title":"SSP Mod Pharm Med"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.71000\/4qz9p237"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/21925682251314823"},{"key":"e_1_3_2_8_2","first-page":"465","article-title":"Chronic musculoskeletal pain: nonpharmacologic, noninvasive treatments","volume":"102","author":"Flynn DM","year":"2020","unstructured":"Flynn DM. Chronic musculoskeletal pain: nonpharmacologic, noninvasive treatments. Am Fam Physician 2020; 102: 465\u2013477.","journal-title":"Am Fam Physician"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1089\/ars.2021.0280"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000437416.34298.43"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2022-eular.3861"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2022.824210"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-019-1184-1"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00208.2014"},{"key":"e_1_3_2_15_2","article-title":"Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions","volume":"10","author":"Cumpston M","year":"2019","unstructured":"Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 2019; 10: Ed000142.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S433685"},{"key":"e_1_3_2_17_2","first-page":"98","article-title":"Efficiency of interval hypoxia-hyperoxytherapy in the rehabilitation of patients with nonspecific musculoskeletal low back pain: results of \u0430 randomized placebo-controlled study","volume":"6","author":"Orlova EV","year":"2024","unstructured":"Orlova EV, Lyamina NP, Skorobogatyth NV, et al. Efficiency of interval hypoxia-hyperoxytherapy in the rehabilitation of patients with nonspecific musculoskeletal low back pain: results of \u0430 randomized placebo-controlled study. Phys Rehabil Med Med Rehabil 2024; 6: 98\u2013108.","journal-title":"Phys Rehabil Med Med Rehabil"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1089\/ham.2023.0127"},{"key":"e_1_3_2_19_2","first-page":"279","article-title":"Controlled hypoxia-hyperoxytherapy as a component of a targeted approach in the rehabilitation of patients with multimorbidity: a single-center, randomized, placebo-controlled, prospective study","volume":"5","author":"Lyamina NP","year":"2023","unstructured":"Lyamina NP, Lyamina SV, Skorobogatyth NV, et al. Controlled hypoxia-hyperoxytherapy as a component of a targeted approach in the rehabilitation of patients with multimorbidity: a single-center, randomized, placebo-controlled, prospective study. Phys Rehabil Med Med Rehabil 2023; 5: 279\u2013288.","journal-title":"Phys Rehabil Med Med Rehabil"},{"key":"e_1_3_2_20_2","first-page":"6","article-title":"\u0421linical efficacy of individually dosed intermittent hypoxia-hyperoxic therapy in osteoarthritis patients with post-COVID syndrome","volume":"21","author":"Orlova E LN","year":"2022","unstructured":"Orlova E LN, Skorobogatykh N, et al. \u0421linical efficacy of individually dosed intermittent hypoxia-hyperoxic therapy in osteoarthritis patients with post-COVID syndrome. Vestnik Vosstanovitel'noj Mediciny 2022; 21: 6\u201316.","journal-title":"Vestnik Vosstanovitel'noj Mediciny"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.32000\/2072-1757-2022-4-81-84"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.2174\/1573403X17666210514005235"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.3390\/metabo13020181"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-240711"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.7150\/ijms.86622"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(01)00349-9"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14051590"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19095339"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms20215405"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-009-0257-2"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.3906\/sag-1810-51"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.048964"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1113\/JP285230"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2022.941740"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.13628"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad655.2594"},{"key":"e_1_3_2_37_2","first-page":"20231130","article-title":"Effects of different protocols of moderate-intensity intermittent hypoxic training on mental health and quality of life in Brazilian adults recovered from COVID-19: the AEROBICOVID double-blind randomized controlled study","volume":"11","author":"Merellano-Navarro E","year":"2023","unstructured":"Merellano-Navarro E, Camacho-Cardenosa M, Costa GP, et al. Effects of different protocols of moderate-intensity intermittent hypoxic training on mental health and quality of life in Brazilian adults recovered from COVID-19: the AEROBICOVID double-blind randomized controlled study. Healthcare (Basel) 2023; 11: 20231130.","journal-title":"Healthcare (Basel)"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.trci.2017.01.002"}],"container-title":["Journal of Back and Musculoskeletal Rehabilitation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10538127251409591","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10538127251409591","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10538127251409591","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T12:20:06Z","timestamp":1782390006000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10538127251409591"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,18]]},"references-count":37,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/10538127251409591"],"URL":"https:\/\/doi.org\/10.1177\/10538127251409591","relation":{},"ISSN":["1053-8127","1878-6324"],"issn-type":[{"value":"1053-8127","type":"print"},{"value":"1878-6324","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,18]]}}}