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Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Meta-analysis showed moderate-to-strong evidence for a small reduction in pain (SMD \u22120.42; 95% CI [\u22120.61, \u22120.24];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.00001; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%) with regard to HT (8 studies, 462 participants; 3 low-risk studies, 223 participants), and moderate-to-strong evidence for a small improvement in health-related quality of life (HRQOL; 7 studies, 398 participants; 3 low-risk studies, 223 participants) at the end of treatment (SMD \u22120.40; 95% CI [\u22120.62, \u22120.18];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0004; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200915%). No effect was seen at the end of treatment for depressive symptoms and tender point count (TPC).\n                    <\/jats:p>\n                    <jats:p>\n                      BT in mineral\/thermal water (5 studies, 177 participants; 3 high-risk and 2 unclear risk studies) showed moderate evidence for a medium-to-large size reduction in pain and TPC at the end of treatment: SMD \u22120.84; 95% CI [\u22121.36, \u22120.31];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200963% and SMD \u22120.83; 95% CI [\u22121.42, \u22120.24];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200971%. After sensitivity analysis, and excluding one study, the effect size for pain decreased: SMD \u22120.58; 95% CI [\u22120.91, \u22120.26],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0004; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090. Moderate evidence is given for a medium improvement of HRQOL (SMD \u22120.78; 95% CI [\u22121.13, \u22120.43];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). A significant effect on depressive symptoms was not found. The improvements for pain could be maintained at follow-up with smaller effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High-quality studies with larger sample sizes are needed to confirm the therapeutic benefit of BT and HT, with focus on long-term results and maintenance of the beneficial effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/ar4603","type":"journal-article","created":{"date-parts":[[2014,7,7]],"date-time":"2014-07-07T13:04:07Z","timestamp":1404738247000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":78,"title":["Therapeutic benefit of balneotherapy and hydrotherapy in the management of fibromyalgia syndrome: a qualitative systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.1186","volume":"16","author":[{"given":"Johannes","family":"Naumann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catharina","family":"Sadaghiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2014,7,7]]},"reference":[{"key":"4234_CR1","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1007\/s40273-014-0137-y","volume":"32","author":"TL Skaer","year":"2014","unstructured":"Skaer TL: Fibromyalgia: disease synopsis, medication cost effectiveness and economic burden. 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