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Sempere-Rubio et al. | Journal of Clinical and Translational Research 2023; 9(6): 369-380 375
intensity variable in favor of HEIs. In addition, Suso-Martí a significant improvement in pain intensity variable (n = 8).
et al. [23] found that PNE showed statistically significant Finally, Saracoglu et al. [22] also found that adding PNE to a
differences reducing post-intervention pain intensity with multicomponent approach resulted in a statistically significant
a moderate clinical effect (n = 7, SMD = −0.76; 95% CI: decrease in pain intensity with a moderate clinical effect (n = 3,
−1.33 – −0.19, P < 0.05, I = 92%) but not at 3 months of standardized mean differences (SMD) = −1.05; 95% confidence
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follow-up (n = 7, SMD = −0.42; 95% CI: −0.93 – 0.08, interval (CI): −1.4 – −0.69, P < 0.001, I =37.7%).
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P > 0.05, I = 89%).
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3.5.2.2. Quality of life
3.5.1.2. Quality of life
A total of four SRs offered at least one outcome for the quality of
A total of two SRs offered at least one outcome for the quality life variable [19-22]. Antunes et al. [19] found in one primary study
of life variable [20,23]. Elizagaray-García et al. [20] found strong that HEI plus multicomponent approach significantly improved
evidence (n = 5) of HEI, in isolation, did not show significant quality of life. Elizagaray-García et al. [20] found strong evidence
improvements in improving quality of life in the short, medium, (n = 4) of HEI plus therapeutic exercise significantly improved
or long term. Finally, Suso-Martí et al. [23] found that PNE did quality of life in the short, medium, and long term. García-Ríos
not show statistically significant post-intervention improvements et al. [21] reported that the best results in improving quality of
in quality of life (n = 8, SMD = −0.37; 95% CI: −0.85 – 0.11, life were found when a multicomponent approach was added to
P > 0.05, I = 91%). However, Suso-Martí et al. [23] found HEIs. Finally, Saracoglu et al. [22] found that adding PNE to a
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statistically significant improvements in quality of life at 3 months multicomponent approach resulted in a statistically significant
of follow-up with a small clinical effect (n = 8, SMD = −0.44; improve in quality of life with a moderate clinical effect (n = 4,
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95% CI: −0.73 – −0.14, P < 0.05, I = 89%). SMD = −1.05; 95% CI: −1.3 – −0.79, P < 0.001, I = 86%).
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3.5.1.3. Functionality 3.5.2.3. Functionality
One SR offered at least one outcome for the functionality A total of two SRs offered at least one outcome for the
variable [20]. Elizagaray-García et al. [20] found controversial functionality variable [20,21]. Elizagaray-García et al. [20]
evidence (n = 3) of HEI, in isolation, did not show significant found strong evidence (n = 3) of HEI plus therapeutic exercise
improvements in improving functionality in the short term. significantly improved functionality in the short and the medium
term. Finally, García-Ríos et al. [21] found that adding HEI to
3.5.1.4. Anxiety a multicomponent approach resulted in a statistically significant

One SR offered at least one outcome for the anxiety variable [23]. improve in functionality (n = 3).
Suso-Martí et al. [23] found no statistically significant differences in 3.5.2.4. Anxiety
anxiety improvement either at post-intervention (n = 5, SMD = −0.06;
95% CI: −0.67 − 0.55, P > 0.05, I = 85%) or at 3-month follow-up A total of two SRs offered at least one outcome for the anxiety
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(n = 5, SMD = −0.07; 95% CI: −0.69 to 0.82, p>0.05, I =85%). variable [21,22]. García-Ríos et al. [21] found that adding HEI to
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a multicomponent approach resulted in a statistically significant
3.5.1.5. Pain catastrophizing improve in anxiety (n = 4). Finally, Saracoglu et al. [22] found
that adding PNE to a multicomponent approach resulted in a
One SR offered at least one outcome for pain catastrophizing
variable [23]. Suso-Martí et al. [23] found no statistically statistically significant improve in anxiety with a moderate clinical
effect (n = 4, SMD = −0.711; 95% CI: −0.86 – −0.55, P < 0.001,
significant differences in pain catastrophizing improvement either I = 51.6%).
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at post-intervention (n = 8, SMD = −0.10; 95% CI: −0.52 – 0.32,
P > 0.05, I = 89%) or at 3-month follow-up (n = 8, SMD = −0.16; 3.5.2.5. Pain catastrophizing
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95% CI: −0.52 – 0.19, P > 0.05, I = 86%).
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A total of two SRs offered at least one outcome for pain
3.5.2. HEI (in combination with other interventions) catastrophizing variable [21,22]. García-Ríos et al. [21] showed
contradictory results with regard to the improvement of pain
3.5.2.1. Pain intensity catastrophizing variable (n = 2). Finally, Saracoglu et al. [22]
A total of four SR offered at least one outcome for the found that adding PNE to a multicomponent approach resulted
pain intensity variable [19-22]. Antunes et al. [19] found in in a statistically significant improve in pain catastrophizing
one primary study that HEI plus multicomponent approach with a moderate clinical effect (n = 3, SMD = −0.89; 95%
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significantly reduced pain intensity. Elizagaray-García et al. [20] CI: −1.43 – −0.34, P = 0.001, I = 70.5%).
found moderate evidence (n = 2) of HEI plus therapeutic exercise 4. Discussion
showed significant improvements in reducing pain intensity in
the medium term although mixed results were found in the short The main aim of this review was to assess the effectiveness
term. García-Ríos et al. [21] found that studies analyzing the of HEI in patients with FMS. We divided the results into two
impact of HEI, in combination with other approaches, showed groups: When HEI were evaluated in isolation and when HEI
DOI: http://dx.doi.org/10.18053/jctres.09.202306.23-00108