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Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions
  1. Ava Lorenc1,
  2. Gene Feder1,
  3. Hugh MacPherson2,
  4. Paul Little3,
  5. Stewart W Mercer4,
  6. Deborah Sharp1
  1. 1 Population Health Sciences, Bristol Medical School, Bristol, UK
  2. 2 Department of Health Sciences, University of York, York, UK
  3. 3 Primary Care and Population Science Unit, University of Southampton, Southampton, UK
  4. 4 General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Ava Lorenc; ava.lorenc{at}


Objective 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.

Methods 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 safety.

Results 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.

Conclusions 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.

  • complementary medicine
  • musculoskeletal disorders
  • mental health
  • primary care

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  • Contributors AL conducted all literature searches, data extraction and quality appraisal, with the project team (GF, HM, PL, SWM and DS) all screening papers for inclusion. The team (GF, HM, PL, SWM and DS) all provided input into the inclusion/exclusion criteria. DS advised on the review process. GF, HM, PL, SWM and DS were all involved in the prioritisation of topics from the review results. AL drafted the paper and all authors reviewed and edited it.

  • Funding The report is based on independent research commissioned and funded by the NIHR Policy Research Programme (The Effectiveness And Cost Effectiveness Of Complementary And Alternative Medicine (Cam) For Multimorbid Patients With Mental Health And Musculoskeletal Problems In Primary Care In The UK: A Scoping Study).

  • Disclaimer The views expressed in the publication are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health, ‘arms’ length bodies or other government departments.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We are able to provide copies of searches and lists of excluded references on request.

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