Effects of Manual Therapy in People with Fibromyalgia: Systematic Review and Meta-Analysis
Efectos de la terapia manual en personas con fibromialgia: Revisión sistemática y metaanálisis
Abstract
Objective. The aim of this systematic review with meta-analysis is to synthesize the available scientific evidence on the effects of manual therapy applied in isolation in comparison to other interventions on pain, functional capacity, global impression of improvement, and self-perceived severity of symptoms in people with fibromyalgia.
Methodology. A systematic review with meta-analysis was conducted with electronic search of MEDLINE, WoS, SCOPUS, PEDro, CENTRAL, and LILACS.
Results. Eleven studies met the selection criteria and six were included in a quantitative synthesis. Pain at the end of treatment had a mean difference of -0.42 (95% CI -1.14, 0.30, p = 0.25), functional status at the end of treatment had a mean difference of -0.15 (95% CI - 0.69, 0.40, p = 0.60), the global impression of health at the end of treatment had a mean difference of -1.13 (95% CI -1.68, -0.57 p = <0.00) and a mean difference of -0.48 after twelve months (95% CI -0.78, -0.19 p = <0.00), the global impression of severity after the intervention had a mean difference of -0.62 (95% CI -1.22, -0.03, p = 0.04 ) and a mean difference of -0.43 after twelve months (95% CI -1.18, 0.32, p = 0.26).
Conclusions. Isolated manual therapy is an intervention that could significantly improve the self-perception of the global state of improvement and severity of symptoms in the short term compared to sham physical agents. However, it is not better than other interventions to reduce pain and improve functional capacity.
Downloads
Citado por
Authors
Keywords
References
Sarzi-Puttini P, Giorgi V, Marotto D, Atzeni F. Fibromyalgia: An update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol [Internet]. 2020;16(11):645-60. doi: https://doi.org/10.1038/s41584-020-00506-w DOI: https://doi.org/10.1038/s41584-020-00506-w
Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: The IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain [Internet]. 2019;160:19-27. doi: https://doi.org/10.1097/j.pain.0000000000001384 DOI: https://doi.org/10.1097/j.pain.0000000000001384
Üçeyler N, Burgmer M, Friedel E, Greiner W, Petzke F, Sarholz M, et al. [Etiology and pathophysiology of fibromyalgia syndrome: Updated guidelines 2017, overview of systematic review articles and overview of studies on small fiber neuropathy in FMS subgroups]. Schmerz [Internet]. 2017;31(3):239-45. doi: https://doi.org/10.1007/s00482-017-0202-5 DOI: https://doi.org/10.1007/s00482-017-0202-5
Sallinen M, Mengshoel AM. “I just want my life back!” - Men’s narratives about living with fibromyalgia. Disabil Rehabil [Internet]. 2019;41(4):422-9. doi: https://doi.org/10.1080/09638288.2017.1395085 DOI: https://doi.org/10.1080/09638288.2017.1395085
Heidari F, Afshari M, Moosazadeh M. Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis. Rheumatol Int [Internet]. 2017;37(9):1527-39. doi: https://doi.org/10.1007/s00296-017-3725-2 DOI: https://doi.org/10.1007/s00296-017-3725-2
Queiroz LP. Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep [Internet]. 2013;17(8). doi: https://doi.org/10.1007/s11916-013-0356-5 DOI: https://doi.org/10.1007/s11916-013-0356-5
Cabo-Meseguer A, Cerdá-Olmedo G, Trillo-Mata JL. Fibromyalgia: Prevalence, epidemiologic profiles and economic costs. Fibromialgia: prevalencia, perfiles epidemiológicos y costes económicos. Med Clin (Barc) [Internet]. 2017 Nov 22;149(10):441-8. doi: https://doi.org/10.1016/j.medcli.2017.06.008 DOI: https://doi.org/10.1016/j.medcli.2017.06.008
Wolfe F, Clauw D, Fitzcharles M, Goldenberg D, Häuser W, Katz R, et al. Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Artritis Reum [Internet]. 2016;46(3):319-29. doi: https://doi.org/10.1016/j.semarthrit.2016.08.012 DOI: https://doi.org/10.1016/j.semarthrit.2016.08.012
Araya-Quintanilla F, Gutiérrez-Espinoza H, Muñoz-Yánez MJ, Cavero-Redondo I, Álvarez-Bueno C, Martinez-Vizcaíno V. Effectiveness of a multicomponent treatment versus conventional treatment in patients with fibromyalgia. Study Protocol. Medicine [Internet]. 2020;99(4):e18833. doi: https://doi.org/10.1097/md.0000000000018833 DOI: https://doi.org/10.1097/MD.0000000000018833
Giusti EM, Castelnuovo G, Molinari E. Differences in Multidisciplinary and Interdisciplinary Treatment Programs for Fibromyalgia: A Mapping Review. Pain Res Manag [Internet]. 2017;2017:7261468. doi: https://doi.org/10.1155/2017/7261468 DOI: https://doi.org/10.1155/2017/7261468
Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis [Internet]. 2017;76(2):318-28. doi: https://doi.org/10.1136/annrheumdis-2016-209724 DOI: https://doi.org/10.1136/annrheumdis-2016-209724
Clauw DJ. Fibromyalgia: a clinical review. JAMA [Internet]. 2014;311(15):1547-55. doi: https://doi.org/10.1001/jama.2014.3266 DOI: https://doi.org/10.1001/jama.2014.3266
Winkelmann A, Bork H, Brückle W, Dexl C, Heldmann P, Henningsen P, et al. Physiotherapie, ergotherapie und physikalische Verfahren Beim Fibromyalgiesyndrom. Schmerz [Internet]. 2017;31(3):255-65. doi: https://doi.org/10.1007/s00482-017-0203-4 DOI: https://doi.org/10.1007/s00482-017-0203-4
Gikaro JM, Bigambo FM, Minde VM, Swai EA. Efficacy of electrophysical agents in fibromyalgia: A systematic review and network meta-analysis. Clin Rehabil [Internet]. 2023;37(10):1295-310. doi: https://doi.org/10.1177/02692155231170450 DOI: https://doi.org/10.1177/02692155231170450
Degenhardt B, van Dun PLS, Jacobson E, et al. Profession-based manual therapy nomenclature: exploring history, limitations, and opportunities. J Man Manip Ther. 2024;32(1):96-110. https://doi.org/10.1080/10669817.2023.2288495 DOI: https://doi.org/10.1080/10669817.2023.2288495
Mintken PE, DeRosa C, Little T, Smith B. A model for standardizing manipulation terminology in physical therapy practice. J Man Manip Ther [Internet]. 2008;16(1):50-6. doi: https://doi.org/10.1179/106698108790818567 DOI: https://doi.org/10.1179/106698108790818567
Montoya P, Pauli P, Batra A, Wiedemann G. Altered processing of pain-related information in patients with fibromyalgia. Eur J Pain [Internet]. 2005;9(3):293-303. doi: https://doi.org/10.1016/j.ejpain.2004.07.012 DOI: https://doi.org/10.1016/j.ejpain.2004.07.012
Desmeules JA, Cedraschi C, Rapiti E, Baugmartner E, Finckh A, Cohen P, et al. Neurophysiologic evidence for a central sensitization in patients with fibromyalgia. Arthritis Rheum [Internet]. 2003;48(5):1420-9. doi: https://doi.org/10.1002/art.10893 DOI: https://doi.org/10.1002/art.10893
Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Man Ther [Internet]. 2009;14(5):531-8. doi: https://doi.org/10.1016/j.math.2008.09.001 DOI: https://doi.org/10.1016/j.math.2008.09.001
Simmonds N, Miller P, Gemmell H. A theoretical framework for the role of fascia in manual therapy. J Bodyw Mov Ther [Internet]. 2012; 16(1):83-93. doi: https://doi.org/10.1016/j.jbmt.2010.08.001 DOI: https://doi.org/10.1016/j.jbmt.2010.08.001
Gay CW, Robinson ME, George SZ, Perlstein WM, Bishop MD. Immediate changes after manual therapy in resting-state functional connectivity as measured by functional magnetic resonance imaging in participants with induced low back pain. J Manipulative Physiol Ther [Internet]. 2014;37(9):614-27. doi: https://doi.org/10.1016/j.jmpt.2014.09.001
Ughreja RA, Venkatesan P, Balebail Gopalakrishna DB, Singh YP. Effectiveness of myofascial release on pain, sleep, and quality of life in patients with fibromyalgia syndrome: A systematic review. Complement Ther Clin Pract [Internet]. 2021;45:101477. doi: https://doi.org/10.1016/j.ctcp.2021.101477 DOI: https://doi.org/10.1016/j.ctcp.2021.101477
Yuan SLK, Matsutani LA, Marques AP. Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis. Man Ther [Internet]. 2015;20(2):257-64. doi: https://doi.org/10.1016/j.math.2014.09.003 DOI: https://doi.org/10.1016/j.math.2014.09.003
Li YH, Wang FY, Feng CQ, Yang XF, Sun YH. Massage therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. PLoS One [Internet]. 2014;9(2):e89304. doi: https://doi.org/10.1371/journal.pone.0089304 DOI: https://doi.org/10.1371/journal.pone.0089304
Ernst E. Chiropractic treatment for fibromyalgia: a systematic review. Clin Rheumatol [Internet]. 2009;28(10):1175-8. doi: https://doi.org/10.1007/s10067-009-1217-9 DOI: https://doi.org/10.1007/s10067-009-1217-9
Schneider M, Vernon H, Ko G, Lawson G, Perera J. Chiropractic management of fibromyalgia syndrome: a systematic review of the literature. J Manipulative Physiol Ther [Internet]. 2009;32(1):25-40. doi: https://doi.org/10.1016/j.jmpt.2008.08.012 DOI: https://doi.org/10.1016/j.jmpt.2008.08.012
Hernando-Garijo I, Jiménez-Del-Barrio S, Mingo-Gómez T, Medrano-de-la-Fuente R, Ceballos-Laita L. Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials. J Back Musculoskelet Rehabil [Internet]. 2022;35(1):3-20. doi: https://doi.org/10.3233/bmr-200282 DOI: https://doi.org/10.3233/BMR-200282
Haller H, Lauche R, Sundberg T, Dobos G, Cramer H. Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord [Internet]. 2019;21(1):1. doi: https://doi.org/10.1186/s12891-019-3017-y DOI: https://doi.org/10.1186/s12891-019-3017-y
Sturman S, Killingback C. Is there a dose response relationship between soft tissue manual therapy and clinical outcomes in fibromyalgia? J Bodyw Mov Ther [Internet]. 2020;24(3):141-53. doi: https://doi.org/10.1016/j.jbmt.2020.02.010 DOI: https://doi.org/10.1016/j.jbmt.2020.02.010
Algar-Ramírez M, Úbeda-D'Ocasar E, Hervás-Pérez JP. Efficacy of manual lymph drainage and myofascial therapy in patients with fibromyalgia: A systematic review. Schmerz [Internet]. 2021;35(5):349-59. doi: http://dx.doi.org/10.1007/s00482-020-00520-7 DOI: https://doi.org/10.1007/s00482-020-00520-7
Schulze NB, Salemi MM, de Alencar GG, Moreira MC, de Siqueira GR. Efficacy of Manual Therapy on Pain, Impact of Disease, and Quality of Life in the Treatment of Fibromyalgia: A Systematic Review. Pain Physician [Internet]. 2020;23(5):461-76. Disponible en: https://www.painphysicianjournal.com/current/pdf?article=NzEyOA%3D%3D&journal=130 DOI: https://doi.org/10.36076/ppj.2020/23/461
Higgins JP, Green S, editores. Cochrane Handbook for Systematic Reviews of Interventions. 2008. doi: https://doi.org/10.1002/9780470712184 DOI: https://doi.org/10.1002/9780470712184
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine [Internet]. 2009;6(7): e1000097. doi: https://doi.org/10.1371/journal.pmed.1000097 DOI: https://doi.org/10.1371/journal.pmed.1000097
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med [Internet]. 2009;6(7):e1000100. doi: https://doi.org/10.1371/journal.pmed.1000100 DOI: https://doi.org/10.1371/journal.pmed.1000100
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ [Internet]. 2019;366:l4898. doi: https://doi.org/10.1136/bmj.l4898 DOI: https://doi.org/10.1136/bmj.l4898
Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen. 2012;141(1):2-18. doi: https://doi.org/10.1037/a0024338 DOI: https://doi.org/10.1037/a0024338
Grindem H, Mansournia MA, Øiestad BE, Ardern CL. Was it a good idea to combine the studies? Why clinicians should care about heterogeneity when making decisions based on systematic reviews. Br J Sports Med [Internet]. 2019;53(7):399-401. doi: https://doi.org/10.1136/bjsports-2018-099516 DOI: https://doi.org/10.1136/bjsports-2018-099516
Sterne JA, Egger M, Smith GD. Systematic reviews in health care: Investigating and dealing with publication and other biases in meta-analysis. BMJ [Internet]. 2001;323(7304):101-5. doi: https://doi.org/10.1136/bmj.323.7304.101 DOI: https://doi.org/10.1136/bmj.323.7304.101
Sterne JA, Sutton AJ, Ioannidis JP, Terrin, N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analysis of randomised controlled trials. BMJ [Internet]. 2011;343:d4002. doi: https://doi.org/10.1136/bmj.d4002 DOI: https://doi.org/10.1136/bmj.d4002
Albers J, Jäkel A, Wellmann K, von Hehn U, Schmidt T. Effectiveness of 2 osteopathic treatment approaches on pain, pressure-pain threshold, and disease severity in patients with fibromyalgia: A randomized controlled trial. Complement Med Res [Internet]. 2018;25(2):122-8. doi: https://doi.org/10.1159/000464343 DOI: https://doi.org/10.1159/000464343
Castro-Sánchez AM, Matarán-Peñarrocha GA, Sánchez-Labraca N, Quesada-Rubio JM, Granero-Molina J, Moreno-Lorenzo C. A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients. Clin Rehabil [Internet]. 2011;25(1):25-35. doi: https://doi.org/10.1177/0269215510375909 DOI: https://doi.org/10.1177/0269215510375909
Castro-Sánchez AM, Matarán-Peñarrocha GA, Granero-Molina J, Aguilera-Manrique G, Quesada-Rubio JM, Moreno-Lorenzo C. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med [Internet]. 2011:1-9. doi: https://doi.org/10.1155/2011/561753 DOI: https://doi.org/10.1155/2011/561753
Castro-Sánchez AM, Matarán-Peñarrocha GA, Arroyo-Morales M, Saavedra-Hernández M, Fernández-Sola C, Moreno-Lorenzo C. Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: A randomized controlled trial. Clin Rehabil [Internet]. 2011;25(9):800-13. doi: https://doi.org/10.1177/0269215511399476 DOI: https://doi.org/10.1177/0269215511399476
Castro-Sánchez AM, Aguilar-Ferrándiz ME, Matarán-Peñarrocha GA, Sánchez-Joya M del, Arroyo-Morales M, Fernández-de-las-Peñas C. Short-term effects of a manual therapy protocol on pain, physical function, quality of sleep, depressive symptoms, and pressure sensitivity in women and men with fibromyalgia syndrome. Clin J Pain [Internet]. 2014;30(7):589-97. doi: https://doi.org/10.1097/ajp.0000000000000008 DOI: https://doi.org/10.1097/AJP.0000000000000008
Castro Sánchez AM, García López H, Fernández Sánchez M, Pérez Mármol JM, Aguilar-Ferrándiz ME, Luque Suárez A, et al. Improvement in clinical outcomes after dry needling versus myofascial release on pain pressure thresholds, quality of life, fatigue, pain intensity, quality of sleep, anxiety, and depression in patients with fibromyalgia syndrome. Disabil Rehabil [Internet]. 2019;41(19):2235-46. doi: https://doi.org/10.1080/09638288.2018.1461259 DOI: https://doi.org/10.1080/09638288.2018.1461259
Ekici G, Bakar Y, Akbayrak T, Yuksel I. Comparison of manual lymph drainage therapy and connective tissue massage in women with fibromyalgia: A randomized controlled trial. J Manipulative Physiol Ther [Internet]. 2009;32(2):127-33. doi: https://doi.org/10.1016/j.jmpt.2008.12.001 DOI: https://doi.org/10.1016/j.jmpt.2008.12.001
Ekici G, Unal E, Akbayrak T, Vardar-Yagli N, Yakut Y, Karabulut E. Effects of active/passive interventions on pain, anxiety, and quality of life in women with fibromyalgia: Randomized Controlled Pilot trial. Women Health [Internet]. 2017;57(1):88-107. doi: https://doi.org/10.1080/03630242.2016.1153017 DOI: https://doi.org/10.1080/03630242.2016.1153017
Marske C, Bernard N, Palacios A, Wheeler C, Preiss B, Brown M, et al. Fibromyalgia with gabapentin and osteopathic manipulative medicine: A pilot study. J Altern Complement Med [Internet]. 2018;24(4):395-402. doi: https://doi.org/10.1089/acm.2017.0178 DOI: https://doi.org/10.1089/acm.2017.0178
Nadal-Nicolás Y, Rubio-Arias JÁ, Martínez-Olcina M, Reche-García C, Hernández-García M, Martínez-Rodríguez A. Effects of manual therapy on fatigue, pain, and psychological aspects in women with fibromyalgia. Int J Environ Res Public Health [Internet]. 2020;17(12):4611. doi: https://doi.org/10.3390/ijerph17124611 DOI: https://doi.org/10.3390/ijerph17124611
Salgado AS, Takemoto MH, de Souza CF, Salm DC, da Rosa D, Cardoso GC, et al. Gentle touch therapy, pain relief and neuroplasticity at baseline in fibromyalgia syndrome: A randomized, Multicenter trial with six-month follow-up. J Clin Med [Internet]. 2022;11(16):4898. doi: https://doi.org/10.3390/jcm11164898 DOI: https://doi.org/10.3390/jcm11164898
Farrar JT, Pritchett YL, Robinson M, Prakash A, Chappell A. The clinical importance of changes in the 0 to 10 numeric rating scale for worst, least, and average pain intensity: analyses of data from clinical trials of duloxetine in pain disorders. J Pain [Internet]. 2010;11(2):109-18. doi: https://doi.org/10.1016/j.jpain.2009.06.007 DOI: https://doi.org/10.1016/j.jpain.2009.06.007
Mease PJ, Spaeth M, Clauw DJ, Arnold LM, Bradley LA, Russell IJ, et al. Estimation of minimum clinically important difference for pain in fibromyalgia. Arthritis Care Res (Hoboken) [Internet]. 2011;63(6):821-6. doi: https://doi.org/10.1002/acr.20449 DOI: https://doi.org/10.1002/acr.20449
Bennett RM, Bushmakin AG, Cappelleri JC, Zlateva G, Sadosky AB. Minimal clinically important difference in the fibromyalgia impact questionnaire. J Rheumatol [Internet]. 2009;36(6):1304-11. doi: https://doi.org/10.3899/jrheum.081090 DOI: https://doi.org/10.3899/jrheum.081090
Lund I, Lundeberg T, Carleson J, Sönnerfors H, Uhrlin B, Svensson E. Corticotropin releasing factor in urine – a possible biochemical marker of fibromyalgia. Responses to massage and guided relaxation. Neurosci Lett [Internet]. 2006;403(1-2):166-71. doi: https://doi.org/10.1016/j.neulet.2006.04.038 DOI: https://doi.org/10.1016/j.neulet.2006.04.038
Bialosky JE, Beneciuk JM, Bishop MD, Coronado RA, Penza CW, Simon CB, et al. Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. J Orthop Sports Phys Ther [Internet]. 2018;48(1):8-18. doi: https://doi.org/10.2519/jospt.2018.7476 DOI: https://doi.org/10.2519/jospt.2018.7476
Coronado RA, Bialosky JE. Manual physical therapy for chronic pain: the complex whole is greater than the sum of its parts. J Man Manip Ther [Internet]. 2017;25(3):115-7. doi: https://doi.org/10.1080/10669817.2017.1309344 DOI: https://doi.org/10.1080/10669817.2017.1309344
Meier ML, Hotz-Boendermaker S, Boendermaker B, Luechinger R, Humphreys BK. Neural responses of posterior to anterior movement on lumbar vertebrae: a functional magnetic resonance imaging study. J Manipulative Physiol Ther [Internet]. 2014;37(1):32-41. doi: https://doi.org/10.1016/j.jmpt.2013.09.004 DOI: https://doi.org/10.1016/j.jmpt.2013.09.004
Gay CW, Robinson ME, George SZ, Perlstein WM, Bishop MD. Immediate changes after manual therapy in resting-state functional connectivity as measured by functional magnetic resonance imaging in participants with induced low back pain. J Manipulative Physiol Ther [Internet]. 2014;37(9):614-27. doi: https://doi.org/10.1016/j.jmpt.2014.09.001 DOI: https://doi.org/10.1016/j.jmpt.2014.09.001
Laimi K, Mäkilä A, Bärlund E, Katajapuu N, Seikkula V, Karppinen J, et al. Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: A systematic review. Clin Rehabil [Internet]. 2018;32(4):440-50. doi: https://doi.org/10.1177/0269215517732820 DOI: https://doi.org/10.1177/0269215517732820
Valera-Calero JA, Fernández-de-Las-Peñas C, Navarro-Santana MJ, Plaza-Manzano G. Efficacy of Dry Needling and Acupuncture in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health [Internet]. 2022;19(16):9904. doi: https://doi.org/10.3390/ijerph19169904 DOI: https://doi.org/10.3390/ijerph19169904
Rodríguez Torres J, Cabrera Martos I, Torres Sánchez I, Ortiz Rubio A, Díaz Pelegrina A, Valenza MC. Results of an Active Neurodynamic Mobilization Program in Patients with Fibromyalgia Syndrome: A Randomized Controlled Trial. Arch Phys Med Rehabil [Internet]. 2015;96(10):1771-8. doi: https://doi.org/10.1016/j.apmr.2015.06.008 DOI: https://doi.org/10.1016/j.apmr.2015.06.008
Araya-Quintanilla F, Gutierrez-Espinoza H, Fuentes J, Prieto-Lafrentz F, Pavez L, Cristi-Montero C, et al. Effectiveness of multicomponent treatment in patients with fibromyalgia: Protocol for a systematic review and meta-analysis. Syst Rev [Internet]. 2020 Dec 15;11(1):69 doi: http://dx.doi.org/10.21203/rs.3.rs-127742/v1 DOI: https://doi.org/10.1186/s13643-022-01944-1
Article Sidebar
HTML (Español (España))
XML (Español (España))
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0).