BACKGROUND: Physiotherapy plays a key role in managing fibromyalgia, a multifaceted disorder, through a combination of active and passive treatments. The purpose of this review is to compare the efficacy of hands-off treatments alone versus the combination of hands-off and hands-on therapies. METHODS: MEDLINE (PubMed), CENTRAL, and Embase were searched. English-language randomized controlled trials involving adults with fibromyalgia were included. The included studies were divided into subgroups to reduce the possible heterogeneity. We calculated the standardized mean difference or mean difference with 95% confidence intervals for the continuous data according to the outcome measures. We used the risk ratio for dichotomous data of the drop-out rate of the studies. RESULTS: We included and analyzed seven RCTs. The meta-analysis showed no significant results in the outcomes, pain, QoL, health status, and drop-out rate. We found significant results (p < 0.001) in favor of combining hands-off and hands-on treatments for the rest quality (SMD 0.72, 95% CI 0.35 to 1.09). CONCLUSIONS: This review increases the treatment options available for clinicians. Up to now, the main guidelines on managing fibromyalgia suggest only approaches based on hands-off treatments. These findings suggest that other approaches based on mixed interventions combining hands-off and hands-on treatments did not reduce the patient outcomes. Moreover, the mixed intervention led to better results for the patients' sleep quality than the hands-off treatments alone.

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