Background and Objective:
Various studies examined mud-therapy in the last twenty years, but mechanisms of action of these non-pharmacological treatments (mudpack or mud-bath) are still almost unknown and it is difficult to establish the efficacy of mud-therapy approach. The aim of this meta-analysis is to offer an update of the existing literature on the efficacy of mud-therapy in rheumatic and dermatologic diseases.

Methods:
Electronic bibliographic databases (PubMed, Embase, Medline, Central, Scopus, Pedro) were screened for articles published in English or Italian from January 2000. Studies that compared mud-therapy (alone or combined with drug or thermal or physical therapies) to any other intervention or to no intervention in adults (≥18 years) with rheumatic and dermatologic diseases were selected. The main outcomes were pain, function, quality of life, adverse events. Randomized clinical trials, non-randomized trials, and comparative cohort (prospective and retrospective) were eligible if they assessed at least one main outcome. Non comparative case series and case reports were included for safety outcome only. For categorical outcomes, the effect measure is synthesized calculating Risk Ratio and Risk Difference and for continuous outcomes calculating Mean Difference or standardized Mean Difference. A meta-analysis is performed based on heterogeneity between included studies, assessed statistically.

Results:
Of the 3332 articles screened after duplicates removing, 76 studies satisfied the eligibility criteria and were included. Preliminary analysis showed an improvement in 29/35 (82.9%) articles evaluating quality of life in adults treated with mud-therapy; this improvement was reported as significant in 54.3% (19/35). Similar evidence was found in studies evaluating function (36/48, 75.0% of improvement; 28/48, 58.3% of significant improvement) and pain (37/46, 80.4%; 31/46, 67.4%, respectively). Meta-analysis is ongoing.

Conclusions:
These preliminary results suggest a therapeutic effect of mud-therapy for rheumatic and dermatologic diseases. Meta-analysis is necessary in order to reach definitive conclusions on the current evidence.