Multimodal vs Single Physiotherapy on Pain Intensity in Dysmenorrhea: Systematic Review and Narrative Synthesis

Abstrak

Background: Primary dysmenorrhea is a highly prevalent condition that significantly affects women’s quality of life and daily functioning. Physiotherapy interventions are widely used; however, the comparative effectiveness of multimodal versus single-modality approaches remains unclear.

Objective: To evaluate the effectiveness of multimodal compared with single physiotherapy interventions in reducing pain intensity among women with primary dysmenorrhea.

Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Scopus and PubMed databases were searched for studies published between 2015 and 2025. Experimental and observational comparative studies evaluating multimodal versus single physiotherapy interventions were included. Due to substantial clinical and methodological heterogeneity, findings were synthesised narratively following the SWiM framework. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and ROBINS-I, while certainty of evidence was evaluated using the GRADE approach.

Results: Eight studies involving 528 participants were included. Two studies demonstrated statistically significant between-group differences favouring multimodal interventions (MD 2.08, 95% CI 0.61–3.54; d = 0.842; and MD −19.8 to −26.0 mm; SMD 1.3–1.8; p < 0.001). The remaining studies showed consistent directional improvements without statistical significance. Risk of bias ranged from low to serious, and overall certainty of evidence was rated as low.

Conclusion: Multimodal physiotherapy may provide greater pain reduction than single-modality interventions. However, the strength of evidence is limited by heterogeneity, risk of bias, and imprecision, indicating the need for high-quality randomized controlled trials.