Physical Therapy for Arteriovenous Fistula Pain: A Systematic Review and Network Meta-Analysis.

PURPOSE: To compare the effects of different physical interventions on pain and identify the most effective intervention.

DESIGN

This systematic review and network meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines.

METHODS

Four English- and one Chinese-language databases were searched, without restrictions on publication dates, up to April 2025. This meta-analysis included randomized controlled trials published in English or Chinese that focused on patients with arteriovenous fistulas (AVFs) and used pain scores (including VAS and NRS scores) as the primary outcome measures. A random-effects model was used for data analysis.

RESULTS

Ten studies involving 865 participants were included in this meta-analysis. In the follow-up after the intervention, physical therapy was associated with improved pain symptoms. The results of the network meta-analysis showed that, in terms of pain improvement, respiratory exercises had the best effect on reducing pain scores in patients with AVFs compared with conventional measures.

CONCLUSIONS

The systematic review and meta-analysis identified the effectiveness of physical therapy in reducing pain in patients with AVFs and provided practical implications for developing effective physical therapy interventions in clinical practice.

CLINICAL IMPLICATIONS: Strong research is needed in the future to explore the long-term effects of physical therapy interventions. Trail Registration PROSPERO CRD: CRD420251024571.