Effectiveness of intermittent hypoxia-hyperoxia therapy for pain and general health in adults with musculoskeletal dysfunctions: A systematic review and meta-analysis

Abstract

Background

Intermittent Hypoxia-Hyperoxia Therapy (IHHT) is a recent, non-invasive method proposed to enhance physiological adaptations and promote recovery in musculoskeletal dysfunctions. However, evidence to guide practice remains limited. This systematic review aims to evaluate the therapeutic effects of IHHT on pain and health outcomes in patients with musculoskeletal dysfunctions.

Methods

A systematic search was conducted following PRISMA guidelines across MEDLINE, EMCARE, CINAHL, Embase, Scopus, Google Scholar, and Semantic Scholar. Eligible studies included patients with musculoskeletal disorders receiving IHHT compared to usual care or no intervention, with outcomes assessing pain and general health. Cochrane RoB 2.0 tool and the PEDro scale evaluated methodological quality, while certainty of the evidence was assessed using the GRADE criteria and review quality with AMSTAR tool.

Results

In seven trials, recruiting 321 participants, IHHT demonstrated significant improvements in pain (SMD = −0.5, 95% CI = −1.14 to −0.13, p < 0.0001), and general health (MD = −12.06, 95% CI = −16.73 to −7.39, p < 0.00001), reduction in psychological parameters (p < 0.00001), and improved functional mobility (p < 0.006). Moderate heterogeneity was reported across outcomes. Sensitivity and subgroup analysis clarified effect directions. Limitations included small sample size, short follow-up durations, and moderate to high methodological quality across included trials.

Conclusion

IHHT appears to be well-tolerated and effective intervention for improving pain, general health, severity of dysfunction, and psychological parameters, with no major adverse events reported in the included trials. However, overall certainty remains moderate, highlighting the need for future trials to monitor and report safety outcomes.