Effectiveness and Safety of Mud Therapy (Pelotherapy) for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis

= 62%; moderate certainty), with sustained effects at 3 months (SMD -0.61; 95% CI -0.81 to -0.41) and 6 months (SMD -0.49; 95% CI -0.71 to -0.27). Physical function also improved (SMD -0.69; 95% CI -0.87 to -0.51). Osteoarthritis demonstrated the largest effects, particularly knee OA (SMD -0.86). The most common adverse events were skin erythema (6.5%) and transient fatigue (4.8%), with no significant increase in serious adverse events (RR 0.98; 95% CI 0.61-1.58). Pelotherapy provides clinically meaningful and sustained reductions in pain and disability, with a generally favorable safety profile. Evidence is strongest for osteoarthritis, supporting its use as an adjunct in naturopathic and integrative medicine.