BACKGROUND: Massage is widely used for neck pain, but its effectiveness remains unclear.
OBJECTIVES: To assess the benefits and harms of massage compared to placebo or sham, no treatment or exercise as an adjuvant to the same co-intervention for acute to chronic persisting neck pain in adults with or without radiculopathy, including whiplash-associated disorders and cervicogenic headache.
SEARCH METHODS: We searched multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, Index to Chiropractic Literature, trial registries) to 1 October 2023.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing any type of massage with sham or placebo, no treatment or wait-list, or massage as an adjuvant treatment, in adults with acute, subacute or chronic neck pain.
DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. We transformed outcomes to standardise the direction of the effect (a smaller score is better). We used a partially contextualised approach relative to identified thresholds to report the effect size as slight-small, moderate or large-substantive.
MAIN RESULTS: We included 33 studies (1994 participants analysed). Selection (82%) and detection bias (94%) were common; multiple trials had unclear allocation concealment, utilised a placebo that may not be credible and did not test whether blinding to the placebo was effective. Massage was compared with placebo (n = 10) or no treatment (n = 8), or assessed as an adjuvant to the same co-treatment (n = 15). The trials studied adults aged 18 to 70 years, 70% female, with mean pain severity of 51.8 (standard deviation (SD) 14.1) on a visual analogue scale (0 to 100). Neck pain was subacute-chronic and classified as non-specific neck pain (85%, including n = 1 whiplash), radiculopathy (6%) or cervicogenic headache (9%). Trials were conducted in outpatient settings in Asia (n = 11), America (n = 5), Africa (n = 1), Europe (n = 12) and the Middle East (n = 4). Trials received research funding (15%) from research institutes. We report the main results for the comparison of massage versus placebo. Low-certainty evidence indicates that massage probably results in little to no difference in pain, function-disability and health-related quality of life when compared against a placebo for subacute-chronic neck pain at up to 12 weeks follow-up. It may slightly improve participant-reported treatment success. Subgroup analysis by dose showed a clinically important difference favouring a high dose (≥ 8 sessions over four weeks for ≥ 30 minutes duration). There is very low-certainty evidence for total adverse events. Data on patient satisfaction and serious adverse events were not available. Pain was a mean of 20.55 points with placebo and improved by 3.43 points with massage (95% confidence interval (CI) 8.16 better to 1.29 worse) on a 0 to 100 scale, where a lower score indicates less pain (8 studies, 403 participants; I2 = 39%). We downgraded the evidence to low-certainty due to indirectness; most trials in the placebo comparison used suboptimal massage doses (only single sessions). Selection, performance and detection bias were evident as multiple trials had unclear allocation concealment, utilised a placebo that may not be credible and did not test whether blinding was effective, respectively. Function-disability was a mean of 30.90 points with placebo and improved by 9.69 points with massage (95% CI 17.57 better to 1.81 better) on the Neck Disability Index 0 to 100, where a lower score indicates better function (2 studies, 68 participants; I2 = 0%). We downgraded the evidence to low-certainty due to imprecision (the wide CI represents slight to moderate benefit that does not rule in or rule out a clinically important change) and risk of selection, performance and detection biases. Participant-reported treatment success was a mean of 3.1 points with placebo and improved by 0.80 points with massage (95% CI 1.39 better to 0.21 better) on a Global Improvement 1 to 7 scale, where a lower score indicates very much improved (1 study, 54 participants). We downgraded the evidence to low-certainty due to imprecision (single study with a wide CI that does not rule in or rule out a clinically important change) and risk of performance as well as detection bias. Health-related quality of life was a mean of 43.2 points with placebo and improved by 5.30 points with massage (95% CI 8.24 better to 2.36 better) on the SF-12 (physical) 0 to 100 scale, where 0 indicates the lowest level of health (1 study, 54 participants). We downgraded the evidence once for imprecision (a single small study) and risk of performance and detection bias. We are uncertain whether massage results in increased total adverse events, such as treatment soreness, sweating or low blood pressure (RR 0.99, 95% CI 0.08 to 11.55; 2 studies, 175 participants; I2 = 77%). We downgraded the evidence to very low-certainty due to unexplained inconsistency, risk of performance and detection bias, and imprecision (the CI was extremely wide and the total number of events was very small, i.e < 200 events).
AUTHORS' CONCLUSIONS: The contribution of massage to the management of neck pain remains uncertain given the predominance of low-certainty evidence in this field. For subacute and chronic neck pain (closest to 12 weeks follow-up), massage may result in a little or no difference in improving pain, function-disability, health-related quality of life and participant-reported treatment success when compared to a placebo. Inadequate reporting on adverse events precluded analysis. Focused planning for larger, adequately dosed, well-designed trials is needed.
BACKGROUND: Many women would like to avoid pharmacological or invasive methods of pain management in labour, and this may contribute towards the popularity of complementary methods of pain management. This review examined the evidence currently available on manual methods, including massage and reflexology, for pain management in labour. This review is an update of the review first published in 2012.
OBJECTIVES: To assess the effect, safety and acceptability of massage, reflexology and other manual methods to manage pain in labour.
SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register (30 June 2017), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 6), MEDLINE (1966 to 30 June 2017, CINAHL (1980 to 30 June 2017), the Australian New Zealand Clinical Trials Registry (4 August 2017), Chinese Clinical Trial Registry (4 August 2017), ClinicalTrials.gov, (4 August 2017), the National Center for Complementary and Integrative Health (4 August 2017), the WHO International Clinical Trials Registry Platform (ICTRP) (4 August 2017) and reference lists of retrieved trials.
SELECTION CRITERIA: We included randomised controlled trials comparing manual methods with standard care, other non-pharmacological forms of pain management in labour, no treatment or placebo. We searched for trials of the following modalities: massage, warm packs, thermal manual methods, reflexology, chiropractic, osteopathy, musculo-skeletal manipulation, deep tissue massage, neuro-muscular therapy, shiatsu, tuina, trigger point therapy, myotherapy and zero balancing. We excluded trials for pain management relating to hypnosis, aromatherapy, acupuncture and acupressure; these are included in other Cochrane reviews.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality, extracted data and checked data for accuracy. We contacted trial authors for additional information. We assessed the quality of the evidence using the GRADE approach.
MAIN RESULTS: We included a total of 14 trials; 10 of these (1055 women) contributed data to meta-analysis. Four trials, involving 274 women, met our inclusion criteria but did not contribute data to the review. Over half the trials had a low risk of bias for random sequence generation and attrition bias. The majority of trials had a high risk of performance bias and detection bias, and an unclear risk of reporting bias. We found no trials examining the effectiveness of reflexology.MassageWe found low-quality evidence that massage provided a greater reduction in pain intensity (measured using self-reported pain scales) than usual care during the first stage of labour (standardised mean difference (SMD) −0.81, 95% confidence interval (CI) −1.06 to −0.56, six trials, 362 women). Two trials reported on pain intensity during the second and third stages of labour, and there was evidence of a reduction in pain scores in favour of massage (SMD −0.98, 95% CI −2.23 to 0.26, 124 women; and SMD −1.03, 95% CI −2.17 to 0.11, 122 women). There was very low-quality evidence showing no clear benefit of massage over usual care for the length of labour (in minutes) (mean difference (MD) 20.64, 95% CI −58.24 to 99.52, six trials, 514 women), and pharmacological pain relief (average risk ratio (RR) 0.81, 95% CI 0.37 to 1.74, four trials, 105 women). There was very low-quality evidence showing no clear benefit of massage for assisted vaginal birth (average RR 0.71, 95% CI 0.44 to 1.13, four trials, 368 women) and caesarean section (RR 0.75, 95% CI 0.51 to 1.09, six trials, 514 women). One trial reported less anxiety during the first stage of labour for women receiving massage (MD -16.27, 95% CI −27.03 to −5.51, 60 women). One trial found an increased sense of control from massage (MD 14.05, 95% CI 3.77 to 24.33, 124 women, low-quality evidence). Two trials examining satisfaction with the childbirth experience reported data on different scales; both found more satisfaction with massage, although the evidence was low quality in one study and very low in the other.Warm packsWe found very low-quality evidence for reduced pain (Visual Analogue Scale/VAS) in the first stage of labour (SMD −0.59, 95% CI −1.18 to −0.00, three trials, 191 women), and the second stage of labour (SMD −1.49, 95% CI −2.85 to −0.13, two trials, 128 women). Very low-quality evidence showed reduced length of labour (minutes) in the warm-pack group (MD −66.15, 95% CI −91.83 to −40.47; two trials; 128 women).Thermal manual methodsOne trial evaluated thermal manual methods versus usual care and found very low-quality evidence of reduced pain intensity during the first phase of labour for women receiving thermal methods (MD −1.44, 95% CI −2.24 to −0.65, one trial, 96 women). There was a reduction in the length of labour (minutes) (MD −78.24, 95% CI −118.75 to −37.73, one trial, 96 women, very low-quality evidence). There was no clear difference for assisted vaginal birth (very low-quality evidence). Results were similar for cold packs versus usual care, and intermittent hot and cold packs versus usual care, for pain intensity, length of labour and assisted vaginal birth.MusicOne trial that compared manual methods with music found very low-quality evidence of reduced pain intensity during labour in the massage group (RR 0.40, 95% CI 0.18 to 0.89, 101 women). There was no evidence of benefit for reduced use of pharmacological pain relief (RR 0.41, 95% CI 0.16 to 1.08, very low-quality evidence).Of the seven outcomes we assessed using GRADE, only pain intensity was reported in all comparisons. Satisfaction with the childbirth experience, sense of control, and caesarean section were rarely reported in any of the comparisons.
AUTHORS' CONCLUSIONS: Massage, warm pack and thermal manual methods may have a role in reducing pain, reducing length of labour and improving women's sense of control and emotional experience of labour, although the quality of evidence varies from low to very low and few trials reported on the key GRADE outcomes. Few trials reported on safety as an outcome. There is a need for further research to address these outcomes and to examine the effectiveness and efficacy of these manual methods for pain management.
El masaje de cicatrices se utiliza en las unidades de quemadura globalmente para mejorar los resultados funcionales y cosméticos de las cicatrices hipertróficas después de una quemadura, sin embargo, la evidencia para apoyar esta terapia es desconocida. OBJETIVO: Revisar la literatura y evaluar la eficacia del masaje de cicatrices en cicatrices de quemaduras hipertróficas. MÉTODOS: MEDLINE, PubMed, Embase, CINAHL y la Cochrane Library fueron buscados utilizando las palabras clave "quemadura", "lesión por quemadura", "lesión térmica" y "cicatriz", "cicatriz hipertrófica" y "masaje", "manipulación" "Movilización de tejidos blandos", "manipulación de tejidos blandos". Los artículos fueron calificados por los evaluadores utilizando la escala de la Base de Datos de Evidencia de Fisioterapia (PEDro) y las medidas de resultado en el rango de movimiento (ROM), cosmesis (vascularidad, flexibilidad, altura), puntuación de dolor, prurito y medidas psicológicas de depresión y ansiedad . Resultados Se incluyeron ocho publicaciones en la revisión con 258 participantes humanos y 15 sujetos animales que recibieron masaje de cicatriz después de una lesión térmica que resultó en cicatrización hipertrófica. Las medidas de resultado que demostraron que el masaje de la cicatriz fue eficaz incluyeron espesor de cicatriz medido con ultrasonografía (p = 0,001; g = -0,512); Depresión (Centro de Estudios Epidemiológicos - Depresión [CES-D]) (p = 0,031; g = -0,555); (P = 0,000; g = -1,333) y cicatriz, incluyendo la vascularidad (p = 0,000; g = -1,837), flexibilidad (p = 0,000; g = -1,270) y la altura de la cicatriz (P = 0,000, g = -2,054). Las medidas de resultado que tendieron a la significación incluyeron una disminución del prurito (p = 0,095; g = -1,157). CONCLUSIONES: Parece que hay evidencia preliminar que sugiere que el masaje de la cicatriz puede ser eficaz para disminuir la altura de la cicatriz, vascularidad, flexibilidad, dolor, prurito y depresión en quemaduras hipertróficas asustar. Esta revisión refleja la mala calidad de la evidencia y la falta de herramientas consistentes y válidas de evaluación de cicatrices. Controlados, los ensayos clínicos son necesarios para desarrollar directrices basadas en la evidencia para el masaje de la cicatriz en cicatrices de quemaduras hipertróficas.
Objetivo Este meta-análisis investiga el efecto del masaje de aromaterapia sobre el dolor en la dismenorrea primaria. Métodos Los ensayos controlados aleatorios se registraron mediante palabras clave en varias bases de datos (Pubmed, ISI Web of Sciences y Google Scholar). En el metanálisis se analizaron seis ensayos controlados aleatorios que incluyeron a 362 participantes con dismenorrea primaria, comparando el masaje con aromaterapia abdominal (n = 184) con masaje con aceites placebo (n = 178). Se utilizó como resultado primario el cambio en la puntuación de dolor de la escala analógica visual (VAS) desde el primer ciclo menstrual hasta el segundo ciclo en el primer día de la menstruación. Resultados El masaje de aromaterapia con aceites esenciales fue superior al masaje con aceites placebo (diferencia de medias estandarizada = -1,06 [IC del 95%: -1,55 a -0,55]). Conclusión El masaje de aromaterapia abdominal con aceites esenciales es un método complementario eficaz para aliviar el dolor en la dismenorrea primaria.
[Purpose] This study performed an effect-size analysis of massage therapy for shoulder pain. [Subjects and Methods] The database search was conducted using PubMed, CINAHL, Embase, PsycINFO, RISS, NDSL, NANET, DBpia, and KoreaMed. The meta-analysis was based on 15 studies, covering a total of 635 participants, and used a random effects model. [Results] The effect size estimate showed that massage therapy had a significant effect on reducing shoulder pain for short-term efficacy (SMD: -1.08, 95% CI: -1.51 to -0.65) and for long-term efficacy (SMD: -0.47, 95% CI: -0.71 to -0.23). [Conclusion] The findings from this review suggest that massage therapy is effective at improving shoulder pain. However, further research is needed, especially a randomized controlled trial design or a large sample size, to provide evidence-based recommendations.
Complementary medicine therapies are frequently used to treat pain conditions such as headaches and neck, back, and joint pain. Chronic pain, described as pain lasting longer than 3-6 months, can be a debilitating condition that has a significant socioeconomic impact. Pharmacologic approaches are often used for alleviating chronic pain, but recently there has been a reluctance to prescribe opioids for chronic noncancer pain because of concerns about tolerance, dependence, and addiction. As a result, there has been increased interest in integrative medicine strategies to help manage pain and to reduce reliance on prescription opioids to manage pain. This article offers a brief critical review of integrative medical therapies used to treat chronic pain, including nutritional supplements, yoga, relaxation, tai chi, massage, spinal manipulation, and acupuncture. The goal of this article is to identify those treatments that show evidence of efficacy and to identify gaps in the literature where additional studies and controlled trials are needed. An electronic search of the databases of PubMed, The Cochrane Library, EMBASE, PsycINFO, and Science Citation Index Expanded was conducted. Overall, weak positive evidence was found for yoga, relaxation, tai chi, massage, and manipulation. Strong evidence for acupuncture as a complementary treatment for chronic pain that has been shown to decrease the usage of opioids was found. Few studies were found in which integrative medicine approaches were used to address opioid misuse and abuse among chronic pain patients. Additional controlled trials to address the use of integrative medicine approaches in pain management are needed.
ANTECEDENTES: Una guía del Colegio Americano de Médicos de 2007 trató las opciones de tratamiento no farmacológico para el dolor lumbar. Hay nuevas pruebas disponibles. OBJETIVO: Revisar sistemáticamente las pruebas actuales sobre terapias no farmacológicas para el dolor lumbar no radicular o radicular agudo o crónico. FUENTES DE DATOS: Ovid MEDLINE (enero de 2008 a febrero de 2016), Registro Cochrane Central de Ensayos Controlados, Base de Datos Cochrane de Revisiones Sistemáticas y listas de referencias. SELECCIÓN DEL ESTUDIO: Ensayos aleatorios de 9 opciones no farmacológicas versus tratamiento simulado, lista de espera, o atención habitual, o de una opción no farmacológica versus otra. EXTRACCIÓN DE DATOS: Un investigador extrajo datos, y una segunda comprobó abstracciones para la exactitud; 2 investigadores evaluaron de forma independiente la calidad del estudio. SÍNTESIS DE DATOS: El número de ensayos que evaluaron terapias no farmacológicas varió de 2 (tai chi) a 121 (ejercicio). Nuevas evidencias indican que el tai chi (fuerza de evidencia [SOE], baja) y la reducción de estrés basada en la atención plena (SOE, moderada) son eficaces para el dolor lumbar crónico y refuerzan hallazgos previos con respecto a la efectividad del yoga. La evidencia continúa apoyando la efectividad del ejercicio, las terapias psicológicas, la rehabilitación multidisciplinaria, la manipulación espinal, el masaje y la acupuntura para el dolor lumbar crónico (SOE, de baja a moderada). Evidencia limitada demuestra que la acupuntura es modestamente eficaz para el dolor lumbar agudo (SOE, bajo). La magnitud de los beneficios del dolor fue pequeña a moderada y generalmente a corto plazo; Los efectos sobre la función en general fueron más pequeños que los efectos sobre el dolor. LIMITACIÓN: Nuevos ensayos cualitativamente sintetizados con metanálisis previos, restringidos a estudios en inglés; Heterogeneidad en las técnicas de tratamiento; Y la incapacidad de excluir los efectos de placebo. CONCLUSIÓN: Varias terapias no farmacológicas para el dolor de espalda crónico principalmente crónico están asociadas con efectos pequeños a moderados, usualmente a corto plazo sobre el dolor; Los hallazgos incluyen nueva evidencia sobre intervenciones mente-cuerpo. FUENTE DE FINANCIACIÓN PRIMARIA: Agencia para la Investigación y Calidad de la Salud. (PROSPERO: CRD42014014735).
BACKGROUND: Pain is a common experience for women during labor. Therefore, pain relief care for mothers during labor is very important. This meta-analysis was conducted to evaluate the efficacy of massage therapy on labor pain reduction in primiparous women.
MATERIALS AND METHODS: In this meta-analysis, the databases of Web of Knowledge, PubMed, Scopus, Cochrane, Iranmedex, Scientific Information Database (SID), and Magiran were searched for published articles in English and Persian language up to January 2016. Among the studies, with regard to the inclusion and exclusion criteria, 10 studies were selected. Data were analyzed by using Stata software version 11, and standard mean difference (SMD) of effects of massage therapy was calculated. The heterogeneity among studies was evaluated by the Chi-square based Q-test and I(2) statistics.
RESULTS: The results of Chi-square based on Q-test and I(2) statistics showed heterogeneity among studies in the latent phase (Q = 63.52, P value < 0.001 and I(2) = 87.4%), active phase (Q = 26.42, P value < 0.001, and I(2) = 77.3%), and transitional phase (Q = 104.84, P value <0.001, and I(2) = 95.2%). Results showed that massage therapy reduces labor pain in the latent phase (SMD = -1.23, 95% CI: -1.73 to -0.74), active phase (SMD = -1.59, 95% CI: -2.06 to -1.12), and transitional phase (SMD = -1.90, 95% CI: -3.09 to -0.71).
CONCLUSIONS: This study provides valid evidence for the effect of massage therapy in Iran for labor pain relief. Therefore, the use of massage therapy can be recommended in the primiparous women.
Las guías de práctica de atención crítica identifican la falta de evidencia clara sobre la efectividad del masaje para el control del dolor. Evaluar el efecto del masaje sobre el dolor agudo en pacientes críticos y agudamente enfermos de cirugía post-torácica. Se realizaron búsquedas en las bases de datos Medline, Embase, CINAHL, PsychInfo, Web of Science, Scopus y Cochrane Library. Los estudios elegibles fueron ensayos controlados aleatorios (ECA) que evaluaron el efecto del masaje en comparación con el control de la atención / masaje simulado o el cuidado estándar solo en la intensidad del dolor agudo después de la cirugía torácica. Se incluyeron doce ECA. De éstos, nueve evaluaron el masaje además de la analgesia estándar, incluyendo 2 que compararon el masaje con el control de la atención / masaje simulado en la unidad de cuidados intensivos (UCI) 6, que comparó el masaje con la analgesia estándar sola, Masaje tanto para el control de atención como para el cuidado estándar en la UCI. Los pacientes que recibieron masaje con analgesia reportaron menos dolor (escala 0-10) en comparación con el control de la atención / masaje simulador (3 ECA, N = 462, diferencia de medias -0,80, intervalo de confianza del 95% [IC] -1,25 a -0,35; p <0,001 ; I (2) = 13%) y atención estándar (7 ECA, N = 1087, diferencia de medias -0,85; IC del 95%: -1,28 a -0,42; p <0,001; I (2) = 70%). El masaje, además de la analgesia farmacológica, reduce la intensidad dolorosa de la cirugía post-cardiaca aguda.
Massage is widely used for neck pain, but its effectiveness remains unclear.
OBJECTIVES:
To assess the benefits and harms of massage compared to placebo or sham, no treatment or exercise as an adjuvant to the same co-intervention for acute to chronic persisting neck pain in adults with or without radiculopathy, including whiplash-associated disorders and cervicogenic headache.
SEARCH METHODS:
We searched multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, Index to Chiropractic Literature, trial registries) to 1 October 2023.
SELECTION CRITERIA:
We included randomised controlled trials (RCTs) comparing any type of massage with sham or placebo, no treatment or wait-list, or massage as an adjuvant treatment, in adults with acute, subacute or chronic neck pain.
DATA COLLECTION AND ANALYSIS:
We used the standard methodological procedures expected by Cochrane. We transformed outcomes to standardise the direction of the effect (a smaller score is better). We used a partially contextualised approach relative to identified thresholds to report the effect size as slight-small, moderate or large-substantive.
MAIN RESULTS:
We included 33 studies (1994 participants analysed). Selection (82%) and detection bias (94%) were common; multiple trials had unclear allocation concealment, utilised a placebo that may not be credible and did not test whether blinding to the placebo was effective. Massage was compared with placebo (n = 10) or no treatment (n = 8), or assessed as an adjuvant to the same co-treatment (n = 15). The trials studied adults aged 18 to 70 years, 70% female, with mean pain severity of 51.8 (standard deviation (SD) 14.1) on a visual analogue scale (0 to 100). Neck pain was subacute-chronic and classified as non-specific neck pain (85%, including n = 1 whiplash), radiculopathy (6%) or cervicogenic headache (9%). Trials were conducted in outpatient settings in Asia (n = 11), America (n = 5), Africa (n = 1), Europe (n = 12) and the Middle East (n = 4). Trials received research funding (15%) from research institutes. We report the main results for the comparison of massage versus placebo. Low-certainty evidence indicates that massage probably results in little to no difference in pain, function-disability and health-related quality of life when compared against a placebo for subacute-chronic neck pain at up to 12 weeks follow-up. It may slightly improve participant-reported treatment success. Subgroup analysis by dose showed a clinically important difference favouring a high dose (≥ 8 sessions over four weeks for ≥ 30 minutes duration). There is very low-certainty evidence for total adverse events. Data on patient satisfaction and serious adverse events were not available. Pain was a mean of 20.55 points with placebo and improved by 3.43 points with massage (95% confidence interval (CI) 8.16 better to 1.29 worse) on a 0 to 100 scale, where a lower score indicates less pain (8 studies, 403 participants; I2 = 39%). We downgraded the evidence to low-certainty due to indirectness; most trials in the placebo comparison used suboptimal massage doses (only single sessions). Selection, performance and detection bias were evident as multiple trials had unclear allocation concealment, utilised a placebo that may not be credible and did not test whether blinding was effective, respectively. Function-disability was a mean of 30.90 points with placebo and improved by 9.69 points with massage (95% CI 17.57 better to 1.81 better) on the Neck Disability Index 0 to 100, where a lower score indicates better function (2 studies, 68 participants; I2 = 0%). We downgraded the evidence to low-certainty due to imprecision (the wide CI represents slight to moderate benefit that does not rule in or rule out a clinically important change) and risk of selection, performance and detection biases. Participant-reported treatment success was a mean of 3.1 points with placebo and improved by 0.80 points with massage (95% CI 1.39 better to 0.21 better) on a Global Improvement 1 to 7 scale, where a lower score indicates very much improved (1 study, 54 participants). We downgraded the evidence to low-certainty due to imprecision (single study with a wide CI that does not rule in or rule out a clinically important change) and risk of performance as well as detection bias. Health-related quality of life was a mean of 43.2 points with placebo and improved by 5.30 points with massage (95% CI 8.24 better to 2.36 better) on the SF-12 (physical) 0 to 100 scale, where 0 indicates the lowest level of health (1 study, 54 participants). We downgraded the evidence once for imprecision (a single small study) and risk of performance and detection bias. We are uncertain whether massage results in increased total adverse events, such as treatment soreness, sweating or low blood pressure (RR 0.99, 95% CI 0.08 to 11.55; 2 studies, 175 participants; I2 = 77%). We downgraded the evidence to very low-certainty due to unexplained inconsistency, risk of performance and detection bias, and imprecision (the CI was extremely wide and the total number of events was very small, i.e < 200 events).
AUTHORS' CONCLUSIONS:
The contribution of massage to the management of neck pain remains uncertain given the predominance of low-certainty evidence in this field. For subacute and chronic neck pain (closest to 12 weeks follow-up), massage may result in a little or no difference in improving pain, function-disability, health-related quality of life and participant-reported treatment success when compared to a placebo. Inadequate reporting on adverse events precluded analysis. Focused planning for larger, adequately dosed, well-designed trials is needed.
