Haraldsson B G, Gross A R, Myers C D, Ezzo J M, Morien A, Goldsmith C, Peloso P M, Bronfort G
North Surrey Massage Therapy Clinic, 201-10366 136A Street, Surrey, BC, Canada V3T 5R3.
Cochrane Database Syst Rev. 2006 Jul 19(3):CD004871. doi: 10.1002/14651858.CD004871.pub3.
Mechanical neck disorders (MND) are common, disabling and costly. Massage is a commonly used modality for the treatment of neck pain.
To assess the effects of massage on pain, function, patient satisfaction and cost of care in adults with neck pain. To document adverse effects of treatment.
Cochrane CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL databases were electronically searched, without language restriction, from their inception to September 2004
Studies using random or quasi-random assignment were included.
Two reviewers independently conducted citation identification, study selection, data abstraction and methodological quality assessment. Using a random-effects model, we calculated the relative risk and standardized mean difference.
Nineteen trials met the inclusion criteria. Overall, the methodological quality was low, with 12/19 assessed as low-quality studies. Trials could not be statistically pooled because of heterogeneity in treatment and control groups. Therefore, a levels-of-evidence approach was used to synthesize results. Assessment of the clinical applicability of the trials showed that the participant characteristics were well reported, but neither the descriptions of the massage intervention nor the credentials or experience of the massage professionals were well reported. Six trials examined massage as a stand-alone treatment. The results were inconsistent. Of the 14 trials that used massage as part of a multimodal intervention, none were designed such that the relative contribution of massage could be ascertained. Therefore, the role of massage in multimodal treatments remains unclear.
AUTHORS' CONCLUSIONS: No recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain. Pilot studies are needed to characterize massage treatment (frequency, duration, number of sessions, and massage technique) and establish the optimal treatment to be used in subsequent larger trials that examine the effect of massage as either a stand-alone treatment or part of a multimodal intervention. For multimodal interventions, factorial designs are needed to determine the relative contribution of massage. Future reports of trials should improve reporting of the concealment of allocation, blinding of outcome assessor, adverse events and massage characteristics. Standards of reporting for massage interventions, similar to CONSORT, are needed. Both short- and long-term follow-up are needed.
颈部机械性疾病（MND）常见、致残且花费高昂。按摩是治疗颈部疼痛常用的一种方法。
评估按摩对颈部疼痛成人患者的疼痛、功能、患者满意度及护理费用的影响。记录治疗的不良反应。
对考克兰中心对照试验注册库、医学索引数据库、荷兰医学文摘数据库、推拿与整脊疗法数据库、护理学与健康领域数据库及国际护理索引数据库进行电子检索，检索时间从建库至2004年9月，无语言限制。
纳入采用随机或半随机分配的研究。
两名评价员独立进行文献检索、研究选择、数据提取及方法学质量评估。采用随机效应模型，计算相对危险度和标准化均数差。
19项试验符合纳入标准。总体而言，方法学质量较低，19项研究中有12项被评定为低质量研究。由于治疗组和对照组存在异质性，试验无法进行统计学合并。因此，采用证据分级方法综合结果。对试验临床适用性的评估表明，参与者特征报告良好，但按摩干预的描述以及按摩专业人员的资质或经验报告均不佳。6项试验将按摩作为单一治疗方法进行研究。结果不一致。在14项将按摩作为多模式干预一部分的试验中，没有一项试验设计能够确定按摩的相对作用。因此，按摩在多模式治疗中的作用仍不明确。
目前无法给出实践建议，因为按摩治疗颈部疼痛的有效性仍不确定。需要开展初步研究以明确按摩治疗的特征（频率、时长、疗程数及按摩技术），并确定在后续更大规模试验中使用的最佳治疗方法，这些试验将按摩作为单一治疗方法或多模式干预的一部分进行效果研究。对于多模式干预，需要采用析因设计来确定按摩的相对作用。未来试验报告应改进分配隐藏、结局评估者盲法、不良事件及按摩特征的报告。需要制定类似于CONSORT的按摩干预报告标准。需要进行短期和长期随访。
