Patel Kinjal C, Gross Anita, Graham Nadine, Goldsmith Charles H, Ezzo Jeanette, Morien Annie, Peloso Paul Michael J
Advantage Health Castleridge, 2210-4818B Westwinds Drive NE, Calgary, Alberta, Canada.
Cochrane Database Syst Rev. 2012 Sep 12(9):CD004871. doi: 10.1002/14651858.CD004871.pub4.
The prevalence of mechanical neck disorders (MND) is known to be both a hindrance to individuals and costly to society. As such, massage is widely used as a form of treatment for MND.
To assess the effects of massage on pain, function, patient satisfaction, global perceived effect, adverse effects and cost of care in adults with neck pain versus any comparison at immediate post-treatment to long-term follow-up.
We searched The Cochrane Library (CENTRAL), MEDLINE, EMBASE, MANTIS, CINAHL, and ICL databases from date of inception to 4 Feburary 2012.
Studies using random assignment were included.
Two review authors independently conducted citation identification, study selection, data abstraction and methodological quality assessment. Using a random-effects model, we calculated the risk ratio and standardised mean difference.
Fifteen trials met the inclusion criteria. The overall methodology of all the trials assessed was either low or very low GRADE level. None of the trials were of strong to moderate GRADE level. The results showed very low level evidence that certain massage techniques (traditional Chinese massage, classical and modified strain/counter strain technique) may have been more effective than control or placebo treatment in improving function and tenderness. There was very low level evidence that massage may have been more beneficial than education in the short term for pain bothersomeness. Along with that, there was low level evidence that ischaemic compression and passive stretch may have been more effective in combination rather than individually for pain reduction. The clinical applicability assessment showed that only 4/15 trials adequately described the massage technique. The majority of the trials assessed outcomes at immediate post-treatment, which is not an adequate time to assess clinical change. Due to the limitations in the quality of existing studies, we were unable to make any firm statement to guide clinical practice. We noted that only four of the 15 studies reported side effects. All four studies reported post-treatment pain as a side effect and one study (Irnich 2001) showed that 22% of the participants experienced low blood pressure following treatment.
AUTHORS' CONCLUSIONS: No recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain.As a stand-alone treatment, massage for MND was found to provide an immediate or short-term effectiveness or both in pain and tenderness. Additionally, future research is needed in order to assess the long-term effects of treatment and treatments provided on more than one occasion.
颈部机械性疾病（MND）的患病率对个人来说是一种阻碍，对社会而言成本高昂。因此，按摩被广泛用作治疗MND的一种方式。
评估按摩对颈部疼痛成年人的疼痛、功能、患者满意度、整体感知效果、不良反应及护理成本的影响，并与即时治疗后至长期随访期间的任何对照进行比较。
我们检索了从创刊至2012年2月4日的考克兰图书馆（CENTRAL）、MEDLINE、EMBASE、MANTIS、CINAHL和ICL数据库。
纳入采用随机分配的研究。
两位综述作者独立进行文献检索、研究选择、数据提取和方法学质量评估。我们使用随机效应模型计算风险比和标准化均数差。
15项试验符合纳入标准。所有评估试验的总体方法学质量为低或极低的GRADE水平。没有一项试验为高至中等的GRADE水平。结果显示，证据质量极低，表明某些按摩技术（中医按摩、经典和改良的应变/反应变技术）在改善功能和压痛方面可能比对照或安慰剂治疗更有效。有证据质量极低表明，在短期内，按摩对疼痛困扰可能比教育更有益。与此同时，有证据质量低表明，缺血性按压和被动拉伸联合使用可能比单独使用在减轻疼痛方面更有效。临床适用性评估显示，15项试验中只有4项充分描述了按摩技术。大多数试验在即时治疗后评估结局，这不是评估临床变化的足够时间。由于现有研究质量存在局限性，我们无法做出任何确凿的陈述来指导临床实践。我们注意到，15项研究中只有4项报告了副作用。所有4项研究均报告治疗后疼痛为副作用，一项研究（伊尔尼希2001年）显示，22%的参与者在治疗后出现低血压。
目前无法给出实践建议，因为按摩对颈部疼痛的有效性仍不确定。作为一种独立治疗方法，按摩被发现对MND在疼痛和压痛方面能提供即时或短期效果，或两者兼具。此外，需要开展未来研究以评估治疗的长期效果以及多次提供治疗的效果。
