Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University Tübingen, Osianderstraße 5, 72076, Tübingen, Germany; National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany.
Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University Tübingen, Osianderstraße 5, 72076, Tübingen, Germany; National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany.
Int J Nurs Stud. 2019 Aug;96:132-142. doi: 10.1016/j.ijnurstu.2018.12.012. Epub 2019 Jan 4.
The number of persons living with dementia will increase. So far, pharmacological management is limited because of small effect sizes and side effects of the drugs. Therefore, it is important to assess non-pharmacological treatment options such as massage, which have nearly no side effects and are easy for caregivers to apply.
To conduct a systematic review with meta-analysis, aiming to pool the evidence for the efficacy of manual massage for persons living with dementia.
A systematic review and meta-analysis.
EMBASE, Medline, PubMed, PSYinfo, BIOSIS, EBM, PSYCINDEX, Osteopathic Research Web, and OSTMED.DR were searched, regardless of publication year, through August 2017.
Randomized controlled trials (RCTs) evaluating manual massage in patients with dementia with or without using (aromatic) oil were included. The intervention of the control group had to guarantee no physical contact between caregiver and patient. Only studies assessing behavioural and psychological symptoms of dementia, cognitive abilities or depressive symptoms with validated instruments were included. Two reviewers independently extracted data and assessed risk of bias using The Cochrane Collaboration's 'Risk of bias' tool. Continuous outcomes are given as standardized mean difference (SMD), with 95% confidence intervals (CI) if different scaling of outcome measurement was used, and as mean difference (MD), with 95% confidence intervals (CI) for identical scaling. Data were pooled using the random-effects model. Sensitivity analysis considered type of massage, oil and outcome. Funnel plots were performed.
Eleven RCTs, with a total of 825 persons living with dementia, were eligible for qualitative synthesis and nine for quantitative synthesis. Two studies, with a total of 95 participants, had a high risk of bias. A pooled analysis of the mean change showed a benefit of manual massage compared to the control group using the Cohen Mansfield Agitation Inventory (SMD = -0.56, 95% CI [-0.95, -0.17], P = 0.005), which included six studies with 395 participants, and using the Cornell Scale of Depression in Dementia (MD = -6.14 [-8.66, -3.61], P < 0.00001), which included three studies with 193 participants. No significant effect could be demonstrated using the Neuropsychiatric Inventory and Mini Mental State Examination. Subgroup analysis of 'acupressure' did not show significant group differences.
Manual massage may serve as a non-pharmacological strategy to improve behavioural and psychological symptoms in persons living with dementia. Thus, healthcare professionals and family caregivers should be encouraged to apply massage to their patients and relatives. More research is needed, however, to provide clearer recommendations with respect to frequency and types of massage.
随着痴呆症患者人数的增加，对其进行药物治疗的效果有限，且存在副作用，因此评估非药物治疗方法（如按摩）变得尤为重要。按摩几乎没有副作用，且易于护理人员操作。
系统评价和荟萃分析旨在评估针对痴呆症患者进行手部按摩的疗效。
系统评价和荟萃分析。
通过 2017 年 8 月前的 EMBASE、Medline、PubMed、PSYinfo、BIOSIS、EBM、PSYCINDEX、Osteopathic Research Web 和 OSTMED.DR 等数据库进行检索，无论发表年份如何均纳入检索范围。
纳入评估手部按摩对痴呆症患者（包括使用和不使用（芳香）油的患者）影响的随机对照试验。对照组的干预措施必须保证护理人员与患者之间没有身体接触。仅纳入使用经过验证的工具评估行为和心理症状、认知能力或抑郁症状的研究。两位评审员独立提取数据，并使用 Cochrane 协作组的“偏倚风险”工具评估偏倚风险。如果使用不同的量表进行结果测量，则连续结果以标准化均数差（SMD）表示，95%置信区间（CI）；如果使用相同的量表进行结果测量，则以均数差（MD）表示，95%置信区间（CI）。使用随机效应模型进行数据合并。敏感性分析考虑了按摩类型、油类和结果。绘制漏斗图。
11 项 RCT，共纳入 825 名痴呆症患者，进行定性综合分析，9 项进行定量综合分析。两项研究（共 95 名参与者）的偏倚风险较高。与对照组相比，手部按摩的汇总分析显示出对改善行为和心理症状的益处，使用 Cohen-Mansfield 激越量表（SMD=-0.56，95%CI[-0.95，-0.17]，P=0.005），包括 6 项研究（共 395 名参与者），使用 Cornell 痴呆抑郁量表（MD=-6.14[-8.66，-3.61]，P<0.00001），包括 3 项研究（共 193 名参与者）。使用神经精神问卷和简易精神状态检查未显示出显著的组间差异。“指压按摩”的亚组分析未显示出显著的组间差异。
手部按摩可能是改善痴呆症患者行为和心理症状的一种非药物策略。因此，应鼓励医疗保健专业人员和家庭护理人员将按摩应用于他们的患者和亲属。然而，需要进一步研究，以提供关于按摩频率和类型的更明确建议。
