Miake-Lye Isomi M, Mak Selene, Lee Jason, Luger Tana, Taylor Stephanie L, Shanman Roberta, Beroes-Severin Jessica M, Shekelle Paul G
1 West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA.
2 Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA.
J Altern Complement Med. 2019 May;25(5):475-502. doi: 10.1089/acm.2018.0282. Epub 2019 Mar 20.
Massage therapy has been proposed for painful conditions, but it can be difficult to understand the breadth and depth of evidence, as various painful conditions may respond differently to massage. The authors conducted an evidence mapping process and generated an "evidence map" to visually depict the distribution of evidence available for massage and various pain indications to identify gaps in evidence and to inform future research priorities. The authors searched PubMed, Embase, and Cochrane for systematic reviews reporting pain outcomes for massage therapy. The authors assessed the quality of each review using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria. The authors used a bubble plot to depict the number of included articles, pain indication, effect of massage for pain, and strength of findings for each included systematic review. The authors identified 49 systematic reviews, of which 32 were considered high quality. Types of pain frequently included in systematic reviews were cancer pain, low back pain, and neck pain. High quality reviews concluded that there was low strength of evidence of potential benefits of massage for labor, shoulder, neck, low back, cancer, arthritis, postoperative, delayed onset muscle soreness, and musculoskeletal pain. Reported attributes of massage interventions include style of massage, provider, co-interventions, duration, and comparators, with 14 high-quality reviews reporting all these attributes in their review. Prior reviews have conclusions of low strength of evidence because few primary studies of large samples with rigorous methods had been conducted, leaving evidence gaps about specific massage type for specific pain. Primary studies often do not provide adequate details of massage therapy provided, limiting the extent to which reviews are able to draw conclusions about characteristics such as provider type.
按摩疗法已被用于治疗疼痛病症，但由于各种疼痛病症对按摩的反应可能不同，因此很难理解证据的广度和深度。作者进行了证据映射过程，并生成了一张“证据图”，以直观地描绘按摩及各种疼痛适应症的现有证据分布，从而找出证据空白并为未来的研究重点提供参考。作者在PubMed、Embase和Cochrane数据库中搜索了报告按摩疗法疼痛结果的系统评价。作者使用系统评价方法学质量评估（AMSTAR）标准评估了每项评价的质量。作者使用气泡图来描绘纳入文章的数量、疼痛适应症、按摩对疼痛的效果以及每项纳入的系统评价的研究结果强度。作者共识别出49项系统评价，其中32项被认为质量较高。系统评价中经常包括的疼痛类型有癌痛、腰痛和颈痛。高质量的评价得出结论，对于分娩、肩部、颈部、腰部、癌症、关节炎、术后、延迟性肌肉酸痛和肌肉骨骼疼痛，按摩潜在益处的证据强度较低。报告的按摩干预属性包括按摩方式、提供者、联合干预、持续时间和对照，14项高质量评价在其评价中报告了所有这些属性。之前的评价得出证据强度较低的结论，是因为很少有采用严格方法的大样本初级研究，这导致针对特定疼痛的特定按摩类型存在证据空白。初级研究往往没有提供所提供按摩疗法的足够细节，限制了评价能够就诸如提供者类型等特征得出结论的程度。
