Massage for mechanical neck disorders

 

Abstract

Background

Mechanical neck disorders (MND) are common, disabling and costly. Massage is a commonly used modality for the treatment of neck pain.

Objectives

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.

Search methods

Cochrane CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL databases were electronically searched, without language restriction, from their inception to September 2004

Selection criteria

Studies using random or quasi-random assignment were included.

Data collection and analysis

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.

Main results

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.

 

Plain language summary

Massage for mechanical neck pain

Neck pain is common and can limit a person's ability to participate in normal daily activities. Massage is a widely used treatment for neck pain. In this review, it was defined as touching or manipulating the soft tissues surrounding the neck with the hand, foot, arm or elbow. There are a number of different types of massage. This review included studies that looked at Traditional Chinese massage, ischemic compression, self-administered ischemic pressure using a J-knob cane, conventional Western massage and occipital release, among other techniques. It did not include studies that examined techniques such as Reiki or Polarity.

We included 19 trials (1395 participants) in this review that assessed whether massage alone or in combination with other treatments could help reduce neck pain and improve function. Results showed that massage is safe and any side effects were temporary and benign. However, neither massage alone nor massage combined with other treatments showed a significant advantage over other comparison groups. Alone, or in combination with other treatments, it was compared to no treatment, hot packs, active range-of-movement exercises, interferential current, acupuncture, exercises, sham laser, TENS, manual traction, mobilization, education and pain medication.

There were a number of challenges with this review. Overall, the quality of the studies was poor and the number of participants in most trials was small. Most studies lacked a definition, description, or rationale for massage, the massage technique or both. In some cases, it was questionable whether the massage in the study would be considered effective massage under any circumstance. Details on the credentials or experience of the person giving the massage were often missing, and only 11/19 trials reported enough detail to determine who actually was giving the massage. There was such a range of massage techniques and comparison treatments in the studies that we could not combine the results to get an overall picture of the effectiveness of massage. Therefore, no firm conclusions could be drawn and the effectiveness of massage for improving neck pain and function remains unclear.

 

摘要

背景

按摩對頸部機械性疾病

頸部機械性疾病(MND)是常見的，造成失能且損失重大的。按摩是一種頸部疼痛常用的治療方式。

目標

為了評估按摩對疼痛，功能，病人滿意度和成人頸部疼痛照護成本的影響。亦寫出按摩治療的不良作用。

搜尋策略

Cochrane CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL databases 經網路搜查，沒有語言限制，從開始收錄到2004年9月

選擇標準

被收錄的研究皆採用隨機或半隨機分配。

資料收集與分析

兩名作者獨立進行引用鑑定，研究的選擇，數據引用和方法品質評估。使用隨機效應模型(randomeffects model)，我們計算相對危險度(relative risk)和標準化平均差(standardized mean difference)。

主要結論

19個試驗符合納入標準。總體而言，方法學品質較低，19個試驗中12個被評定為低品質研究。由於在治療組和對照組的異質性(heterogeneity)，導致各試驗無法經統計匯集。因此，用各級證據的做法(a levelsofevidence approach)來合成結果。臨床適用性試驗的評估呈現受試者的特點，但無論是按摩的描述、或按摩專業人士的憑據和經驗皆沒有報告。6項研究將按摩視為一個獨立的治療。其結果並不一致。14個試驗將按摩視為的多種模式干預(multimodal interventions)的一部分，但沒有任何設計能證實按摩的相對貢獻度。因此，按摩的作用多種模式治療(multimodal treatments)仍不清楚。

作者結論

在這個時候無法做出實用建議做法，因為頸部疼痛的按摩效果仍然不明朗。需要試驗性研究探究按摩治療的特徵(頻率，持續時間，節數，按摩技術)，並建立最佳的治療，將其用於隨後的更大規模的試驗，以檢查其獨立治療效果或視為多模式處置(multimodal interventions)的一部分。在多模式處置中(multimodal interventions)，需要多因子實驗設計(factorial designs)來確定按摩的相對貢獻值。今後的試驗報告應改進分組隱密性，結果測量人員盲性(concealment of allocation，blinding of outcome assessor)，不良反應和按摩特點之報告。對於按摩處置報告之標準治療，和配偶(CONSORT)需有標準一樣是必要的。短期和長期的後續追蹤是必要的

翻譯人

本摘要由臺灣大學附設醫院陳明峰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

按摩對機械性頸部疼痛頸部疼痛是常見的，可以限制一個人參與正常的日常活動的能力。按摩是一種廣泛用於頸部疼痛的治療。在這次回顧文獻中，它被定義為使用手，腳，胳膊或肘部觸摸或操縱頸部周圍的軟組織。有多個不同類型的按摩。這項回顧文獻包括各個 研究，研究了傳統的中式按摩，缺血性壓迫，自己使用J形旋棒(Jknob cane)做缺血性壓迫，傳統的西方按摩和枕部放鬆，以及其他技術。本文不包括日式靈氣(Reiki)或極性(Polarity)的研究。 我們在這篇文章納入19項試驗 (共1395人)，評估單獨按摩或與合併其他治療方法是否有助於減少頸部疼痛及改善功能。結果顯示，按摩是安全的，任何副作用皆是暫時的且良性的。然而，無論是單獨按摩或按摩結合其他治療方法皆無法顯示顯著地優於其他對照組。單獨或合併其他治療方法與不治療、熱敷、自主關節活動、干擾波、針灸、運動、sham laser、電刺激(TENS)、手動牽引、活動(mobilization) 、衛教和止痛藥相比較。本文有相當多挑戰。總體而言，研究的品質很差，大多數試驗的受試者很少。大多數研究對按摩、按摩技術或兩者，沒有明確的定義、說明或原理。在某些情況下，有人懷疑在這種情境下，是否可將研究裡的按摩視為有效的按摩。按摩師的詳細憑據或經驗常常闕如，19個試驗中只有11個有足夠的細節來得知按摩師的資料。在這些研究中有這樣一個大範圍的按摩技術和其他相比較的治療方法，我們無法結各個的結果，來窺知按摩的效用。因此，無法得到確切的結論，故按摩對改善頸部疼痛和功能的效果仍不清楚。