The aim of this umbrella review was to provide a synthesis
and judgment of best available research evidence related to
the effectiveness of massage therapy for the treatment of
nonspecific low back pain. With increasing consumption of
CAM therapies, in an era of evidence-based practice, it is
only appropriate to investigate the evidence underpinning
the effectiveness of CAM therapies.
The systematic reviews included in this umbrella review
ranged from poor methodological quality10,16 to moderate,18,19
good,4,15,20 or excellent methodological quality.17,23 Therefore,
we recommend that caution be used when interpreting the
conclusions of these reviews, as the primary research relat-
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Effectiveness of massage therapy for nonspecific low back pain
ing to massage and non-specific low back pain, for the most
part, had a high risk of bias.
While there are a number of systematic reviews investigating
the effectiveness of massage therapy for nonspecific
low back pain, there is mixed and conflicting evidence on
outcomes from massage therapy. There is emerging evidence
that massage may be an effective treatment option
for treating low back pain when compared to placebo or
sham therapies and other interventions (such as relaxation
techniques) in improving short-term pain and disability. The
role of massage as a moderately effective nonpharmacological
treatment option has also been discussed by Chou et al24
and Imamura et al8
as a recommendation for chronic low
back pain therapy.
The evidence is contradictory for the effectiveness of
massage when compared to other popular treatment options,
such as standard medical care, mobilization, and acupuncture
in improving short-term pain and disability. Spinal manipulative
therapy seems consistently to provide better outcomes
when compared to massage therapy. There was no evidence
found for the long-term (beyond 6 months) effectiveness of
massage therapy.
The methodology underpinning the primary research,
which informed the systematic reviews, was, for the most
part, classified as weak. This is a significant issue that has
plagued the evidence base for massage therapy and has
also been acknowledged by other researchers (Airaksinen
et al25). The methodological issues reported by the systematic
reviews include small sample size, lack of adequate
blinding of assessors, and varied intervention parameters
and outcome measures. This is demonstrated by the finding
that only one of the nine included systematic reviews was
able to undertake a meta-analysis of the included primary
literature.18 This was due to the variability in the description
of intervention parameters, operational definition of massage
therapy, comparators, and outcome measures utilized in the
remaining eight included systematic reviews.
The poor quality of the primary research evidence base
may be partly due to the conflict between what occurs in
clinical practice and rigorous standards required within
research settings. In a clinical practice context, massage
therapy may often be offered as a “package of care” in
addition to advice and education and using a combination
of modalities. However, in a research context, a package
of care is rarely offered in order to avoid cointervention
bias. Therefore, the primary research undertaken may
not truly capture and replicate what occurs in a clinical
practice context. This is a challenge and a limitation when
undertaking and interpreting findings of research evidence
for massage therapy.
Limitations of this review
This umbrella review, like any other research, has its limitations,
and these need to be acknowledged in the context of the
findings. Firstly, while all attempts were made to interrogate
and access all relevant literature, it is possible some publications
may have been missed in the search process. This is
especially relevant for CAM topics, as publications in other
languages, originating from countries where English may not
be a first language, such as the People’s Republic of China
and India, may not be captured in Western databases. Secondly,
as there was a lack of clarity around the type, use, and
comparators of massage therapy in these systematic reviews,
the heterogeneity made it impossible to combine the findings
across all included systematic reviews and come to an absolute
conclusion. Thirdly, one of the recurrent issues when interpreting
these systematic review findings was the imperfect
primary research designs included in these reviews. Several of
the primary research studies had poor evaluations with several
methodological issues (such as lack of adequate descriptions
of interventions and poor long-term follow-up).
วัตถุประสงค์ของการตรวจสอบร่มนี้คือเพื่อให้สังเคราะห์
และการตัดสินที่ดีที่สุดการวิจัยที่มีอยู่หลักฐานที่เกี่ยวข้องกับ
ประสิทธิผลของการนวดบำบัดสำหรับการรักษาของการติดเชื้อ
ปวดหลัง . กับการบริโภคที่เพิ่มขึ้นของ
แคมาบัด ในยุคของการปฏิบัติตามหลักฐานเชิงประจักษ์ , มันเป็นเพียงเหมาะสมเพื่อตรวจสอบหลักฐาน
ประสิทธิผลของการรักษา
ลูกเบี้ยว .รีวิวรวมอยู่ในระบบนี้ร่มทบทวน
ระหว่าง quality10,16 วิธีการยากจนถึงปานกลาง 18,19
ดี 4,15,20 หรือคุณภาพความสมบูรณ์ 17,23 ดังนั้น
เราขอแนะนำให้ระมัดระวังที่จะใช้เมื่อการตีความ
สรุปของความคิดเห็นเหล่านี้เป็นหลักวิจัยความสัมพันธ์ -
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