SYSTEMATIC REVIEWS: EDITORIAL NOTE

Systematic Reviews are now frequently produced to evaluate a range of evidence on a particular therapy, and methodogies for such reviews have been developed and refined by a number of centres.  The literature and databases are systematically searched e.g. MEDLINE, CINAHl, EMBASE etc, and reviewers who are blinded as to authors, journals and institutions assess the methodological quality of the reviews in a standardised way.  Out of this emerges a critique and evaluation of the studies in the area, and overall conclusions are drawn.  The University of York NHS Centre for Reviews and Dissemination is responsible for leading edge work in the field.  Each issue of Bulletin of Massage Research will provide a synopsis of the outcome of recent and current systematic reviews.  The reviews which follow here relates to low back pain.

Cochrane Database Systematic Review 2002; (2) CD001929

Massage for low back pain

Furlan AD,   Brossean L,            Imamura M, Irvin E

Research Institute for Work and Health

481 University Avenue, Suite 80, Toronto,

Ontaria, Canada M5G 2E9

afurlan@iwh.on.ca

The objectives of this review were to assess the effects of massage therapy for low back pain.  Studies conducted were randomised or quasi randomised trials of massage using hands or mechanical devices for non specific low back pain.  Eight randomised trials were selected.  Massage was compared to an inert treatment (sham laser), and was superior in effect, especially when given with exercises and education.  In the other seven studies massage was compared with active therapies.  Massage was superior to relaxation therapy, to acupuncture, and to self-care education.  Massage was equal to corsets and exercises, and massage was inferior to manipulation.

The beneficial effects of massage in patients with chronic low back pain lasted a minimum of one year after the end of treatment.

One study which compared two different types of massage found that acupuncture massage performed better than classic Swedish massage.

Featured Study

Effectiveness of massage therapy for sub-acute low back pain: a randomised controlled trial.

Michele Preyde

Canadian Medical Association Journal

June 27 2000     182(13)

This randomised controlled trial compared comprehensive massage therapy (soft tissue manipulation, remedial exercise and posture education), 2 components of massage therapy and placebo in the treatment of sub-acute (between 1 week and 8 months) low back pain.

Subjects were randomly assigned to one of 4 groups

       i)          comprehensive massage therapy                  n=25

       ii)         soft tissue manipulation only             n=25

iii)                  remedial exercise with posture

education only                                                         n=22

iv)                  placebo of sham laser therapy                      n=26

The study lasted 1 month and each subject had 6 treatments.  Measures were taken at the start, at the end of the month of treatment and 1 month after that.  The measures dealt with disability level, pain, anxiety and lumbar range of motion.

The comprehensive massage group had improved function i.e. less disability, and less intense pain compared with the other three groups.

At 1 month follow up 63% of subjects in the comprehensive massage therapy group reported no pain compared with 27% of the soft tissue manipulation group, 14% of the remedial exercise group, and 0% of the sham laser therapy group.