The
NHS Centre for Reviews and Dissertations at the University of York, England publishes systematic reviews of therapies, written
by a professional team of reviewers and meeting defined quality criteria. The
web site reference to this article is given below. The objectives of the review were to assess the effectiveness of abdominal
massage therapy for chronic constipation.
Abdominal
massage played a substantial part in the treatment of chronic constipation in the classical era of massage, from around 1880
to 1940, when massage was a routine orthodox medical therapy (Goldstone, 2001). Abdominal
massage for constipation is a regular feature of all major massage texts of this period (e.g. Graham, 1890), and is the basis
of questions on the qualifying examination papers for membership of the Chartered
Institute of Massage and Medical Gymnastics and its precursor bodies in the early part of the 20th Century. (Goldstone,
2001). Post World War II however saw the decline of massage and its replacement over a wide range of conditions, including
constipation, with new drug therapies and technology-based physiotherapy.
The
subject of abdominal massage for constipation has been re-visited in the review by the NHS Centre for Reviews and Dissertation
which concludes that, on the basis of some recent studies massage therapy cold be a promising treatment for chronic constipation;
and that future rigorous trials should be undertaken. Such trials would need
to utilise the best features of modern research design, including randomisation, blinding of evaluators and use of control
groups including conventional laxative therapies. It is the case that the nature
of the massage and possible alternative styles would need to be seriously addressed. Massage as undertaken in the classical
period had significant differences in frequency, stroke speed, episode duration and lubricants and much modern research in
massage takes little or no cognisance of these differences.
The
reviewers in the York
study carefully evaluated the quality of studies available in this area and reduced the number to be included to 4 cross-over
controlled trials, one of which was randomised; and one case study of 61 patients. (In
cross-over trials the patients alternately receive the active therapy and with a suitable interval, the placebo or control
therapy; or vice versa). The participants in these studies included patients
with chronic constipation and a transit time exceeding 60 hours; elderly bed and chair bound patients with chronic constipation
and laxative use; disabled adults in institutional care with severe chronic constipation; and healthy male volunteers.
The
reviewers noted that the methodological quality of trials was poor. and inconsistent results were reported. There was evidence of improvement of stool frequency during the massage period in one study. Another study reported improvement in the number of days with bowel movement. Once small study of 12 people however reported no change in colonic transit time. Two trials reported no statistically significant differences in constipation between the active massage
period and the control period.
The
conclusions drawn by the reviewers were on the positive side in relation to the value of abdominal massage for constipation: massage therapy could be a promising treatment for chronic constipation, but more
rigorous trials are needed. The studies and reviewers offer no guidance on the
nature of the massage movements.
An inspection of massage
texts from the previous era of Classical massage offers no equivocation in its value in reducing constipation, and thus future
research, as well as including all the desirable features of modern research design, needs to carefully document features
of the massage(s) used including stroke, characteristics, depth, speed, instruments, massage frequency and the length of the
treatment episode. A suggested list of features of a massage which would assist in replication is shown in Table 1 (below).
Reference to the Classical Massage texts would be an essential prerequisite to research design.
Table 1
REPLICATION
FACTORS FOR REPORTING MASSAGE
For massage strokes
· type or description of strokes
· rhythm / rate/stroke frequency / speed of strokes
· number of strokes
· pressure / depth of strokes
· sequence / mix of strokes
· direction(s) of strokes
· stroke length
· body area
For massage
as a whole
· purpose ( e.g. specific remedial / general
therapeutic /
· stress relief / leisure)
· body areas
· frequency of massage / interval between massages
· number of massages
· duration per massage
· lubricant
· patient position
· time of day
· use of conversation
· rest period after massage
· advice after massage
For the environment
· temperature
· privacy
· music
· location ( e.g. clinic)
For the masseur / masseuse
· qualifications
· experience
· style
· standardisation
For the patient
· age
· gender
· occupation / former occupation
· clinical condition / health
The URL of this review of
this review from the Centre for Reviews and Dissemination is : http://nhscrd.york.ac.uk/online/dare/991593.htm
REFERENCES
Goldstone, L.A.
2000 Massage as an Orthodox Medical Treatment: Past and Future
Complementary Therapies in
Nursing and Midwifery, 6, 169-175
Graham, D 1890 A Treatise
on Massage 2nd edition St Louis:J.H. Chambers & Co
New York:J.H. Vail
& Co
