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Effectiveness of Different Styles of Massage Therapy in fibromyalgia: a Systematic Review and Meta-Analysis

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Effectiveness of Different Styles of Massage Therapy in fibromyalgia: a Systematic Review and Meta-Analysis See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/266620613 Effectiveness of different styles of massage therapy in fibromyalgia: A systematic review and meta-analysis Article in Manual Therapy · October 2014 DOI: 10.1016/j.math.2014.09.003 CITATIONS READS 31 1,553 3 authors: Susan L K Yuan Luciana Akemi Matsutani University of São Paulo 25 PUBLICATIONS 675 CITATIONS 18 PUBLICATIONS 148 CITATIONS SEE PROFILE SEE PROFILE Amélia Pasqual Marques University of São Paulo 180 PUBLICATIONS 2,337 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Effects of Physical Therapy in Pain and Posture of Fibromyalgia Patients View project Development of a mobile application to promote self-care in patients with fibromyalgia View project All content following this page was uploaded by Amélia Pasqual Marques on 11 November 2018. The user has requested enhancement of the downloaded file. Manual Therapy 20 (2015) 257e264 Contents lists available at ScienceDirect Manual Therapy journal homepage: www.elsevier.com/math Systematic review Effectiveness of different styles of massage therapy in fibromyalgia: A systematic review and meta-analysis * Susan Lee King Yuan , Luciana Akemi Matsutani, Amelia Pasqual Marques University of Sao Paulo, School of Medicine, Department of Physical Therapy, Occupational Therapy and Speech Therapy, Rua Cipotanea, 51 e Cidade Universitaria, CEP: 05360-160 Sao Paulo, SP, Brazil article info abstract Article history: The systematic review aimed to evaluate the effectiveness of massage in fibromyalgia. An electronic Received 28 January 2014 search was conducted at MEDLINE, SCiELO, EMBASE, ISI, PEDro, SPORTDiscus, CINAHL, Cochrane CEN- Received in revised form TRAL and LILACS (Jan 1990eMay 2013). Ten randomized and non-randomized controlled trials investi- 21 September 2014 gating the effects of massage alone on symptoms and health-related quality of life of adult patients with Accepted 29 September 2014 fibromyalgia were included. Two reviewers independently screened records, examined full-text reports for compliance with the eligibility criteria, and extracted data. Meta-analysis (pooled from 145 partici- Keywords: pants) shows that myofascial release had large, positive effects on pain and medium effects on anxiety Fibromyalgia Massage and depression at the end of treatment, in contrast with placebo; effects on pain and depression were Physical therapy modalities maintained in the medium and short term, respectively. Narrative analysis suggests that: myofascial Review release also improves fatigue, stiffness and quality of life; connective tissue massage improves depression Systematic and quality of life; manual lymphatic drainage is superior to connective tissue massage regarding stiffness, depression and quality of life; Shiatsu improves pain, pressure pain threshold, fatigue, sleep and quality of life; and Swedish massage does not improve outcomes. There is moderate evidence that myofascial release is beneficial for fibromyalgia symptoms. Limited evidence supports the application of connective tissue massage and Shiatsu. Manual lymphatic drainage may be superior to connective tissue massage, and Swedish massage may have no effects. Overall, most styles of massage therapy consistently improved the quality of life of fibromyalgia patients. © 2014 Elsevier Ltd. All rights reserved. Fibromyalgia is a chronic, widespread pain disorder commonly (Baranowsky et al., 2009; Terhorst et al., 2011; Terry et al., 2012) associated with fatigue, sleep disturbance, tenderness, stiffness and included a wide range of interventions of which massage was just mood disturbances. It can have devastating effects on quality of life, one. Baranowsky et al. (2009) performed a systematic review impairing the patient's ability to work and participate in everyday focused on complementary and alternative medicine. The cate- activities and affecting relationships with family, friends and em- gories identified were manual manipulation, acupuncture, bal- ployers (Arnold et al., 2011). Fibromyalgia is common in the general neotherapy, thermotherapy, magnetic therapy, homeopathy, mind- population (0.6e4.4%), with a higher prevalence among women body medicine, diet therapy and music therapy. They found only (Cavalcante et al., 2006; Branco et al., 2010). one trial assessing massage (Brattberg, 1999), and suggested its While there is strong evidence for the effectiveness of phar- possible effect on fibromyalgia pain and quality of life. Several re- macological interventions in the management of fibromyalgia, cords relating to massage might have been missed, possibly due to there is no conclusive evidence of the effectiveness of non- the extensive search required for the wide range of interventions. pharmacological interventions, which are frequently recom- Terhorst et al. (2011) conducted another systematic review on mended by health professionals and used by patients (Carville et al., complementary and alternative therapies for fibromyalgia, and 2008; Hauser et al., 2012). performed a more comprehensive search. The meta-analysis sug- Massage has been investigated in the management of fibromy- gests that massage is not effective for pain, but it should be noted algia, as described in five literature reviews. Three reviews that trials with high risk of bias and considerable heterogeneity were included. Additionally, other outcomes besides pain were not investigated, and the results for massage were reported and dis- cussed briefly, considering that massage was just one topic among * Corresponding author. Tel.: þ55 11 3091 8423; fax: þ55 11 3091 7462. E-mail address: [email protected] (S.L.K. Yuan). many others in the review. http://dx.doi.org/10.1016/j.math.2014.09.003 1356-689X/© 2014 Elsevier Ltd. All rights reserved. 258 S.L.K. Yuan et al. / Manual Therapy 20 (2015) 257e264 Kalichman (2010) issued a narrative review focused on massage CENTRAL and LILACS (last access: 31 May 2013). Additional records therapy and concluded that most of the evidence supports the were identified from reference lists of other reviews (Kalichman, assumption that massage is beneficial for patients with fibromy- 2010; Kong et al., 2011) or indicated by the review authors. algia. The reliability of his findings is limited due to the lack of a systematic method for performing the review. The author stressed 1.4. Electronic search strategy the need for further research to establish the effectiveness of massage. Kong et al. (2011) conducted a systematic review aimed The databases were searched using the terms “massage” and for the effect of massage on fibromyalgia pain, and suggested that it “fibromyalgia”. The search was limited to records published since might have positive effects on this outcome. They just considered 1990, when the American College of Rheumatology classification pain as the outcome of interest, and included trials with high risk of criteria for fibromyalgia were first published (Wolfe et al., 1990). bias and considerable heterogeneity in the meta-analysis. Furthermore, the review is poorly described, as only the annual 1.5. Study selection scientific meeting abstract is available. Recently, Terry et al. (2012) performed an overview of system- After removing duplicates, a screening of records was per- atic reviews of complementary and alternative medicine for fibro- formed by examining titles and abstracts. Full-text reports were myalgia, summarizing the evidence from multiple interventions retrieved and examined for compliance with eligibility criteria. reviews. They suggested that massage therapy may have short- Screening of records and eligibility assessment were performed term beneficial effects. However, their conclusion may be limited, independently by two reviewers. Disagreements between re- because it is based on the results of a single narrative review viewers were resolved through consensus; if no consensus could be (Kalichman, 2010). reached, a third reviewer decided. Accordingly, there is a need for an updated, focused and rigorous systematic review to identify, appraise and synthesise all available 1.6. Data collection process evidence regarding the effects of massage on fibromyalgia. Recent studies might assist in settling disagreements stemming from Two reviewers independently extracted data using a form based previous conflicting reviews. With the acknowledgement of the on the checklist of the Cochrane Handbook for Systematic Reviews importance of symptoms other than pain by the time of the pub- of Interventions (Higgins and Green, 2011). Due to missing data and lication of the American College of Rheumatology 2010 criteria for need for clarification, attempts were made to contact the authors of fibromyalgia (Mease, 2005; Wolfe et al., 2010), other relevant nine included studies. symptoms that were not considered outcomes of interest in pre- vious systematic reviews (Kong et al., 2011; Terhorst et al., 2011) 1.7. Risk of bias assessment now need to be investigated. The aim of this review was to evaluate the effectiveness of massage alone to improve pain, pressure pain Two reviewers independently assessed risk of bias according to threshold (PPT), fatigue, stiffness, anxiety, depression, sleep and recommendations of the Cochrane Collaboration's tool (Higgins health-related quality of life (HRQoL) in adult fibromyalgia patients. and Green, 2011). Five domains were used to assess four types of bias: selection bias (random sequence generation and allocation
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