The Study Question
Mental and emotional health can play a role in postoperative recovery; for example, postoperative pain can be exacerbated by anxiety. Previous research, including a Cochrane systematic review, has shown that massage can reduce anxiety. However, no systematic reviews or meta-analysis of its efficacy specifically for postoperative patients have been conducted. This Japanese study addresses that question through a systematic review and meta-analysis of the effects of massage therapy on anxiety and pain manage-ment among postoperative patients.
The Study Methods
To be included, studies were limited to randomized controlled trials of hospitalized patients receiving general anesthesia, excluding studies with patients receiving hysterectomies or those under 15 years of age. The databases MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Library’s CENTRAL were searched by the authors.
A manual search was then conducted by reviewing references from all relevant articles to identify missing studies through a database search. If a study was only presented at a conference, the author was contacted to identify and obtain the results of the study. A total of 905 studies were identified; only 10 met all the inclusion criteria and qualified to be included in the meta-analysis.
Studies were assessed for methodologic quality using the Cochrane Collaboration’s tool for assessing risk of bias (Higgins & Green, 2008). To estimate an overall treatment effect size, a standardized mean difference (SMD) was computed to determine the magnitude of the treatment effect, and 95 percent confidence intervals (CIs) were used.
All of the 10 studies included a control group that received either usual care or usual care plus a social visit or rest. Six studies had an intervention group that received another treatment such as aromatherapy. The total sample size was 1,157, with an average patient age range between 54 and 68 years. Most of the studies used Swedish massage performed by trained therapists and, in some cases, by nurses.
Body areas massaged included the back, feet, whole body or the patient’s choice of body area, with pressures ranging from light to moderate to firm. Duration ranged from 10 to 45 minutes. Massage was provided once or twice daily until discharge or twice daily for seven days.
Following surgery, massage was initiated at various times, ranging from the day of surgery to the fifth day after surgery. Outcomes measured included pain and anxiety. Nine studies investigated the effects of pain and used the visual analog scale, numeric rating scale and the Faces Pain Scale. Eight studies assessed anxiety and used the visual analog scale, numeric rating scale and the Spielberger State-Trait Anxiety Inventory (STAI).
The meta-analysis showed a great deal of variation in the results of the combined studies, and a moderate effect size, roughly 1 point on a 0–10 scale in a subgroup of four studies of thoracic surgery that used a single “dose” of massage. The duration of the effects of massage on pain and anxiety appeared to last from about one to four hours.
Limitations of the Study
This study has a few limitations and is a good example of how systematic reviews and meta-analyses of massage therapy can pose challenges. The strict standard of double-blinding is nearly impossible to meet, and combining multiple types of surgical procedures contributed to the large amount of variation across the different studies.
No conclusions regarding pressure were reached. Additionally, only three databases were searched, and studies not published in English were excluded. In spite of efforts to obtain unpublished studies, publication bias is possible.
Implications for Evidence-Informed Practice
Despite this study’s limitations, massage appears to have some short-term benefits for postoperative patients in terms of reducing the pain and anxiety associated with surgery. Because deep vein thrombosis and lymphedema are common complications following surgery, individual therapists working in hospital settings should use clinical judgment to make appropriate adjustments regarding the amount of pressure used, as well as patient positioning and area massaged in terms of surgical site and IV lines.
Massage Therapy Journal
Post-surgery Relief for Pain
1. Kukimoto Y, Ooe N, Ideguchi N. "The effects of massage therapy on pain and anxiety after surgery: A systematic review and meta-analysis." Pain Manag Nurs. 2017 Dec;18(6):378-390.