Systematic review of massage intervention for adult patients with cancer: a methodological perspective

Findings from studies of massage, one of the most commonly used nonpharmacological nursing interventions for managing cancer pain, are inconsistent. The purpose of this article was to elucidate the methodological underpinnings of these inconsistencies with a systematic review of study design, methods, and massage efficacy in adult patients with cancer. A total of 15 studies published in English between 1986 and 2006 were identified by searching in 6 electronic databases. An author-developed tool and an adapted assessment tool were used to extract information from each study and examine the quality of reviewed studies. Methodological issues that potentially account for discrepancies across studies included less rigorous inclusion criteria, failure to consider potential confounding variables, less than rigorous research designs, inconsistent massage doses and protocols, measurement errors related to sensitivity of instruments and timing of measurements, and inadequate statistical power. Areas for future study include determination of appropriate cutoff values of selected outcome measures, delivery of equal doses along with standardized massage protocols, examination of length of massage effects over time, and use of single-blinding randomized clinical trials with large sample sizes.