Massage Therapy as a Self-Management Strategy for Musculoskeletal Pain and Chronic Conditions: A Systematic Review of...

Background: Musculoskeletal pain and chronic conditions are associated with deteriorating pain, stress, anxiety, and health-related quality of life (HR-QOL). There is emerging evidence that performing massage therapy as self-management (MTSM) is a viable approach to alleviate these symptoms across various clinical populations. However, a significant gap remains on the effectiveness and limitation of MTSM usage as no systematic review has been conducted to comprehensively evaluate and synthesize the scope, feasibility, and efficacy of MTSM. This systematic review aimed to investigate the effect of MTSM on common symptoms of musculoskeletal and chronic conditions, followed by identifying characteristics of MTSM dosage, setting, and adherence for formulating themes. Methods: A systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, which involved searching seven electronic databases, including Medline (OVID), CINAHL (EBSCO), PEDro, Web of Science (Clarivate), PsycINFO (EBSCO), Google Scholar, and EMBASE (Elsevier) from inception to January 2023. Clinical studies were eligible if they included MTSM, and massage treatment was more than 50% of the intervention. The quality of studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool. Target variables were extracted, including study design, participants' characteristics, outcome measures, massage dosage (duration, frequency, and timing), training setting, provider of massage training, adherence to the MTSM intervention, comparator, and key findings. Results: A total of 17 studies were evaluated and included 770 participants (female: N = 606) with musculoskeletal pain or chronic conditions. The emerged themes for MTSM utilization consisted of arthritis pain (knee, n = 3; neck, n = 1, hand, n = 2), neck and back pain (n = 4), and stress and anxiety (n = 3). Prescribed self-administered massage duration ranged from a single session to a maximum of 8-12 weeks, where 4 weeks (n = 8) was the most commonly prescribed duration. Out of 11 studies that used MTSM as a solo modality, 7 studies (41.2%) showed significant improvement in the outcome measures such as chronic neck and back pain, stress or anxiety, fatigue, quality of sleep, and HR-QOL. In addition, health benefits, including anxiety, depression, pain intensity, and pain threshold, were observed in six studies (35.3%) where MTSM was applied as a coadjuvant modality, which was combined with therapist-applied massage and physiotherapy. Conclusions: These findings support that MTSM is a viable approach to enhance the benefit of therapist-applied massage or as a solo modality for symptom management of musculoskeletal pain and chronic conditions. The review provides suggestions for design improvement, such as reporting participants' adherence to the prescribed massage regimen, that would be informative for providing a robust understanding of the magnitude or the extent to which MTSM is effective. Future studies on MTSM intervention are encouraged to use a theoretical framework and validated measures for determining and facilitating treatment fidelity.