Post for Sanaz Sarabi, Cherry To, Ray Shieh, Fanny LondonReferenceVickers,A., Ohlsson, A., Lacy, J., & Horsley, A. (2004).
Massage for promotinggrowth and development of preterm and/or low birth-weight infants. CochraneDatabase of Systematic Reviews, 2, CD000390.doi:10.1002/14651858.cd000390.pub2 SummaryTheresearch study aimed to address the growth progress of preterm infants, bydetermining whether massage therapy would promote weight gain and decrease thenumber of hospitalized days. The research suggests that in addition toexamining the risks and benefits of using massage therapy as a treatment, thecost-effective use of time and potential for harm needs to be considered.
ResearchQuestion and Design of the StudyTheresearchers explained that since premature infants admitted to the NICU aresubjected to an abrupt transition from their safe mother’s womb to a highlystressful environment in which they lack tactile stimulation with regularinterruptions for nursing treatment, they would physically benefit from gentlemassage. The research questions were “Do preterm and/or LBW infants exposed tomassage, experience improved weight gain and earlier discharge compared tothose infants receiving standard neonatal care?” (Vickers A. et al.
, p. 3). And”Does massage have any other beneficial or harmful effects on this population?”(Vickers A. et al.
, p. 3). The design was a systematic review which criticallyanalyzed multiple research studies that would answer their research questionsusing a structured methodology. The methodological criterion used to approveeach paper were the concealment of treatment allocation, performance bias,blinding of observers, and exclusions/withdrawals. Each paper was reviewed by threeindependent researchers and was given a rank of A, B, or C. Rank A meantthe least amount of bias, while rank C corresponded to the most amount of bias.Disagreements regarding paper inclusion were settled by committee.
Sampleand SettingThe samplewas a random selection of LBW infants <37 weeks or the birth weight of<2500g. The study used as many trials as possible. The infants weregenerally healthy and stable, with no health conditions, and had beentransferred to intermediate, or "grower" care before the start of theintervention. Infants with congenital anomalies, history of maternal drugabuse, ventilatory assistance, intravenous feedings, or those who had a seriouspathology such as necrotizing enterocolitis, were excluded from the study toeliminate or limit the independent variables as much as possible.
The parentsof the subjects studied were generally of low socioeconomic status. One trialhad an inclusion criterion which specified a disease state (maternal drugaddiction for Wheeden 1993 (Links to an external site.)Links to an external site.)in addition to preterm birth or low-birth weight.
The interventions used in thetrial were in two categories: “gentle physical massage” and “gentle, stilltouch”. Infants receiving gentle physical massage were typically rubbed andstroked gently for approximately 15 minutes, three or four times a day. Manymassage interventions also included kinesthetic stimulation consisting ofpassive flexion/extension movements of the limbs. Infants assigned to still,gentle touch had nurses place their hands on them gently as they slept. After15 or 20 minutes, the hands would be removed. No stroking or rubbing motionswere used.
Both types of therapy were applied for 5-10 days. The resultsmeasured the advantages and disadvantages of massage on weight gain, length ofhospital stay, and behavioral and developmental changes. The length of massagetherapy applied to the infants was based on the number of days they stayed atthe hospital and the data that was recorded. We felt that although theselection criteria was pretty simple and the design of the selection made iteasier to eliminate unexpected variables in the study, 5-10 days of therapy doesnot seem to be a significant amount of time in order to produce results. Therewas no evidence of a correlation between infants who got a shorter massage andthe ones who received longer duration. It is important to note that recordingthe data directly during the hospital stay of the infant, would eliminate manyunknown variables that would otherwise affect the results of the study. ResearchMethodsTheoutcomes of greatest interest to the study were weight gain and length of stayin the hospital. The study also recorded developmental and behavioural outcomesusing the Brazleton 1983 (Links to an external site.
)Links to an external site. scale,which is a standard developmental measure. The weight was measured dailyusing the hospital scale.
No trial described procedures to blind thosetaking weight measurements. Nonetheless, poor blinding of the main outcomemeasure might be considered to be a flaw of the research included in thereview. Also, there is an independent variable of caloric intake by theinfants that affects the weight gain directly. The kind of nutrition theinfants received, whether or not the infants were breastfed, nor the type offormula they received, were documented within the research study. The othersignificant value was the hospital stay, which was reported as significantlyreduced to 4-5 days.
But only one study (White Traut 1986 (Links to an external site.)Links to an external site.)of the two studies explicitly stated that physicians responsible fordischarging infants were blind to group assignment. However, it is unclear howthis blinding was achieved.
StudyFindings and LimitationsThefindings show that massage interventions resulted in improved daily weight gainby 5 grams and reduced length of stay by 4.5 days. Although there were nonegative effects shown, the results of the benefits of massage on developmentaloutcome of preterm infants were weak. Researchers could not conclude thatit doesn’t warrant wider use of massage as a treatment for preterm infants. Thelimitations consist of methodological issues when analyzing the results. Forexample, performance bias was not thoroughly observed to ensure each treatmentwas similar for the infants. Thus, it is important to consider that there maybe differences in care due to the difficulty of creating a blind study.
It isclear that more research should be done, because there were no significantoutcomes specifying the effectiveness of massage therapy for LBW infants. Also,data recording and performance bias affected the results. Because the resultsdo not seem to be significant, there is question whether health care personnelshould invest time in performing the therapy. Relevanceof StudyThis studyemphasizes the importance of a less invasive non-pharmaceutical treatment optionto promote weight gain for LBW infants. Massage therapy is a low-riskaffordable therapy that is easy to implement in many settings in order topromote growth and health to at-risk infants.
This therapy requires very littletraining and is able to be performed by non-licensed individuals such ascaregivers. Based on the studies performed, there are no adverse effects ofmassage therapy for premature/LBW infants, nor are there significant benefitsto massage therapy.