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The Cochrane Database of Systematic... Apr 2013Infant massage is increasingly being used in the community with babies and their primary caregivers. Anecdotal reports suggest benefits for sleep, respiration and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Infant massage is increasingly being used in the community with babies and their primary caregivers. Anecdotal reports suggest benefits for sleep, respiration and elimination, the reduction of colic and wind, and improved growth. Infant massage is also thought to reduce infant stress and promote positive parent-infant interaction.
OBJECTIVES
The aim of this review was to assess whether infant massage is effective in promoting infant physical and mental health in low-risk, population samples.
SEARCH METHODS
Relevant studies were identified by searching the following electronic databases up to June 2011: CENTRAL; MEDLINE; EMBASE; CINAHL; PsycINFO; Maternity and Infant Care; LILACS; WorldCat (dissertations); ClinicalTrials.gov; China Masters' Theses; China Academic Journals; China Doctoral Dissertations; China Proceedings of Conference. We also searched the reference lists of relevant studies and reviews.
SELECTION CRITERIA
We included studies that randomised healthy parent-infant dyads (where the infant was under the age of six months) to an infant massage group or a 'no-treatment' control group. Studies had to have used a standardised outcome measure of infant mental or physical development.
DATA COLLECTION AND ANALYSIS
Mean differences (MD) and standardised mean differences (SMD) and 95% confidence intervals (CIs) are presented. Where appropriate, the results have been combined in a meta-analysis using a random-effects model.
MAIN RESULTS
We included 34 studies, which includes one that was a follow-up study and 20 that were rated as being at high risk of bias.We conducted 14 meta-analyses assessing physical outcomes post-intervention. Nine meta-analyses showed significant findings favouring the intervention group for weight (MD -965.25 g; 95% CI -1360.52 to -569.98), length (MD -1.30 cm; 95% CI -1.60 to -1.00), head circumference (MD -0.81 cm; 95% CI -1.18 to -0.45), arm circumference (MD -0.47 cm; 95% CI -0.80 to -0.13), leg circumference (MD -0.31 cm; 95% CI -0.49 to -0.13), 24-hour sleep duration (MD -0.91 hr; 95% CI -1.51 to -0.30), time spent crying/fussing (MD -0.36; 95% CI -0.52 to -0.19), deceased levels of blood bilirubin (MD -38.11 mmol/L; 95% CI -50.61 to -25.61), and there were fewer cases of diarrhoea, RR 0.39; 95% CI 0.20 to 0.76). Non-significant results were obtained for cortisol levels, mean increase in duration of night sleep, mean increase in 24-hour sleep and for number of cases of upper respiratory tract disease and anaemia.Sensitivity analyses were conducted for weight, length and head circumference, and only the finding for length remained significant following removal of studies judged to be at high risk of bias. These three outcomes were the only ones that could also be meta-analysed at follow-up; although both weight and head circumference continued to be significant at 6-month follow-up, these findings were obtained from studies conducted in Eastern countries only. No sensitivity analyses were possible.We conducted 18 meta-analyses measuring aspects of mental health and development. A significant effect favouring the intervention group was found for gross motor skills (SMD -0.44; 95% CI -0.70 to -0.18), fine motor skills (SMD -0.61; 95% CI -0.87 to -0.35), personal and social behaviour (SMD -0.90; 95% CI -1.61 to -0.18) and psychomotor development (SMD -0.35; 95% CI -0.54 to -0.15); although the first three findings were obtained from only two studies, one of which was rated as being at high risk of bias, and the finding for psychomotor development was not maintained following following removal of studies judged to be at high risk of bias in a sensitivity analysis. No significant differences were found for a range of aspects of infant temperament, parent-infant interaction and mental development. Only parent-infant interaction could be meta-analysed at follow-up, and the result was again not significant.
AUTHORS' CONCLUSIONS
These findings do not currently support the use of infant massage with low-risk groups of parents and infants. Available evidence is of poor quality, and many studies do not address the biological plausibility of the outcomes being measured, or the mechanisms by which change might be achieved. Future research should focus on the impact of infant massage in higher-risk groups (for example, demographically and socially deprived parent-infant dyads), where there may be more potential for change.
Topics: Child Development; Humans; Infant; Infant, Newborn; Massage; Mental Health; Outcome Assessment, Health Care; Physical Stimulation; Randomized Controlled Trials as Topic; Therapeutic Touch
PubMed: 23633323
DOI: 10.1002/14651858.CD005038.pub3 -
The Cochrane Database of Systematic... Jun 2012Therapeutic Touch (TT) is an alternative therapy that has gained popularity over the past two decades for helping wounds to heal. Practitioners enter a meditative state... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Therapeutic Touch (TT) is an alternative therapy that has gained popularity over the past two decades for helping wounds to heal. Practitioners enter a meditative state and pass their hands above the patient's body to find and correct any imbalances in the patient's 'life energy' or chi. Scientific instruments have been unable to detect this energy. The effect of TT on wound healing has been expounded in anecdotal publications.
OBJECTIVES
To identify and review all relevant data to determine the effects of TT on healing acute wounds.
SEARCH METHODS
For this fourth update, we searched The Cochrane Wounds Group Specialised Register (searched 27 January 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1); Ovid MEDLINE (2010 to January Week 2 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, January 26, 2012); Ovid EMBASE (2010 to 2012 Week 03); and EBSCO CINAHL (2010 to January 6 2012).
SELECTION CRITERIA
All randomised or quasi-randomised controlled trials, which compared the effect of TT with a placebo, another treatment, or no treatment control were considered. Studies which used TT as a stand-alone treatment, or as an adjunct to other therapies, were eligible.
DATA COLLECTION AND ANALYSIS
One author (DO'M) determined the eligibility for inclusion of all trials in the review. Both authors conducted data extraction and evaluation of trial validity independently. Each trial was assessed using predetermined criteria.
MAIN RESULTS
No new trials were identified for this update. Four trials in people with experimental wounds were included. The effect of TT on wound healing in these studies was variable. Two trials (n = 44 & 24) demonstrated a significant increase in healing associated with TT, while one trial found significantly worse healing after TT and the other found no significant difference. All trials are at high risk of bias.
AUTHORS' CONCLUSIONS
There is no robust evidence that TT promotes healing of acute wounds.
Topics: Acute Disease; Bandages; Biopsy; Humans; Randomized Controlled Trials as Topic; Therapeutic Touch; Wound Healing
PubMed: 22696330
DOI: 10.1002/14651858.CD002766.pub2 -
Neurology May 2011To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). (Review)
Review
Evidence-based guideline: Treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.
OBJECTIVE
To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN).
METHODS
We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: "What is the efficacy of a given treatment (pharmacologic: anticonvulsants, antidepressants, opioids, others; and nonpharmacologic: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?"
RESULTS AND RECOMMENDATIONS
Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL.
Topics: Analgesics, Opioid; Anticonvulsants; Antidepressive Agents; Diabetic Neuropathies; Electric Stimulation Therapy; Electromagnetic Fields; Evidence-Based Medicine; Humans; Pain; Pain Management
PubMed: 21482920
DOI: 10.1212/WNL.0b013e3182166ebe -
Revista Da Associacao Medica Brasileira... 2009Steroid therapy has been tested as a protector in spinal cord injury. Multicenter studies evaluating the methylprednisolone (MP) in post traumatic neurological recovery... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Steroid therapy has been tested as a protector in spinal cord injury. Multicenter studies evaluating the methylprednisolone (MP) in post traumatic neurological recovery have shown promising results according to NASCIS. A large number of critical studies related to the NASCIS results have been published.
OBJECTIVE
To review literature related to use of methylprednisolone compared with placebo.
METHODS
This analysis added the average improvement achieved in groups of patients who used MP and placebo (PL) to the average scores of groups at baseline, before treatment, resulting in the final neurological outcome for both groups.
RESULTS
The motor score of the MP group was only 2.5 points higher than the PL in a one year follow-up. In neurologically intact patients, the total score is 70 points. Improvement in sensitive scores was also discrete (1.1 and 1.7 points for the pinprick and light touch respectively). A high rate of complications was observed in a group of patients about 60 years old who used MP.
CONCLUSION
Differences in the clinical magnitude of benefit obtained (not confirmed by other studies) with the use of MP or PL are not significant, in comparison with the potential for complications when using methylprednisolone.
Topics: Humans; Methylprednisolone; Neuroprotective Agents; Placebos; Randomized Controlled Trials as Topic; Spinal Cord Injuries
PubMed: 20191229
DOI: 10.1590/s0104-42302009000600019 -
International Journal of Behavioral... Mar 2010Biofield therapies (such as Reiki, therapeutic touch, and healing touch) are complementary medicine modalities that remain controversial and are utilized by a... (Review)
Review
BACKGROUND
Biofield therapies (such as Reiki, therapeutic touch, and healing touch) are complementary medicine modalities that remain controversial and are utilized by a significant number of patients, with little information regarding their efficacy.
PURPOSE
This systematic review examines 66 clinical studies with a variety of biofield therapies in different patient populations.
METHOD
We conducted a quality assessment as well as a best evidence synthesis approach to examine evidence for biofield therapies in relevant outcomes for different clinical populations.
RESULTS
Studies overall are of medium quality, and generally meet minimum standards for validity of inferences. Biofield therapies show strong evidence for reducing pain intensity in pain populations, and moderate evidence for reducing pain intensity hospitalized and cancer populations. There is moderate evidence for decreasing negative behavioral symptoms in dementia and moderate evidence for decreasing anxiety for hospitalized populations. There is equivocal evidence for biofield therapies' effects on fatigue and quality of life for cancer patients, as well as for comprehensive pain outcomes and affect in pain patients, and for decreasing anxiety in cardiovascular patients.
CONCLUSION
There is a need for further high-quality studies in this area. Implications and future research directions are discussed.
Topics: Chronic Disease; Electromagnetic Phenomena; Evidence-Based Medicine; Holistic Health; Humans; Neoplasms; Outcome Assessment, Health Care; Pain Management; Qi; Quality Assurance, Health Care; Therapeutic Touch
PubMed: 19856109
DOI: 10.1007/s12529-009-9062-4 -
The Cochrane Database of Systematic... Jul 2007Anxiety disorders are a common occurrence in today's society. There is interest from the community in the use of complementary therapies for anxiety disorders. This... (Review)
Review
BACKGROUND
Anxiety disorders are a common occurrence in today's society. There is interest from the community in the use of complementary therapies for anxiety disorders. This review examined the currently available evidence supporting the use of therapeutic touch in treating anxiety disorders.
OBJECTIVES
To examine the efficacy and adverse effects of therapeutic touch for anxiety disorders.
SEARCH STRATEGY
We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCTR-References) (search date 13/01/06), the Controlled Trials website and Dissertation Abstracts International. Searches of reference lists of retrieved papers were also carried out and experts in the field were contacted.
SELECTION CRITERIA
Inclusion criteria included all published and unpublished randomised and quasi-randomised controlled trials comparing therapeutic touch with sham (mimic) TT, pharmacological therapy, psychological treatment, other treatment or no treatment /waiting list. The participants included adults with an anxiety disorder defined by the Diagnostic and Statistical Manual (DSM-IV),the International Classification of Diseases (ICD-10), validated diagnostic instruments, or other validated clinician or self-report instruments.
DATA COLLECTION AND ANALYSIS
Two review authors independently applied inclusion criteria. Further information was sought from trialists where papers contained insufficient information to make a decision about eligibility.
MAIN RESULTS
No randomised or quasi-randomised controlled trials of therapeutic touch for anxiety disorders were identified.
AUTHORS' CONCLUSIONS
Given the high prevalence of anxiety disorders and the current paucity of evidence on therapeutic touch in this population, there is a need for well conducted randomised controlled trials to examine the effectiveness of therapeutic touch for anxiety disorders.
Topics: Anxiety Disorders; Humans; Therapeutic Touch
PubMed: 17636838
DOI: 10.1002/14651858.CD006240.pub2 -
The Cochrane Database of Systematic... 2002Snoezelen, multi-sensory stimulation, provides sensory stimuli to stimulate the primary senses of sight, hearing, touch, taste and smell, through the use of lighting... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Snoezelen, multi-sensory stimulation, provides sensory stimuli to stimulate the primary senses of sight, hearing, touch, taste and smell, through the use of lighting effects, tactile surfaces, meditative music and the odour of relaxing essential oils (Pinkney 1997). The clinical application of snoezelen has been extended from the field of learning disability to dementia care over the past decade. The rationale for its use lies in providing a sensory environment that places fewer demands on intellectual abilities but capitalizes on the residual sensorimotor abilities of people with dementia (e.g. Buettner 1999, Hope 1998). Practitioners are keen to use snoezelen in dementia care, and some encouraging results have been documented in the area of promoting adaptive behaviours (e.g. Baker, Long 1992, Spaull 1998). However, the clinical application of snoezelen often varies in form, nature, principles and procedures. Such variations not only make examination of the therapeutic values of Snoezelen difficult, but also impede the clinical development of snoezelen in dementia care. A systematic review of evidence for the efficacy of snoezelen in the care of people with dementia is therefore needed to inform future clinical applications and research directions.
OBJECTIVES
This review aims to examine the clinical efficacy of snoezelen for older people with dementia.
SEARCH STRATEGY
"Snoezelen", "multi-sensory", "dement*", "Alzheimer*", "randomized control/single control/double control" were used as keywords to search seven electronic databases (e.g. MEDLINE, PsyLIT). The list of trials was compared with those identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group.
SELECTION CRITERIA
All RCTs in which Snoezelen or multi-sensory programmes were used as an intervention for people with dementia were included in the review. Trial data included in the review were restricted to those involving people aged over 60 years suffering from any type of dementia, except one subject of Baker's study was aged below 60 years.
DATA COLLECTION AND ANALYSIS
Only two RCTs fulfill the inclusion criteria for this systematic review. Two reviewers independently extracted the data from these two inclusion studies. Quantitative synthesis of the comparable data from the two trials was performed.
MAIN RESULTS
Two trials were included. Both Baker (and Kragt examined the short-term values of snoezelen on the behaviours of people with dementia. Although the pooled results were insignificant, the trend was in the direction of favouring treatment (hence a negative value of the SMD). The standardized mean difference (SMD) was -1.22, with a 95% confidence interval (CI) (-4.08, 1.64). Kragt's result, weighted 47%, was significant in favour of treatment, with a SMD of -2.77 and a 95% CI (-4.24, -1.29). During the snoezelen session, Kragt's subjects presented significantly fewer apathetic behaviours (t=-8.22, p<0.01), fewer restless behaviours (t=-3.00, p=0.01), fewer repetitive behaviours (t=-.822, p<0.01), and fewer disturbances (t=-4.91, p<0.01). Baker's result was slightly not in favour of the treatment, with a SMD of 0.16 and a 95% CI (-0.41, 0.73). The control subjects touched objects/equipment more appropriately within the activity sessions than the subjects who participated in snoezelen sessions (F(1,47)=5.96, p=.001). Kragt did not examine the carryover and long-term effects of snoezelen, so only Baker's results were analysed. Baker used the Behavioural and Mood Disturbance scale (BMD), the REHAB, the CAPE and MMSE to assess patients mood, behaviour and cognition after (but not immediately after) four treatment sessions and eight treatment sessions. Some assessments were carried at home, some at day hospital. There were many subscores and mostly there were no differences between treatment and control. The following significant differences were found with benefit in favour of snoezelen compared with control after four sessions: apathy ezelen compared with control after four sessions: apathy score of the BRS (CAPE) (MD -3.00, 95%CIs -5.87 to -0.13, P=0.04), after eight sessions: mood score of the BRS (CAPE) (MD -2.60, 95%CIs -4.92 to -0.28, P=0.03), total score of the BRS (CAPE) (MD -6.92, 95%CIs -13.13 to -0.7, P=0.03), speech skills of the REHAB (MD 1.46, 95%CIs 0.01 to 2.82, P=0.03), psychomotor subscore of the cognitive assessment scale of CAPE (MD -3.12, 95%CIs -5.31 to -0.93, P<0.01).
REVIEWER'S CONCLUSIONS
Two trials were reviewed. Although both studies examined the short-term values of snoezelen on people with dementia, it is not feasible to draw a firm conclusion at this stage, for two main reasons. Firstly, very limited data were available for analysis, thus limiting data inference and generalization. Secondly, different methodology and control conditions were adopted in the two trials. Such variations not only require a careful interpretation of results but also make the comparison of results across studies less valid. Hence, there is an urgent need for more systematic and scientific research studies to examine the clinical value of snoezelen for people with dementia. To our knowledge, there are four RCTs currently in progress. It is hoped that the data and results of these trials will enrich the systematic review of snoezelen for dementia in the next update.
Topics: Aged; Complementary Therapies; Dementia; Humans; Middle Aged; Randomized Controlled Trials as Topic; Sensory Art Therapies
PubMed: 12519587
DOI: 10.1002/14651858.CD003152