martes, 28 de julio de 2015

Evidence-Based Medicine and Massage

Over the past 20 years, randomized, controlled studies have evaluated tactile/kinesthetic stimulation effects (more popularly referred to as massage therapy) for preterm infants residing in neonatal intensive care units. The protocol in these studies typically involves administering 30 to 45 minutes of daily stroking and flexion and extension of extremities to medically stable preterm infants. The massage therapy is provided in 10- to 15-minute sessions, 3 times a day, for 2 to 4 weeks.

Critical findings from 3 studies indicate a 21% to 47% greater weight gain for the massage therapy versus the standard care control group. Other findings of interest include greater bone mineralization,1 earlier hospital discharge,2,,3and more optimal behavioral and motor responses for the massage therapy group.2,,3These findings and a meta-analysis of 19 studies indicating that 72% of infants receiving massage therapy did better than controls support the view that massage therapy improves the clinical and developmental course of preterm infants.4

In a more recent study, we were unable to replicate the weight gain findings when the massage therapy was performed on medically stable preterm infants who were within 7 to 10 days of discharge from a neonatal intermediate care unit (Table 1). A closer inspection of the data revealed that the preterm weight at time of entry for the current study was approximately 468 g greater (M entry weight = 1764) than that of the earlier studies (M entry weight = 1296). Massage therapy apparently facilitates weight gain only if the intervention is started when the preterm infant weighs between 1100 and 1300 g.

Table 1.

Background, Data Entry, and Outcome Variables for Massage Therapy Studies

Given that the percent of preterm births rose to 11.8% over the past decade5 and weight gain is a critical measure for evaluating growth and well-being in the preterm infant, interventions, such as massage therapy, that promote weight gain should be of interest to the neonatologist and should be implemented at a time when they yield the most benefit. Underlying-mechanism studies are currently underway to examine massage therapy effects on IGF-1, oxytocin, and gastric motility with preterm infants weighing between 1100 and 1300 g at entry.

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