Massage (v no intervention) on pain in people with SCI | SCI Physiotherapy Clinical Practice Guidelines

	Massage (v no intervention) on pain in people with SCI
P	People with SCI	Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence.		Weak opinion statement FOR Massage therapy may be provided to treat pain in people with SCI.
I	Massage therapy
C	No intervention	Consensus-based opinion statement Weak for (96%)
O	Pain	Consensus-based opinion statement Weak for (96%)
	SUMMARY	2 RCTs		Mean difference (95% CI) 0.1 (-0.4 to 0.5) Favours no intervention
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Very serious	Inconsistency No serious	Imprecision Serious	Indirectness Serious	Publication bias Serious

MASSAGE ON PAIN: GRADE Evidence to Decision
PROBLEM	No	Probably no	Probably yes	Yes		Don't know
DESIRABLE EFFECTS	Trivial	Small	Moderate	Large		Don't know
UNDESIRABLE EFFECTS	Large	Moderate	Small	Trivial		Don't know
CERTAINTY OF EVIDENCE	Very low	Low	Moderate	High		No included studies
HOW MUCH PEOPLE VALUE THE MAIN OUTCOME	Important uncertainty or variability	Possibly important uncertainty or variability	Probably no important uncertainty or variability	No important uncertainty or variability
BALANCE OF EFFECTS	Favours the Control	Probably favours the Control	Does not favour either the intervention (I) or the comparison (C)	Probably favours the I	Favours the I	Don't know
RESOURCES REQUIRED	Large costs	Moderate costs	Negligible costs and savings	Moderate savings	Large savings	Don't know
CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES	Very low	Low	Moderate	High		No included studies
COST EFFECTIVENESS	Favours the comparison	Probably favours the comparison	Does not favour either the intervention or the comparison	Probably favours the intervention	Favours the intervention	No included studies
EQUITY	Reduced	Probably reduced	Probably no impact	Probably increased	Increased	Don't know
ACCEPTABILITY	No	Probably no	Probably yes	Yes		Don't know
FEASIBILITY	No	Probably no	Probably yes	Yes		Don't know

MASSAGE ON PAIN: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
CHASE 2013	Massage V No intervention	Six 20 min massage sessions over 2 weeks	People with complete and incomplete SCI	20/20	Shortform McGill Pain Questionnaire (SF-MPQ)	High Risk of Bias PEDro = 5/10
LOVAS 2017	Massage V Guided imagery relaxation	1 x per week (30 mins) for 5 weeks	People with complete and incomplete SCI	20/20	Intensity on the Brief Pain Inventory	High Risk of Bias PEDro = 4/10

The Australian and NZ SCI Physiotherapy guideline committee recommends massage therapy to treat pain in people with SCI.

This is a consensus-based opinion statement supported by the opinions of the experts even though there is one randomised controlled trial related to this topic. However, the result of this randomised controlled trial is inconclusive preventing an evidence recommendation. The guideline states:

Massage therapy may be provided to treat pain in people with SCI.

This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. The results of one randomised controlled trial was also taken into consideration. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.

This is a strong consensus-based opinion statement which means that the guideline panel is confident they can probably recommend massage therapy may be provided to treat pain in people with SCI based on opinion.

To learn more about the research related to this intervention go to the research summary.

Chase T, Jha A, Brooks CA, et al. A pilot feasibility study of massage to reduce pain in people with spinal cord injury during acute rehabilitation. Spinal Cord 2013 Nov;51(11):847-851.
Lovas J, Tran Y, Middleton J, Bartrop R, Moore N, Craig A. Managing pain and fatigue in people with spinal cord injury: A randomized controlled trial feasibility study examining the efficacy of massage therapy. Spinal Cord 2017; 55: 162-166.