Summary of findings 2. Massage versus active controls for sub‐acute and chronic LBP.
| Massage versus active controls for sub‐acute and chronic LBP for LBP | ||||||
| Patient or population: patients with LBP Settings: Intervention: Massage versus active controls for sub‐acute and chronic LBP | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Massage versus active controls for sub‐acute and chronic LBP | |||||
| Pain intensity (higher scores mean more pain) ‐ Short‐term follow‐up Numerical pain rating scales (higher scores man more pain) Follow‐up: 0 to 6 months | The mean pain intensity in the active control group is 40.6 points (SD 26.7) VAS1 | The mean pain intensity in the massage group is 30.7 points (95%CI 24.0 to 37.1 points) | Not applicable | 964 (12 studies, 1 study is duplicated because it had two types of massage) | ⊕⊝⊝⊝ very low2,3 | Medium, statistically significant effect size (SMD ‐0.37, 95% CI ‐0.62 to ‐0.13) |
| Pain intensity (higher scores mean more pain) ‐ Long‐term follow‐up Back and Leg pain; VAS and Von Korff Pain Scale. Follow‐up: 6 to 12 months | The mean pain intensity in the active control group is 40.6 points (SD 26.7) VAS1 | The mean pain intensity in the massage group is 29.9 points (95%CI 19.2 to 40.3 points) | Not applicable | 757 (5 studies) | ⊕⊝⊝⊝ very low2,4,5 | Medium, statistically significant effect size SMD ‐0.4 (‐0.8 to ‐0.01) |
| Function (higher scores mean more disability) ‐ Short‐term follow‐up Interference with daily activities (higher scores mean more disability). Follow‐up: 0 to 6 months | The mean function in the active control group is 36.6 points (SD 17.7) Oswestery Disability Questionnaire1 | The mean function in the massage group is 32.4 points (95%CI 25.6 to 38.9 points) | Not applicable | 618 (6 studies) | ⊕⊝⊝⊝ very low2,6 | Small, non‐significant effect size SMD ‐0.24 (‐0.62 to 0.13) |
| Function (higher scores mean more disability) ‐ Long‐term follow‐up RMDQ and ODI. Follow‐up: 6 to 12 months | The mean function in the active control group is 36.6 points (SD 17.7) Oswestry Disability Questionnaire | The mean function in the massage group is 32.9 points (95%CI 26.0 to 39.6 points) | Not applicable | 616 (4 studies) | ⊕⊝⊝⊝ very low2,6,7 | Small, non‐significant effect size SMD ‐0.21 (‐0.6 to 0.17) |
| Adverse events Self‐reported | 29 per 1000 | 37 per 1000 (19 to 59) | See comment | 585 (5 studies) | ⊕⊝⊝⊝ very low2,6 | Small, non statistically significant difference (RD 0.01, 95% CI ‐0.01 to 0.03) |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; ODI: Oswestry disability index; RMDQ: Roland Morris Disability Questionnaire; VAS: visual analog scale. | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
1Final scores. Poole 2007 was the most representative trial included in this meta‐analysis. 2Downgraded two levels because of risk of bias: The studies included in this meta‐analysis had high risk of selection, performance, detection and attrition bias. Unclear risk of reporting bias. 3Downgraded one level because of inconsistency. Although the I² statistic value was < 80%, we found that there was some underlying heterogeneity because 2 studies found the opposite results from this meta‐analysis (Lara‐Palomo 2013; Kumnerddee 2009). 4Downgraded one level because of inconsistency. The I² statistic value is 86%. 5Downgraded one level because of imprecision. The 95% CI includes a small effect. 6Downgraded one level becasue of imprecsision. The 95% CI includes "no effect". 7Downgraded one level because of inconsistency. The I² statistic value is 82%.