Issue link: https://www.massageandbodyworkdigital.com/i/1037165
(5 percent), and other self-reported racial and ethnic descriptors (6 percent). Both groups were similar at baseline, except that those in the intervention group woke up an average 34 minutes earlier than those in the control group. The number of night wakings was significantly better for children in the massage-based bedtime routine group at the end of the study, and those children decreased their number of nightly wakings while those in the control group did not. While no significant reductions in sleep onset occurred for either group during the study, mothers in the massage group reported declining bedtime difficulty, improved child mood, and decreased perception of infant sleep difficulty throughout and at the end of the study. Reported sleep quality and mood improved for mothers in the massage-based bedtime routine group over the course of the study, with 69 percent and 80 percent reporting more connection with their children after one and two weeks of the massage-based bedtime routine intervention, respectively. Study findings were not incredibly robust but were positive overall with a massage-based bedtime routine resulting in fewer nighttime waking episodes, improved infant mood, and less difficulty at bedtime. The authors acknowledge several limitations, including the broad age range of the children, the lack of a long-term follow-up, and the introduction of only one bedtime routine intervention. However, other limitations exist that are not reported. As far as I can tell, there is no description of the actual instruction materials for study replication or to share with those who would like to try the intervention for themselves. The authors do not indicate the materials are proprietary, but may be open to sharing the information with those who contact them (the article indicates that first author Jodi Mindell is the corresponding author: jmindell@sju.edu). In addition, there is no reporting of intervention compliance, and the extent to which participants did the massage-based bedtime routine is unclear. While the study appears to take a pragmatic, intent-to-treat approach (pragmatic meaning that analysis is run as planned regardless of intervention adherence and/or compliance), that design specification is not stated, so the rationale for the exclusion of compliance reporting should not be assumed. The duration of the massage application is also missing, both in relation to the instructions given and how long provided massages actually lasted; no rationale or explanation as to why these items are not reported are given. Despite the work's limitations, there is a key practice-related takeaway discussion point. The massage in this study was not provided by trained massage therapists and it isn't clear what the massage actually entailed. How does this study and its results even relate to massage therapy as practiced by massage therapists? Mothers provided the massage in this study and very little detail is given in the article about what the massage entailed, making it unclear in what ways the intervention reflected massage practice. What we do know, however, is that a massage product (given the funder and prior research from these authors, I expect it was an unlabeled Johnson & Johnson lotion or oil) and instructional materials for possible massage techniques and application instruction for the infant's chest, tummy, back, arms, hands, legs, and feet were provided. Even though the intervention massage is not provided by a massage therapist, this intervention is reflective of how a majority of massage for infants, particularly right before bedtime, is applied and accessed, making it rather "real-world" in that regard, and the practice of mothers massaging their infants should be supported by the massage field. The fact that large effects were not necessarily seen 54 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 8 Mothers or caregivers providing massage as part of a bedtime routine is appropriate, and massage therapists can have a role in helping clients feel confident in providing this for their children to help with sleep issues or to support a healthy bedtime routine.