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Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 45 is called a meta-analysis. Meta-analysis in combination with a systematic review constitutes the highest tier on the evidence hierarchy pyramid (see chart on page 47). Systematic review procedures include multiple time-consuming steps to identify, screen, and select articles for inclusion. Once articles are identified, relevant data is extracted from each of the included studies and organized in a meaningful way for synthesis, discussion, and analysis (if applicable). The extracted data are often the table components in the article, reporting the findings from the systematic review. The initial search in a systematic review casts a broad net in an effort to identify as many relevant articles as possible. Research librarians are excellent resources and partners for systematic reviews, due to their familiarity with literature identification, search databases, and various research support software. The key words chosen for use in the search are important and allow for more targeted searches. For example, in this column's highlighted study, including "child" and "adolescent" in the search criteria filtered out studies in other aged populations. Searches can also narrow the "net" for precision by including "not" statements. For example, the term "massage" is used in a lot of contexts and for procedures that fall out of the scope of typical massage therapists (for example, cardiac massage). When a search is returning a lot of similar unrelated articles, "not" statements can be effectively used to narrow down the field before human resources are spent filtering them out. After the initial article identification search, researchers for the systematic review examine each title and abstract to exclude those studies clearly not meeting the criteria. The last pre-inclusion set of articles are considered in full, read, and reviewed by researchers and compared against the inclusion criteria for final determinations. Those articles that remain are included in the review, and then progress to the data extraction step of the process. In many cases, hand searches seek out any missed and final articles identified through works cited in other articles, other similar reviews, or non-indexed journal searches. The PRISMA statement 7 encompasses the reporting guidelines for systematic reviews. PRISMA is open access for those interesting in learning more about, and improving their consumption of, systematic review processes and content (see A meta-analysis is the statistical analysis of combined data from multiple studies. Not all systematic reviews include meta- analysis, but all meta-analysis require a systematic review to ensure all potential articles are identified for the analysis. There is a set process for meta-analyses, and training is needed to conduct such a study and often requires the know-how and use of statistical analysis software. Meta-analysis requires specific data-analysis information from the original studies, including, for example, the sample size, means and standard deviations, specific test scores, and confidence intervals. In addition, studies included in a meta-analysis must also share the same outcomes and, ideally, similar data collection time points. Unfortunately, the design and reporting consistency of massage research do not tend to align with meta- analysis needs—particularly those from Integrative approaches, such as diet modification, exercise, or therapeutic massage, seek to provide assistance with troublesome ADHD symptomology without pharmacological burden. efforts prior to the early-mid 2000s (the point at which reporting guidelines within the medical research community were becoming more available, circulated, and adopted 8 ). Regardless, because meta-analysis pools the outcomes and effects of multiple studies addressing the same questions, results are more comprehensive and higher on the "strength" scale of evidence. SYSTEMATIC REVIEW AND META- ANALYSIS OF MASSAGE THERAPY FOR PEDIATRIC ADHD TREATMENT The article "Massage Therapy For the Treatment of Attention Deficit/ Hyperactivity Disorder (ADHD) in Children and Adolescents: A Systematic Review and Meta-Analysis" 9 examined the question: What is the impact of massage therapy on ADHD treatment for children and adolescents? Unlike many earlier systematic reviews focused on massage therapy, author Shu-Cheng Chen and associates included eligible articles published in any language so long as they were identified in major English or Chinese search engines. Historically, many systematic reviews excluded articles not published in English, so this review contains a broader breadth of knowledge synthesis on its topic area. The authors also point out that prior to their work, no systematic review existed that specifically focused on massage for young people with ADHD, although a review of pediatric massage from 2007 10 did identify two random control trials on the topic. The systematic review's inclusion criteria required that studies were trials (rigorously reported case series were

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