Issue link: https://www.massageandbodyworkdigital.com/i/398416
52 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 4 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 4 spectrum disorder. 3 Twenty databases were searched for articles using the search terms "(massage OR touch OR acupressure) AND (autistic OR autism OR Asperger's syndrome OR pervasive developmental disorder)." All forms of research were allowed, including case reports and case series, even though these lower forms of study design are not typically included in systematic reviews. Of the 132 articles found, only six were included in the review and most were found to have signifi cant biases in the study design. The conclusion for this review was that "limited evidence exists for the effectiveness of massage as a symptomatic treatment of autism. Because the risk of bias was high, fi rm conclusions cannot be drawn. Future, more rigorous randomized clinical trials seem to be warranted." The need for more research is a common statement in review articles. In a 2011 article by Jenny Sau-Lai Chan and Sonny Hing-Min Tse, articles were assessed on massage therapy for relaxation and reduction of challenging behaviors in persons with intellectual disabilities. 4 Sixty-four articles were found, but only seven were included in the review. Even though the majority of results were positive, there were many methodological problems with the study designs. "Case study designs, large amounts of qualitative data, and small sample sizes meant that the therapeutic effect of massage therapy could not be substantiated. Hence, future studies with randomized clinical trials or of experimental design are recommended," Chan and Tse concluded. Besides the need for a higher quantity of research, review articles frequently also call for higher quality. Wendy Moyle and her team wrote a review on the effects of massage on agitated behaviors in older people with dementia. 5 The search revealed 13 studies that met the inclusion criteria, but only one study had adequate methodological quality to be included in the review. "This prospective study found that massage signifi cantly reduced levels of agitation Review articles offer a great deal of information in one place, and can provide input on which original research studies might be worth reading. in 52 cognitively impaired residents in two long-term care facilities," Moyle wrote. A stronger conclusion than this could be made if there were more articles and if they were higher quality study designs. META-ANALYSES The fi nal form of review articles is called the meta- analysis. A meta-analysis is a systematic review that includes an analysis of the data from the individual articles, such as the 2011 Moyer article on cortisol levels after massage discussed earlier. A meta- analysis will describe the method of searching the literature, what articles were included and excluded, and the quality of the included articles, and will then pool the data from the chosen articles into one major statistical analysis. If we look at the pyramid of study design hierarchy, the meta-