Issue link: https://www.massageandbodyworkdigital.com/i/78617
It is less common to find research on individual hands-on bodywork approaches. Therefore, rather than narrowing the search to a technique that may not yield very many results, I chose to use the general term massage and cast a wider net. Specifying dosing—when, how often, and how long the massage would be administered—further clarifies the research question. In order to have a direct effect on acute postoperative pain, I felt massage needed to be administered within three days of the surgical intervention, performed at least once, and applied for at least 20 minutes. Finally, we must determine the criteria for those implementing the protocol. For this SR to be useful for influencing the integration of massage therapy in health-care settings, it seems important that the massage is performed by licensed or certified massage therapists, rather than untrained touch administered by family members or massage performed mechanically. I also decided to rule out nursing studies unless the nurses were dual-licensed as massage therapists. The intervention is defined as non- specified massage performed by licensed or certified massage therapists at least once within three days of the surgical intervention for at least 20 minutes. Comparison Comparison specifies the type of control group used in the massage studies. Many SRs review randomized control trials or clinical comparison trials and ignore smaller pilot studies, making the control group an important factor in the article selection process. However, massage therapy does not easily lend itself to placebo trials, so it may be helpful to conduct reviews that include smaller studies, which may not include comparison groups, so we can begin to drawn meaningful conclusions. "Grey" literature includes studies that have yet to be published in peer-reviewed journals. Conference proceedings, dissertations, and studies that are still in process can be searched and included in the reviews. I have been citing grey literature in the form of conference proceedings in an attempt to bring forth current information, even though it was not yet published in peer-reviewed journals. Articles that have not been peer-reviewed, however, have not been critically assessed for bias, and therefore warrant a rigorous review before inclusion in SRs. Outcomes Outcomes identify the measures that will be used to note the efficacy, success, or progress of the intervention. Pain is the primary symptom in postoperative patients. Measures for pain can vary, most commonly including a zero-to-10 numerical rating scale or a visual analog scale by which patients mark their current level of pain on a continuum between no pain and unbearable pain. Pain can also affect blood pressure, function, heart rate, and sleep, and contribute to anxiety, fatigue, stress, or tension, inviting many other effect measures. I refined my outcomes criteria to include three categories of information: pain, function (including but not limited to sleep), and anxiety (including but not limited to relaxation, stress, and tension). SELECTING ARTICLES FOR REVIEW The next step is to select articles to inform the review. First, identify relevant keywords or search terms. Here is the list of keywords culled from the work we did above by defining PICO: "massage," "massage therapy," "postsurgery," "acute pain," "sleep," "patient satisfaction," "stress," "anxiety," "depression." Next, identify which databases to search. In order to conduct a comprehensive search and include as many articles on the subject as possible, a wide range of databases 60 massage & bodywork september/october 2012