Original Title: Eficacia y seguridad del masaje tailandés como terapia en condiciones clínicas seleccionadas

Authors' results and conclusions: RESULTS: A systematic review of systematic reviews and randomized clinical trials, published between January 2014-July 2019, identified by a scientific literature search conducted in main scientific databases, clinical trial registries and health technology assessment sources. Fifty-nine studies on Thai massage in different clinical conditions were retrieved. Finally, one systematic review and 11 randomized clinical trials were included in the review. None of the included studies aims to collect relevant information on the safety of Thai massage. Only one study on spasticity reported mild adverse effects such as muscle stiffness, muscle pain, inflammation or ecchymosis. The rest of the included studies do not show quantitative clinical outcomes related to safety, although according to the authors, there do not appear to be any relevant adverse effects related to the intervention. In general, TM interventions are well tolerated by patients and there is little evidence from the included studies on complications and adverse effects associated with Thai massage. Acute, subacute or chronic non-specific low-back pain and chronic myofascial pain syndrome. The studies related with low-back pain included in this assessment show a high risk of bias. TM reduces pain intensity and improves function from baseline but is no different from the control group (joint manipulation and mobilization, Swedish massage). Tree studies of chronic myofascial pain syndrome, two with high risk of bias and one with low risk of bias, showed reduced pain and improved quality of life scales with TM compared to topical diclofenac or sham nonactive treatment.The systematic review included, with moderate quality, includes six studies with favourable results to MT in reducing pain intensity, physical flexibility and muscle tension. Osteoarthrosis of the knee. Two high risk of bias studies present similarly favourable results of TM versus standard physical therapy or oral ibuprofen in relative improvements in pain intensity, function, gaitability and quality of life. Chronic tension headache. One study with a low risk of bias shows no significant reduction of pain with MT in the short or long term compared to sham. One study with high risk of bias shows reduction in pain intensity compared with amitriptyline. Both trials show a relative increase in the MT group at the pressure pain threshold. Diabetic neuropathy. One study with high risk of bias shows no significant differences between TM and measures of health education and self-care in functional dynamic balance, range of motion in foot, ankle and knee joints, and sensation of the foot. Spasticity and muscle tension in neurological pathology. One study with a high risk of bias shows no difference in patients with stroke with spasticity, treated with TM versus standard physical therapy, regarding improvement in muscle spasticity, degree of disability and quality of life, anxiety and depression. Quality of evidence The methodological quality of the systematic review was assessed as moderate using the AMSTAR scale criteria. The risk of bias of randomized clinical trials was assessed using the RoB-2 bias risk assessment tool from the Cochrane collaboration. Two of the trials were rated as of good quality and low risk of bias. The rest of the included trials were assessed as of low quality and high risk of bias due to different methodological limitations, such as the lack of information on the randomization process, the method of concealment of the sequence of allocation of patients to the comparison groups, the lack of blinding of interventions to patients and therapists and the risk of selection of results. Although the authors of most of the included studies conclude that TM has similar or more favourable results than comparators in pain reduction and improvement of function in selected clinical conditions, these conclusions are limited by the characteristics and high risk of bias of these trials. The available studies are of small sample size, from 15 to 70 patients per comparison group, there is a wide variety of ways of applying massage and it is difficult to standardize the interventions, outcome measures are made in the short term, and some comparators are not active, or are of unknown efficacy or are not the reference for effective treatment. CONCLUSIONS: There are few studies with robust and good quality designs that specifically assess the efficacy and safety of Thai massage (TM) as a therapeutic or rehabilitative intervention in clinical pathologies. With the information provided by the included studies and considering their methodological drawbacks, it is not possible to make definitive conclusions about the efficacy and safety of Thai massage in acute, subacute or chronic nonspecific low-back pain, chronic myofascial pain syndrome, osteoarthrosis of the knee, chronic tension headache, diabetic neuropathy and spasticity in neurological pathology. In general, TM interventions are well tolerated by patients. There is little evidence from the included studies on adverse effects associated with the application of the various techniques of TM, which makes it impossible to exclude complications caused by the use of TM.

Project Status: Completed

Year Published: 2020

URL for published report: https://redets.sanidad.gob.es/productos/buscarProductos.do?metodo=detalle&id=981

Requestor: Spanish Ministry of Health

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Evaluacion de Tecnologias Sanitarias

Contact Address: Instituto de Salud "Carlos III", Calle Sinesio Delgado 6, Pabellon 4, 28029 Madrid, Spain. Tel: +34 9 1 822 2005; Fax: +34 9 1 387 7841;

Contact Name: Luis M. Sánchez Gómez

Contact Email: luism.sanchez@isciii.es

Copyright: <p>Agencia de Evaluacion</p>