Post A, B, or C. Rank A

Post for Sanaz Sarabi, Cherry To, Ray Shieh, Fanny LondonReferenceVickers, A., Ohlsson, A., Lacy, J., & Horsley, A. (2004). Massage for promoting growth and development of preterm and/or low birth-weight infants. Cochrane Database of Systematic Reviews, 2, CD000390. doi:10.1002/14651858.cd000390.pub2 SummaryThe research study aimed to address the growth progress of preterm infants, by determining whether massage therapy would promote weight gain and decrease the number of hospitalized days. The research suggests that in addition to examining the risks and benefits of using massage therapy as a treatment, the cost-effective use of time and potential for harm needs to be considered. Research Question and Design of the StudyThe researchers explained that since premature infants admitted to the NICU are subjected to an abrupt transition from their safe mother’s womb, to a highly stressful environment in which they lack tactile stimulation with regular interruptions for nursing treatment, they would physically benefit from gentle massage. The research questions were “Do preterm and/or LBW infants exposed to massage, experience improved weight gain and earlier discharge compared to those infants receiving standard neonatal care?” (Vickers A. et al., p. 3).  And “Does massage have any other beneficial or harmful effects on this population?” (Vickers A. et al., p. 3). The design was a systematic review, they critically analyzed multiple research studies that would answer their research questions using a structured methodology. The methodological criterion used to approve each paper were the concealment of treatment allocation, performance bias, blinding of observers, and exclusions/withdrawals. Each paper was reviewed by 3 independent researchers and was given a rank A, B, or C.  Rank A meant the least amount of bias, while rank C corresponded to the most amount of bias. Disagreements regarding paper inclusion were settled by committee. Sample and SettingThe sample was a random selection of LBW infants <37 weeks or the birth weight of <2500g. The study used as many trials as possible. The infants were generally healthy and stable, with no health conditions, and had been transferred to intermediate, or "grower" care before the start of the intervention. Infants with congenital anomalies, history of maternal drug abuse, ventilatory assistance, intravenous feedings, or those who had a serious pathology such as necrotising enterocolitis, were excluded from the study to eliminate or limit the independent variables as much as possible. The parents of the subjects studied were generally of low socioeconomic status. One trial had an inclusion criterion which specified a disease state (maternal drug addiction for Wheeden 1993 (Links to an external site.)Links to an external site.) in addition to preterm birth or low-birth weight.The interventions used in the trial were in two categories: "gentle physical massage" and "gentle, still touch". Infants receiving gentle physical massage were typically rubbed and stroked gently for approximately 15 minutes, three or four times a day. Many massage interventions also included kinesthetic stimulation consisting of passive flexion/extension movements of the limbs. Infants assigned to still, gentle touch had nurses place their hands on them gently as they slept. After 15 or 20 minutes, the hands would be removed. No stroking or rubbing motions were used. Both types of therapy were applied for 5-10 days. The results measured the advantages and disadvantages of massage on weight gain, length of hospital stay, and behavioral and developmental changes. The length of massage therapy applied to the infants was based on the number of days they stayed at the hospital and the data that was recorded. We felt that although the selection criteria was pretty simple and the design of the selection made it easier to eliminate unexpected variables in the study, 5-10 days of therapy does not seem to be a significant amount of time in order to produce results. There was no evidence of a correlation between infants who got a shorter massage and the ones who received longer duration. It is important to note that recording the data directly during the hospital stay of the infant, would eliminate many unknown variables that would otherwise affect the results of the study. Research MethodsThe outcomes of greatest interest to the study were weight gain and length of stay in the hospital. The study also recorded developmental and behavioural outcomes using the Brazleton 1983 (Links to an external site.)Links to an external site. scale, which is a standard developmental measure. The weight was measured daily using the hospital scale. No trial described procedures to blind those taking weight measurements. Nonetheless, poor blinding of the main outcome measure might be considered to be a flaw of the research included in the review. Also, there is an independent variable of caloric intake by the infants that affects the weight gain directly.  The kind of nutrition the infants received, whether or not the infants were breastfed, nor the type of formula they received, were documented within the research study. The other significant value was the hospital stay, which was reported as significantly reduced to 4-5 days.  But only one study (White Traut 1986 (Links to an external site.)Links to an external site.) of the two studies explicitly stated that physicians responsible for discharging infants were blind to group assignment. However, it is unclear how this blinding was achieved. Study Findings and LimitationsThe findings show that massage interventions resulted in improved daily weight gain by 5 grams and reduced length of stay by 4.5 days. Although there were no negative effects shown, the results of the benefits of massage on developmental outcome of preterm infants were weak.  Researchers could not conclude that it doesn't warrant wider use of massage as a treatment for preterm infants. The limitations consist of methodological issues when analyzing the results. For example, performance bias was not thoroughly observed to ensure each treatment was similar for the infants. Thus, it is important to consider that there may be differences in care due to the difficulty of creating a blind study. It is clear that more research should be done, because there were no significant outcomes specifying the effectiveness of massage therapy for LBW infants. Also, data recording and performance bias affected the results. Because the results do not seem to be significant, there is question whether health care personnel should invest time in performing the therapy.. Relevance of StudyThis study emphasizes the importance of  a less invasive non-pharmaceutical treatment option to promote weight gain for LBW infants. Massage therapy is a low-risk affordable therapy that is easy to implement in many settings in order to promote growth and health to at-risk infants. This therapy requires very little training and is able to be performed by non-licensed individuals such as caregivers. Based on the studies performed, there are no adverse effects of massage therapy for premature/LBW infants, nor are there significant benefits to massage therapy.