Use of massage therapy for non-painful health conditions: an evidence map of systematic reviews

Abstract Background There is high- or moderate-certainty evidence that massage therapy is beneficial for certain painful conditions. Massage therapy has also been evaluated for a range of non-painful health conditions, but the extent and certainty of this evidence are less well characterized. We mapped the systematic reviews, conclusions, and certainty (quality or strength) of evidence for outcomes of massage therapy for non-painful health conditions. Methods Computerized search of PubMed, AMED, CINAHL, Cochrane Database of Systematic Reviews, and Web of Science from July 2018 to July 2024. This evidence map updates a Department of Veterans Affairs (VA) report that covered massage therapy reviews published through July 2018. Study selection included systematic reviews of massage therapy for non-painful adult health conditions that formally rated the certainty (quality or strength) of evidence supporting the conclusions. Systematic reviews of sports massage therapy, osteopathy, dry cupping/dry needling, and internal massage therapy (e.g., for pelvic floor pain), and self-administered massage therapy techniques (e.g., foam rolling) were ineligible. Main outcomes and measures include health condition, number of included studies, intervention, comparison group, conclusions, and certainty of evidence. Results A total of 13 systematic reviews of massage therapy for 8 non-painful adult health conditions were identified. Of 190 full-text reviews, 20 used a formal method to rate the certainty (quality or strength) of evidence supporting their conclusions; 7 reviews overlapped in health condition, resulting in 13 included reviews. Across these, one conclusion about abdominal massage therapy for functional constipation was rated as high certainty of evidence. There were 4 conclusions from 3 reviews rated as moderate certainty of evidence: 2 conclusions in 1 review about acupressure and auricular acupressure for improving sleep quality in patients with cancer, 1 conclusion about acupressure for sleep latency and fatigue in people with chronic kidney disease, and 1 conclusion about massage improving depressive symptoms in individuals living with dementia; all remaining conclusions were rated as low or very low certainty of evidence. Evidence on adverse events was collected by 7 of 13 (54%) reviews; serious adverse events attributed to massage therapy were not identified in those reviews, but adverse event data were often incomplete or inconsistently described. Conclusions Only a small number of systematic reviews reported high- or moderate-certainty evidence supporting the potential benefit of massage therapy for specific non-painful adult health conditions. High-certainty evidence was limited to abdominal massage therapy for functional constipation, whereas moderate-certainty evidence indicated that acupressure and auricular acupressure may improve sleep quality in patients with cancer, acupressure may improve sleep latency and decrease fatigue in people with chronic kidney disease, and massage therapy may reduce depressive symptoms in individuals living with dementia. For most other non-painful adult health conditions evaluated, available conclusions are supported only by low- or very low-certainty evidence. Additional high-quality research is needed to strengthen the evidence base for massage therapy for non-painful adult health conditions, particularly for conditions and outcomes that currently lack at least moderate-certainty evidence.