Massage therapy improves behavior in neonates born to HIV-positive mothers

A systematic review and multivariate meta-analysis of the physical and mental health benefits of touch interventions

Receiving touch is of critical importance, as many studies have shown that touch promotes mental and physical well-being. We conducted a pre-registered (PROSPERO: CRD42022304281) systematic review and multilevel meta-analysis encompassing 137 studies in the meta-analysis and 75 additional studies in the systematic review (n = 12,966 individuals, search via Google Scholar, PubMed and Web of Science until 1 October 2022) to identify critical factors moderating touch intervention efficacy. Included studies always featured a touch versus no touch control intervention with diverse health outcomes as dependent variables. Risk of bias was assessed via small study, randomization, sequencing, performance and attrition bias. Touch interventions were especially effective in regulating cortisol levels (Hedges' g = 0.78, 95% confidence interval (CI) 0.24 to 1.31) and increasing weight (0.65, 95% CI 0.37 to 0.94) in newborns as well as in reducing pain (0.69, 95% CI 0.48 to 0.89), feelings of depression (0.59, 95% CI 0.40 to 0.78) and state (0.64, 95% CI 0.44 to 0.84) or trait anxiety (0.59, 95% CI 0.40 to 0.77) for adults. Comparing touch interventions involving objects or robots resulted in similar physical (0.56, 95% CI 0.24 to 0.88 versus 0.51, 95% CI 0.38 to 0.64) but lower mental health benefits (0.34, 95% CI 0.19 to 0.49 versus 0.58, 95% CI 0.43 to 0.73). Adult clinical cohorts profited more strongly in mental health domains compared with healthy individuals (0.63, 95% CI 0.46 to 0.80 versus 0.37, 95% CI 0.20 to 0.55). We found no difference in health benefits in adults when comparing touch applied by a familiar person or a health care professional (0.51, 95% CI 0.29 to 0.73 versus 0.50, 95% CI 0.38 to 0.61), but parental touch was more beneficial in newborns (0.69, 95% CI 0.50 to 0.88 versus 0.39, 95% CI 0.18 to 0.61). Small but significant small study bias and the impossibility to blind experimental conditions need to be considered. Leveraging factors that influence touch intervention efficacy will help maximize the benefits of future interventions and focus research in this field.

The effect of M technique massage on behavioral state and weight gain in preterm neonates: A randomized controlled trial

This study aimed to investigate the effect of M technique massage on behavioral state and weight gain in preterm neonates admitted to neonatal intensive care unit (NICU). This was a randomized controlled trial study in which a total of 64 preterm neonates were randomly allocated to intervention and control group. Intervention group received M technique massage and control group received routine care. Neonatal weight and behavioral state were measured for two weeks. After intervention, no statistically significant difference was found between groups in terms of neonatal weight (mean difference: 44.03, 95% CI [-180.66, 268.74]). At baseline, the mean score for behavioral state response was 5.84 ± 2.20 (mean ± SD) in control group and 5.68 ± 2.15 (mean ± SD) in intervention group and the difference was not significant (mean difference: 0.16, 95% CI [-1.21, 1.52]), but 2 weeks later, and also, after intervention, a statistically significant difference was found between groups (mean difference: 2.16, 95% CI [1.19, 3.17]) and (mean difference: 3.03, 95% CI [2.15, 3.91]), respectively, meaning that it was significantly lower in intervention group compared with control group. According to the findings, massage with M technique in premature neonates can have a positive effect on behavioral state, but no effect on their weight gain.

Mental health of women living with HIV and its impact on child development in Andhra Pradesh, India

Global literature examining the association between mental health of women living with HIV (WLWH) and child development is scarce. In this study, we examined the relationship between mothers' mental health and their children's social development outcomes 6 months later. Data for these analyses come from several waves of interviews of 600 WLWH in the South Indian state of Andhra Pradesh, India. These women were enrolled in a 2×2 factorial clinical trial designed to assess the impact of food supplementation and nutrition education, both in addition to ASHA support, on adherence to ART and improved health outcomes for the women and one of their children. They were assessed on food security, stigma, social support, quality of life, depressive symptoms and child development outcomes. Results of longitudinal GEE regression analysis indicate that mother's depressive symptoms were significantly negatively associated with child's social quotient 6 months later. These findings have important implications for targeted health interventions, integrating mental health, both for WLWH and their children in India.

Six versus twelve weeks of Swedish massage therapy for generalized anxiety disorder: Preliminary findings

Acute treatment of Generalized Anxiety Disorder often requires 3 months or more of care in order to optimize response. As part of an exploratory grant we have previously demonstrated that six weeks of twice-weekly Swedish Massage Therapy (SMT) was more effective than an active control in decreasing Hamilton Anxiety Rating Scale Scores (HAM-A). An additional goal of this project was to determine if an additional six weeks of twice-weekly SMT led to greater clinical and statistical benefit. We found that HAM-A scores did continue to decrease with an additional six weeks of therapy but that the greatest benefit occurred during the first versus the second 12 sessions (-9.91 vs.-3.09, t = 2.21; df = 10; p = 0.052). These preliminary findings suggest that the majority of benefit in symptom reduction occurs in the first six weeks and that six weeks of twice-weekly SMT may be sufficient for the majority of patients.

The power of touch: external applications from whole medical systems in the care of cancer patients (literature review)

PURPOSE

In the context of whole medical systems (WMSs), external applications are manual treatments that stem from complementary medicine and are performed by practitioners, nurses and caregivers through the application of interpersonal touch. These applications work via physiological, psychological and social processes and are intended for holistic healing. In integrative oncology, these applications are used to improve patients' wellbeing. The purpose of the review is to collect and compare research results concerning external applications from WMSs applied to patients with cancer.

METHODS

We conducted a literature review to explore the effects of external applications on patients undergoing cancer treatment. Inclusion criteria were external applications from Anthroposophic Medicine, Traditional Chinese Medicine (TCM) and Ayurvedic Medicine, examined detached from the effect interdependencies of their respective WMSs.

RESULTS

Searches identified 111 publications. Final inclusions were four Shiatsu studies (from TCM), supplemented by two case reports exploring anthroposophic external applications. The literature review suggests that external applications may improve patients' wellbeing during cancer treatment and are associated with physical and psychological effects that potentially enhance supportive cancer care. The number and quality of published studies in the field is limited.

CONCLUSIONS

Future empirical investigations should assess the effectiveness and underlying effects in patients with cancer, adhere to a patient-tailored approach, and investigate the systemic complexity of touch-based applications from WMSs.

Pediatric Massage Therapy Research: A Narrative Review

This narrative review on pediatric massage literature from the last decade suggests that massage therapy has positive effects on several pediatric conditions. These include preterm infant growth, psychological problems including aggression, gastrointestinal problems including constipation and diarrhea, painful conditions including burns and sickle cell, muscle tone disorders including cerebral palsy and Down syndrome, and chronic illnesses including diabetes, asthma cancer, and HIV. Potential underlying mechanisms for the massage therapy effects include increased vagal activity and decreased stress hormones. Limitations of the literature include the need for more randomized controlled trials, longitudinal studies, and underlying mechanism studies.

Interventions for developmental delays in children born to HIV-infected mothers: a systematic review

Children born to HIV-infected mothers have worse developmental outcomes compared to HIV-unexposed children. However, little is known about interventions to improve developmental outcomes in this population. This study systematically reviews the literature on interventions to improve development in children born to HIV-infected mothers. We systematically searched the following electronic bibliographic databases: Ovid MEDLINE, Embase, PsycINFO, Education Resources Information Center, and the Cochrane Database of Systematic Reviews. Studies were selected on the basis of defined inclusion criteria and excluded if antiretroviral medication was the only intervention. Titles, abstracts, and full texts were assessed by 2 independent reviewers. Data were collected on characteristics of the study design, intervention, and developmental outcomes measured. Risk of bias and strength of evidence were assessed on all included articles. Our search resulted in 11,218 records. After our initial review, 43 records were appraised in their entirety and 9 studies met all inclusion criteria. Six were performed in sub-Saharan Africa, while the remaining 3 were performed in the United States. Eight were randomized-controlled trials and one was a retrospective chart review. Four studies focused on caregiver-training, 2 studied massage therapy, and the remaining studies focused on maternal vitamin supplementation, video-based cognitive therapy, or center-based interventions. Massage therapy had the most consistent improvements in the domains measured, while caregiver training and cognitive therapy interventions had limited benefits. The center-based intervention showed no benefit. Only 3 studies had a low risk of bias, and 4 studies had good strength of evidence. Most studies found some benefit. However, these findings are limited by the quality of the study designs, small sample size, and heterogeneity of the interventions and assessments used to measure outcomes. There is a critical need for the creation of evidence-based interventions to promote development in this vulnerable population.

The effect of tactile-kinesthetic stimulation on growth indices of healthy neonates

Therapeutic touch is emphasized by healthcare professionals for improvement of neonates' growth and development. However, inconsistencies exist regarding effects and methods of massage in neonates. The purpose of this clinical trial is to assess and comprise intervention and control groups regarding the effects of tactile-kinesthetic stimulation (TKS) by mothers on growth indices of healthy term neonates. Sixty healthy term neonates were randomly assigned into intervention and control groups. Mothers of neonates in the experimental group were trained to perform TKS for their newborns at home before feeding for at least 28 consecutive days, two times a day, and 15 min each time. Neonates in the control group were not required to receive this intervention. The neonates' growth indices were measured within 24 h after birth, and then at days 14 and 28. During the study and the three consecutive measurements, no significant difference was found between the mean weights, heights, and head circumferences of the neonates in the two groups (p > 0.05).

Infant Massage and Quality of Early Mother-Infant Interactions: Are There Associations with Maternal Psychological Wellbeing, Marital Quality, and Social Support?

Infant massage programs have proved to be effective in enhancing post-natal development of highly risk infants, such as preterm newborns and drug or HIV exposed children. Less studies have focused on the role of infant massage in supporting the co-construction of early adult-child relationships. In line with this lack of literature, the present paper reports on a pilot study aimed at investigating longitudinally the quality of mother-child interactions, with specific reference to emotional availability (EA), in a group of mother-child pairs involved in infant massage classes. Moreover, associations between mother-child EA, maternal wellbeing, marital adjustment, and social support were also investigated, with the hypothesis to find a link between low maternal distress, high couple satisfaction and high perceived support and interactions of better quality in the dyads. The study involved 20 mothers and their children, aged between 2 and 7 months, who participated to infant massage classes. The assessment took place at three stages: at the beginning of massage course, at the end of it and at 1-month follow-up. At the first stage of assessment self-report questionnaires were administered to examine the presence of maternal psychiatric symptoms (SCL-90-R), perceived social support (MSPSS), and marital adjustment (Dyadic Adjustment Scale); dyadic interactions were observed and rated with the Emotional Availability Scales (Biringen, 2008) at each stage of data collection. The results showed a significant improvement in the quality of mother-child interactions, between the first and the last evaluation, parallel to the unfolding of the massage program, highlighting a general increase in maternal and child's EA. The presence of maternal psychological distress resulted associated with less optimal mother-child emotional exchanges, while the hypothesis regarding couple satisfaction and social support influence were not confirmed. These preliminary results, if replicated, seem to sustain the usefulness of infant massage and the importance of focusing on early mother-infant interactions.

Touch Therapy Effects on Development

In this review empirical data are presented on the use of touch therapy, specifically massage therapy for improving the clinical course of several conditions including growth and development of pre-term infants, reducing pain, increasing attentiveness, diminishing depression, and enhancing immune function. Potential underlying mechanisms for the massage therapy effects are proposed for each of these conditions. The general effect appears to derive from the stimulation of pressure receptors and the ensuing increase in vagal activity and slowing physiology which in turn facilitates a more relaxed behavioural state, effects a decrease in stress hormones, most particularly cortisol, and an increase in immune function, particularly natural killer cells.

Massage therapy improves the development of HIV-exposed infants living in a low socio-economic, peri-urban community of South Africa

The aim of this study was to assess the effect of massage therapy on the growth and development of infants of HIV-infected mothers in a low socio-economic community in Cape Town. It was a prospective, randomised, controlled intervention trial that included massage therapy and control groups of HIV-infected mothers and their normal birth weight infants who were enrolled in the prevention of mother-to-child transmission (PMTCT) programme. Participants were recruited at the 6-week clinic visit and followed up every 2 weeks until their infants were 9 months of age. Mother-infant pairs in the massage therapy and control groups included 73 and 88 at 6 weeks and 55 and 58 at 9 months, respectively. Mothers in the intervention group were trained to massage their infants for 15 min daily. The socioeconomic status, immunity, relationship with the partner and mental pain of mothers; the infants' dietary intake, anthropometry and development (Griffiths Mental Development Scales); and haematological and iron status of mothers and infants were assessed at baseline and follow-up. Nine infants (5.3%) were HIV-infected on the HIV DNA PCR test at 6 weeks. Despite significantly higher levels of maternal mental pain, infants in the massage therapy compared to control group scored higher in all five of the Griffiths Scales of Mental Development and significantly higher in the mean quotient (p=0.002) and mean percentile (p=0.004) for the hearing and speech scale at 9 months. Based on the mean difference in scores, the massage therapy group showed greater improvement for all five scales compared to the control group. The mean difference in scores was significantly greater for the hearing and speech quotient (21.9 vs. 11.2) (p<0.03) and the general quotient percentile (19.3 vs. 7.7) (p=0.03) in the massage therapy compared to the control group. These scales remained significant when adjusting for the relationship with the partner and maternal mental pain. Both groups had lower scores in the performance scale at 9 months although this was significantly worse in the control compared to the massage therapy group when adjusting for maternal CD4 count, anaemia, relationship with the partner and mental pain. There were no significant differences in the anthropometric measurements between the two groups. In conclusion, based on the Griffiths Scales, massage therapy improved the overall development and had a significant effect on the hearing and speech and general quotient of HIV-exposed infants in this study.

Learning and adherence to baby massage after two teaching strategies

PURPOSE

Little is known about learning/adherence after different baby massage teaching strategies. We compared the learning/adherence after two strategies.

DESIGN AND METHODS

Twenty mothers from the group manual-course (GMC) and 20 from the group manual-orientations (GMO) received a booklet. GMC participated in a course during the third trimester. GMO received verbal instructions during the postpartum hospital stay. Multiple-choice and practical tests assessed learning (GMC: performing strokes on a doll; GMO: on the baby). Adherence was measured 3 months after childbirth.

RESULTS

No differences were found between the groups in learning/adherence.

PRACTICE IMPLICATIONS

Both teaching strategies showed similar and positive results.

Systematic review of heath care interventions to improve outcomes for women with disability and their family during pregnancy, birth and postnatal period

BACKGROUND

Health care providers are often unfamiliar with the needs of women with disability. Moreover maternity and postnatal services may not be specifically tailored to the needs of women with disability and their families. We conducted a systematic review to determine the effectiveness of healthcare interventions to improve outcomes for pregnant and postnatal women with disability and for their families.

METHODS

Studies on pregnant and postnatal women with disability and their families which evaluated the effectiveness of an intervention using a design that met the criteria used by the Cochrane Effective Practice and Organization of Care group were eligible for inclusion in this review. A comprehensive search strategy was carried using eleven electronic databases. No restriction on date or language was applied. Included studies were assessed for quality and their results summarized and tabulated.

RESULTS

Only three studies fully met the inclusion criteria. All were published after 1990, and conducted as small single-centre randomized controlled trials. The studies were heterogeneous and not comparable. Therefore the main finding of this review was the lack of published research on the effectiveness of healthcare interventions to improve outcomes for pregnant women with disability and their families.

CONCLUSIONS

More research is required to evaluate healthcare interventions to improve outcomes for pregnant women with disability and their families.

Benefits of massage therapy for infants with symptoms of gastroesophageal reflux disease

OBJECTIVES

This randomized controlled pilot trial was conducted to evaluate the clinical efficacy of massage therapy (MT) for relief of symptoms of gastroesophageal reflux disease (GERD). The hypothesis was that, when compared to infants who received nonmassage therapy, infants who received MT would display fewer GERD symptoms, greater weight gain, greater amount of sleep, lower cortisol levels before and after treatment, and lower daily (area under the curve [AUC]) cortisol secretion.

METHODS

Participants were 36 infants born at term, 4-10 weeks of age at enrollment, healthy except for a diagnosis of GERD by their pediatrician, and with a score of at least 16 on the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R). Infants were randomized to receive either MT or a nonmassage sham treatment in their homes for 30 min twice a week for 6 weeks. Data collectors and parents were blind to study condition.

RESULTS

GERD symptoms decreased in both groups and weight increased. Pretreatment salivary cortisol levels decreased significantly over time in the massage group while increasing in the nonmassage group. Daily cortisol level also decreased in the massage group and increased in the nonmassage group, but the difference was not significant.

CONCLUSIONS

MT administered by a professional therapist did not affect symptoms of GERD differently than a sham treatment but did decrease infant stress as measured by cortisol. Research focusing on stress reduction in infants with GERD and multimodal treatments addressing GERD symptoms may yield the most effective treatment.

Complementary therapy provision in a London community clinic for people living with HIV/AIDS: a case study

AIM

To present a case study of complementary therapy (CT) provision within a community HIV multi-agency service in a Northwest London deprived area.

METHODS

Anonymised routine service data were provided for all clients (n = 1030) August 2010 to October 2012. Face-to-face meetings provided feedback from volunteers (9 CT-using clients and 9 staff).

RESULTS

CT-users were demographically similar to other clients. Support for coping with HIV was commonly cited as a service benefit. Over 26 months 1416 CT sessions were provided; 875 aromatherapy and 471 shiatsu. CT-users' most common concerns were pain (48%), stress (15%) and insomnia (13%), few had heard of or used CT before. Perceived mental and emotional benefits included relaxation,stress relief, relieving musculoskeletal aches and pains. Service challenges included time and funding, though staff felt CT may be cost-effective.

CONCLUSIONS

CT may provide important support and treatment options for HIV disease, but cost effectiveness requires further evaluation.

Massage for promoting mental and physical health in typically developing infants under the age of six months

BACKGROUND

Infant massage is increasingly being used in the community with babies and their primary caregivers. Anecdotal reports suggest benefits for sleep, respiration and elimination, the reduction of colic and wind, and improved growth. Infant massage is also thought to reduce infant stress and promote positive parent-infant interaction.

OBJECTIVES

The aim of this review was to assess whether infant massage is effective in promoting infant physical and mental health in low-risk, population samples.

SEARCH METHODS

Relevant studies were identified by searching the following electronic databases up to June 2011: CENTRAL; MEDLINE; EMBASE; CINAHL; PsycINFO; Maternity and Infant Care; LILACS; WorldCat (dissertations); ClinicalTrials.gov; China Masters' Theses; China Academic Journals; China Doctoral Dissertations; China Proceedings of Conference. We also searched the reference lists of relevant studies and reviews.

SELECTION CRITERIA

We included studies that randomised healthy parent-infant dyads (where the infant was under the age of six months) to an infant massage group or a 'no-treatment' control group. Studies had to have used a standardised outcome measure of infant mental or physical development.

DATA COLLECTION AND ANALYSIS

Mean differences (MD) and standardised mean differences (SMD) and 95% confidence intervals (CIs) are presented. Where appropriate, the results have been combined in a meta-analysis using a random-effects model.

MAIN RESULTS

We included 34 studies, which includes one that was a follow-up study and 20 that were rated as being at high risk of bias.We conducted 14 meta-analyses assessing physical outcomes post-intervention. Nine meta-analyses showed significant findings favouring the intervention group for weight (MD -965.25 g; 95% CI -1360.52 to -569.98), length (MD -1.30 cm; 95% CI -1.60 to -1.00), head circumference (MD -0.81 cm; 95% CI -1.18 to -0.45), arm circumference (MD -0.47 cm; 95% CI -0.80 to -0.13), leg circumference (MD -0.31 cm; 95% CI -0.49 to -0.13), 24-hour sleep duration (MD -0.91 hr; 95% CI -1.51 to -0.30), time spent crying/fussing (MD -0.36; 95% CI -0.52 to -0.19), deceased levels of blood bilirubin (MD -38.11 mmol/L; 95% CI -50.61 to -25.61), and there were fewer cases of diarrhoea, RR 0.39; 95% CI 0.20 to 0.76). Non-significant results were obtained for cortisol levels, mean increase in duration of night sleep, mean increase in 24-hour sleep and for number of cases of upper respiratory tract disease and anaemia.Sensitivity analyses were conducted for weight, length and head circumference, and only the finding for length remained significant following removal of studies judged to be at high risk of bias. These three outcomes were the only ones that could also be meta-analysed at follow-up; although both weight and head circumference continued to be significant at 6-month follow-up, these findings were obtained from studies conducted in Eastern countries only. No sensitivity analyses were possible.We conducted 18 meta-analyses measuring aspects of mental health and development. A significant effect favouring the intervention group was found for gross motor skills (SMD -0.44; 95% CI -0.70 to -0.18), fine motor skills (SMD -0.61; 95% CI -0.87 to -0.35), personal and social behaviour (SMD -0.90; 95% CI -1.61 to -0.18) and psychomotor development (SMD -0.35; 95% CI -0.54 to -0.15); although the first three findings were obtained from only two studies, one of which was rated as being at high risk of bias, and the finding for psychomotor development was not maintained following following removal of studies judged to be at high risk of bias in a sensitivity analysis. No significant differences were found for a range of aspects of infant temperament, parent-infant interaction and mental development. Only parent-infant interaction could be meta-analysed at follow-up, and the result was again not significant.

AUTHORS' CONCLUSIONS

These findings do not currently support the use of infant massage with low-risk groups of parents and infants. Available evidence is of poor quality, and many studies do not address the biological plausibility of the outcomes being measured, or the mechanisms by which change might be achieved. Future research should focus on the impact of infant massage in higher-risk groups (for example, demographically and socially deprived parent-infant dyads), where there may be more potential for change.

Effects of infant massage on HIV-infected mothers and their infants

PURPOSE. To determine the feasibility of implementing an infant massage intervention and to evaluate the preliminary effects of infant massage on HIV-infected mothers and their infants. DESIGN AND METHODS. In this two-group, randomized controlled pilot study, intervention group mothers were taught to perform infant massage daily for 10 weeks. RESULTS. Infant massage training had a positive impact on maternal depression, parental distress, and infant growth along with facilitating more optimal parent-child interactions. PRACTICE IMPLICATIONS. Infant massage, a quick, easy, and inexpensive intervention, is feasible in a clinic setting and may benefit human immunodeficiency virus-infected mothers and their infants.

Infant massage in the NICU. Interview by Deb Discenza

MOTHERS OF BABIES IN THE NICU face a serious challenge: bonding with their infants despite doctors’ rounds, medical equipment, and requirements for minimal stimulation. When her infant becomes stable enough for touch, what can a mother do to provide comfort to her child? One approach is infant massage. There is much neonatal nurses can do to promote the connection between mother and child through infant massage. Infant Massage USA’s executive director, Linda Storm, discusses this approach and its benefits for baby and parent in the interview that follows.

Touch and massage for medically fragile infants

Research investigating the efficacy of infant massage has largely focused on premature and low birth weight infants. The majority of investigations have neglected highly acute patients in academic neonatal intensive care units (NICUs). The current study was developed with two aims: (Phase 1) to develop, implement and demonstrate the feasibility and safety of a parent-trained compassionate touch/massage program for infants with complex medical conditions and (Phase 2) to conduct a longitudinal randomized control trial (RCT) of hand containment/massage versus standard of care in a level III academic Center for Newborn and Infant Critical Care (CNICC). Certified infant massage instructors (CIMIs) taught parents to massage their hospitalized infants. Massage therapy and instruction were performed for seven consecutive days and health outcomes were collected for up to 1 month following treatment. Caregivers, nurses and certified infant massage therapists indicated moderate to high levels of satisfaction and feasibility with the implementation of hand containment/massage in a level III academic center CNICC. In addition, infant behavioral and physiological measures were within safe limits during the massage sessions. All caregivers participating in the massage group reported high levels of satisfaction 7 days into the intervention and at the 1-month follow-up with regards to their relationship with their infant, the massage program's impact on that relationship and the massage program. Due to unequal and small sample sizes, between group analyses (control versus massage) were not conducted. Descriptive infant characteristics of health outcomes are described. Preliminary data from this study indicates feasibility and safety of infant massage and satisfaction among the caregivers, CIMIs and the nurses in the CNICC. An important contribution from this study was the demonstration of the infants' safety based on physiological stability and no change in agitation/pain scores of the infants receiving massage. Massage in a tertiary urban academic NICU continues to be an area of needed study. Future studies examining infant health outcomes, such as weight gain, decreased length of hospitalization and caregiver-infant bonding, would provide greater insight into the impact of massage for medically fragile infants.

Improving hospital care for young children in the context of HIV/AIDS and poverty

Paediatric wards in South African government hospitals are occupied predominantly by children with HIV and AIDS-related illnesses. Although access to anti-retroviral treatment for adults is being scaled up, it is likely to be many years before South Africa achieves anywhere near universal access for children. Currently, most children living with HIV or AIDS are identified only when they become acutely or chronically ill and/or hospitalized, if at all. In the absence of treatment, the stress of caring for ill and hospitalized HIV-positive children often results in emotional withdrawal among both health professionals and caregivers. The demoralizing cycle of repeated admissions, treatment failure and death also affect the quality of the care given to HIV-negative children in over-burdened wards. This article describes the development of simple, low-cost and context-relevant interventions to improve the care environment for young hospitalized children within the context of the HIV/AIDS epidemic and poverty.

[Effectiveness of the application of therapeutic touch on weight, complications, and length of hospital stay in preterm newborns attended in a neonatal unit]

OBJECTIVE

To determine the effectiveness of therapeutic touch on weight, the presence of postnatal complications, and length of hospital stay in preterm newborns, as well as on parental satisfaction with the care provided.

METHOD

We performed an experimental study in the Neonatal Intensive Care Unit of the Virgen Macarena University Hospital in Seville (Spain). Seventy eight premature neonates were randomly assigned to one of the comparison groups (39 in the control group and 39 in the experimental group). The outcome variables of weight, length of hospital stay, the presence of complications, and parental satisfaction were evaluated. Control variables related to maternal socio-demographic and clinic characteristics were also measured. The intervention was based on the application of therapeutic touch.

RESULTS

The mean weight in grams was 1,867.80 (SD=149.72) in the experimental group and 1,860 (SD=181.92) in the control group (t=0.148; p=0.883). Length of hospital stay was 16.82 (SD=6.47) in the experimental group and 20.30 (SD=8.04) in the control group (t=2.100; p=0.039). Complications developed in 5.3% of the premature neonates in the experimental group and in 20% of those in the control group (chi(2)=3.78; p=0.049). The odds ratio for developing complications was 1.673 (CI 1.089-2.571).

CONCLUSIONS

The application of therapeutic touch reduces the length of hospital stay and the presence of complications. Nevertheless, further research in larger samples is required.

Dominican Children with HIV not Receiving Antiretrovirals: Massage Therapy Influences their Behavior and Development

Forty-eight children (M age = 4.8 years) infected with HIV/AIDS and living in the Dominican Republic were randomly assigned to a massage therapy or a play session control group. The children in the massage therapy group received two weekly 20-min massages for 12 weeks; the children in the control group participated in a play session (coloring, playing with blocks) for the same duration and length as the massage therapy group. Overall, the children in the massage therapy group improved in self-help abilities and communication, suggesting that massage therapy may enhance daily functioning for children with HIV/AIDS. Moreover, the HIV infected children who were six or older also showed a decrease in internalizing behaviors; specifically depressive/anxious behaviors and negative thoughts were reduced. Additionally, baseline assessments revealed IQ equivalence below normal functioning for 70% of the HIV infected children and very high incidences of mood problems (depression, withdrawn) for 40% of the children and anxiety problems for 20% of the children, suggesting the need for better monitoring and alternative interventions in countries with limited resources to improve cognition and the mental health status of children infected with HIV/AIDS.

Evidence-based kernels: fundamental units of behavioral influence

This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior-influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior.

Energy expenditure in growing preterm infants receiving massage therapy

OBJECTIVE

Massage therapy has been consistently shown to increase weight gain in preterm infants. The mechanism of this presumed improved metabolic efficiency is unknown. We conducted the following trial to test the hypothesis that massage therapy reduces energy expenditure in growing healthy preterm infants.

STUDY DESIGN

A prospective, randomized, cross-over design study was conducted in 10 healthy, appropriate weights for gestational age, gavage fed preterm infants. Each infant was studied twice: after a period of either 5 days of massage therapy, or after a period of 5 days without massage therapy. Infants were randomized to 5 days of massage followed by 5 days of no massage (n = 5) or the opposite sequence (n = 5). During the massage therapy period, massage was provided daily for three 15 minute periods at the beginning of each 3 hour period every morning. Metabolic measurements were performed by indirect calorimetry, using the Deltatrac II Metabolic cart.

RESULTS

Energy expenditure was significantly lower in infants after the 5 day massage therapy period (59.6 +/- 3.6 Kcal/Kg/ 24 hours) than after the period without (63.1 +/- 5.4 Kcal/Kg/ 24 hours) (p = 0.05).

CONCLUSIONS

Energy expenditure is significantly lowered by 5 days of massage therapy in metabolically and thermally stable preterm infants. This decrease in energy expenditure may be in part responsible for the enhanced growth caused by massage therapy.

Pediatric massage therapy: an overview for clinicians

Pediatric massage therapy (MT), similar to its younger counterpart infant massage, has a limited number of rigorous studies supporting its clinical application and associated effects. However, clinicians and researchers have been intrigued by the potential benefits of pediatric MT for improving psychological and physiologic states in children who have various health conditions. This article provides a broad overview of pediatric MT, including proven and promising effects of MT across disease-specific clinical applications, contraindications, safety, context and availability of services, and future directions. Computerized databases were searched for relevant studies, including prior reviews, primary case studies, and randomized controlled trials of infant and pediatric MT. Current findings provide varying levels of evidence for the benefits of pediatric MT in children who have diverse medical conditions; however, anxiety reduction has shown the strongest effect. Future studies should use rigorous study design and methodology, with long-term follow-up, for examining the longitudinal effects of pediatric MT.

A novel clinical-trial design for the study of massage therapy

OBJECTIVES

To develop and test the feasibility and acceptability of a structured design for a massage therapy clinical trial that included a treatment arm designed to control for the non-specific effects of a massage therapy intervention.

DESIGN

Pilot randomized controlled clinical trial.

SETTING

University-integrated medicine research clinic.

INTERVENTIONS

Participants were randomized to a structured Swedish-style massage therapy intervention, a light-touch bodywork control intervention, or usual medical care. Details of the interventions are provided.

MAIN OUTCOME MEASURES

The primary outcome measures were the adherence of the participants to the study protocol and the perception of the intervention experience.

RESULTS

Forty-four participants were randomized. Participants often found adherence to the twice-weekly outpatient bodywork interventions to be somewhat difficult; while, overall, 84% of participants completed the study, only 76% of those in an intervention arm successfully completed the trial. Participants randomized to the massage arm expressed uniformly positive attitudes both before and after the intervention. While some participants randomized to the light-touch bodywork arm initially expressed some reservations about their randomization assignment, all participants available for interview were pleased with their experience after the intervention period.

CONCLUSIONS

The proposed design was found to be relatively straightforward to implement and acceptable to participants. Early disappointment with not receiving massage therapy expressed by the light-touch intervention participants dissipated quickly. Twice-weekly outpatient intervention appointments were found to be highly burdensome for many patients actively undergoing chemotherapy, thus reducing adherence.

Massage intervention for promoting mental and physical health in infants aged under six months

BACKGROUND

Infant massage is increasingly being used in the community for low-risk babies and their primary care givers. Anecdotal claims suggest benefits for sleep, respiration, elimination and the reduction of colic and wind. Infant massage is also thought to reduce infant stress and promote positive parent-infant interaction.

OBJECTIVES

The aim of this review was to assess the effectiveness of infant massage in promoting infant physical and mental health in population samples.

SEARCH STRATEGY

Searches were undertaken of CENTRAL 2005 (Issue 3), MEDLINE (1970 to 2005), PsycINFO (1970 to 2005), CINAHL (1982 to 2005), EMBASE (1980 to 2005), and a number of other Western and Chinese databases.

SELECTION CRITERIA

Studies in which babies under the age of six months were randomised to an infant massage or a no-treatment control group, and utilising a standardised outcome measuring infant mental or physical development.

DATA COLLECTION AND ANALYSIS

Weighted and standardised mean differences and 95% confidence intervals are presented. Where appropriate the results have been combined in a meta-analysis using a random effects model.

MAIN RESULTS

Twenty-three studies were included in the review. One was a follow-up study and thirteen were included in a separate analysis due to concerns about the uniformly significant results and the lack of dropout. The results of nine studies providing primary data suggest that infant massage has no effect on growth, but provides some evidence suggestive of improved mother-infant interaction, sleep and relaxation, reduced crying and a beneficial impact on a number of hormones controlling stress. Results showing a significant impact on number of illnesses and clinic visits were limited to a study of Korean orphanage infants. There was no evidence of effects on cognitive and behavioural outcomes, infant attachment or temperament. The data from the 13 studies regarded to be at high risk of bias show uniformly significant benefits on growth, sleep, crying and bilirubin levels.

AUTHORS' CONCLUSIONS

The only evidence of a significant impact of massage on growth was obtained from a group of studies regarded to be at high risk of bias. There was, however, some evidence of benefits on mother-infant interaction, sleeping and crying, and on hormones influencing stress levels. In the absence of evidence of harm, these findings may be sufficient to support the use of infant massage in the community, particularly in contexts where infant stimulation is poor. Further research is needed, however, before it will be possible to recommend universal provision.

Implications of Timing of Maternal Depressive Symptoms for Early Cognitive and Language Development

: Statistically, women, particularly pregnant women and new mothers, are at heightened risk for depression. The present review describes the current state of the research linking maternal depressed mood and children's cognitive and language development. Exposure to maternal depressive symptoms, whether during the prenatal period, postpartum period, or chronically, has been found to increase children's risk for later cognitive and language difficulties. The present review considers both the timing of maternal depression and the chronicity of mothers' depression on children's risk for cognitive and language delays. Infancy is frequently identified as a sensitive period in which environmental stimulation has the potential to substantially influence children's cognitive and language development. However, children's exposure to chronic maternal depression seems to be associated with more problematic outcomes for children, perhaps because depression interferes with mothers' ability to respond sensitively and consistently over time. Consistent with this expectation, interventions targeting parenting practices of depressed mothers have been found to increase children's cognitive competence during early childhood. The current review provides a synthesis of the current state of the field regarding the association between maternal depression and children's cognitive and language development during early childhood.

Use of Complementary and Alternative Medicine in Pediatric Pain Management Service: A Survey: Table 1

OBJECTIVE

To survey the use of complementary and alternative medical therapies by pediatric pain management services affiliated with major universities.

DESIGN

A telephone survey was conducted of pediatric anesthesia training programs accredited by the Accreditation Council for Graduate Medical Education in the United States. The survey instrument included questions on the provision of complementary and alternative medical therapies in their pediatric pain programs.

RESULTS

Forty-three pediatric anesthesia fellowship programs (100%) responded to the survey. Thirty-eight institutions (86%) offered one or more complementary and alternative medical therapies for their patients. Those therapies included biofeedback (65%), guided imagery (49%), relaxation therapy (33%), massage (35%), hypnosis (44%), acupuncture (33%), art therapy (21%), and meditation (21%).

CONCLUSIONS

This report documents trends in complementary and alternative medical therapies usage in the tertiary pediatric pain management service. There is a high prevalence in the integration of complementary and alternative medical therapies in pediatric pain management programs. Additional clinical research in the safety and efficacy in complementary and alternative medical therapies for pediatric pain management is urgently needed.

Association of complementary and alternative medicines with HIV clinical disease among a cohort of women living with HIV/AIDS

To assess the association between the use of complementary and alternative medicine (CAM) and HIV clinical disease indicators, CD4+ T-cell counts, viral load, number of HIV-related infections, Centers for Disease Control and Prevention categories, and Karnofsky scores. Data were collected from 391 HIV-positive women aged 18 to 50 years in Alabama and Georgia. A survey examining CAM use and other sociodemographic variables was used. Multiple logistic regression analyses were used to identify predictors of CAM use. Approximately 60% of study participants used 1 or more type of CAM. Predictors of CAM use included higher educational level (odds ratio [OR] = 2.4; P = 0.0008), absence of health insurance (OR = 0.49; P = 0.0055), longer disease duration (OR = 2.21; P = 0.0006), and higher number of infections (OR = 0.58; P = 0.017). Vitamins were the most commonly used CAM ( approximately 36%). Sociodemographic variables associated with vitamin use included higher educational level (OR = 2.34; P = 0.0055), longer disease duration (OR = 1.87; P = 0.026), and higher use among white women than among African-American women (OR = 0.41; P = 0.017). The use of CAM is prevalent among HIV-positive women, and vitamins are the most commonly used CAM among our study population. Several sociodemographic and clinical factors predicted CAM use. These findings have implications for improvement of care for HIV-positive women.

Massage for promoting growth and development of preterm and/or low birth-weight infants

BACKGROUND

It has been argued that infants in Neonatal Intensive Care Units are subject both to a highly stressful environment - continuous, high-intensity noise and bright light - and to a lack of the tactile stimulation that they would otherwise experience in the womb or in general mothering care. As massage seems to both decrease stress and provide tactile stimulation, it has been recommended as an intervention to promote growth and development of preterm and low-birth weight infants.

OBJECTIVES

To determine whether preterm and/or low birth-weight infants exposed to massage experience improved weight gain and earlier discharge compared to infants receiving standard care; to determine whether massage has any other beneficial or harmful effects on this population.

SEARCH STRATEGY

The following databases were searched: the specialized register of the Cochrane Neonatal Review Group and that of the Cochrane Complementary Medicine Field. Searches were also undertaken of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2003), MEDLINE, EMBASE, Psychlit, CINAHL and Dissertation Abstracts International (up to July 1, 2003). Further references were obtained by citation tracking, checking personal files and by correspondence with appropriate experts. Data provided in published reports was supplemented by information obtained by correspondence with authors. There were no language restrictions.

SELECTION CRITERIA

Randomised trials in which infants with gestational age at birth <37 weeks or weight at birth <2500g received systematic tactile stimulation by human hands. At least one outcome assessing weight gain, length of stay, behaviour or development must be reported.

DATA COLLECTION AND ANALYSIS

Data extracted from each trial were baseline characteristics of sample, weight gain, length of stay and behavioural and developmental outcomes. Physiological and biochemical outcomes were not recorded. Data were extracted by three reviewers independently. Statistical analysis was conducted using the standard Cochrane Collaboration methods.

MAIN RESULTS

Massage interventions improved daily weight gain by 5.1g (95% CI 3.5, 6.7g). There is no evidence that gentle, still touch is of benefit (increase in daily weight gain 0.2g; 95% CI -1.2, 1.6g). Massage interventions also appeared to reduce length of stay by 4.5 days (95% CI 2.4, 6.5) though there are methodological concerns about the blinding of this outcome. There was also some evidence that massage interventions have a slight, positive effect on postnatal complications and weight at 4 - 6 months. However, serious concerns about the methodological quality of the included studies, particularly with respect to selective reporting of outcomes, weaken credibility in these findings.

REVIEWERS' CONCLUSIONS

Evidence that massage for preterm infants is of benefit for developmental outcomes is weak and does not warrant wider use of preterm infant massage. Where massage is currently provided by nurses, consideration should be given as to whether this is a cost-effective use of time. Future research should assess the effects of massage interventions on clinical outcome measures, such as medical complications or length of stay, and on process-of-care outcomes, such as care-giver or parental satisfaction.

Preterm infant massage therapy studies: an American approach

Preterm infants have been noted to benefit from massage therapy. Following massage therapy protocols using moderate pressure preterm infants have gained 31-49% more weight on average. Some studies have also shown length and head circumference growth and bone mineral density increases associated with massage therapy. These studies are reviewed in this paper along with discussion of potential underlying mechanisms.

Infant massage as a component of developmental care: past, present, and future

Infant massage has been practiced for centuries by segments on the continents of Africa and South America and in the Far East. Infant massage is a relatively new modality in North America. Numerous studies support its use in preterm infants, who have exhibited decreased stress levels, increased weight gain, and improved motor function when compared with non-massaged controls. Research has recently turned to the benefits of massage in the cocaine-exposed population and in those with human immunodeficiency virus. Massage in ill preterms has been targeted for clinical testing.

Massage therapy by mothers and trained professionals enhances weight gain in preterm infants

BACKGROUND

The method of "massage therapy" has consistently shown increased weight gain in preterm infants. The weight gain was apparent during massages administered by professionals.

AIMS

To replicate the results of increased weight gain in the course of "massage therapy" in preterm infants, and utilize a new, cost-effective application of this method by comparing maternal to nonmaternal administration of the therapy.

STUDY DESIGN

Random cluster design.

SUBJECTS

The study comprised 57 healthy, preterm infants assigned to three groups: two treatment groups--one in which the mothers performed the massage, and the other in which a professional female figure unrelated to the infant administered the treatment. Both these groups were compared to a control group.

RESULTS

Over the 10-day study period, the two treatment groups gained significantly more weight compared to the control group (291.3 and 311.3 vs. 225.5 g, respectively). Calorie intake/kg did not differ between groups.

CONCLUSIONS

Mothers are able to achieve the same effect size as that of trained professionals, allowing cost-effective application of the treatment within the neonatal intensive care unit.

Complementary and alternative medicine for children: does it work?

Paediatric use of complementary and alternative medicine is common and increasing, particularly for the sickest children. This review discusses the various options available including dietary supplements, hypnosis, massage, chiropractic, and acupuncture.

Alternative and Complementary Therapies in Nursing Curricula

The growing interest in and use of alternative and complementary therapies by health care professionals and laypersons, the incorporation of these therapies in medical curricula and practice, and the greater acceptance of the legitimacy of such treatment methods require that nurse educators consider how this content may be incorporated into curricula. The authors propose that prelicensure students learn the premises that support such healing practices and develop skill in eliciting and evaluating patients' use of alternative therapies. In-depth study of one or more complementary therapies may be the focus of continuing education or elective courses. Students in graduate programs may investigate the safety and efficacy of nonorthodox therapies.

A case study of infant massage outcomes

This article describes a case study of infant massage for a neonate in a neonatal intensive care unit (NICU). Infant massage is grounded in the theory of touch. In an NICU, the infant's tactile experiences can be uncomfortable or painful. This can lead to touch aversion. It is possible that providing pleasurable touch experiences through infant massage can help to develop touch acceptance. It is important to first assess the infant's readiness for massage according to his or her need and response. Infant massage as a complementary therapy in the NICU is demonstrated here in a photo-study of "Nicholas." The initial uncertainty and gradual acceptance by Nicholas of the massage experience is clearly depicted. At the end of the massage, Nicholas was relaxed and asleep in a semi-fetal position. The behavioral change in this infant indicates that he made a transition from touch aversion to touch acceptance.

The self as healer: reflections from a nurse's journey

Complementary and alternative medicine is rapidly making its way into the mainstream through the addition of a variety of therapies in existing settings. Yet, in national surveys, the public seems interested not only in alternative therapies, but also in a more holistic form of healthcare. Nurses have a critical role to play in creating such a healthcare system. Recovering their own identity as healers is a first step in that direction. This article explores the topic of the self as healer through four key questions: what is healing, who or what is the locus of healing, how can nurses facilitate healing, and how does one become a healer?

Massage for promoting growth and development of preterm and/or low birth-weight infants

BACKGROUND

It has been argued that infants in Neonatal Intensive Care Units are subject both to a highly stressful environment - continuous, high-intensity noise and bright light - and to a lack of the tactile stimulation that they would otherwise experience in the womb or in general mothering care. As massage seems to both decrease stress and provide tactile stimulation, it has been recommended as an intervention to promote growth and development of preterm and low-birth weight infants.

OBJECTIVES

To determine whether preterm and / or low birth-weight infants exposed to massage experience improved weight gain and earlier discharge compared to infants receiving standard care; to determine whether massage has any other beneficial or harmful effects on this population.

SEARCH STRATEGY

Databases were searched using the term 'massage', 'touch' or 'tactile stimulation' with 'infant - newborn', 'infant - premature' and 'infant - low birth weight'. The main databases searched were those of the Cochrane Collaboration Field in Complementary Medicine and the Neonatal Collaborative Review Group.

SELECTION CRITERIA

Randomised trials in which infants with gestational age at birth < 37 weeks or weight at birth < 2500g received systematic tactile stimulation by human hands. At least one outcome assessing weight gain, length of stay, behaviour or development must be reported.

DATA COLLECTION AND ANALYSIS

Data extracted from each trial were baseline characteristics of sample, weight gain, length of stay and behavioural and developmental outcomes. Physiological and biochemical outcomes were not recorded. Data were extracted by three reviewers independently. Statistical analysis was conducted using the standard Cochrane Collaboration methods.

MAIN RESULTS

Massage interventions improved daily weight gain by 5g (95% CI 3.5, 6.7g). There is no evidence that gentle, still touch is of benefit (increase in daily weight gain -0.2g; 95% CI -2.4, 1.9g). Massage interventions also appeared to reduce length of stay by 4.6 days (95% CI 2.6, 6.6) though there are methodological concerns about the blinding of this outcome. There was also some evidence that massage interventions have a slight, positive effect on postnatal complications and weight at 4 - 6 months. However, serious concerns about the methodological quality of the included studies, particularly with respect to selective reporting of outcomes, weaken credibility in these findings.

REVIEWER'S CONCLUSIONS

Evidence that massage for preterm infants is of benefit for developmental outcomes is weak and does not warrant wider use of preterm infant massage. Where massage is currently provided by nurses, consideration should be given as to whether this is a cost-effective use of time. Future research should assess the effects of massage interventions on clinical outcome measures, such as medical complications or length of stay, and on process-of-care outcomes, such as care-giver or parental satisfaction.