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Guideline Summary
Guideline Title
Best evidence statement (BESt). Cystic fibrosis - effects of massage therapy on quality of life.
Bibliographic Source(s)
Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Cystic fibrosis - effects of massage therapy on quality of life. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2009 May 8. 6 p. [11 references]
Guideline Status

This is the current release of the guideline.

Scope

Disease/Condition(s)

Cystic fibrosis

Guideline Category
Assessment of Therapeutic Effectiveness
Management
Treatment
Clinical Specialty
Family Practice
Internal Medicine
Pediatrics
Physical Medicine and Rehabilitation
Pulmonary Medicine
Intended Users
Advanced Practice Nurses
Nurses
Physical Therapists
Physician Assistants
Physicians
Respiratory Care Practitioners
Guideline Objective(s)

To evaluate the effect of massage therapy on improving quality of life in youth with cystic fibrosis aged 8 to 18

Target Population

Youth ages 8 to 18 years with cystic fibrosis

Interventions and Practices Considered

Massage therapy

Note: Massage therapy is defined as hands on manipulation of the soft tissue of the body with the intent to produce therapeutic, physiologic effects and to promote health and well being.

Major Outcomes Considered
  • Quality of life
    • Pulmonary function
    • Oxygen saturation
    • Anxiety
    • Pain
  • Massage protocols

Methodology

Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

Databases

  • OVID MEDLINE
  • OVID EBM Reviews - Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, NHSEED
  • EBM Reviews Full Text – Cochrane DSR, ACP Journal Club, and DARE
  • EBSCO medline, Biomedical Reference Collection, CINAHL, Nursing & Allied Health, Psychology and Behavioral Sciences, PsycINFO, PsycARTICLES, Cochrane Database of Systematic Reviews
  • PubMed Clinical Queries
  • NACHRI List serve
    • Inquiry regarding working with youth with Cystic Fibrosis.  Are you providing massage therapy to youth with Cystic Fibrosis?  If yes, what have you found regarding the effects of massage therapy in youth with Cystic Fibrosis, especially related to quality of life?

Search Terms

  • Massage and cystic fibrosis (and quality of life)
  • Massage and asthma (and quality of life), massage and lung and quality of life

Limits and Filters

None

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence

Table of Evidence Levels

Quality Level Definition
1a or 1b Systematic review, meta-analysis, or meta-synthesis of multiple studies
2a or 2b Best study design for domain
3a or 3b Fair study design for domain
4a or 4b Weak study design for domain
5 Other: general review, expert opinion, case report, consensus report, or guideline

a = good quality study; b = lesser quality study

Methods Used to Analyze the Evidence
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

Not stated

Rating Scheme for the Strength of the Recommendations

Table of Recommendation Strength

Strength Definition
"Strongly recommended" There is consensus that benefits clearly outweigh risks and burdens (or vice versa for negative recommendations).
"Recommended" There is consensus that benefits are closely balanced with risks and burdens.
No recommendation made There is a lack of consensus to direct development of a recommendation.
Dimensions: In determining the strength of a recommendation, the development group makes a considered judgment in a consensus process that incorporates critically appraised evidence, clinical experience, and other dimensions as listed below.
  1. Grade of the Body of Evidence
  2. Safety/Harm
  3. Health benefit to the patients (direct benefit)
  4. Burden to patient of adherence to recommendation (cost, hassle, discomfort, pain, motivation, ability to adhere, time)
  5. Cost-effectiveness to healthcare system (balance of cost/savings of resources, staff time, and supplies based on published studies or onsite analysis)
  6. Directness (the extent to which the body of evidence directly answers the clinical question [population/problem, intervention, comparison, outcome])
  7. Impact on morbidity/mortality or quality of life
Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation

Not stated

Recommendations

Major Recommendations

The strength of the recommendation (strongly recommended, recommended, or no recommendation) and the quality of the evidence (1a‒5) are defined at the end of the "Major Recommendations" field.

  1. It is recommended that massage therapy be used in youth with cystic fibrosis (CF) based on findings outlined in the Table in the original guideline document (Hernandez-Reif et al., 1999 [2a]; Field et al., 1998 [2b]; Robertson et al., 1984 [2b]; Witt & MacKinnon, 1986 [4a]; Lee et al., 2009 [4b]; McQueen, Button, & Heathcote, 2003 [4b]; Beeken et al., 1998 [4b]).

    Note: There is insufficient evidence to recommend any specific frequency, type, or duration of massage therapy over another. Higher-level evidence reported that parent-administered massage resulted in decreased child and parent anxiety with improved child mood and peak airflow (Hernandez-Reif et al., 1999 [2a]) and decreased anxiety with improved breathing (Field et al, 1998 [2b]). The remaining studies included adults with CF, asthma or other chronic lung disease. All but one (Robertson et al., 1984 [2b]) reported positive findings related to the benefits of massage on improving quality of life (as defined above).

  2. It is recommended that further research be done on the effects of massage therapy on improving quality of life in youth with CF (using a valid and reliable quality of life tool) (Local Consensus [5]).

Definitions:

Table of Evidence Levels

Quality Level Definition
1a or 1b Systematic review, meta-analysis, or meta-synthesis of multiple studies
2a or 2b Best study design for domain
3a or 3b Fair study design for domain
4a or 4b Weak study design for domain
5 Other: general review, expert opinion, case report, consensus report, or guideline

a = good quality study; b = lesser quality study

Table of Recommendation Strength

Strength Definition
"Strongly recommended" There is consensus that benefits clearly outweigh risks and burdens (or vice versa for negative recommendations).
"Recommended" There is consensus that benefits are closely balanced with risks and burdens.
No recommendation made There is a lack of consensus to direct development of a recommendation.
Dimensions: In determining the strength of a recommendation, the development group makes a considered judgment in a consensus process that incorporates critically appraised evidence, clinical experience, and other dimensions as listed below.
  1. Grade of the Body of Evidence
  2. Safety/Harm
  3. Health benefit to the patients (direct benefit)
  4. Burden to patient of adherence to recommendation (cost, hassle, discomfort, pain, motivation, ability to adhere, time)
  5. Cost-effectiveness to healthcare system (balance of cost/savings of resources, staff time, and supplies based on published studies or onsite analysis)
  6. Directness (the extent to which the body of evidence directly answers the clinical question [population/problem, intervention, comparison, outcome])
  7. Impact on morbidity/mortality or quality of life
Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

References Supporting the Recommendations
Type of Evidence Supporting the Recommendations

The type of evidence is classified for each recommendation (see "Major Recommendations").

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

The potential benefits of massage therapy on individuals with cystic fibrosis (CF) and other chronic pulmonary conditions include: decreased pain, muscle tightness, and anxiety; improved mood, breathing, pulmonary function, muscle strength, sleep, relaxation, energy, ability to perform activities of daily living, and improved overall sense of well being. 

Potential Harms

One study described mild discomfort from deep tissue work.

Qualifying Statements

Qualifying Statements

This Best Evidence Statement addresses only key points of care for the target population; it is not intended to be a comprehensive practice guideline. These recommendations result from review of literature and practices current at the time of their formulation. This Best Evidence Statement does not preclude using care modalities proven efficacious in studies published subsequent to the current revision of this document. This document is not intended to impose standards of care preventing selective variances from the recommendations to meet the specific and unique requirements of individual patients. Adherence to this Statement is voluntary. The clinician in light of the individual circumstances presented by the patient must make the ultimate judgment regarding the priority of any specific procedure.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Getting Better
Living with Illness
IOM Domain
Effectiveness
Patient-centeredness

Identifying Information and Availability

Bibliographic Source(s)
Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Cystic fibrosis - effects of massage therapy on quality of life. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2009 May 8. 6 p. [11 references]
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2009 May 8
Guideline Developer(s)
Cincinnati Children's Hospital Medical Center - Hospital/Medical Center
Source(s) of Funding

Cincinnati Children's Hospital Medical Center

Guideline Committee

Not stated

Composition of Group That Authored the Guideline

Group/Team Members: Kate Zink, MSN, RN, LMT, Team Leader, Point of Care Scholar Group; Barbie Giambra, MS, RN, CPNP

Financial Disclosures/Conflicts of Interest

Not stated

Guideline Status

This is the current release of the guideline.

Guideline Availability

Electronic copies: Available from the Cincinnati Children's Hospital Medical Center External Web Site Policy.

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

Availability of Companion Documents

The following are available:

  • Judging the strength of a recommendation. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2008 Jan. 1 p.
  • Grading a body of evidence to answer a clinical question. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 1 p.
  • Table of evidence levels. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2008 Feb 29. 1 p.

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI Institute on October 1, 2009.

Copyright Statement

This NGC summary is based on the original full-text guideline, which is subject to the following copyright restrictions:

Copies of Cincinnati Children's Hospital Medical Center (CCHMC) External Web Site Policy Best Evidence Statement (BESt) are available online and may be distributed by any organization for the global purpose of improving child health outcomes. Examples of approved uses of the BESt include the following:

  • Copies may be provided to anyone involved in the organization's process for developing and implementing evidence based care
  • Hyperlinks to the CCHMC website may be placed on the organization's website
  • The BESt may be adopted or adapted for use within the organization, provided that CCHMC receives appropriate attribution on all written or electronic documents
  • Copies may be provided to patients and the clinicians who manage their care.

Notification of CCHMC at EBDMInfo@cchmc.org for any BESt adopted, adapted, implemented or hyperlinked by the organization is appreciated.

Disclaimer

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