Medicine Insufficient Evidence for the Efficacy of Massage as Intervention for Autism Spectrum Disorder: A Systematic Review

Abstract

The efficacy of massage therapy in the treatment of children with autism spectrum disorder (ASD) remains unclear. This study systematically reviewed the impact of massage therapy on children with ASD according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) declaration guidelines. A literature search of the PubMed, Web of Science, Science Direct, Scopus, Google Scholar, and China National Knowledge Infrastructure (CNKI) electronic databases from inception to December 20, 2020, was conducted using the term "autistic/autism" along with one of the following terms, "massages," and "Tui na." The risk of bias was assessed using the Cochrane risk of bias Tool. Eight randomized controlled trials examining the impact of massage on children with ASD were included. Interventions combining Qigong massage or Tui na with the control group treatments from once a day to twice a week, for a duration of 15-30 mins, and lasting for six weeks to five months were the main interventions. All reviewed studies reported significant improvement in children with ASD who received massage, especially in the sensory domain, and that massage in combination with control treatment was superior to control treatment alone. However, the overall quality of the available studies is poor with a high degree of heterogeneity. The majority of studies showed a high risk of bias with poor study design, inconsistency in massage protocols, and subjective outcome measures. Assessment bias was a common weakness of these studies. Therefore, there is insufficient evidence to conclude that massage is effective for ASD. Future studies should include large sample sizes, incorporate double-blind designs, employ appropriate outcome measures, and allow for long observation and follow-up periods. Furthermore, consensus must be reached on standardized treatments and additional therapies in order to provide better quality evidence for the treatment of ASD.

Figure 1

PRISMA flow diagram of the study selection process.

Figure 2

Risk of bias in included studies.