Is massage therapy and isometric exercises effective in helping women with primary dysmenorrhea?
Date of publication of the randomized controlled trial: October 2015
Design
Randomized controlled trial (RCT).
Participants
120 students having primary dysmenorrhea (diagnosed based on the demographic questionnaire and a gynecologist’s confirmation) with pain intensity of 5 or higher according to the visual analog scale (VAS). The authors did not mean age of the participants.
Intervention
Effleurage massage with gentle and rotary strokes was performed as intervention. Lavender extract based on olive oil with 10% purity was used.
Isometric exercises were performed since the third day of the menstrual cycle 5 days a week, 2 sessions a day, and 10 times per session for 8 weeks.
Comparator
Comparison 1: Massage versus no intervention;
Comparison 2: Isometric exercises versus no intervention.
Major Outcomes
Outcome 1: Decrease in pain intensity as assessed by VAS in the third month. Higher marks indicated higher level of pain.
Outcome 2: Mean duration of pain as measured based on the hours of pain reported by the participants in the third month;
Outcome 3: Mean level of anxiety as measured by Spielberger’s standard anxiety questionnaire in the third month.
Settings
This study was performed in an outpatient setting.
Comparison    Massage versus no intervention
Main Results
Compared to no intervention, massage resulted in significant reduction in pain intensity (p<0.001) and mean duration of pain (p<0.001) among women with primary dysmenorrhea. Besides, massage showed significant decrease in the mean level of anxiety (p=0.017).
Comparison 1: Massage versus no intervention in women with primary dysmenorrhea
Outcomes No. of studies (Total number of participants) Decrease in pain intensity (SD)/No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 1 (68) 3.44 (1.86)/34 1.96 (6.67)/34 Not applicable as there is only 1 study. Not reported <0.001 Moderate
Keys: SD = standard deviation; MD: mean difference; CI = confidence interval.
Comparison 1: Massage versus no intervention in women with primary dysmenorrhea
Outcomes (unit) No. of studies (Total number of participants) Mean value (SD)/No. of participants Heterogeneity test ( I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
2 (hours) 1 (68) 4.73 (3.58)/34 6.03 (8.35)/34 Not applicable as there is only 1 study. Not reported <0.001 Moderate
3 (NA) 1 (68) 91.20 (20.22)/34 23.74 (94.08)/34 Not applicable as there is only 1 study. Not reported 0.017 Moderate
Keys: SD = standard deviation; MD: mean difference; CI = confidence interval.
Comparison    Isometric exercises versus no intervention
Main Results
Compared to no intervention, isometric exercises resulted in significant reduction in pain intensity (p<0.001) and mean duration of menstrual pain (p<0.001). However, massage showed no significant difference in the mean level of anxiety (p=0.670).
Comparison 2: Isometric exercises versus no intervention in women with primary dysmenorrhea
Outcomes No. of studies (Total number of participants) Decrease in pain intensity (SD)/No. of participants Heterogeneity test ( I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 1 (68) 2.12 (4.17)/34 1.96 (6.67)/34 Not applicable as there is only 1 study. Not reported <0.001 Moderate
Keys: SD = standard deviation; MD: mean difference; CI = confidence interval.
Comparison 2: Isometric exercises versus no intervention in women with primary dysmenorrhea
Outcomes (unit) No. of studies (Total number of participants) Mean value (SD)/No. of participants Heterogeneity test ( I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
2 (hours) 1 (68) 4.77 (5.29)/34 6.03 (8.35)/34 Not applicable as there is only 1 study. Not reported <0.001 Moderate
3 (NA) 1 (68) 90.61 (15.26)/34 23.74 (94.08)/34 Not applicable as there is only 1 study. Not reported 0.670 Moderate
Keys: SD = standard deviation; MD: mean difference; CI = confidence interval.
Comparison    Massage versus no intervention
Main Results
Compared to no intervention, massage resulted in significant reduction in pain intensity (p<0.001) and mean duration of pain (p<0.001) among women with primary dysmenorrhea. Besides, massage showed significant decrease in the mean level of anxiety (p=0.017).
Comparison 1: Massage versus no intervention in women with primary dysmenorrhea
Outcomes 1
No. of studies (Total number of participants) 1 (68)
Decrease in pain intensity (SD)/No. of participants Intervention 3.44 (1.86)/34
Comparator 1.96 (6.67)/34
MD (95% CI) Not reported
p value <0.001
Overall quality of evidence* Moderate
Keys: SD = standard deviation; MD: mean difference; CI = confidence interval.
Comparison 1: Massage versus no intervention in women with primary dysmenorrhea
Outcomes (unit) 2 (hours) 3 (NA)
No. of studies (Total number of participants) 1 (68) 1 (68)
Mean value (SD)/No. of participants Intervention 4.73 (3.58)/34 91.20 (20.22)/34
Comparator 6.03 (8.35)/34 23.74 (94.08)/34
MD (95% CI) Not reported Not reported
p value <0.001 0.017
Overall quality of evidence* Moderate Moderate
Keys: SD = standard deviation; MD: mean difference; CI = confidence interval.
Comparison    Isometric exercises versus no intervention
Main Results
Compared to no intervention, isometric exercises resulted in significant reduction in pain intensity (p<0.001) and mean duration of menstrual pain (p<0.001). However, massage showed no significant difference in the mean level of anxiety (p=0.670).
Comparison 2: Isometric exercises versus no intervention in women with primary dysmenorrhea
Outcomes 1
No. of studies (Total number of participants) 1 (68)
Decrease in pain intensity (SD)/No. of participants Intervention 2.12 (4.17)/34
Comparator 1.96 (6.67)/34
MD (95% CI) Not reported
p value <0.001
Overall quality of evidence* Moderate
Keys: SD = standard deviation; MD: mean difference; CI = confidence interval.
Comparison 2: Isometric exercises versus no intervention in women with primary dysmenorrhea
Outcomes (unit) 2 (hours) 3 (NA)
No. of studies (Total number of participants) 1 (68) 1 (68)
Mean value (SD)/No. of participants Intervention 4.77 (5.29)/34 90.61 (15.26)/34
Comparator 6.03 (8.35)/34 23.74 (94.08)/34
MD (95% CI) Not reported Not reported
p value <0.001 0.670
Overall quality of evidence* Moderate Moderate
Keys: SD = standard deviation; MD: mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to no interventions, the use of isometric exercises and aromatic massage therapy showed significant reduction in the intensity and duration of primary dysmenorrhea. For all outcomes, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
The authors did not mention adverse events of the intervention.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26272447
The synopsis is based on the following article:
Azima S, Bakhshayesh HR, Kaviani M, Abbasnia K, Sayadi M. Comparison of the Effect of Massage Therapy and Isometric Exercises on Primary Dysmenorrhea: A Randomized Controlled Clinical Trial. J Pediatr Adolesc Gynecol. 2015 Dec;28(6):486-91.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.