Introduction Background 1 2 3 4 2 5 6 7 8 9 g P g P g 10 Current Review 11 12 et al 7 8 13 et al 10 Operational Definition 14 15 16 17 Types of Effects single-dose multiple-dose 18 19 single-dose multiple-dose Affective Physiological Behavioral Methods Literature Search massage child pediatric Table 1 Statistical Analysis g g g d g g t P 20 Results Table 2 g k N g P g P g g g g P g P g P Of the 24 RCTs, 15 (accounting for 458 research participants) do not report sufficient data to permit effect size calculation, a frequent problem in MT research that makes objective interpretation of results difficult. Nevertheless, by judiciously comparing the scant data presented in this subset of studies with the objective data previously summarized, it should be possible to see if there are any dramatic contrasts among the findings. These interpretations, within the context of the more objective findings, appear in the results categories that follow. Single-Dose Effects Affective Dimension State anxiety et al Table 1 22 g = g Fig. 1 8 g 23 24 25 26 27 28 29 Mood. 30 Table 1 31 g g Physiological Dimension Salivary cortisol Table 1 32 33 g g Behavioral Dimension Distress behaviors. Table 1 34 35 cry facial verbal torso touch legs g n Behavior Observation Scale 36 Multiple-Dose Effects Affective Dimension Depression 37 Table 1 g g Trait anxiety. Table 1 38 g Pain Table 1 g 23 39 26 Physiological Dimension Muscle tone. Table 1 g Table 1 Range of motion. Table 1 g Immune measures. Table 1 g g 29 Pulmonary function. Table 1 g 27 Skin condition. 26 Glucose level. Table 1 25 Behavioral Dimension Developmentally appropriate functioning. Table 1 g Spasticity. Table 1 g n Hostility. Table 1 g Classroom behavior. Table 1 hyperactivity conduct emotional-indulgent anxious-passive asocial daydream/attention g 40 41 Cognitive performance. Table 1 42 Sleep and relaxation. Table 1 41 21 23 Discussion Available data reveals that MT provides benefit to pediatric recipients, though not as universally as has sometimes been reported. Benefits from both single-dose and multiple-dose sessions are evident. Most of the statistically significant effect sizes were observed for affective outcomes; findings for the behavioral and physiological dimensions were less consistent. These results parallel known MT effects in adult recipients, where multiple-dose reductions of depression and trait anxiety are the largest effects. In reviewing MT for pediatric recipients, we encountered several weaknesses endemic to the MT research literature that should be addressed in subsequent studies. These included (i) low statistical power, (ii) frequent failure to report basic descriptive statistics, (iii) descriptions of results that do not logically follow study designs, and (iv) lack of replication. We discuss these in turn. Low statistical power. Failure to report basic descriptive statistics. Results that do not logically follow study designs. 12 P Lack of replication. 43 44 45 46 47 48 Conclusion Current research indicates that MT is not a panacea for conditions studied in the pediatric population. In contrast to what has sometimes been claimed, there is little to no evidence to date to support effects such as improved immune system functioning, reduction of spasticity, or amelioration of hostility. In addition, there is currently scant evidence that MT provides benefits by first reducing cortisol, as MT's effect on this stress hormone is seen to be small when analyzed correctly (i.e. in between-groups as opposed to within-group comparisons). There is, however, a set of MT effects that have been shown to have real value to the pediatric population. MT shows a considerable impact on the state and trait anxiety levels of children. Because these effects are strong, and also because they are consistent with the findings in adults, future research on the anxiolytic effects of MT on pediatric recipients does not need to simply replicate previous studies. The greatest progress can now be made by focusing on the mediators and moderators of MT effects on anxiety, and on testing explanatory theories of these outcomes. MT effects on arthritis pain and muscle tone also appear to be strong, but these results do need to be replicated, as they are based on single studies. Other pediatric outcomes that are promising, but in need of further study, include MT's effects on depression, negative mood, certain types of behavior (likely due to reductions of anxiety) and air flow in those suffering from pulmonary disorders such as cystic fibrosis. As increased statistical power in the form of additional studies is brought to bear on these potential benefits, it is likely that some will be quantitatively validated. 10 10 As adult consumers continue to explore and utilize all of their health care options, children will increasingly be recipients of MT. With this in mind, it is essential that we continue to study the benefits of MT for children, and the explanatory models that underlie them, so children's health and wellness can be maximized. The value of MT has been examined for many specific conditions that afflict children. It is our hope that this review has consolidated those findings, indicated areas that require further study, and led to an increased scientific understanding of pediatric MT.