Effect of massage therapy on sleep quality in critically ill patients: A systematic review and meta‐analysis

Abstract Aim The aim of the study was to compare the effects of massage interventions on sleep quality among patients in the adult critical care unit. Background Massage interventions have positive effects when applied to manage sleep quality in critical care units. However, research identifying the effect of massage intervention is limited. Design This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Methods Five databases were searched from their inception to 15 April 2022 (the last search was conducted on 15 November 2022, but it yielded no additional eligible studies). The literature search was conducted using Embase, MEDLINE, the Cochrane Library, CINAHL, PsycINFO and additional sources such as Google Scholar. The Cochrane risk of bias tool for randomised trials (RoB 2.0) was used to assess the risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system assessed the certainty of evidence and recommendations. Results In total, ten randomised controlled trials comprising 569 participants were used in the systematic review, and eight trials were included in the meta‐analysis. Subgroup analysis revealed significant effects of foot reflexology massage on subjective sleep quality. Massage therapy for a two‐night duration in cardiac care unit patients exhibited a significant effect on subjective sleep quality. The overall GRADE certainty of evidence was low. Conclusion Massage intervention, particularly foot reflexology massage, with a two‐night duration showed improvement in subjective sleep quality among critically ill patients. Although evidence quality was low, the results suggest that massage interventions provide a non‐invasive, low‐cost and effective way to promote sleep quality in critically ill adult patients. Relevance to clinical practice Massage interventions can enable nurses to recommend and implement strategies promoting and improving sleep quality among critically ill patients. Study registration The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews ( www.crd.York.ac.uk/Prospero with the registration number # CRD42022332371). Patient or public contribution No patient or public contribution if such details are not necessary or do not apply to your work and state why.