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

Table 1

Characteristics of the included studies.

Study	Participants	Intervention	Comparator	Outcome measures	Major findings
Silva et al. (2007) [27]	N = 15 (M = 13, F = 2), 3∼6 years old	EG: (N = 8) Qigong massage + State of Oregon’s special education program,; duration 5 months of treatment twice a week for two five-week periods, with five weeks in between,; twice a week for 5 weeks (by a specialist), every day for 5 months (by a parent) 15 min/d	CG: (N = 7) state of Oregon’s special education Program	(1) Batelle: the cognitive domain screening test,; (2) Sensory profile evaluation tool,; (3) Vineland adaptive behavior scales,; (4) ABC; (5) Parent questionnaire	(1) Compared with CG, significant improvement in the sensory profile score, sensory processing score, sensory modulation score, social skills, and the basic living skills score in EG was observed, and; autism behavior decreased in both groups; (2) No statistical difference was observed between motor and language development.; Improvement in bowel and sleep abnormalities in EG was observed
Silva et al. (2009) [28]	N = 46 (M = 37, F = 9), 3∼6 years old	RCT EG: (N = 25) Qigong massage plus special education program; once a week (by a therapist) and everyday for 5 months (by a parent); 15 min/d	CG: (N = 21) special education program	(1) PDDBI teacher and parent versions,; (2) ABC, and; (3) SSC	(1) Compared with CG, significant main intervention effects were found in the ABC and the PDDBI social/communication composite. Significant main intervention effects were found in parent maladaptive behavior composite and PDDBI social/Communication composite; (2) No significant treatment effect was found on the PDDBI measure of maladaptive classroom behavior between the two groups as both were being improved; (3) Sense and self-regulation impairment (SSC and PDDBI sensory) and the three composite scores of the PDDBI (the maladaptive behavior composite, social/communication composite, and the total autism composite) were highly related
Silva et al. (2011) [29]	N = 47 (M = 33, F = 14),; 3∼6 years old	RCT; EG: (N = 28) trained parent Qigong massage plus special education program; everyday for 5 months; (by a parent); 15 min/d	CG: special education program (N = 19)	(1) ABC,; (2) PDDBI,; (3) APSI, and; (4) SSC	Compared with CG, significant intervention effects were found for the PDDBI, the SSC, and the APSI. The main effect was found in the interaction between treatment and severity of sensory and self-regulation impairment on the PDDBI scales
Silva et al. (2015) [30]	N = 84 (M = 75, F = 9),; 3∼6 years old	RCT; EG: (N = 42) Qigong massage plus special education program; once a week (by a therapist) and everyday (by a parent); 15 min/d; RCT	CG: (N = 42); special education program	(1) CARS-2edition,; (2) PLS-5edition,; (3) Vineland-II,; (4) ABC,; (5) SSC,; (6) APSI, and; (7) The beach center family-professional partnership scale	Compared with CG, significant improvement in normalization of receptive language, autistic behavior, total sensory abnormalities, tactile abnormalities, and decreased autism severity was observed.; Parents reported improved child-to-parent interactions, bonding, and significant decreased parenting stress
Liu et al. (2017) [31]	N = 60; (M = 50, F = 10); 2–8 years old	EG: (N = 30) acupuncture plus Tui na (by a specialist),; acupuncture for 1 hour, 2 times a week for 30 times; Tui na, 2 times a week for30 times	CG:(N = 30); acupuncture; (by a specialist)	(1) ABC	(1) Compared with CG, significant improvement in the ABC total scores in both groups before and after treatment was observed, and the EG group showed an increased difference in the ABC total scores; (2) EG: significant improvement in four of the ABC scale dimensions (sensation, communication, physical movement, and self-care ability) except language was observed; (3) CG: the ABC scale showed significant improvement in other dimensions except for sensation
Jing et al. (2019) [32]	N = 136; M = 109, F = 27; age:4.42 ± 0.19	RCT; EG:(N = 68)Tui na plus acupuncture (by a specialist); 2 section/week, 15 weeks	CG: (N = 68); acupuncture; (by a specialist); 2 section/week, 15 weeks	(1) ABC subset self-help	(1) After the intervention, the self-help score in both groups decreased, and EG was significantly better than that of CG; (2) The effective rate of the EG (100%) was higher than that of CG (96.43%) but showed no significant difference
Feng et al. (2020) [33]	N = 44 (M = 33, F = 11), age:3.57 ± 0.84	RCT; EG: (N = 22) behavioral intervention plus traditional Chinese massage; (by a specialist); 1 section/day, 5 section/week, 6 weeks.	CG: (N = 22); behavioral intervention; (by a specialist)	(1) ABC; (2) CARS	After the intervention, the ABC and CARS score in both groups decreased, and EG was significantly better than CG
Wu et al. 2020 [34]	N = 120; (M = 57, F = 63); Age: 2.69 ± 0.22	RCT; EG: (N = 60)Tui na plus acupuncture (by a specialist); 2 section/day, 30 mins	CG: (N = 60); Acupuncture; (by a specialist)	(1) Language ability (self-designed questionnaire); (2) SAS,; (3) SDS; 4. Parents’ treatment satisfaction	(1) EG language recovery level and language training effect were significantly higher than that of the control group; (2) The scores of anxiety and depression in EG were lower than those of the CG (); (3) The treatment satisfaction of EG was higher than that of CG (0 < 0.05)