Abstract Body (Do not enter title and authors here):
Background: Massage therapy has been increasingly recognized as a complementary intervention that can help alleviate pain and anxiety in various clinical settings. However, the efficacy of this intervention in patients undergoing cardiac surgeries remains unclear. This systematic review and meta-analysis aims to evaluate the existing evidence of massage therapy for postoperative pain in cardiac surgery patients.

Methods: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing the efficacy of massage therapy in patients undergoing cardiac surgeries. We pooled standardized mean differences (SMD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We utilized mean change from baseline values and post intervention values in separated plots to preserve the weighting of this meta-analysis. We performed a trial sequential analysis (TSA) to assess the random risk of postoperative pain with mean change from baseline values. We used R version 4.3.2 and TSA version 0.9.5.10 for statistical analyses.

Results: Our meta-analysis included 12 RCTs comprising 1015 patients, of whom 484 (47.7%) were randomized to massage therapy. Compared with control, massage significant reduced postoperative pain based on mean change from baseline values (SMD -0.47; 95% CI: -0.73 to -0.21; p<0.01; Figure A), and post intervention values (SMD -0.47; 95% CI: -0.82 to -0.12; p<0.01; Figure B). Additionally, massage therapy demonstrated a significant reduction in postoperative anxiety analyzing mean change from baseline values (SMD -0.46; 95% CI: -0.73 to -0.20; p<0.01; Figure C), and post intervention values (SMD -0.60; 95% CI: -0.94 to -0.26; p<0.01; Figure D). For the primary endpoint, TSA indicated a low risk of type 1 error, therefore this result may not be conclusive.

Conclusion: In patients undergoing cardiac surgery, massage therapy significantly reduced postoperative pain and anxiety.