Effectiveness of massage therapy for constipation in children with cerebral palsy: A systematic review and meta-analysis

BACKGROUND: Constipation affects 75 % of children with cerebral palsy (CP). While massage is a safe non-invasive intervention, its clinical adoption remains limited due to insufficient evidence of its efficacy. OBJECTIVE: To evaluate the efficacy and safety of massage for CP-related constipation through meta-analysis. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched seven databases for randomised controlled trials (RCTs) on pediatric CP-related constipation treated with massage. Eligible RCTs underwent Cochrane risk-of-bias assessment. Meta-analysis using Stata evaluated the overall efficacy, defecation parameters, and heterogeneity sources. RESULTS: A total of 11 RCTs involving 728 patients were included. The results of the meta-analysis showed that, compared with traditional therapy alone, massage was more effective in treating constipation in children with CP. This difference was statistically significant (p < 0.05), as evaluated by the overall effective rate (RR, Relative Risk = 1.23; 95 % CI, 95 % Confidence Interval = 1.14, 1.33), defecation frequency (MD, Mean Difference = 1.57; 95 % CI = 0.40, 2.75), defecation time (MD = -3.23; 95 % CI = -3.82, -2.64), and stool form score (SMD, Standardized Mean Difference = 0.66; 95 % CI = 0.39, 0.94), confirming the superior efficacy of massage over conventional therapy. However, both interventions showed comparable effects on defecation difficulty (p > 0.05). The baseline patient characteristics, duration and techniques of the massage, and efficacy of the control group intervention may be the sources of heterogeneity. CONCLUSION: Massage therapy improves constipation symptoms in children with CP. These results require validation through larger, high-quality RCTs given the sample size limitations of the current study.