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The article stated its research problem clearly in the introduction section. The research problem is that although Swedish massage is an elaborate form of massage therapy, no study has assessed its effectiveness in the management of labor pain when administered by a registered massage therapist (Janssen, Shroff, & Jaspar, 2012). This problem is important to nursing because the management of labor pain is central to the successful delivery of babies and improvement of maternity care.
The justification for the study is that numerous studies performed in Taiwan, Turkey, the United Kingdom, Iran, and the United States have confirmed massage therapy relieves labor pain (Janssen et al., 2012). Additionally, the understanding of the theoretical mechanism of massage therapy that it hinders transmission of pain impulses to the brain and induces the release of serotonin and endorphins provides the basis for justifying the study.
In the assessment of the effectiveness of massage therapy administered by a registered massage therapist, the study hypothesized the therapy would relieve labor pain and defer the use of epidurals. The objective of the study is clear for it aimed to assess the effectiveness of massage therapy offered by a registered massage therapist in the management of pain during labor.
The study used the conceptual and theoretical framework in elucidating the mechanism of massage. In the conceptual framework, the article implies that Swedish massage comprises five strokes, namely, percussive, tapping, vibration, rolling, and kneading. With the help of oil to lubricate, the theoretical framework implies that the five strokes alleviate pain by preventing transmission of impulses to the brain while inducing the release of pain-relieving hormones such as serotonin and endorphin (Janssen et al., 2012). The use of a registered massage therapist to administer Swedish massage links framework to the research purpose.
The scrutiny of the literature reviewed shows that the study used current sources. Evidently, most sources (17/21) used are within the past ten years of the publication date of the article (Janssen et al., 2012). The assessment of the organization of the literature review reveals that there is logical organization. In examining the literature review of massage therapy, the study selected studies performed in various countries across the world. Further, the assessment of the literature review shows that it adequately supports the essence of the study. Fundamentally, the study examined numerous randomized controlled trials with a high level of evidence to justify and buttress the purpose of the study.
The study employed a randomized controlled trial as a research design in determining the effectiveness of a Swedish massage when administered by a registered massage therapist. The design is a randomized controlled trial because the study randomly assigned pregnant women active in labor to treatment group that received massage therapy and the control group that received standard care.
The analysis of the design shows that it fits the purpose of the study, which seeks to determine the effectiveness of Swedish therapy administered by a registered massage therapy in relieving pain during labor. Comparison of the outcomes of Swedish massage and standard care would reveal differences, which are valid and reliable in ascertaining the effectiveness of Swedish massage in the management of labor pain.
The design links to sampling method because the study randomly assigned 37 pregnant women to the treatment group and 40 pregnant women to the control group. The article adequately and clearly describes the sample used in the study. The article sampled 131 pregnant women aged between 18 and 15 who were at their gestation period of between 37 and 40 weeks. The study excluded pregnant women with pre-existing health conditions such as hypertension, diabetes, renal disease, epilepsy, and psychosis.
The article discussed the sampling procedure in detail for it describes the inclusion and exclusion criteria, administration of informed consent, assignment of sampled pregnant women to the treatment group and the control group. Evidently, the study screened 324 pregnant women for eligibility criteria out of which 131 met the inclusion criteria. Out of 131, 77 pregnant women gave their consent to participate in the study where 40 and 37 assigned to standard care group and the massage group respectively. Since the sample size is small and does not represent the population adequately, the study justifies that it did not consider representation because it is a pilot study.
The study presents its protocol in a clear and concise manner. The participants who met the inclusion criteria and consented to participate in the study were assigned to treatment group (massage) and control group (standard care). The treatment group received Swedish massage for five hours while the control group did not receive any treatment to alleviate the pain during labor. Cervical dilation and perception of pain were outcomes measured to determine the effectiveness of Swedish massage in the management of pain.
The article described cervical dilation monitor and the McGill Present Paint Intensity Scale as research instruments used. In measuring cervical dilation and labor pain respectively. Cervical dilation monitor accurately measures cervical dilation in centimeters, which is consistent with the operational definition. The pain scale has 16 items that measure labor pain accurately on a four-point scale ranging from none to severe pain, which is consistent with the operational definition. Since the McGill Present Paint Intensity Scale is an established scale for pain, the authors stated that it has adequate internal validity (α = 0.83) and sufficient convergent validity (r = 0.48). However, the authors did not present the information regarding the reliability of the instruments.
The authors addressed threats to external validity by selecting pregnant women on singleton gestation without pre-existing health conditions to eliminate interaction of history and experiment and randomly assigned pregnant women to prevent selection bias. In addressing threats to the internal validity that are inherent to randomized controlled trial, the study randomly selected pregnant women to eliminate selection bias, recruited pregnant women without pre-existing medical conditions to eliminate confounding variables and performed massage for five hours to prevent experimental mortality.
The study protected human subjects because ethics committee from the hospital (BC Women’s Hospital Research Review Committee) and university (the University of British Columbia Clinical Ethics Research Board) reviewed and approved the study. Moreover, as the study sought informed consent from the participants, there were no ethical concerns. Overall, the assessment of the methodology shows that the study described its protocols with sufficient details to allow replication.
The study describes characteristics of the sample as pregnant women on their singleton gestation aged between 18 and 35 years without pre-existing health conditions. The study answered the research hypothesis separately by stating that massage increases cervical dilation statistically significantly, but it reduces labor pain statistically insignificantly. The study collected quantitative data, which measured the size of cervical dilation in centimeters and labor pain on a Likert scale.
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Analysis of variance is the statistical analysis that the study used to determine the significance of differences of cervical dilation and labor pain between the massage group and the control group. In the presentation of data, the study used flowchart diagram presenting sampling procedure and tables in presenting demographic attributes, participants’ characteristics, and research outcomes. The text supplement data in tables for it summarizes extensive data presented. In summary, the findings of the study are that Swedish massage administered by a registered massage therapist increases cervical dilation statistically significantly but reduces labor pain in a statistically significant manner. Thus, the findings suggest the use of Swedish massage in the management of labor pain.
Discussion/Implications for Practice
The analysis of the findings reveals that authors related them to research purpose and hypothesis. The findings of the study are consistent with the findings of the previous studies for they support the use of massage therapy in relieving pain during labor. Given that the findings are consistent with the previous findings, the study does not discuss findings that conflict with the previous studies related to the management of labor pain using the massage therapy.
The limitations that the study noted are small sample size, lack of blinding, and a short period of massage. In this view, the study suggests future research to use large sample size, blind participants, and massage therapists, and extend the period of massage as long as the participants prefer. Evidently, the new research finding that emerged from this study is that massage therapy delays the use of epidural analgesia. Since Swedish massage technique is sophisticated, widely accepted, and does not have side effects, it has a high potential for use in nursing practice.
Overall Presentation and final summary
The title is descriptive for it accurately describes the type of study as a randomized controlled trial, variables as massage therapy and labor outcomes, and the target population as pregnant women. The abstract accurately summarizes the study for it presents introduction, research purpose, methodology, results, and conclusions. Overall, the report of the study is logically consistent because it has all major parts and the writing style is clear and concise because it uses simple and scientific language.
Janssen, P., Shroff, F., & Jaspar, P. (2012). Massage therapy and labor outcomes: A randomized controlled trial. International Journal of Therapeutic Massage and Bodywork, 5(4), 15-20.