Wang, T., Wang, H., Yang, T., Jane, S., Huang, T., Wang, C., & Lin, Y. (2015). The effect of abdominal massage in reducing malignant ascites symptoms. Research in Nursing and Health, 38, 51–59. 

To evaluate the effect of abdominal massage on reducing ascites, pain, and other ascites-related symptoms

Gentle abdominal massage consisting of straight rubbing, point rubbing, and kneading was provided by a trained nurse practitioner (NP) for 15 minutes, twice a day (7–8 am and 4–5 pm) for three consecutive days. Control participants received social attention by the same NP who delivered the massage. The NP followed a script during the interaction exploring the patient’s feelings and thoughts and providing information about treatment. Symptoms and body weight were measured in the morning for four successive days (pre- to post-test).

• N = 80
• MEAN AGE = 59.11 years (SD = 11.05 years)
• MALES: 66%, FEMALES: 34%
• KEY DISEASE CHARACTERISTICS: Stage IV cancer; had not received chemotherapy in the preceding month; most common type of cancer was liver followed by colorectal, gastric, and pancreatic
• OTHER KEY SAMPLE CHARACTERISTICS: 54% of the patients had mild ascites, 28% were moderate, and 18% were severe as defined by the Moore and Aithal grading system

• SITE: Single site
• SETTING TYPE: Inpatient
• LOCATION: Northern Taiwan

• PHASE OF CARE: End of life care
• APPLICATIONS: Palliative care 

Randomized, controlled trial using repeated measures

• Symptoms were measured using the Edmonton Symptom Assessment System–Ascites Modification (ESAS-AM).
• Body weight was measured with a scale.
• A blinded assessor collected the data.

There was no significant change in pain, tiredness, nausea, drowsiness, poor appetite, shortness of breath, mobility limitation, or body weight among patients who received massage. The intervention group did experience a significant improvement in depression (p = 0.003), anxiety (p = 0.002), poor well-being (p = 0.001), and perceived abdominal bloating (p < 0.001). These symptoms improved gradually over time for the intervention group, but slightly increased over time for the control group. No massage-related adverse events occurred.

Abdominal massage did not improve pain in this study; however, this may be related to the low level of pain among patients at baseline. Massage improved depression, anxiety, well-being, and perceived abdominal bloating. Additional study is needed with larger groups of patients with malignant abdominal ascites.

• Small sample (< 100)
• Baseline sample/group differences of import
• Findings not generalizable
• Intervention expensive, impractical, or training needs
• Other limitations/explanation: Patients were from one medical center. All the patients were randomized except patients in the same patient room who were assigned to the same group. The intervention group had more multiple-organ metastases, and this was controlled for in the analysis. In addition, the intervention group at baseline had significantly more nausea, poorer appetite, and more shortness of breath, but less drowsiness than the control group.

This non-invasive, inexpensive intervention was not effective in reducing pain for patients with abdominal ascites, but it may provide relief for other symptoms such as abdominal bloating, depression, anxiety, and poor well-being. After additional study, if this intervention is proved to be appropriate for pain management, nurses will need training on proper massage techniques.