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Effleurage backrub for relaxation

Clinical bottom line: Insufficient evidence to show whether effleurage backrub promotes relaxation.

Effluerage is a type of massage and involves long, slow, gliding strokes. It is used to promote relaxation and rest.

Systematic review:

Labyak SE, Metzger BL. The effects of effleurage backrub on the physiological components of relaxation: a meta-analysis. Nursing Research 1997;46:59-62

Date review completed: published in 1997; no other details.

Number of trials included: Nine.

Number of patients: Total 250

Control groups: Pretreatment condition.

Main outcomes: heart rate; respiratory rate; diastolic and systolic blood pressure.

Inclusion criteria were: treatment groups which included effleurage backrub (a type of massage using long, slow, gliding strokes); length of backrub at least three minutes; assessment of pre- and post-backrub vital signs; presentation of outcome data as mean values and standard deviation (or sufficient information to allow their calculation).

A search for published studies, includig those published in Dissertation Abstracts International, and unpublished data was conducted. No further details were provided. Effect size were calculated using correction factors to compensate for small group size.


Nine studies were included. Patients were between 19-96 years of age and were described as healthy in three studies, post-MI (2), post-CAB (coronary artery bypass; 1), from a hospice (1), nursing home (1), from medical wards (1) and immobile for 1 week or more (1). Three minute effleurage led to an 11% decrease in blood pressure and heart rate and a 6% decrease in respiratory rate. Ten minute effleurage led to an 11% decrease in blood pressure and heart rate and a 25% decrease in respiratory rate. The blood pressure and heart rate of post-CAB patients rose. The results were not sustained past the 3-10 minute rest period. Men were reported to have benefited more than women.

Adverse effects

Adverse effects were not mentioned, though the increase in blood pressure and heart rate in post-CAB patients could be considered an adverse effect.



The reviewers' conclusions that effleurage is effective in reducing heart rate and respiratory rate, and the reported gender differences are misleading for a number of reasons. It is not known how comprehensive a search was conducted or which databases were used to identify studies for inclusion in this review. No mention was made regarding the methodological design, quality or validity of the studies, including whether they were randomised or blind. It may be assumed that the studies were neither randomised nor blind, in which case they were open to major sources of bias. The studies were small; small studies produce misleading results. They were reported to have used different measurement tools to assess outcomes. This limits the clinical homogeneity of the studies and the credibility of any analyses.

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