Effectiveness of manual interventions on overall symptoms, pain and quality of life in patients with chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis.

Abstract

<h4>Purpose</h4>The systematic review and meta-analysis aim to thoroughly assess the efficacy of manual interventions like massage therapy, reflexology, and acupressure techniques in relation to overall symptoms, pain, and quality of life (QOL) in patients suffering from CIPN.<h4>Methods</h4>A total of eight Chinese and English databases were searched, including PubMed, Embase, Cochrane Library, Web of Science, CINAHL, ProQuest, China National Knowledge Infrastructure, and Wan Fang Database. The searching lasted from the establishment of each database to July 2025. The study aims to include randomized controlled trials (RCTs) and quasi-experimental studies. The risk of bias was assessed using the Cochrane risk of bias tool. The primary outcome measures were symptoms of CIPN, pain, and QOL. Standard Deviation (SMD) and 95% CI were calculated in a random-effects model. This study was registered on the International Prospective Register of Systematic Reviews (PROSPERO, CRD420251112391).<h4>Results</h4>In total, 11 RCTs with a total of 646 patients were included. The meta-analysis showed that manual interventions may improve primary outcomes, including quality of life (SMD = 1.05; 95% CI = 0.60, 1.50; P < 0.00001), sensory (SMD = -0.62; 95% CI = -0.88, -0.35; P < 0.00001), and motor (SMD = -0.42; 95% CI = -0.72, -0.12; P = 0.006) symptoms, with low to moderate levels of heterogeneity. Although the aggregated data for overall CIPN symptoms (SMD = -1.67; 95% CI = -3.03, -0.30; P = 0.02) and pain (SMD = -0.77; 95% CI = -1.31, -0.24; P = 0.006) were statistically significant, they showed high heterogeneity (I² > 90%), which may be related to the limited number of existing studies and differences in intervention details.<h4>Conclusions</h4>Low- to very low-certainty evidence suggests that manual interventions may reduce core symptoms and pain associated with CIPN, and potentially improve sleep quality and quality of life. However, due to high heterogeneity and risk of bias, these findings should be interpreted with caution.