15 CMAI scale units or 75%) appears to be comparable with the effects of other treatments, pharmacological as well as non-pharmacological (Opie 1999; Snowden 2003), but it should be noted that evaluation methods and scales vary considerably and also that this study only assesses immediate and very short-term effects of a single treatment. Eaton 1986 found a significant increase in mean intake of calories (from 570 to 740 cal/day) as well as protein (from 32 to 43 g/day) in the group receiving verbal encouragement with touch, but no change in the control group receiving verbal encouragement only - a difference they report to be statistically significant. The only adequate data available for entry into RevMan’s statistical module was the additional set made available by Dr Remington (see Comparison 01). In the absence of comparable data our analysis merely repeats the study’s conclusion of a positive and statistically significant difference between scores in the hand massage group and the no treatment group. D I S C U S S I O N Although a wide range of research questions and methodologies have been applied to this family of interventions, questions of clinical effectiveness clearly dominate. However, few RCTs were identified, and only two of these were found to be of sufficient methodological quality to produce reliable evidence regarding effectiveness. This evidence relates only to one small aspect of the overall question of clinical benefits of massage and touch in dementia. Both of the included studies assessed short-term or immediate effects on behaviour. Longer-term effects, effects on mood or depression, and effects in terms of degree of cognitive dysfunction have all been addressed only by small studies which lack sufficient methodological rigour to count as reliable evidence. Although the available reliable evidence supports the use of massage and touch, it is so limited in scope that it is not possible to draw general conclusions about benefits in dementia. However, a number of recommendations can be made on the basis of the recent wider literature described in the ’Introduction’ above, none of which could be formally included in the meta-analysis of this review. First, several studies shift the focus away from the patient as the sole target of the intervention to patient-caregiver ’dyads’, or aim to produce benefits in terms of communication with staff and family members or the need of caregivers and family to feel they can contribute something meaningful to the care of the person with dementia. Further development of such perspectives may help to indicate how basic sensory contact and stimulation could interact with conditions affecting cognitive abilities. Secondly, the review identified a number of intervention trials rich in good ideas and features of high quality, which would often have required a limited additional effort to meet the criteria for inclusion. Given the relatively small resources available for research Massage and touch for dementia (Review) 7 Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. in complementary and alternative medicine, it is essential to ensure that trials provide high-quality evidence. When blinding of patient and provider is impossible or irrelevant, as seems generally the case with massage and touch interventions, it makes no sense to consider its absence as a lack of quality. Similarly it is important that this is not taken to imply that other quality criteria are poor: it should be possible to maintain a well-described randomization procedure, concealed allocation and a well-defined primary effect parameter. Thirdly, the existing literature points to a number of research approaches which could help answer a range of different questions on these interventions.