No studies report outspoken adverse effects of the interventions, although in a few cases a patient was reported to find the treatment uncomfortable and/or withdraw from the study. We conclude that the existing published research provides no basis for determining whether any of the many types of touch and massage are more effective than others, or how to best characterize and delimit the possible benefits of these interventions. Future research should include multidisciplinary, hypothesis-driven work. Some of the many creative ideas expressed in existing work (e.g. action research to refine intervention, or the focus on families and carer-patient ’dyads’ as the target of intervention) should lead to clear, operational definitions and hypotheses which can be tested in future clinical trials. Finally, in order to make results useful for practice, it is important to give precise descriptions of interventions. The specifications should be in concrete as well as in general terms, as there is not yet a well-established system of general terms for complementary and alternative therapies (Murphy 2003). A minimal set of information on a massage or touch intervention must include: who gives the massage or touch; the duration, frequency, situation and time of day; physical positions of provider and patient; parts of body touched; the force applied (if any); the style and tempo of movements; the conversation or silence accompanying them; and any required mental or spiritual preparation of the therapist. If the intervention is standardized according to the training or instructions of a particular school of massage etc., this should also be specified. A U T H O R S ’ C O N C L U S I O N S Implications for practice There is insufficient evidence regarding the efficacy of massage/ touch interventions, and insufficient data to conduct a meta-analysis. Some evidence is available to support the efficacy of two specific applications: the use of hand massage for an immediate and short-term reduction of agitated behaviour, and the addition of touch to verbal encouragement to eat for the normalization of nutritional intake. Implications for research Given the limited evidence available, there is a need for further, more methodologically rigorous research. Well-designed RCTs are needed to add to the evidence base in this area. In particular, trials should include a well-described randomization procedure, concealed allocation, and a well-defined primary effect parameter. It is important to give careful and precise descriptions of the interventions used. A C K N O W L E D G E M E N T S We gratefully acknowledge the contributions of: • Consumer editor, Susanne Bjerregaard • Dr Snyder, Dr Scherder, and Dr Remington for giving us access to additional data and other information on their studies • The State Library at the University of Aarhus for retrieving hard copies of all the studies considered in this review • ViFAB for providing technical facilities and enabling NVH to work on this review as part of his function in the institution Ear therapy and massage therapy in the elderly with dementia: a pilot study Juan Rodríguez-Mansilla, María Victoria González-López-Arza, Enrique Varela-Donoso, Jesús Montanero-Fernández, María Jiménez-Palomares, Elisa Maria Garrido-Ardila aa Juan Rodríguez-Mansilla, María Victoria González-LópezArza, María Jiménez-Palomares, Elisa Maria Garrido-Ardila, Department of Medical-Surgical Therapy, Medicine Faculty, Extremadura University, Badajoz 06006, Spain Enrique Varela-Donoso, Department of Physical Medicine and Rehabilitation, Medicine Faculty, University Complutense, Madrid 28040, Spain Jesús Montanero-Fernández, Mathematics Department, Medicine Faculty, Extremadura University, Badajoz 06006, Spain Correspondence to: Prof. Juan Rodríguez-Mansilla, Department of Medical-Surgical Therapy, Medicine Faculty, Extremadura University, Badajoz 06006, Spain. jrodman@unex.es Telephone: +34-924-289466-86150 Accepted: April 5, 2013 Abstract OBJECTIVE: To assess the impact of massage versus ear acupuncture on behavior and participation in occupational therapy of dementia patients. METHODS: We performed a controlled, randomized longitudinal trial approved by the Bioethics Commission of the University of Extremadura. One hundred twenty elderly subjects with dementia institutionalized in residential homes in Extremadura (Spain) received treatment based on massage and ear acupuncture over three months. Behavior alterations, sleep disturbance, and participation in rehabilitation and eating were assessed every month during the three months of intervention, and at one and two months of follow-up after the end of treatment. The assessment was performed through a structured questionnaire with closed format questions done by an occupational therapist not involved in the study. RESULTS: There was a statistically significant positive effect of massage and ear acupuncture (P< 0.001) on measured variables in the third month of intervention, which were maintained at two months after completing the treatment (PI would like to thank my family, friends, professors, and all those who have supported me throughout my educational journey. Thank you Dr. Colleen Marzilli for your guidance when I changed my intervention from music therapy to massage therapy as