JMIR Publications

ABSTRACT

Background:

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by social communication deficits, repetitive behaviors, and cognitive impairment. Side effects and inconsistent efficacy often limit current interventions such as pharmacological treatments and behavioral therapies. Massage therapy—including Tuina, acupressure, and other manual techniques—has been used as a non-pharmacological, low-risk complementary approach to improve cognitive symptoms in ASD, yet its overall efficacy and safety have not been systematically evaluated.

Objective:

This systematic review and meta-analysis aims to evaluate the efficacy and safety of massage therapy for improving cognitive impairment in individuals with ASD.

Methods:

Randomized controlled trials (RCTs) will be identified through searches of PubMed, Web of Science, Scopus, Cochrane Library, Embase, ClinicalTrials.gov, the Chinese Clinical Trial Registry, CNKI, Wanfang, VIP, and CBM until September 2025. Two reviewers will independently perform study selection, data extraction, and risk of bias assessment. For data synthesis, mean differences (MD) or standardized mean differences (SMD) will be used for continuous outcomes (e.g., ABC, CARS, ATEC scores), and odds ratios (OR) will be used for dichotomous outcomes (e.g., clinical efficacy rates). A random-effects model will be applied if the I²≥ 50%; otherwise, a fixed-effects model will be used. Subgroup, sensitivity, and meta-regression analyses will be performed to explore heterogeneity. The GRADE approach will be used to assess the quality of evidence.

Results:

This review will summarize evidence on the effect of manual therapy on cognitive outcomes measured by scales such as ABC, CARS, and ATEC, as well as safety profiles.

Conclusions:

The findings will provide evidence regarding the role of massage therapy in managing cognitive impairment in ASD and support clinical decision-making. Clinical Trial: PROSPERO 2025 CRD420251038194