Nazari G, Bobos P, MacDermid JC, et al. The Effectiveness of Instrument-Assisted Soft Tissue Mobilization in Athletes, Participants Without Extremity or Spinal Conditions, and Individuals with Upper Extremity, Lower Extremity, and Spinal Conditions: A Systematic Review. Arch Phys Med Rehabil. 2019 Sep;100(9):1726-1751. doi: 10.1016/j.apmr.2019.01.017. Epub 2019 Feb 22. (Systematic review)

OBJECTIVE: To assess the effectiveness of instrument-assisted soft tissue mobilization (IASTM) to other treatments or placebo in athletes or participants without extremity or spinal conditions and individuals with upper extremity, lower extremity, and spinal conditions.

DATA SOURCES: The MEDLINE, EMBASE, CINAHL, and PEDro electronic databases were searched from January 1998 to March 2018.

STUDY SELECTION: Randomized controlled trials of participants without extremity or spinal conditions or athletes and people with upper extremity, lower extremity, or spinal conditions, who revived IASTM vs other active treatment, placebo, or control (no treatment), to improve outcome (function, pain, range of motion).

DATA EXTRACTION: Two independent review authors extracted data, assessed the trials for risk of bias using the Cochrane Risk of Bias tool in included studies, and performed the rating of quality of individual trials per outcome across trials was also performed using the Grading of Recommendations, Assessment, Development, and Evaluations guidelines.

DATA SYNTHESIS: Nine trials with 43 reported outcomes (function, pain, range of motion, grip strength), compared the addition of IASTM over other treatments vs other treatments. Six trials with 36 outcomes reported no clinically important differences in outcomes between the 2 groups. Two trials with 2 outcomes displayed clinically important differences favoring the other treatment (without IASTM) group. Six trials with 15 reported outcomes (pressure sensitivity, pain, range of motion, muscle performance), compared IASTM vs control (no treatment). Three trials with 5 outcomes reported no clinically important differences in outcomes between the 2 groups. Furthermore, in 1 trial with 5 outcomes, IASTM demonstrated small effects (standard mean difference range 0.03-0.24) in terms of improvement muscle performance in physically active individuals when compared to a no treatment group.

CONCLUSION: The current evidence does not support the use of IASTM to improve pain, function, or range of motion in individuals without extremity or spinal conditions or those with varied pathologies.

Discipline Area Score
Rehab Clinician (OT/PT) 5 / 7
Physician 4 / 7
Comments from MORE raters

Physician rater

Two problems: 1. The technique is not actually described. 2. It is not an issue with which internists are involved.

Rehab Clinician (OT/PT) rater

As a physical therapist, I find this was a relevant and clinically important study which will influence my use of IASTM. Our hospital invested heavily on purchasing IASTM equipment and training clinicians on the use of these instruments. The authors findings indicate the lack of if NO evidence of clinical relevance supporting the costs associated with IASTM despite vendors' claims. In the USA as payers are changing from fee-for-service to value-based reimbursements, prescribing evidence-based treatments are increasingly important.

Rehab Clinician (OT/PT) rater

The findings support the 'null'; therefore, the article has little relevance. The main positive features from the research are the measures used that could prove useful for researchers in the area.
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