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Okvat, H. A., Oz, M.C, Ting, W, Namerow,
P.B. (2002 May/June). Massage Therapy for Patients Undergoing Cardiac
Catheterization. Alternative Therapies In Health and Medicine,
8(3), 68-75.
New York Presbyterian Hospital was the site for a very interesting study using
massage therapy in a very unique and non-conventional setting: an interventional
cardiac center. Noting that anxiety and its pharmacological treatments can often
interfere with cardiac catheterization, the investigators hypothesized that
massage therapy might be an appropriate intervention to reduce stress and
anxiety levels prior this invasive procedure. Secondary hypotheses included the
suggestions that massage would reduce blood pressure levels, heart rates and
respiratory rates to a more relaxed level; decrease cortisol levels and decrease
the need for administering analgesics and anxiolytics during the procedure.
These hypotheses were based on the knowledge that massage has been used
primarily in nonmedical settings for relaxation and stress reduction, with some
efficacy also demonstrated in medical environments.
The design was a prospective, randomized, controlled, single-masked pilot with
seventy-eight patients (59 men and 19 women) participating. The average age of
subjects was 60.1 years and all were scheduled for an elective, diagnostic
catheterization based on routine clinical practices.
The study evaluated the feasibility of using massage between the patient’s
arrival at the hospital and the catheterization procedure, the patient’s
interest in receiving massage, and available staff support to administer
massage. Anxiety was rated on a self-evaluated pain and/or discomfort visual
analog scale prior to, during and after the procedure. Vital signs (including
heart rate, blood pressure and respiration rates), cortisol levels and analgesic
or anxiolytic intake were also measured at similar intervals.
Patients meeting reasonable inclusion/exclusion criteria were assigned to either
a treatment group who received a 10-minute massage in the holding area of the
catheterization laboratory from a female licensed massage therapist, or a
control group who sat with the massage therapist, quietly and without TV, so
that the researchers and medical staff were “masked” to patient assignment of
treatment or control groups.
Results of the study were quite telling. Of the 88 patients recruited to
participate, 10 did not complete the study for the following reasons: timing of
the procedure; dissatisfaction with control group assignment; and confusion with
study instruments by staff. 44% of the participants in the treatment group and
21% in the control group reported having previous experience with professional
massage—a difference that approached statistical significance. There was no
significance in the different medications taken by participants for hypertension
and/or pain management for the purposes of this study.
Compared to patients who did not receive massage, those receiving massage
experienced a greater reduction in anxiety between baseline and after
catheterization, though the difference was just shy of statistical significance.
There was no significance in anxiety level or pain/discomfort levels between the
control and massage groups. There was no difference between the control and
massage groups relative to the need to administer analgesic or anxiolytic
medication during the catheterization. Physiological vital signs were found to
be similar at baseline and during measured intervals during and after the
procedure for both groups, as well.
While these results do not rattle the world with their significance, the
researchers nonetheless feel that this pilot achieved its primary purpose and
confirms the feasibility of incorporating a brief massage between the patient’s
arrival at the center and the actual catheterization procedure, that patients
were interested in receiving this therapeutic, relaxing intervention, and that
medical staff was supportive of the use of this complementary therapy in this
acute setting.
The fact that hypotheses were not supported beyond the feasibility issue
received very significant comment from the researchers that appear to be as
significant as the confirmation of feasibility. Researchers noted that the short
duration and the single massage (10 minutes) administered were significant and
not typical to the practice of massage therapy. Another comment noted that the
protocol for massage was standardized and not tailored to the needs of the
individual—common in the allopathic care delivery system but not common in the
delivery of CAM practices.
Another significant comment from the researchers concerned the environment in
which the massage was administered. Noting that there was significant background
noise, occasional interruption by medical staff, and the sometimes-audible
comments about a “distressing” result of another procedure all may have
contributed to higher anxiety ratings, cortisol levels and vital signs in
subjects. Additionally, comment was also made that 2 of the 5 massage therapists
found the environment do be distracting to them and their work.
A weakness of the study, also noted by the researchers, was the failure to
approach patients prior to their arrival at the hospital, just one hour prior to
the catheterization procedure. This could have a significant impact on anxiety
levels and vital signs due to the fact that being asked to participate in a
study, albeit with likelihood of positive and beneficial outcomes, could indeed
add to the stress level of the patients.
The article concludes with a summary stating that the results achieved in the
study do indicate support for the need of studies on a larger scale to determine
whether longer, more frequent or individualized massage therapy treatments would
be beneficial in reducing anxiety and physical discomfort during
catheterization. Additionally, the early approach of patients to participate in
the study and an environment that is more conducive to relaxation and free of
interruptions should be considered.
John Balletto
Massage Therapy Foundation President
February 17, 2003
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