Massage Therapy Foundation Poster Sessions

The Massage Therapy Foundation poster sessions are a showcase of research done by community service and research grant recipients as well as other massage therapy researchers. The Foundation encourages participation in this event at The AMTA National Convention in order to create a forum for informal discussion of research and to provide Convention attendees with the opportunity to learn how therapists have improved their communities and advanced the massage therapy profession. Posters include research findings, photographs, charts, and diagrams and are accompanied by an abstract. The following posters and abstracts are from previous AMTA National Conventions.

Pain management is becoming a more critical issue for hospitals, and has received the attention of hospital accreditors. The acute care setting of the hospital provides an excellent opportunity for the integration of massage therapy into the team-centered approach of patient care. In this study, 65 hospital inpatients were given 30-minute massage therapy sessions with a physicians order. Pre and post massage therapy pain levels were recorded using the visual analog scale (VAS). Results were triangulated with nursing comments taken from the patient’s charts, and a survey completed by patients. Patients noted improvement in all survey elements, including relaxation, pain levels, emotional well-being, ability to sleep, quicker recovery, and the need for less pain medication. Pre and post pain levels demonstrate a moderately strong correlation between massage and reduction in pain levels. The study shows the integration of massage therapy in the acute care setting creates overall positive results in the patient’s ability to deal with the challenging physical, psychological, and spiritual aspects of their health condition. Benefits include a possibly shorter length of stay for the patient, leading to less nosocomial infections, a more positive patient experience, enhanced recovery, and an improved financial bottom line for the hospital.

Authors:
Mary Kay Brennan, MS, RN, LMBT
Dr. Rita D. DeBate, PhD, MPH, CHES

Context: Studies have shown that hospital bedside nursing is a stressful occupation. Massage therapy has been shown to be an effective intervention in stress management.

Objective: The goal of this study was to determine if a ten-minute on-site chair massage was more effective at reducing the stress perception of hospital bedside nurses than a standard ten-minute break.

Design: Randomized trial with a control group, who took a ten-minute break, and a massage group, who received a 10-minute chair massage.

Setting: A small suburban hospital on the maternity, medical-surgical, telemetry, and critical care nursing units.

Main Outcome Measure: Stress perception was assessed using the Perceived Stress Scale (PSS) in an experimental pretest - posttest design and analyzed using t-tests for independent samples.

Results: Stress perception was significantly lower in the massage group after the chair massage (P<.05) and not significantly changed in the control group.

Conclusion: The results of this study support the effectiveness of chair massage in the reduction of stress perception for this population. Further research is warranted to study the feasibility of providing chair massage on a regularly scheduled basis on a nursing unit as well as its impact on other aspects of a nursing position, such as, job satisfaction, retention, absenteeism, injury, and worker's compensation claims. Additionally, it would be beneficial to study the effects of chair massage with individuals in other occupations that are identified as being high stress and burnout occupations.

Introduction: Massage therapy affects people's lives in many ways, and as therapists we have many interesting cases that we share with each other. However, these interesting cases are not usually shared beyond our immediate circle of friends and colleagues. Case studies are a great way to share your experience and knowledge with other therapists, health care providers, and current and potential clients. Also, as the foundation in the hierarchy of evidence, many case studies have lead researchers towards new areas of discovery.

Even though case studies are published in scientific journals, they are much different than other research articles. First of all, they represent the 'real world' within a therapist's practice, something that can be difficult to mimic in larger, more structured research studies that occur within academic settings. Second, the data presented about the case can take on a richness that is not possible in other studies with hundreds of subjects. Case studies can get more in-depth with one single case, whereas most research studies give an overview of the demographic and clinical characteristics as well as the structured treatment plan. Finally, case studies are written by health care providers in the field. A researcher may help the therapist with the writing, but the purpose of writing the case study is to share the specifics of your experience with a client rather than to report on a scientific study

In order for the massage therapy profession to continue to grow in the research realm, more practicing therapists need to write and publish case studies. The following is a brief overview of how to get started.

Sections of a case study: There are four main sections of a case study (possibly more depending on the journal to which the case is submitted). The first section is the abstract. The abstract is an overview of the case, usually written by taking one or two main sentences from the full article. The abstract should include a brief description of the case as well as the outcome, not leaving the final results as a surprise ending only for people who read the full article. Many times, people will only read the abstract of a study and it is important that they know what the results of the case, even if it is only a very brief overview.

The introduction section of a case study should entice the reader to continue reading by setting the stage for why this case is important or what is special about this case. Perhaps you have a unique client with physical deformities and this case will enable the reader to better understand how to position such a client, or perhaps you successfully utilized a new technique for an injury for which most people have surgery and therefore saved them money, time, and trouble. The introduction does not need to be long; it needs to focus the reader on your topic and allow them to realize the importance.

The case description and intervention section of a case study is the 'nuts and bolts' of the article. This section is similar to an expanded progress note and includes a summary of the client's presentation, treatment, and outcomes. You do not need to include every aspect of every visit, but you should include enough information to enable another therapist to duplicate your treatment. Pictures and diagrams are a great way to demonstrate your therapy without having to use many words. You should not, however, include any side comments in this section, that information goes in the discussion. The case description and intervention should be 'just the facts' of the case.

The discussion section can include your overall impression of the case in an open and free manner. It might include your initial thoughts on the usefulness of your treatment or perhaps your impression of how this treatment could be expanded to other types of clients. Frequently, case studies include a disclaimer in the discussion such as 'This case study does not demonstrate that this technique is useful in all clients with this disorder. More research is needed in this area.'

Finally, the references section includes any supporting literature that you cited in your article. Because case studies are usually published in scientific journals, your references should also be from scientific journals. Most journals do not accept citations from magazines, websites, or other non-peer-reviewed materials, so be sure not to include this type of information.

Common problems: There are many areas of potential failure when writing a case study. Certainly, getting started is one of the biggest hurdles and each author needs to determine the best way to get and stay motivated.

Second, some massage therapists do not have clear or complete progress notes with which to write their case study. As you work with clients, try to be more contentious about your progress notes and use the same method to measure their progress each time they come in. It is much easier to write a case report if you can say 'The client started out with a pain level of 8 out of 10, which was reduced to a 2 out of 10 after one week of care.'

Third, some authors do not follow the instructions listed in the journal to which they plan to submit. Be sure to get these instructions before you start writing so that you know the 'rules.'

Finally, client confidentiality is a big issue with case studies because someone might be able to tell who your client it. So, be sure to get informed consent from the client to publish this article about them. Most journals have their own consent document that you will need the client to sign.

What to do next: In order to get started on your case study, first choose a current or past case that is interesting to you. It might be the amazing recovery that you talk about when you get together with your colleagues or perhaps the case you discuss when approaching other health care providers regarding your services.

Next, search the literature to determine if there are already case studies on this topic. You do not want to put hours into writing up a case just to find out that this information has already been reported.

Be sure to ask other health care professionals to read the case before submitting it for publication. Other massage therapists will be able to tell you if you were complete in your description of the therapy. And, non-massage professionals will be able to tell you if you are using jargon that they do not understand.

Finally, do not give up. After you submit your case, you will receive a letter in which other people have critiqued your article. These critiques may be difficult to read, and you may even disagree with some of what they have to say. However, this is just part of the process. Be polite and thankful for the reviewers' efforts, and make the indicated changes if it seems to improve the readers' understanding. If you strongly disagree with something suggested, return the article with a letter politely explaining why you disagree. These correspondences may go back and forth a couple of times, and with luck your case may get accepted for publication.

Conclusion: Case studies are an important way for massage therapists in the field to communicate with their peers, other health care providers, researchers, and clients about the amazing findings that occur within their practice. If you have an interesting case, write a case study and submit it to a journal for publication! You will be helping the massage profession if you do.

OBJECTIVES: The objective of this study was to determine the change in blood pressure (BP) in normotensive and prehypertensive adults resulting from a therapeutic massage, and the factors associated with such changes, including demographic and massage characteristics.

DESIGN: SETTINGS/LOCATION: National University of Health Sciences Massage Therapy Clinic, Lombard, IL.

SUBJECTS: The subjects were 150 current adult massage therapy clients with BP lower than 150/95.

OUTCOME MEASURES: Change in BP and potential associated factors such as type of massage, duration of massage, specific body area massaged, amount of massage pressure, and demographic characteristics were studied.

RESULTS: Overall, systolic BP decreased by 1.8 mm Hg and diastolic BP increased by 0.1 mm Hg. Demographic factors associated with BP decrease included younger age (p = 0.01) and taller stature (p = 0.09). Type of massage was associated with change in BP: Swedish massage had the greatest effect at BP reduction. Trigger point therapy and sports massage both increased the systolic BP, and if both forms of massage were included in a session, both the systolic and diastolic BP readings significantly increased. No other massage factors were associated with a significant change in BP.

CONCLUSIONS: Type of massage was the main factor affecting change in BP. Increases in BP were noted for potentially painful massage techniques, including trigger point therapy.

Objectives: The study investigates the ability of Massage Therapy modalities to have a positive effect upon anxiety, depression, body image in a subject diagnosed with Bulimia.

Methods: The subject is a 25-year-old female, presenting with chronic bulimia nervosa diagnosed 8 years ago. Massage treatments were administered once a week for 5 weeks, 90 minutes per session. Techniques employed included Swedish, Deep Tissue, Reflexology, Neuromuscular Technique, Sports Massage Compressions, Passive Stretching and range-of-motion (ROM).

The intention of the work was to provide a nurturing full-body experience with an emphasis on body awareness. Measurement of anxiety, depression, and body image was accomplished with 5 self-report assessments, administered one month prior, before, and after the treatment series.

Results: A reduction in anxiety, depressive symptoms, and body image anxiety were reported, as well as an increase in body awareness.

Conclusions: This study suggests that massage therapy is a useful adjunct to traditional psychotherapy and an effective treatment choice for the comorbid symptomatology of bulimia nervosa.

INTRODUCTION: The use of brief massage therapy promotes relaxation and helps to manage pain in a wide variety of workers. The purpose of this report is to detail the use of 15-minute scheduled chair massage therapy sessions on university employees who experience different degrees of pain levels prior to their massage sessions. Our goal was to reduce pain levels in employees while reducing work injuries and lost days within this group.

METHODS: Staff scheduled at least one 15-minute massage per month with a contract licensed massage therapist. Sessions consisted of chair massage using pressure point, effleurage, and tapoment strokes. The majority of staff had incurred at least one workplace or non-industrial injury within the previous five years that affects their daily living activities. Prior to and immediately after each massage, staff would fill out a modified McGill pain rating scale (1-10 pain rating, 10 is worst) rating their pain levels at that time. Staff information was categorized into two distinct groups. Those with initial pain levels above 5.5 (on a 10-point scale), indicated previous injuries in the neck, back, and/or shoulder areas. Those with initial pain levels lower than 5.5 indicated no previous injuries or high pain levels. Pain ratings pre and post were tallied and categorized into high pain (n=43 sessions), and low pain (n=34 sessions). Data was analyzed using Student’s t-test statistics (SPSS software systems), using an alpha level of 0.05 level of statistical significance.

RESULTS: After three months of chair massage, the average reduction in pain in both groups was 55%. The high pain group reduced pain levels by 47%, the low pain group by 63%. A table of both groups is presented below:

High pain level group (N=43 sessions, pain levels 5.5 or above at start of MT)

Pre-massage pain Post-massage pain significance

6.83 + 1.0 3.67 + 2.0 p=0.001

_______________________________________________________________________

Low pain level group (N=34 sessions, pain levels < 5.5 at start of MT)

Pre-massage pain Post massage pain significance

3.47 + 1.2 1.29 + 1.2 p=0.001

CONCLUSIONS: Results indicate that 15 minute on-site chair massage therapy significantly decreased perceived pain in university employees. Of interest is that statistically significant improvements were seen in both sub groups of employees.

Authors: Eric Durak, Katie Manion, Melinda Martin
Injury Prevention Program, University of California at Santa Barbara 93106

BACKGROUND: The use of massage therapy for pain reduction and management is well reported. Its use in chronic pain with concomitant degenerative bone disease is not as well known. The purpose of this project was to test the effects of pressure point massage therapy in relief of general and specific pain symptoms. The question we asked was: What effect does long term massage have on reducing pain symptoms in a person with chronic degenerative bone disease?

METHODS: We performed pressure point massage therapy on systems inspector (age 61, weight 148 pounds, diagnosed with ankylosing spondylitis in 1981).

Our subject has surgically fused vertebrae (C6-7,); other vertebrae (C-1-4, C8-9, and L4-5) have become un-naturally fused from the progression of Ankylosing Spondylitis over the last 25 years. The subject is diagnosed with spinal and metacarpal arthritis, has had bi-lateral hip replacement, and right knee joint replacement. Subject takes three (3) types of pain and anti-inflammatory medication daily, including Prednisone (since 1985), and pain medication as needed for movement and sleep. The segmental pressure point massage uses thumbs to concentrate on pressure to the erector spinae thoracic muscles moving down each vertebral segment from lateral to each spinus process, starting from T2 through L4 for 15 minutes, two days per week for 6 months. During these sessions we also performed both pressure point and effleurage in the neck and shoulder regions during treatment.

RESULTS: Over a six month period, our subject gained 15 degree in left spinal neck rotation, 13 degrees in right rotation, side to side lateral trunk stretch improved to 14 degrees bi-laterally, trunk rotation improved to 30 degrees left and 15 degrees right (was inhibited by hip pain) measured by goniometer. Our subject reports 70% overall improvement in pain (90% in past three months). His physician reports less inflammation in joints and has reduced Prednisone prescription by 60%. Our subject also reports "popping" of vertebral segments during chest stretches which he believes are a gauge for improvement in his condition (both pain levels and range of motion).

CONCLUSION: We report that specialized massage therapy techniques have a dramatic impact on the overall health and mobility of a person with chronic degenerative bone disease and high levels of chronic pain. Massage reduced symptoms up to 90% over a six month period of time.

OBJECTIVE: To document Structural Integration in individuals with peripheral neuropathy

BACKGROUND: Peripheral neuropathy describes damage to the peripheral nervous system, the vast communication network that transmits information from the brain and spinal cord (the central nervous system) to every part of the body. Peripheral nerves also send sensory information back to the brain and spinal cord, such as a message that the feet are cold or a finger is burned. Damage to the peripheral nervous system interferes with these vital connections. Like static on a telephone line, peripheral neuropathy distorts and sometimes interrupts messages between the brain and the rest of the body.

CASE STUDY: 77 year old man has 25 degrees of Scoliosis and Neuropathy in the feet and legs, resulting in loss of balance. Had been using cane for 18 months at suggestion of his attending physician. As a previous massage client of mine, I recognized the potential value of Structural Integration as a solution to his problem.

RESULTS: After two 60-minute structural integration sessions, patient stated he felt his feet and legs “for the first time in 10 or 15 years”. When patient returned for third session he was walking freely without a cane, and has continued to walk for four subsequent months without cane.

DISCUSSION: Lengthening the back as the heels become free to extend the entire back of the body can lengthen the back of the torso, develop a sense of lumbar balance and help patient feel more “rooted” to the ground by restoring sensation to legs and feet.

Authors: Kutner, JS, Smith MC, Corbin L, Hemphil L, Benton K, Mellis BK, Beaty B, Felton S, Yamashita TE, Bryant LL, Fairclough DL.

BACKGROUND: Small studies of variable quality suggest that massage therapy may relieve pain and other symptoms.

OBJECTIVE: Evaluate efficacy of massage for decreasing pain and symptom distress and improving quality of life among persons with advanced cancer.

PATIENTS: 380 adults with advanced cancer experiencing moderate-severe pain.

INTERVENTION: Six 30-minute massage or simple touch sessions over two weeks.

MEASUREMENTS: Pain (Memorial Pain Assessment Card, MPAC, Brief Pain Inventory, BPI, 0 – 10 scales) mood (MPAC 0 – 10 scale), quality of life (McGill Quality of Life Questionnaire, MQOL, 0 – 10 scale), and symptom distress (Memorial Symptom Assessment Scale, MSAS, 0 – 4 scale).

RESULTS: Both groups demonstrated immediate improvement in pain (massage -1.87 points (CI, -2.07, -1.67), control -0.97 points (CI, -1.18, -0.76)) and mood (massage 1.58 points (CI, 1.40, 1.76), contol 0.97 points (CI, 0.78, 1.16)). Massage was superior for both pain and mood (mean difference 0.90 and 0.61 points, respectively, P<0.001). There were no between group mean differences over time in pain (BPI Mean 0.07 (CI, -0.23, 0.37), BPI Worst -0.14 (CI, -0.59, 0.31)), quality of life (MQOL Overall 0.08 (CI, -0.37, 0.53)), or symptom distress (MSAS Global Distress Index -0.002 (CI, -0.12, 0.12)).

LIMITATIONS: Measurement or reporting bias; Selection bias; Incomplete follow up; Lack of a “usual care” control arm.

CONCLUSIONS: Massage provided greater short-term improvement in pain and mood than simple touch, findings not sustained over time. Massage should be offered for short-term symptom relief and potential benefits of attention and simple touch should be considered.

The Cape York Massage Therapy Training Program (CYMTTP) is not just a training program but wears many hats. For over 4 years now, volunteers have been travelling up to Far North Queensland to answer a call from elders in the remote Aboriginal community of Hopevale. The program provides a free community massage clinic for 1 week per month where there is otherwise no access to massage therapies. It also provides a children's healthy touch program where volunteers visit the childcare centre, kindergarten and primary schools to massage the children using interactive play, encouraging healthy touch in a safe environment. Many of these children have been affected by sexual and physical abuse and may not have any other opportunities to experience healthy touch.

Originally designed as a massage therapy training program, it also has a number of students keen to learn massage to integrate with their current roles, such as aged care & child care workers. These students are learning massage therapy in order to continue the programs benefits on clients within their care in our absence.

The project makes daily visits to the local arts & culture centre to massage the artists and encourage mobility & self-care. It is also based at the Aged Care Hostel and therefore massages the elderly residents as a priority to maintain independence for as long as possible. In addition to this, the program is working on documenting & producing traditional medicinal oils for use in the clinic.

Most recently CYMTTP has established a monthly “Wellbeing Day” for Disability, Home and Community Care Services clients. This incorporates massage therapy, hairdressing, hand and foot care, healthy foods and encouraging activities of daily living through socialization, self care, value and respect.

The project endeavors to assist in meeting whatever the community’s needs might be, as exchange for allowing our volunteers to camp on the traditional owner's lands, the project has raised funds to purchase a gas fridge, tents and a shed for the camp grounds to enhance the facilities and enable the traditional owners to charge a small fee for other visitors to pay therefore encouraging sustainable micro tourism.

Later this month we are bringing some musicians and artists to the community for a free feel-good concert, who knows what the next element of the program might be?

OBJECTIVE: To date, no known studies have explored the brain regions and circuitry activated in response to a therapeutic massage treatment. As such, the purpose of the present pilot study was to delineate the neural pathways in response to a massage therapy treatment in healthy adults.

DESIGN: A randomised pilot study enrolled healthy adults aged 18 to 50 years to receive a Swedish massage, a reflexology treatment or a massage administered with a wooden object on the right foot, while undergoing a functional magnetic resonance imaging (fMRI) testing procedure. Questionnaires assessing mood states were administered at the beginning of the study and a Likert-scale question was given at pre-scan (once participants were placed in the MRI apparatus) and post-scan (after having received the treatment condition).

SETTING: Participants came to the Ottawa General Hospital for the fMRI. Adults aged 18-50 years were recruited from University campuses as well as from a newspaper ad and other community venues. Each person was screened for contraindications.

INTERVENTION: Participants (N=40) received 8.5 min of either a Swedish massage, a reflexology treatment or a massage administered with a wooden object on the right foot. A control group did not receive any tactile stimulation while undergoing the same fMRI procedure as the three above-mentioned treatment conditions.

MAIN OUTCOME MEASURES: The Positive and Negative Affect Schedule is a 41-item scale measuring the degree of positive and negative affective mood states at the present moment. The Beck Depression Inventory is a valid and reliable 21-item scale questionnaire used to reveal depressive symptomatology in both healthy and clinical populations.

RESULTS: Preliminary results indicate significant brain activations in each of the treatment conditions (i.e. Swedish massage, reflexology treatment and massage administered with a wooden object on the right foot) compared to the control condition (i.e. no tactile stimulation on the foot). However, the Swedish massage elicits the strongest activations in the orbitifrontal cortex as well as the precuneus, areas associated with reward, pleasure and positive affect.

CONCLUSIONS: Our preliminary findings from this pilot study indicate that massage therapy enhances positive well-being and might have great beneficial effects in populations suffering from mood disorders such as anxiety, stress and depression.

Objective Summary – This study considered the efficacy of causing positive systemic effects translating into sustained periods of symptomatic remission in the management of rheumatoid arthritis (RA) for a recently diagnosed patient. Autoimmune diseases are noted for their deteriorative properties of physiological systems as a faulty immune response (Werner, 2005). The functionality of the circulatory system and the presence of persistent stress levels can have a negative impact on circulation, triggering pathogen invasion and producing symptomatic pain, discomfort, and inevitable decline consistent with the progressive nature of autoimmune diseases such as RA. Massage therapy has the ability to significantly affect systemic disorders because of its applicative methodology: the promotion of detoxification through vasodilation to assist in the removal of toxins, which can cause pain responses; the improvement of overall circulation by encouraging blood and lymph flow; the activation of the parasympathetic nervous system division by lowering blood pressure, heart rate, and respiration rate inducing relaxation and stress reduction (Prekumar, 2004; O’Brien, n.d.). Massage therapy, when used in conjunction with other prescribed treatments, can have a positive systemic effect in the management of the symptoms and disease progression of rheumatoid arthritis.

Methods – The subject was a 39-year-old female, recently diagnosed with RA after enduring 8 months of a constant “flare-up” condition until diagnosis discovery. She reported pain related symptoms and visible joint swelling in the right shoulder, forearm, and second (index) finger, causing difficulty in mobility and a reduction in ability to perform daily tasks. Over a 10-week period, the subject received 8 therapeutic massage sessions; 7 were scheduled at a strategic 7-day interval and one was held after 3 weeks had passed (Wine, 1995). Each session lasted for 1 to 1 ½ hours and was mainly comprised of Swedish and myofascial techniques to the musculature surrounding the right glenohumeral joint, friction and compression strokes to cleanse the affected bursae (Andrade & Clifford, 2001), a specific arthritic hand massage protocol used by the Touch Research Institute (Field et al., 2006), and light friction strokes in the right antecubital region to encourage lymph flow. The subject kept a daily log, noting number of hours of sleep, any incidence of flare-up or pain, pain scale rating, and personal descriptive comments. Range of motion testing was also performed prior to and after the study period to document any improvements in mobility.

Results – The subject’s overall commentary of her massage therapy treatment experiences was very positive. Subjective visual observation of her posture and gait showed her arms and hands appearing more level and relaxed compared to pre-treatment. By the third weekly session, the client reported experiencing no pain or discomfort, recording low and/or null pain scale ratings. This period of non-flare up continued through the remainder of the study period, even with a longer 3-week duration between sessions at the end of 10 weeks, for a total of 38 days without pain. The client also noted that no pain medication other than her weekly Methotrexate dosage was taken throughout the duration of the study and that she had obtained a better quality of sleep and daily activity. Range of motion testing showed gains in mobility.

Conclusion – Therapeutic massage treatments while able to achieve qualitative muscle releases in an affected joint region, can also positively affect the physiological systems of a patient with RA. By eliciting more comfortable movement in the affected shoulder joint as well as in the opposing shoulder, alleviating its compensatory actions to achieve balance, and more restful sleep periods and virtually eliminating any pain sensations, massage therapy reduces the apparent necessity of high levels of prescription medication to manage the disease and its symptomatic pain. It bears further scrutiny that RA patients could reduce the dosages and conjunctively employ the use of therapeutic massage to manage and ward off the progressively damaging effects of an autoimmune disorder such as RA.

This study evaluated the effectiveness of massage therapy as a component in increasing range-of-motion (ROM), decreasing pain and assisting in healing of a client with low back pain (LBP) and sciatica symptoms. The client presents with an insidious onset of LBP and pain that radiates into the right lower extremity (sciatica). The client has been experiencing this pain daily for the past 9 months. Frequency, duration, and intensity of symptoms were recorded in a daily log book at two or three different times during the day. This task was completed by the client each evening before retiring for the day. The client began recording this information the day after the client’s first visit with the massage therapist. Data for LBP intensity, functional assessment, and ROM results are presented in the following figures. The 10-week study consisted of baseline LBP measures recorded from the first four weeks of clinic and periodically thereafter. During week six a weekly, 45 minute manual therapy session consisting of a structured protocol directed mainly toward muscles of the lumbar spine, pelvis, thigh, and leg regions was implemented. Treatment sessions included muscle tissue warm-up strokes, followed by muscle stripping, ischemic compression, myofascial release techniques, cross-fiber friction massage, deep pressure gliding strokes and passive stretches. A student massage therapist with at least 150 hours of clinical massage experience performed all manual treatment sessions. Reduction of LBP intensity was noted in the first three weeks. The reduction in post-massage LBP intensity was maintained from week one until week 10 with the exception of week six and week seven. In week six there was no change in pain intensity post-massage. The post-massage pain intensity on week seven went up due to intense trigger point therapy work. At the beginning of the treatment period the client had limited ROM in all areas, but by the end of the treatment period the client’s ROM had increased significantly, thus it may be assumed that some healing of tissues took place. Since the client was getting massages weekly, one can also assume that these massages assisted the client’s tissues in healing. What cannot be assumed is that only massage increased the client’s ROM, reduced the level of pain and healed the client’s tissues because the client was also utilizing a physical therapist during the course of the study. The massage therapy regiment used in this study was successful in increasing the client’s ROM as well as reducing the client’s LBP and overall pain. However, factors other than massage could have been responsible or contributed to the overall effects of the treatments, for example, spinal manipulation (used before study), physical therapy (used during study), and stretching techniques such as the ones used in this study by the massage and physical therapists have achieved various positive results for people with LBP. The limitations of this study included the use of a therapy other than massage, the use of specific massage techniques, the use of only one subject, and the lack of a control group. Positive results were most likely due to the combination of treatments the client received, but the distinct techniques and stretches used during the course of this study may have the possibility of becoming useful, non-pharmacological interventions for reducing or eliminating pain and sciatica symptoms associated with low back pain. These findings suggest that a larger, more thorough study that includes a non-LBP control group and uses massage as the only treatment modality is necessary.

Massage leads to a relaxation response, which is typically measured through subjective means. However, relaxation is based on a person’s physiology which can also be measured. One possible measure is called heart rate variability (HRV). HRV is a measure of the variability in beat-to-beat intervals and is calculated by analyzing the time series of beat-to-beat intervals from an electrocardiogram (Task force 1996). HRV response is a non-invasive indicator of changes in autonomic balance. The two components of the autonomic nervous system, sympathetic and parasympathetic normally respond in a reciprocal fashion to regulate body functions, and this system is especially important in orchestrating the body’s response to stress. Increased stress typically shifts the autonomic balance towards a predominantly sympathetic state, whereas relief of stress (relaxation) shifts the balance towards a predominantly parasympathetic state (Lucini 2002; Lucini 2005; Sarzi-Puttini 2006; Paul-Labrador 2006).

The total variability in the R-R time series can be separated into frequency components (Berntson 1997; Pumprla 2002), just as a prism can be used to separate white light into various shades of color. This is routinely accomplished by mathematically computing the power spectrum of the R-R time series, which is analogous to the prism. Of the total spectral power associated with the R-R time series, the low frequency (LF) component, encompassing a range of 0.04 to 0.15 Hz, reflects primarily sympathetic nervous activity, whereas the high frequency (HF) component, encompassing a range of 0.15 to 0.40 Hz, reflects primarily parasympathetic nervous activity (Task Force 1996; Berntson 1997). A change in the relative distribution of the total spectral power between these two ranges is thought to reflect a change in the overall autonomic balance (Pagani 1986; Malliani 1991; Malliani 1994; Zhong 2005).

There are three known massage research studies that utilized HRV as an outcome measure. Studying the effect of therapeutic touch, Sneed et al. (2001) reported that not all subjects responded to treatment, and that significant changes in HRV spectral power that were attributed to the entire study group were actually due to rather large responses in a smaller subgroup. Unfortunately, the authors were not able to differentiate a distinguishing characteristic between the stratified populations. Delaney (2002) utilized trigger-point therapy to the head, neck, and shoulder areas in healthy normal volunteers, and reported a significant increase in HF spectral power (parasympathic response) compared to a control group not receiving the treatment. Their interpretation was that the treatment was “highly effective” in increasing cardiac parasympathetic activity (thus increasing relaxation) in normal subjects. McNamara (2003) reported on patients undergoing diagnostic cardiac catheterization randomized to either a 20 minute back massage prior to the diagnostic procedure or routine care without massage. Compared to controls there was no change in the HF response following massage, suggesting no change in parasympathetic activity, although the authors did report a significant reduction in the systolic blood pressure.

A single case study was completed by this research group on a 39 year old healthy female who demonstrated frequency predominance towards sympathetic nervous system (LF) imbalance at baseline. Immediately after a one hour Swedish relaxation massage, her HRV shifted towards a balancing of the LF and HF measures. Based on this case study, we hypothesize that massage in a larger group of subjects will lead to a shift in the autonomic balance towards increased parasympathetic and reduced sympathetic activity, as reflected by a shift in the distribution of HRV spectral power towards HF.

Within this study, eight subjects attended four sessions each. Each session consisted of “pre” and “post” intervention measurements of HRV. HRV was measured via skin electrodes for recording the ECG placed on the subject’s wrists and left ankle. After a brief (2 to 10 minute) period for acclimation in the prone position, each subject remained quiet and relaxed for 8 minutes during the ECG recording. The first two sessions were baseline sessions (B1 and B2) in which there was no treatment but the subjects rested in the prone position for 15 minutes. The two other sessions were treatment sessions in which either a gentle touch massage (GT) or a Swedish massage (SW) was administered to the back for 15 minutes in the prone position. Treatments were in random order, were choreographed, and were administered by a licensed therapist. HRV was again measured post-intervention.

Each subject’s breathing rate was controlled by using a metronome set for 13 breaths per minute. Consistency of breathing rate allowed for the reduction in HRV variance due to this factor.An elastic strap was affixed around the chest during the HRV recordings in order to simultaneously measure the breathing rate along with the HRV recordings. The strap was carefully unsecured prior to the treatment and secured post-treatment without any motion by the subject.

The median breathing rate among the 8 subjects was 13 breaths per minute, corresponding to the controlled rate.

Individual subjects presented with a consistent heart rate across each of their four sessions (p=0.21), although there were differences between the eight subjects (p<0.00). None of the subjects were tachycardic (>100/minute), whereas two presented with heart rates of less than 60 beats per minute. The presumed reason for the bradycardia in these two subjects was cardiovascular fitness rather than cardiac or regulatory pathology. One of the eight subjects presented with considerably higher total power compared to the other seven. This one subject exhibited an unusual pattern in the R-R time series, with a marked transient lowering of the heart rate coincident with expiration on some, but not all breaths.

Initial (B1 and B2) heart rate values among the eight subjects ranged from 45.2 to 83.1 beats per minute.

the normalized LF spectral power ranged from 13.0% to 68.3% and the normalized HF spectral power ranged from 28.3% to 85.9%. The presenting values for the ratio between the LF and HF components of the R-R spectral power distribution (LF/HF ratio) ranged from 0.16 to 1.39. The differences in heart rate at baseline between the individual subjects did not correlate with any of the results for the R-R series spectral power.

The purpose for these baseline sessions was to determine whether any of the response variables change in a consistent fashion when there is no intervention between the “pre” and “post” measurements. There were no difference in any of the measures for B1 versus B2; therefore, these data were combined (Table 1). Because we did not observe any consistent change in heart rate nor HRV in the “post” recording compared to the “pre” recording suggests that the autonomic nervous state remained stable in these subjects when no intervening treatment was applied.

For either type of massage, there was on average a slight reduction in the heart rate post-massage compared to the pre-massage period (Table 1). However, the presenting heart rate in these subjects was normal, and an average reduction of two beats per minute most likely does not convey any physiologic significance.

As depicted in Table 1, there was an elevation in the normalized LF power after both forms of massage. To a lesser extent, there was also an overall reduction in the normalized HF power after both forms of massage. However, the magnitude of the LF and HF shifts during SW massage were similar to those demonstrated during baseline indicating no difference in autonomic activity when a subject is laying prone for 15 minutes versus receiving a Swedish massage. The magnitude of LF and HF shifts after the GT massage, however, was greater than those during the baseline visits. Furthermore, the LF to HF ratio shifted higher for seven of the eight subjects receiving GT massage, a phenomenon dissimilar to the baseline or SW measures (Table 2).

The results from this pilot study provide three insights. The first is that within this particular group of subjects, when individuals return on different days for repeated study, their presenting HRV remains consistent and stable, relative to the magnitude of difference that appears between individuals. The second is that on a given day, each subject’s HRV appears to remain stable over the duration of time that it would take for a normal massage therapy treatment. The third is that in this particular group of subjects, gentle touch and Swedish massage appeared to cause differing changes in each individual’s HRV.

These results should encourage additional study into the use of HRV measurement to assess autonomic nervous responses to massage therapy. If the sensitivity of HRV to alterations in the autonomic state was so great as to cause HRV measurements to vary continuously over time, it may be difficult to separate a specific treatment response from the ongoing “background” variation. However, these pilot results suggest that in the absence of any specific intervention the HRV will remain stable over the time it would normally take to administer massage therapy. These results further suggest that the presenting HRV within individual subjects will also remain stable from one session to the next. It should be noted that the first and last session was separated by as much as one month in two of the eight subjects.

The subjects who participated in this pilot study were healthy and pain free. Furthermore, their overall state of health did not change over the duration of the study. This most likely helps to explain the consistent repeatability of each subject’s initial presentation at each of the four study sessions. It may also help to explain why these subjects did not appear to respond strongly to either form of massage. Also, there is not yet a firmly established normal for these various measurements of HRV, it is highly likely that these subjects fall into the normal range.

Most of the literature describes an excessive sympathetic state as becoming deleterious to one’s overall health. Subjects in such a state would most commonly present as a predominance of the low frequencies in the total R-R series spectral power, which is opposite what we observed in the present study. A hypothesized mechanism of response to massage therapy is a relaxation response in which there is a lessening of the sympathetic activity, perhaps accompanied by an increase in the parasympathetic. We may further hypothesize that if a person is not initially in a predominant sympathetic state, then they may not demonstrate an HRV response to massage therapy. This is presumably the situation that our subjects were in for this pilot study.

Table 1: Average measures of heart rate (HR), normalized low frequency (LF), normalized high frequency (HF), and low to high frequency ratio during the two baseline visits combined, gentle touch (GT) massage, and Swedish (SW) massage (n=8)

Table 2: Actual measures of low to high frequency ratios per each of the eight subjects

Many people are interested in what massage therapy has to offer; however, they are unsure about what to expect during a massage therapy session. As the massage therapy profession continues to grow in the United States, more information is needed on practice characteristics in order to better define the practice of massage for new clients and referring health care providers.

Three previous studies focus on the topic of massage therapy practice characteristics. Lee and Kemper (2000) appear to be the first authors to define practice characteristics of massage therapists by randomly selecting 126 massage therapists from the Greater Boston Area yellow pages. Results demonstrated that massage therapists in this area were most likely to be Caucasian females treating approximately 20 clients per week for approximately 50-60 minute visits.

Cherkin et al. (2002, 2002) assessed the demographic and practice characteristics of various complementary and alternative medicine (CAM) practitioners including massage therapists (MT). MT’s from Connecticut (n=114) and Washington (n=112) were interviewed for basic demographic and practice characteristic information. A more in depth interview regarding specific massage visit data was provided respectively by 61 and 65 of these therapists. The MT’s in this study were mostlyfemale, had the fewest client visits per week, had the highest percent of referrals from other CAM practitioners, and were least likely to be covered by insurance, when compared to acupuncturists, chiropractic, and naturopathic physicians. Sherman et al. (2005) continued with the presentation of this study in an article that specifically referred to the assessment and treatment of the massage clients, describing that the majority of therapists utilized tissue assessment, range of motion, and postural assessment in their evaluation of clients. Therapies most commonly used during the treatment session included Swedish techniques, deep tissue massage, and trigger point therapy.

Even though these studies are interesting and relevant, the sample sizes were somewhat small and the data did not reflect the Midwestern massage therapist population. The purpose of this study was to survey all licensed massage therapists in Illinois as a comparison to these two other states and to expand on the previous information learned.

A list of all Illinois-licensed massage therapists (n=4,512) was acquired from the state of Illinois, and a letter of introduction, survey, and self-addressed returned envelope was mailed to every name on the list. Names were not included on any survey; rather a unique identification number was used for tracking purposes of return receipt verification. Therapists who did not return their survey were mailed a follow up letter, another copy of the survey, and a self-addressed returned envelope.

Survey questions included information on gender, race/ethnicity, age, massage education, assessment and massage techniques utilized, and self care recommendations.

Of the 4,512 mailed surveys, 194 practices had undeliverable addresses yielding 4,318 eligible subjects. Of the 4,318 therapists, 413 responded to the first mailing and an additional 1,006 responded to the second for a total of 1,419 responses. Therefore, the response rate was 32.9% (1,419 respondents completed survey of 4,318 eligible therapists).

The majority of Illinois massage therapists are female (80.0%), Caucasian (83.4%), and non-Hispanic (76.3%) with an average age of 41 years old (range 20-78). These therapists have been in practice for an average of 7.6 years (range 1-50) and 89.7% received formal training from a massage therapy school.

Most therapists commonly practice (Table 1) in an office outside of their home (63.2%), treating approximately 13 clients per week (range 0-80 clients), and for an average of 60 minutes per session (range 5-135 minutes). Therapists receive the majority of their referrals (Table 2) from chiropractors (47.0%) and other massage therapists (47.0%), and clients typically self pay (87.9%, Table 3)

Assessments (Table 4) by massage therapists mainly include range of motion (64.8%), tissue assessment (61.3%), and postural assessment (57.4%). When treating, the majority of therapists utilize (Table 5) deep tissue massage (84.4%), Swedish techniques (84.0%), and trigger point therapy (73.3%). Clients receive self care recommendations (Table 6) to increase water intake (82.4%), be active (74.6%), apply hot/cold therapy (63.5%), and increase self awareness (61.7%).

Description of massage therapists’ demographic and practice characteristics allow other health care providers and their patients to better understand who massage therapists are and what they do. This issue becomes increasingly important with the increase in massage care utilization. The data from the present study demonstrate very consistent results when compared with the previous studies, indicating that even with a larger sample of therapists who reside in a different part of the country the overall generalized description of the massage therapy profession appears reliable.

Limitations of this study include the usual issues involving survey instruments, including non-response bias and recall bias.

Objective:
A growing body of evidence suggests that Complimentary and Alternative Medicine (CAM) may be effective in pain management. Current reimbursement structures limit service availability. The objective was to develop and fund a hospital based CAM program for persons following spinal cord injury.

Design:
Customer service surveys, medical record reviews and a literature review were conducted to gather data determining service recommendations. A program was implemented and pilot data for future research was collected.

Participants/Methods:
Funding was obtained via donations. A massage therapist provided five, 1 hour sessions to 21 subjects. Of these, 80% had a new SCI (< 4 months) while 20% were injured between 5 and 12 months. Treatment included a combination of soft tissue massage, myofascial techniques, trigger point massage and Swedish relaxation. Data included: area/quality of pain, pre/post treatment pain scales, and subjective reports for pain affects on daily activities. Satisfaction surveys were given post treatment.

Results:
Customer service surveys following initial rehabilitation indicated adequate pain management is of highest priority. Unresolved pain negatively impacted functional outcomes per medical record reviews. Post treatment pain assessment findings: 71% (n=15) reported a clinical significant reduction of 2 or more points on a 0-10 pain scale; 24% (n=5) had a 1 point reduction, and .05% (n=1) reported no change in pain. Thirty eight percent of subjects returned the post-treatment survey. All reported a reduction in pain or tightness, an enhanced ability to meet goals, a desire to continue massage therapy and recommended that massage therapy is included as standard practice during rehabilitation.

Conclusion:
Massage therapy can be integrated into traditional rehabilitation programs without increasing operational expenses. Preliminary data indicates massage therapy may reduce pain.

Objective: This study presents the results to date of program evaluation data collected pursuant to a treatment services grant from the Susan G. Komen for the Cure Foundation Community Organization Grants program. The project’s primary goal is to reduce the impact of the symptoms of breast cancer and its treatment by making professional massage therapy available free of charge to breast cancer patients in need.

Participants: Medically underserved breast cancer patients in treatment and survivors in the Washington, DC area, referred by their oncology healthcare providers. Referring organizations include the Arlington Free Clinic, Nueva Vida, Smith Farm Center for Healing and the Arts, Washington Cancer Institute, Lombardi Cancer Center, Sibley Memorial Hospital, and Suburban Hospital.

Main Outcome Measures: VAS ratings for perceived pain, stress, fatigue, anxiety, depression, and nausea, completed before and after massage. The measure also allows patients to make open-ended comments if they wish. A focus group interview with patients is scheduled for late July.

Results: Data collection is still ongoing. Since its opening in mid-April, 2007, the Breast Cancer Massage Clinic has provided 80 sessions, half of those during June. Clients report statistically significant reductions in symptom severity, with most symptom scores averaging a rating of 4 prior to massage and falling to less than 1 after massage. Clients’ written comments have ranged from a simple “Thanks!” to the poetic: “I feel light, like a burden has been lifted, like a feather.” No adverse responses have been reported.

Conclusion: Although preliminary quantitative data shows statistical significance, effect sizes for symptom reduction are likely to be overestimated due to the observational and uncontrolled nature of the study. Qualitative data to date indicates that clients find the massage helpful and relaxing. Massage therapy appears to be a useful adjunct to breast cancer treatment that reduces the burden of symptoms for patients and survivors.

Background: The effectiveness of massage therapy for low-backpain has not been documented. This randomized controlled trialcompared comprehensive massage therapy (soft-tissue manipulation,remedial exercise and posture education), 2 components of massagetherapy and placebo in the treatment of subacute (between 1week and 8 months) low-back pain.

Methods: Subjects with subacute low-back pain were randomlyassigned to 1 of 4 groups: comprehensive massage therapy (n= 25), soft-tissue manipulation only (n = 25), remedial exercisewith posture education only (n = 22) or a placebo of sham lasertherapy (n = 26). Each subject received 6 treatments withinapproximately 1 month. Outcome measures obtained at baseline,after treatment and at 1-month follow-up consisted of the RolandDisability Questionnaire (RDQ), the McGill Pain Questionnaire(PPI and PRI), the State Anxiety Index and the Modified Schobertest (lumbar range of motion).

Results: Of the 107 subjects who passed screening, 98 (92%)completed post-treatment tests and 91 (85%) completed follow-uptests. Statistically significant differences were noted aftertreatment and at follow-up. The comprehensive massage therapygroup had improved function (mean RDQ score 1.54 v. 2.86-6.5,p < 0.001), less intense pain (mean PPI score 0.42 v. 1.18-1.75,p < 0.001) and a decrease in the quality of pain (mean PRIscore 2.29 v. 4.55-7.71, p = 0.006) compared with the other3 groups. Clinical significance was evident for the comprehensivemassage therapy group and the soft-tissue manipulation groupon the measure of function. At 1-month follow-up 63% of subjectsin the comprehensive massage therapy group reported no painas compared with 27% of the soft-tissue manipulation group,14% of the remedial exercise group and 0% of the sham lasertherapy group.

Interpretation: Patients with subacute low-back pain were shownto benefit from massage therapy, as regulated by the Collegeof Massage Therapists of Ontario and delivered by experiencedmassage therapists

Institution: Center for the Study of Complementary and Alternative Therapies
University of Virginia School of Nursing
Charlottesville, Virginia

Description: Patients with cancer undergoing autologous stem cell transplantation (ASCT) endure a series of stressors and adverse symptoms throughout treatment, resulting in impaired quality of life (QoL). The objective of this study was to investigate the immediate and cumulative effects of massage on stress, relaxation, and comfort; explore effects of massage on anxiety, pain, and QoL outcomes; and identify the benefits of, and barriers to, patient acceptance of massage during phases of the ASCT process.

Research Methods: This pilot study used a mixed-methods, unmasked, prospective, randomized experimental design. Assessments were made of health-related QoL; state anxiety; perceived stress, comfort, and relaxation levels; pain; and social support.

Statistical Analyses: Descriptive statistics and graphing techniques were used to analyze the data.

Outcomes: Immediate post massage effects included reduced stress , increased relaxation, and increased comfort. Cumulative effects of massage over transplant phases were not seen in the massage group. Participants in the massage group also reported lower anxiety scores across the transplant phases and lower affective and sensory pain scores during hospitalization following transplant than those in the SMC alone group. Perceived benefits of massage for the participants included improvement in symptoms that they had been experiencing prior to undergoing ASCT as well as their current treatment-related symptoms.

Future Directions: It is feasible to provide massage across the continuum of outpatient, inpatient, and home settings to patients undergoing ASCT. Supportive care massage can have immediate effects on stress, comfort, and relaxation and can improve treatment-related symptoms for patients undergoing ASCT. Research should continue to evaluate the effects of massage for patients in the acute care environment.

Funding: Supported by National Cancer Institute (NCI) Grant No. R21-CA100627 and National Center for Complementary and Alternative Medicine (NCCAM) Grant No. K30-AT-000060, and its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCI, NCCAM, or the National Institutes of Health.

Healing effects of massage therapy on an acute rehabilitation unit

Massage therapy promotes comfort and relaxation. It is part of the holistic approach to nursing. Research has substantiated that massage helps lower cortisol levels, anxiety and depression. See References.

Low Back Pain and Sleep Disturbance are Reduced Following Massage Therapy

Authors: Tiffany Field, PhD ^1,2, Maria Hernandez-Reif, PhD¹, Miguel Diego, PhD¹ & Monica Fraser³¹Touch Research Institutes, University of Miami School of Medicine
² Fielding Graduate University
³ BIOTONE, Inc, San Diego, CA

In this study, massage therapy was compared to relaxation therapy effects for chronic low back pain. Thirty adults (mean age = 41 years old) participated with low back pain of at least 6-months duration. The participants were cleared by their primary physician for participation and met exclusion criteria of no fractured vertebrae, herniated or degenerated disks, surgery, sciatic nerve involvement or workmen’s compensation. The massage group received 30-min massages twice a week for 5 weeks by massage therapists and the relaxation group conducted progressive muscle relaxation exercises of the same duration and on the same time schedule as the massage group. Both groups were evaluated for pain, depression, anxiety, and sleep disturbances. In addition, trunk range of motion was assessed. The massage therapy group, compared to the relaxation group, reported experiencing less pain, depressed mood, anxiety and sleep disturbance. They also showed improvement in trunk and pain flexion performance. These findings support the use of massage therapy for chronic low back pain.

The findings appear in the July 2006 issue of the Journal of Bodywork and Movement Therapy and are available in the June 5, 2006 online edition.

Authors: Maria Hernandez-Reif, PhD¹, Tiffany Field, PhD ¹, Gail Ironson, MD, PhD², Julia Beutler, MPH³, Yanexy Vera, BA¹,
Judith Hurley, MD⁴, Mary Ann Fletcher, PhD⁵, Saul Schanberg, MD, PhD⁶, Cynthia Kuhn, PhD⁶ & Monica Fraser⁷

¹Touch Research Institutes, University of Miami School of Medicine² Department of Psychology, University of Miami³ Office of Research, University of Miami⁴Hematology/Oncology Clinics Jackson Memorial Hospital⁵Department of Medicine EM Papper Laboratory, University of Miami⁶Department of Pharmacology, Duke University Medical School⁷BIOTONE, San Diego, CA

Fifty-eight women (mean age = 53 yrs old) with breast cancer were assigned to a massage, relaxation or standard care control group. The massage group received 30-min massages three times a week for 5 weeks by massage therapists and the relaxation group conducted progressive muscle relaxation exercises of the same duration and on the same time schedule as the massage group. The women were evaluated on the first and last days of the study for mood, pain, and anxiety. Blood and urine samples were also collected to assay immune measure profile and urinary hormone values. The massage and relaxation groups reported less depressive symptoms, anxiety and pain after their first and last sessions. However, by the end of the study, only the massage group reported being less depressed, anxious and angry and having more vigor. With respect to immune measures, Natural Killer cell numbers (NK cells) increased by 12% for the massage group. This may be of clinical significance given that NK cells fight tumors and viruses. Dopamine and serotonin levels, neurotransmitters associated with depression, also increased by 59% and 36% respectively, corroborating the massage group’s self-report of decreased depressive symptoms. Overall, these findings support the use of massage therapy for women with breast cancer to improve their psychological as well as their biochemical and immune profiles.

Authors: Amanda Baskwill, RMT and Trish Dryden, MEd, RMT

The purpose of this review was to investigate the current research evident to support or oppose the use of massage therapy (MT) during the stages of pregnancy, labour and delivery, and infancy.

For this review, the electronic databases, specific to health care and complementary and alternative health care were searched from 1973 to 2005. Relevant search words were used alone and in combination to find MT effectiveness trials specific to pregnancy, labour and delivery, and infant massage. The search was limited to trials in English. In total, 15 studies were included that spanned the following categories: MT and pregnancy (3), MT and labour/delivery (3), MT and infants (9).

Although other variables were included in the review, variables specific to improving maternal mood and level of anxiety, decreasing pain, decreasing obstetrical complications and improving neonatal health and development had the most significant results. All studies involving pregnant women showed that the MT group had greater or longer lasting improvements in maternal mood and anxiety when compared to the control group. This finding was further supported through the measurement of biological measures such as cortisol, dopamine and serotonin. Subjects in the MT group experienced a decrease in the level of back and leg pain. Women who received MT during labour and delivery reported decreased levels of anxiety and pain compared to women who used breathing exercises alone. When measuring obstetrical complications, the MT group had more optimal scores then the control group(s). Premature infants who received MT scored higher on the Brazelton Neonatal Behavior Assessment Scale and experienced greater daily weight gain.

The small number and mixed methodological quality of studies on the effectiveness of massage therapy for maternal and neonatal health and the absence of studies on mechanism of action, makes drawing definitive conclusions difficult. The best available, albeit limited, evidence at this time, supports the use of massage therapy for pregnant women to improve maternal mood and level of anxiety, decrease pain, decrease obstetrical complications and improve neonatal health and development.

Background: Prior studies have demonstrated improvement in pain with massage therapy in a variety of conditions and experimental settings, though few have examined patients in a hospital setting. Objective: To describe the experience of an inpatient integrative therapy program and measure the effects of massage therapy on pain scores in hospitalized patients. Methods: This was a 23 month, retrospective, database review from an inpatient integrative therapy department of an urban tertiary care academic medical center. Age, sex, reason for referral and pain location were recorded, as were initial and final pain scores on a 0 – 10 numerical rating scale before and after a 30 minute gentle Swedish massage intervention with relaxing background music. Analgesic medications were not controlled, but were routinely prescribed to all patients. Data are expressed as median + standard deviation (with 95% confidence intervals), and groups are compared with Mann-Whitney Rank Sum Test. Results: There were 209 subjects, including 109 (52.2%) men and100 women, aged 53.5 + 17.8 years (range 13 – 89). The most common reasons for massage referral were cancer (57), post-operative (36), palliative care (17), sickle cell (9), trauma (7) and relaxation (6). The most common pain locations specified were upper back (32), shoulder (28), head (29), neck (24), abdomen (18), and lower back (15). Initial pain scores, 6.51 + 2.31 (6.19, 6.83), and final pain scores, 2.96 + 1.88 (2.70, 3.22), were significantly different, p<0.001. Pain decreased by an average of 3.56 + 1.77 (3.32, 3.80), remained unchanged in only 5 (2.4%), and did not increase in any patient. A 50% or greater pain reduction was achieved in 156 (74.6%) subjects. Conclusion: Pain scores are significantly reduced immediately following therapeutic massage for a variety of clinical conditions in hospitalized patients despite concomitant analgesic medication use. Routine use of massage therapy in hospitalized patients of all types could have potentially important implications on clinical outcome and patient satisfaction.

Authors: Jennifer Rheingans, RN, BSN, CPON; Brandi Ancrum, BS, MPH; Jodi Savell, BA; Cynthia Myers, PhD, LMT University of South Florida College of Nursing and H. Lee Moffitt Cancer Center, Tampa, FL

Purpose: To review and critically evaluate published research on complementary and alternative medicine (CAM) in patients with sickle cell disease.

Methods: A systematic review of the literature was conducted using medical index subheadings for sickle cell disease in PubMed, CINAHL, and PsycInfo from root of each database to December 2005 seeking CAM in each of the following domains: alternative medical systems, manipulative and body-based therapies, mind-body therapies, and energy therapies. Review of retrieved titles for inclusion was completed by two independent reviewers. Inclusion criteria were met by original research reporting results of controlled or uncontrolled clinical studies, including case reports and qualitative studies. Each study was critiqued by two independent reviewers.

Results: Few studies met the inclusion criteria (N=11). Alternative medical systems yielded two studies, both on acupuncture. Manipulative and body-based therapies yielded two reports, both on massage therapy. Seven studies in mind-body therapy met inclusion criteria. These included studies of hypnosis, relaxation training, and biofeedback. No studies were found on energy therapies.

Conclusions: Few studies were found on the effects of complementary therapies for sickle cell disease. Methodological weaknesses such as small sample sizes, lack of information on compliance with treatment, blinding of assessors, details of interventions, nonstandardized assessment instruments, and gaps in the reporting of outcomes limit interpretability of the studies reviewed. Several complementary therapies appear promising for patients with sickle cell disease but further study is needed. Given that severe pain is the hallmark symptom of this disease and pain is often incompletely controlled by biomedical therapies, there is a great need for more research in the use of potentially helpful adjunctive complementary therapies with minimal side effect profiles for symptom management, quality of life, and health care utilization in sickle cell disease.

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Authors: Jennifer Hattan BSc RN RM, Independent Midwife, The Birth Centre, London; Lindy King PhD BN RN, Senior Lecturer School of Nursing and Midwifery, Flinders University, Adelaide, Australia; Peter Griffiths BA PhD RGN, Senior Lecturer Primary and Intermediate Care, Head of Graduate Studies (taught programmes), School of Nursing and Midwifery, King's College London

Background: Due to the widely presumed association between heart disease and psychological wellbeing, the use of so-called ‘complementary' therapies as adjuncts to conventional treatment modalities have been the subject of considerable debate. The present study arose from an attempt to identify a safe and effective therapeutic intervention to promote wellbeing, which could be practicably delivered by nurses to patients in the post-operative recovery period following coronary artery bypass graft (CABG) surgery.

Aim: To investigate the impact of foot massage and guided relaxation on the wellbeing of patients who had undergone CABG surgery.

Method: Twenty-five subjects were randomly assigned to either a control or one of two intervention groups. Psychological and physical variables were measured immediately before and after the intervention. A discharge questionnaire was also administered.

Results: No significant differences between physiological parameters were found. There was a significant effect of the intervention on the calm scores (ANOVA p=0.014). Dunnett's multiple comparison showed that this was attributable to increased calm among the massage group. Although not significant the guided relaxation group also reported substantially higher levels of calm than control. There was a clear (non-significant) trend across all psychological variables for both foot massage and, to a lesser extent, guided relaxation to improve psychological wellbeing. Both interventions were well received by the subjects.

Conclusions: These interventions appear to be effective, non-invasive techniques for promoting psychological wellbeing in this patient group. Further investigation is indicated.

Marcia M Piotrowski, RN MS, Cynthia Paterson, RN MSA, Allison Mitchinson, MPH, Hyungjin Myra Kim, ScD, Marvin Kirsh, MD FACS, Daniel B. Hinshaw, MD FACS

Background: Opioid analgesia alone may not fully relieve all aspects of acute postoperative pain. Complementary medicine techniques used as adjuvant therapies have the potential to improve pain management and palliate postoperative distress.

Study Design: This prospective randomized clinical trial compared pain relief after major operations in 202 patients who received one of three nursing interventions: massage, focused attention, or routine care. Interventions were performed twice daily starting 24 hours after the operation through postoperative day 7. Perceived pain was measured each morning.

Results: The rate of decline in the unpleasantness of postoperative pain was accelerated by massage (P = 0.05). Massage also accelerated the rate of decline in the intensity of postoperative pain but this effect was not statistically significant. Use of opioid analgesics was not altered significantly by the interventions.

Conclusions: Massage may be a useful adjuvant therapy for the management of acute postoperative pain. Its greatest effect appears to be on the affective component (i.e., unpleasantness) of the pain.

Joe Delaney FIBMS PhD, King Sun Leong BMed Sci, BMBS, MRCP, MD, Alan Watkins BSc MBBS, David Brodie BSc MIBiol PhD.

Aim: To investigate the effects of myofascial trigger-point massage therapy to the head, neck and shoulder areas on cardiac autonomic tone.

Background: No studies have reported on the effect of back massage on autonomic tone as measured by heart rate variability. This is especially relevant to the nursing profession, as massage is increasingly available as a therapy complementary to conventional nursing practice.

Design : An experimental study in which subjects were initially placed in age- and sex-matched groups and then randomised to treatment or control by alternate allocation.

Methods: The study involved 30 healthy subjects (16 female and 14 male, aged 32.5 ± 8.5 years). A five-minute cardiac inter-beat interval recording, systolic and diastolic blood pressure and subjective self-evaluations of muscle tension and emotional state were taken before and after intervention. Autonomic function was measured using time and frequency domain analysis of heart rate variability.

Results: Following myofascial trigger-point massage therapy there was a significant decrease in heart rate (P < 0.0001), systolic blood pressure, (P < 0.02) and diastolic blood pressure (P < 0.01). Analysis of heart rate variability revealed a significant increase in parasympathetic activity following myofascial trigger-point massage therapy. Additionally both muscle tension and emotional state, showed significant improvement (P > 0.001).

Conclusion: In normal healthy subjects myofascial trigger-point massage therapy to the head, neck and shoulder areas is effective in increasing cardiac parasympathetic activity and improving measures of relaxation.

Keywords: Massage, heart rate variability, autonomic tone, muscle tension, relaxation.

For further information please contact Dr Joe Delaney on email: delaney@liv.ac.uk

Svircev, A., Craig, L., Ansari, F.P., Juncos, J.L., and Bliwise, D.L.
Atlanta School of Massage, Atlanta, GA
Emory University Medical School, Department of Neurology, Atlanta, GA

Introduction:
Patients with Parkinson's disease (PD) typically have markedly disturbed sleep with conventional treatments showing only minimal success. Recently neuromuscular therapy (NMT), a form of massage therapy, has been shown to offer beneficial effects on motor function in PD (UPDRS motor subscale) (Svircev and Craig, Amer Pub Hlth Assn, 2002). Massage has been identified previously as offering beneficial effects in spinal cord injury (Diego et al, Int J Neurosci 2002: 112: 133-42) and for improving sleep in hospitalized patients (Richards et al, AACN Clin Issues, 2000, 11, 77-96). The present study examined the effects of NMT on reported sleep relative to a control condition (music relaxation therapy, MRT) in PD patients.

Methods:
There were 32 participants with mild-to-moderate stage PD (mean age 63.1, 23 men, 9 women). They were randomized to receive either NMT (n=18) or MRT (n=14). NMT was administered by a certified massage therapist over a 4 week period, 2x/week (8 sessions total, 45 minutes each) at the Atlanta School of Massage Clinic. In the NMT sessions, specific attention was paid to identification of trigger points and pressured release and music was played during the session. A consistent protocol was used for each NMT session. MRT consisted of identical protocol for each participant but excluded NMT. The Pittsburgh Sleep Quality Index (PSQI) was administered at Baseline and Follow-up, and the PSQI Global Score was used as the primary outcome in this analysis. PSQI subscales served as secondary outcomes.

Results:
The NMT group (n=18) had participants with slightly more advanced PD the MRT group (n=14) (Hoehn-Yahr, 1.8 [1.0] vs 1.3 [0.5] t=1.76, p<.10) but did not differ in age or characteristic sleep quality (Baseline PSQI Global = 8.1 [3.6] vs 7.0 [3.6], t=0.81, NS). Repeated measures ANOVA indicated no group by time interactions for either the PSQI Global Score or any of the 7 subscales. With the exception of subscale 5 (subjective sleep quality), absence of even simple time effects suggest the recalcitrant nature of disturbed sleep in this population for placebo effect.

Conclusions:
Despite massage-induced improvements in PD motor function reported elsewhere (Svircev, 2002), self-reported sleep did not show improvement with this alternative treatment modality. Because of the severity of disturbed sleep in PD, possible efficacy of various massage modalities in other conditions (e.g., primary insomnia) should still be examined.

As the public begins to focus on integrative medicine, many healthcare systems are seeking to incorporate more holistic ways to deliver care. After incorporating massage therapy into the ICU, staff observed increased relaxation in patients and restoration of a degree of tranquility. Patients often encounter many invasive and frightening experiences while in the hospital, including the placement of PICC (Percutaneously Inserted Central Catheters) and Mid-Arm catheters. The goal of this study was to determine the impact of using massage on improving the patient’s physical comfort and reducing stress and anxiety levels during PICC and Mid-Arm catheter insertion. A Likert-scale survey was administered pre-procedure and post-procedure to 21 patients who required PICC/Mid-Arm catheter insertion at McKenzie-Willamette Hospital over a 15-month period of time. Results indicate a 39% improvement in anxiety levels and 23% improvement in physical comfort levels in the group who received massage during the catheter insertion. Those patients who experienced massage as a relaxation technique were also generally easier to cannulate for line placement.

· 21 adult patients were surveyed.
9 of the patients received massage during the procedure.
12 patients did NOT receive massage.

· Massage was offered according to the patient’s comfort level. The massage therapist and the patient determined where the patient would feel most comfortable receiving touch during the procedure.

· Generally massage (light effleurage) was provided to the hand, arm (not receiving the catheter), feet, neck or scalp.

· The focus of massage was to redirect the attention of the patient and provide soothing, calming, comforting touch during the procedure.

· Those patients receiving massage indicated:
23% improvement in physical comfort levels post procedure.
39% improvement in anxiety levels post procedure.

· Those patients NOT receiving massage indicated:
08% improvement in physical comfort levels post procedure.
29% improvement in anxiety levels post procedure.

· Patients receiving massage demonstrated significant improvement in physical comfort and anxiety levels over those that did not receive massage.

· It was also observed that there was less vascular constriction and a more peaceful recovery among those patients receiving massage during the procedures.

· 77% of patients, when asked if massage affected their physical comfort level indicated, "very much" (the highest score they could give).

· 67% of patients, when asked if massage affected their anxiety levels indicated "very much."

· “I think the massage caused a definite improvement in my comfort level. It kept me from focusing on the procedure and relaxed me.”

· “I’m glad that the massage was given. I have had this done three times before without massage. This was the lowest level of anxiety.”

· “Having had two PICC installs without massage, I can say it helped to have it. Thanks!”

· Highly recommend using massage to reduce anxiety and improve patient comfort during PICC/Mid-Arm catheter placements.

· Highly recommend trying massage to compliment other potentially anxiety or pain producing procedures such as thorocentesis, pre-cardioversion, or with naso-gastric or naso-duodenal feeding tube placement.

OUR PLAN is to modify our survey to include demographics such as gender and age to see if there is any correlation regarding perception of massage or its benefits. We also plan to gather data regarding massage as it affects physical comfort levels and anxiety levels during other invasive procedures in addition to the PICC/Mid-Arm catheter placements.

Principal Investigator: Laurie Craig - Atlanta School of Massage
Project Coordinator: Anna Svircev - Atlanta School of Massage
Emory University Rollins School of Public Health

Parkinson’s disease (PD) is a progressive neurodegenerative disorder of the central nervous system characterized by tremor, muscular rigidity, abnormalities of posture, and bradykinesia (slowness of movement) as well as psychological symptoms such as depression and anxiety. Although pharmacological treatments provide partial and temporary relief of symptoms, disease progression leads to increasing neuromuscular discomfort and disability. Objectives for this study were to investigate the value of neuromuscular therapy (NMT) as a complementary treatment for physical and mental symptoms of PD. Specifically, the study seeks to examine the effects of NMT, using standard clinical measures, on tremor, rigidity, bradykinesia, fine motor skills, depression, and anxiety in patients with PD.

The methodology employed for the study was a controlled prospective experimental design. The data from 32 participants over a 6-month period were evaluated. Participants were randomly assigned to one of two groups: an experimental NMT group or a control music therapy group. Participants received two treatments per week for four weeks. Data were collected at baseline prior to the first treatment, immediately following the final (eighth) treatment, and eight days following the final treatment. A variety of assessment instruments were used to evaluate parkinsonian symptoms. Instruments included the United Parkinson’s Disease Rating Scale (UPDRS) Part A (Mentation, Behavior, and Mood), Part B (Activities of Daily Living) and Part C (Motor Abilities); the Purdue Pegboard (a test of fine motor skills), a finger-tapping test to measure bradykinesia, the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Clinical Global Impression Scale (CGI). The CGI is a standardized assessment tool used to rate severity of illness and change over time.

A standard statistical test was used to evaluate the participants’ scores on each of the assessment tools. Statistically significant results were found in both groups for all tests except the UPDRS Part A. This indicates that relaxation in general may benefit patients with PD. There were statistically significant results on the UPDRS Parts B and C and the CGI for participants in the NMT group. This suggests that those participants showed substantial improvement in activities of daily living, motor abilities, and patient and investigator perception of disease severity.

To the investigators’ knowledge, this pilot study is the first single-blinded controlled study to examine NMT on patients with PD. The outcomes of this study offer information on complementary therapies for patients with this neurodegenerative disease. Neurologists may consider utilizing a more comprehensive health care plan that includes NMT for patients with PD. To confirm the statistical validity of these promising results, future studies should be conducted with a larger number of participants.

Abstract:
In this randomized crossover study we enrolled low income Anglo and Hispanic women with chronic pain in a program of 8 weekly one-hour whole body massage treatments. Patients were randomized to either active treatment or an 8 week waiting period followed by the massage program. In preliminary analyses we found a significant and lasting improvement on physical functioning on the SF-36 but no improvement in mental health functioning. The study was limited by the high dropout rate.

Background:
Chronic pain is a frustrating problem for both patients and physicians. Despite frequent office visits and expensive and sometimes harmful medications, many patients do not improve. Sometimes the pain is part of a more complex mental health problem like depression, anxiety, or somatization. Low income patients with chronic pain may be particularly difficult to treat for a variety of reasons. Patients from developing countries or minority ethnic groups may be more likely to articulate distress in bodily symptoms; yet these same patients are also more likely to suffer from chronic debilitating diseases and have fewer resources available to manage their health care. Whole body massage therapy offers an alternative approach to the treatment of chronic pain patients. Massage therapy is widely used in sports medicine to reduce pain and promote flexibility and has been documented to reduce pain and behavioral and biochemical measures of anxiety and depression in various populations.

Objectives:
Our objectives are to present the design and preliminary results of a study of massage therapy for women patients with chronic pain. The following information will be presented and discussed.

Study Design:
Randomized controlled trial (double cross-over) with four months of follow-up observations.

Setting:
Inner-city community health center serving low-income multi-ethnic families.

Participants:
A total of 70 low-income Anglo and Hispanic women patients age 18-65 referred by their family physician or family nurse practitioner were enrolled of whom 48 completed at least 6 massage treatments and at least two follow-up measures. Eligibility requirements: at least one year of primary care at the health center and chronic pain lasting at least 6 months documented in the medical chart.

Intervention:
After completion of the baseline assessment measures, patients were randomized to either the first or second treatment group by means of a random number table. Within each cohort, the initial treatment group received 8 weekly one hour full-body massage treatments by an experienced licensed female massage therapist in a quiet setting within the health center. Follow-up evaluations were performed at the end of treatment and 2 and 4 months later. The crossover group had a baseline assessment and then underwent an 8 week period without any change in treatment (that coincided with the time that the initial group was receiving treatments). At 8 weeks, after assessments had been repeated, the crossover group then received the 8 week massage intervention and the three post-treatment observations. Patients were assigned to one massage therapist for the duration of the program. Whole body massage was conducted using soft tissue manipulation of the head, neck, arms, legs and trunk, focusing on symptomatic areas. A combination of adjunctive therapies such as trigger point, cross fiber friction, Reiki, and oriental massage techniques were incorporated on an individual basis.

Main Outcome Measures:
The composite SF-36 mental health (MCS) and physical functioning (PCS) scores over time; CES-D and STAI-S scores over time; Dartmouth COOP scores over time.

Statistical Methods:
SF-36 scores were available for the 48 subjects who completed at least 6 weeks of massage therapy and 38 subjects had observations out to the final follow-up. A mixed model analysis with repeated measures was employed. The mixed models approach is similar to Analysis of Variance procedures but without some of the assumptions of ANOVA that are often not satisfied in the data. In this particular situation, it was important to employ an analytic approach that allowed cases with missing data to be included in the analysis and also allowed for selection of the appropriate variance-covariance matrix since the more restrictive assumptions of ANOVA were not met. The SAS PROC MIXED procedure was used for the analysis.

Results:
The group undergoing 8 weeks of observation after enrollment and before the intervention experienced no improvement in symptoms and SF-36 scores did not differ significantly from baseline in this group. Therefore, the two groups were combined and subsequent analyses were carried out using only baseline, post-treatment and the 2 follow-up observations for all subjects. Mental health scores (MCS) differed significantly between Latino and Anglo subjects (lower for Latino subjects) but there was no improvement in MCS following massage therapy. Physical health scores (PCS) were similar for Latino and Anglo patients and differed significantly over time (p<.01). There was no significant interaction between ethnicity and time with respect to either outcome. In particular, PCS scores improved in both groups following massage therapy and this improvement was sustained through the entire follow-up period. Scores on CES-D, STAI-S and Dartmouth COOP scales all improved during massage therapy but returned to pretreatment levels within 4 months of completing treatment. Of note, 86% of the Anglo patients and 53% of Latino patients acknowledged some form of prior physical or sexual victimization in either childhood or adulthood.

Conclusions:
Massage therapy may be an effective treatment for some chronic pain patients. For patients who completed 6 or more massage therapy treatments there was an improvement in physical functioning and furthermore, this improvement was sustained over a 4-month follow-up period. In this setting most Anglo women with chronic pain and more than half of Latino women with chronic pain were survivors of prior violent victimization.

Discussion:
This study suggests that massage therapy was a lasting and effective treatment for improving physical functioning in those women with chronic pain problems who were able to participate in a sustained treatment program. The study was limited by the high number of dropouts from treatment. Dropouts offered two main reasons for not continuing in the program: 1) logistical problems typical for low-income families including moving away, sickness in the family, multiple conflicting appointments, and work and child care obligations; and 2) discomfort with massage therapy itself, or lack of result from the initial massage. To offset the first set of difficulties, future studies might need to offer childcare and transportation and increased flexibility in the scheduling appointments. Massage therapy may not be a suitable modality for the second group.

Improvement in physical functioning rather than mental health functioning after a course of massage therapy is a plausible outcome since patients experience chronic pain problems as physical, and the modality of massage directly addresses the location of the pain in the body. Insofar as chronic pain is sometimes linked with depression and somatization, a long-standing improvement in physical functioning may have the potential to improve mental health functioning. The likelihood of prior violent victimization in women with chronic pain should be addressed in considering the use of massage therapy. We were unable to demonstrate any significant effect on mental health scores over a four month follow-up period. However, this analysis included only SF-36 composite scores; more sensitive measures of mental health symptomatology and pain should be assessed in the future.

Objective.
The objective was to test the effects of massage therapy on physical function, stress perception, sleep, and general well-being among older adults compared to a guided relaxation control condition.

Design.
After screening for eligibility and contraindications, physical clearance for participation was obtained. Eligible participants were randomly assigned to massage or guided relaxation. Sessions were provided twice-weekly for four consecutive weeks. Functional assessments and interviews were conducted before the first session and after the last session.

Setting.
Participants came to the university for all sessions where a massage room had been reserved for the study.

Participants.
Forty-nine participants aged 60+ completed the study (25 massage and 24 guided relaxation). Three-fourths of participants were female; 88% white, 10% African American, and 2% Asian. Participants were independently living, relatively “well” older adults rather than a clinically defined group of patients.

Main Outcome Measures.
The main outcome measures were range of motion at shoulder, hip, and ankle by goniometer measurement; flexibility (chair sit-and-reach); tandem balance; agility (timed up and go test); general well-being (General Well-Being Scale, with subscales for anxiety, depression, positive well-being, self-control, vitality, and general health); Perceived Stress Scale; and Sleep (two items from the Philadelphia Sleep Quality Index).

Results.
The massage group improved significantly more than the guided relaxation group on anxiety, depression, vitality general health, positive well-being, timed up and go test, chair sit and reach test, shoulder abduction, and hip flexion.

Conclusion.
Massage therapy has positive effects on psychosocial and functional health of older adults.

This study assessed the effectiveness of massage therapy as an intervention for coping with stress in healthy university students approaching final examinations (N = 34). Participants were randomly assigned to an attention control condition (watching 3 different television programmes) or to a massage therapy group, who received one 45-minute massage per week for 3 consecutive weeks. Measures of blood pressure, heart rate, and state anxiety (State Trait Anxiety Inventory – short form) were taken before and after each of the sessions. Stress (Perceived Stress Scale) and coping (Coping Efficacy) were measured three times at baseline (T1), immediately after the three sessions (T2), and at one week follow up (T3). Both groups reported lower anxiety after each of the sessions; however, the massage group had a greater reduction in comparison to the television group (p < .05). The massage group had a lower heart rate after each of the massages, while the television group showed no change (p < .05). There were no significant differences between the groups for systolic and diastolic blood pressure. At T2 the massage group reported a significant decrease in perceived stress and an increase in coping efficacy (p < .05). However, by time 3 these effects are no longer evident. Implications for stress and coping from a self-regulatory perspective will be discussed, using Leventhal’s (1997) Parallel Response Model.

Tina Ferner, LMT, RD *, Buford Lively, PhD., Bhakti Arondekar, MS., Curtis Black, PhD, St. Vincent Mercy Medical Center*, Toledo, OH and The University of Toledo, College of Pharmacy.

Objective: To determine the cost-effectiveness of massage therapy as an adjunct to anti-emetic drug therapy compared to anti-emetic drug therapy without massage for treating high-dose chemotherapy-induced nausea and vomiting in patients in a stem cell transplant program.

Setting: A stem cell transplant unit of a tertiary care hospital in an urban setting.

Participants: 31 women with breast and ovarian cancer receiving high-dose chemotherapy undergoing peripheral blood stem cell transplant as inpatients. Fourteen patients in the control group that did not receive massage and 17 patients in the treatment group that received massage. The average age of these predominately Caucasian women was 45.5 years of age.

Procedure: Massage therapy was provided to the patients in the treatment group approximately 3 times per week in their hospital room. Care was taken to minimize interruptions by posting a “do not disturb” sign on the patient’s door. The phone was turned off, lighting was softened and relaxing, instrumental music was played. The massage was given with the intention to provide the patient comfort and relief from nausea. Each session was approximately 20 – 30 minutes in length. The procedure consisted of head and neck massage, concentrating on releasing tightness and constriction of the sternocleidomastoid (SCM) muscle. The rationale behind this was that a constricted SCM muscle could potentially impinge upon the vagus nerve (which effects gastric function) whose pathway is in close proximity to the SCM muscle.

The following craniosacral techniques were also employed: Still Point, Frontal Lift, Spheno-Basilar Compression-Decompression and Temporal Ear Pull. These were all done with the intention of affecting the sympathetic nervous system and the function of the vagus nerve. Massage to the leg and thigh was also given post transplant in an attempt to stimulate the bone marrow contained in the femur to reinitiate normal hematopoiesis of stem cells.

Main Outcome Measures: The following parameters were measured: hospital length of stay, number of days of nausea/vomiting, number of days on total parenteral nutrition (TPN) and prealbumin levels (a nutritional status parameter).

Results: The results of the study indicated that the following significant changes were made in the treatment group who received massage therapy:
¨       a decrease in hospital length of stay
¨       a decrease in the number of days of nausea/vomiting
¨       a decrease in the number of days on TPN
¨       an increase in the prealbumin levels
¨       a decrease in emesis related cost
¨       A net cost savings of approximately $2,850.00 per patient

Conclusion: Massage therapy is a cost effective adjunct in controlling nausea and vomiting in stem-cell transplant patients receiving high-dose chemotherapy.

Massage Therapy Reduces Headache Frequency in Chronic Tension-Type Headache Subjects.
Click the thumbnail to view Albert Moraska's Poster Presentation.

Healing effects of massage therapy on an acute rehabilitation unit

Low Back Pain and Sleep Disturbance are Reduced Following Massage Therapy Authors: Tiffany Field, PhD 1,2, Maria Hernandez-Reif, PhD1, Miguel Diego, PhD1 & Monica Fraser3 1Touch Research Institutes, University of Miami School of Medicine 2 Fielding Graduate University 3 BIOTONE, Inc, San Diego, CA

Authors: Amanda Baskwill, RMT and Trish Dryden, MEd, RMT