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.

View Instructions on Participation in our annual Poster Sessions

2006 Posters

Healing Effects of Massage Therapy on an Acute Rehabilitation Unit

What Factors Contribute to Client Comfort in Massage Therapy?

Low Back Pain and Sleep Disturbance are Reduced Following Massage Therapy

Natural Killer Cells and Lymphocytes Increase in Women with Breast Cancer Following Massage Therapy

Side Effects of Massage Therapy: a Pilot Study

Therapeutic Massage for Pediatric Burn Survivors

Acupuncture and Massage Improve Patient Satisfaction in Post-Operative Cancer Patients

Acupuncture and Massage Reduce Post-Operative Pain among Cancer Patients

The State of the Evidence:  A Review of the Literature for the Use of Massage Therapy during Pregnancy, Labour and Delivery and Infancy

Massage Therapy Effectively Reduces Pain in Hospitalized Patients

A Systematic Review of Research on Complementary Therapies in Sickle Cell Disease

2004 Posters

The Impact of Foot Massage and Guided Relaxation following Cardiac Surgery: a Randomized Controlled Trial

Massage as Adjuvant Therapy in the Management of Acute Postoperative Pain:  A Preliminary Study in Men
 

2003 Posters

The Acute Effects of Myofascial Trigger Point Massage Therapy on Cardiac Autonomic Tone in Healthy Subjects

A Pilot Study Examining the Effects of Neuromuscular Therapy on Reported Sleep in Parkinson's Disease

The History of Massage: An Illustrated Survey from Around the World
 

2002 Posters

Nurturing Touch in the NICU

PICC and Mid-Arm Line Insertions with Massage in a Community Hospital

A Controlled Pilot Study of the Effects of Neuromuscular Therapy in Patients with Parkinson’s Disease 

Massage therapy for chronic pain in low-income women

Effects of massage for older adults

Massage Therapy as a Technique for Coping With Stress

Massage Therapy in Controlling High-Dose Chemotherapy Induced Nausea in Patients Undergoing Stem Cell Transplant

Massage Therapy Reduces Headache Frequency in Chronic Tension-Type Headache Subjects

2006 AMTA National Convention, Atlanta, GA

Poster Session Participant Abstracts

Healing effects of massage therapy on an acute rehabilitation unit

Elisabeth B. Woodrich, BSN, CRRN, LMT, Inpatient Rehabilitation, Carondelet St. Mary's Hospital, 1601 W. St. Mary's Rd, Tucson, AZ 85745

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 Fraser^3
1Touch Research Institutes, University of Miami School of Medicine
² Fielding Graduate University
³ BIOTONE, Inc, San Diego, CA

 Summary

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.

Natural Killer Cells and Lymphocytes Increase in Women with Breast Cancer Following Massage Therapy

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 Medicine
² Department of Psychology, University of Miami
³ Office of Research, University of Miami
⁴ Hematology/Oncology Clinics Jackson Memorial Hospital
⁵Department of Medicine EM Papper Laboratory, University of Miami
⁶Department of Pharmacology, Duke University Medical School
⁷BIOTONE, San Diego, CA

Summary

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.   

Published in: International Journal of Neuroscience, 115, 495-510.

Therapeutic Massage for Pediatric Burn Survivors - view the poster

Author: Diane Garrison

The State of the Evidence:  A Review of the Literature for the Use of Massage Therapy during Pregnancy, Labour and Delivery and Infancy

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.

Massage Therapy Effectively Reduces Pain in Hospitalized Patients

Authors: Tina E. Ferner, LMT, RD,  Michael C. Plewa, M.D.

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.

A SYSTEMATIC REVIEW OF RESEARCH ON COMPLEMENTARY THERAPIES IN SICKLE CELL DISEASE

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.

•  Agargun MY, Oner AF, Akbayram S. (2001). Hypnotic intervention for pain management in a child with sickle cell anemia. Sleep
    and Hypnosis, 3(3), 127-128.
•  Barnes PM, Powell-Griner E, McFann K, Nahin RL. (2004). Complementary and alternative medicine use among adults: United
    States, 2002. Adv Data(343), 1-19.
•  Benjamin LJ, Dampier CD, Jacox AK, Odesina V, Phoenix D, Shapiro B, Strafford M, Treadwell M. (1999). Guideline for the
    Management of Acute and Chronic Pain in Sickle Cell Disease, APS Clinical Practice Guidelines Series, No. 1. Glenview, IL:
    American Pain Society.
•  Bodhise PB, Dejoie M, Brandon Z, Simpkins S, Ballas SK. (2004). Non-pharmacologic management of sickle cell pain.
    Hematology, 9(3), 235-237.
•  Broome ME, Maikler V, Kelber S, Bailey P, Lea G. (2001). An intervention to increase coping and reduce health care utilization
    for school-age children and adolescents with sickle cell disease. J Natl Black Nurses Assoc, 12(2), 6-14.
•  Co LL, Schmitz TH, Havdala H, Reyes A, Westerman MP (1979). Acupuncture: An evaluation in the painful crises of sickle cell
    anemia. Pain, 7, 181-185.
•   Cozzi L, Tryon WW, Sedlacek K. (1987). The effectiveness of biofeedback-assisted relaxation in modifying sickle cell crises.
    Biofeedback Self Regul, 12(1), 51-61.
•   Dinges DF, Whitehouse WG, Orne EC, Bloom PB, Carlin MM, Bauer NK, Gillen KA, Shapiro BS, Ohene-Frempong K, Dampier
     C, Orne MT. (1997). Self-hypnosis training as an adjunctive treatment in the management of pain associated with sickle cell
     disease. Int J Clin Exp Hypn, 45(4), 417-432.
•   Hall H, Chiarucci K, Berman B. (1992). Self-regulation and assessment approaches for vaso-occlusive pain management for
    pediatric sickle cell anemia patients. Int J Psychosom, 39(1-4), 28-33.
•   Myers CD, Robinson ME, Guthrie TH, Lamp SP, Lottenberg R. (1999). Adjunctive approaches for sickle cell chronic pain.
     Alternative Health Practitioner, 5(3), 203-212.
•   Motulsky AG. (1973).  Frequency of sickling disorders U.S. Blacks.  N Engl J Med, 288, 31-33.
•   Sodipo J. (1993). Acupuncture and blood studies in sickle-cell anemia. Am J Chin Med, 21(1), 85-89.
•   Thomas JE, Koshy M, Patterson L, Dorn L, Thomas K. (1984). Management of pain in sickle cell disease using biofeedback
      therapy: A preliminary study. Biofeedback Self Regul, 9(4), 413-420.
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AMTA National Convention 2004, Nashville, TN

Poster Session Participant Abstracts

The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial.

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

Abstract

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.

Massage as Adjuvant Therapy in the Management of Acute Postoperative Pain:  A Preliminary Study in Men

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.

Published in J Am Coll Surg 2003;197:1037-1046

AMTA National Convention 2003, Richmond, VA

Poster Session Participant Posters and Abstracts

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

A PILOT STUDY EXAMINING THE EFFECTS OF NEUROMUSCULAR THERAPY ON REPORTED
SLEEP IN PARKINSON'S DISEASE

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.

Robert Noah Calvert

Institution based: none

Project title: The History of Massage: An Illustrated Survey from Around the World

Objective: To explore a heretofore unexplored variety of human activity for evidence of massage

AMTA National Convention 2002, Portland, OR

Poster Session Participant Posters and Abstracts

Patricia Cadolino: Stony Brook University Hospital

PICC and Mid-Arm Line Insertions with Massage in a Community Hospital

Jan Locke, LMT & Glenda Dennis, RN, CCRN

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.

 METHODOLOGY:

·     Patients were surveyed pre and post procedure using a Likert scale. 

·     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.

 FINDINGS:

·     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."

 PATIENT COMMENTS:

 ·    “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.”

 ·    “Very good to me.  Kept my mind off what you’re doing.”

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

 RECOMMENDATIONS:

 ·     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.

A Controlled Pilot Study of the Effects of Neuromuscular Therapy in Patients with Parkinson’s Disease 

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.

Massage therapy for chronic pain in low-income women
by Lucy Candib, MD Family Health Center, 26 Queen St. Worcester MA 01610 USA 
508-860-7700  fax 508-860-7855   lcandib@massmed.org

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.

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Effects of massage for older adults

Patricia A. Sharpe, PhD, LMT

Prevention Research Center,  Norman J. Arnold School of Public Health

University of South Carolina, Columbia, SC  29208

pasharpe@sc.edu

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.

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MASSAGE THERAPY AS A TECHNIQUE FOR COPING WITH STRESS.

SHELEIGH LAWLER & LINDA CAMERON 

IN COLLABORATION WITH

THE NEW ZEALAND COLLEGE OF MASSAGE 

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.

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Massage Therapy in Controlling High-Dose Chemotherapy Induced Nausea in Patients Undergoing Stem Cell Transplant.

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. 

Design: This was a retrospective, cost-effectiveness, cohort study. 

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.
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