Archive for the 'research on massage' Category

May 18 2015

A proposed experimental model of myofascial trigger points in human muscle after slow eccentric exercise

Published by under research on massage

Abstract

Kazunori Itoh, research assistant1, Kaoru Okada, lecturer2, Kenji Kawakita, professor3

Background The purpose of this study was to develop an experimental model of myofascial trigger points to investigate their pathophysiology.

Methods Fifteen healthy volunteers who gave informed consent underwent repetitive eccentric exercise of the third finger of one hand (0.1Hz repetitions, three sets at five minute intervals) until exhaustion. Physical examination, pressure pain threshold, and electrical pain threshold of the skin, fascia and muscle were measured immediately afterwards and for seven days. Needle electromyogram (EMG) was also recorded in a subgroup of participants.

Results Pressure pain thresholds decreased to a minimum on the second day after the exercise, then gradually returned to baseline values by the seventh day. On the second day, a ropy band was palpated in the exercised forearm muscle and the electrical pain threshold of the fascia at the palpable band was the lowest among the measured loci and tissues. Needle EMG activity accompanied with dull pain sensation was recorded only when the electrode was located on or near the fascia of the palpable band on the second day of exercise.

Conclusion These results suggest that eccentric exercise may yield a useful model for the investigation of the myofascial trigger points and/or acupuncture points. The sensitised nociceptors at the fascia of the palpable band might be a possible candidate for the localised tender region.

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May 18 2015

The Effects of Employer-Provided Massage Therapy on Job Satisfaction, Workplace Stress, and Pain and Discomfort

■ Chris Back, BSc, CCPE ■ Helen Tam, BSc (OT) ■ Elaine Lee, BSc (Kin) ■ Bodhi Haraldsson, RMT
Long-term care staff have high levels of musculoskeletal concerns. This research provided a pilot program to evaluate the efficacy of employer-funded on-site massage therapy on job satisfaction, workplace stress, pain, and discomfort. Twenty-minute massage therapy sessions were provided. Evaluation demonstrated possible improvements in job satisfaction, with initial benefits in pain severity, and the greatest benefit for individuals with preexisting symptoms. A long-term effect was not demonstrated. KEY WORDS: massage therapy, musculoskeletal injury, workplace stress Holist Nurs Pract 2009;23(1):19–31
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20 HOLISTIC NURSING PRACTICE • JANUARY/FEBRUARY 2009
to represent an unsolved problem. It is well established in the existing literature that musculoskeletal problems have multifactorial etiology.7 Also, there is an extensive body of research on the work-related physical risk factors such as working postures and manual lifting and handling, as well as on the role of nonpsychological individual factors (age, gender, physical exercise) in musculoskeletal pain. There is also an increasing body of evidence that the psychosocial factors play an important role in the development of MSI.
Musculoskeletal injury (MSI) prevention programs in healthcare have primarily focused on education, ergonomic training, and engineering controls. However, the rate of MSIs in this industry continues to be of very high incidence. High work demand, small recovery time, fatigue, and escalated pressure can all lead to MSI and low job satisfaction.
MASSAGE THERAPY
The art and science of massage has a time-honored history in western medicine dating back to ancient Greece.8 Although there are different types of massage, including aromatherapy, reflexology, sports massage, and shiatsu, Swedish (or classic) massage remains the most commonly practiced.9 Classic types of massage includes effleurage (stroking), pe ́trissage (compression), tapotement (percussion), vibration, and friction.9
More and more, massage therapy is being utilized to relieve health problems.10 In his meta-analysis of massage therapy effects, Moyer reports that a single applications of massage therapy reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level. Multiple applications reduced delayed assessment of pain. Reductions of trait anxiety and depression were massage therapy’s largest effects, with a course of treatment providing benefits similar in magnitude to those of psychotherapy.
Massage therapy is considered a form of medical treatment in several countries where it is covered by national health insurance, including China, Japan, Russia, and West Germany. On the European continent, massage has been a routine form of therapy for acute and chronic lower back pain for many decades.11 In Canada, massage therapy still is considered an alternative therapy. Nonetheless, its popularity seems to be growing.
Massage therapy has been described as having 4 principal goals of treatment: (1) to promote relaxation and wellness (relaxation massage); (2) to address clinical concerns (clinical massage); (3) to enhance posture, movement, and body awareness (movement reeducation); and (4) to balance and “move” subtle energy (energy work).12
The College of Massage Therapists of British Columbia defines the practice of massage therapy as the assessment of soft tissue and joints of the body and the treatment and prevention of dysfunction, injury, pain, and physical disorders of the soft tissues and joints by manual and physical methods to develop, maintain, rehabilitate, or augment physical function to relieve pain and promote health.
Massage therapy has been recommended by many studies as an effective intervention to combat work-related anxiety, depression, and musculoskeletal pain.13–15 Tsao in her systematic review of the massage therapy literature notes that “existing research provides fairly robust support for the analgesic effects of massage for nonspecific low back pain, but only moderate support for such effects on shoulder pain and headache pain. There is only modest, preliminary support for massage in the treatment of fibromyalgia, mixed chronic pain conditions, neck pain and carpal tunnel syndrome.”16(p165)
Massage therapy has also been attributed with increasing serotonin and dopamine levels, 2 important neurotransmitters. Cherkin et al17 reported in their study that those who received massage therapy had less severe back pain symptoms than the control group or those that received acupuncture. In a study by Brennan and De Bate,14 nurses in the study group received a 10-minute chair massage while the control group received a 10-minute break.18 Using the Perceived Stress Scale, the study group reported significantly lower stress perception after the chair massage, whereas the control group reported no significant changes. In addition to reducing pain and tension levels, massage therapy has been found to increase relaxation and improve the overall mood of patients.19
With past initiatives focusing primarily on physical factors in the reduction/elimination of musculoskeletal injuries, this research endeavored to explore the effects of a wellness intervention program on psychological well-being, physical health, and safety. The holistic approach of a wellness intervention focuses on the promotion or maintenance of good health rather than correction of poor health.
Thus, this article presents an examination of the impact of massage therapy, used as an experimental intervention, on healthcare workers’ health, especially from the work-related injury prevention and control point of view.
MATERIAL AND METHODS
Research design
The evaluation of this project followed a quasi-experimental time-series design. The intervention facility was George Pearson Centre (GPC), a facility with high rates of sick time and MSI. The GPC is a residential care facility with 200 employees providing care for adults with severe disabilities in Vancouver, British Columbia, Canada. The first questionnaire was distributed on February 1, 2005, after ethics approval was received from the University of British Columbia Behavioral Research Ethics Board. Figure 1 presents a graphical representation of the study time frame and methodology.
Questionnaires
Six matched questionnaires were distributed: 3 preintervention (Q1, Q2, and Q3) and 3 postintervention (Q4, Q5, and Q6) during the period February 1, 2005, to August 16, 2005. Each participant was assigned an encrypted identification number for the entire study. In Q1, 107 participants were asked to rank a descriptive list of 4 personal wellness programs (massage therapy, integrative energy healing, nap/sleep room, and no wellness program) according to their first and last preference. Massage therapy was chosen as the most preferred relaxation modality by 94 (88%) of the 107 respondents.
Questionnaires Q1, Q2, Q5, and Q6 were placed in the facility mailbox of each staff member. Completed questionnaires were returned to the unit clerk at each of the 6 wards. The ward that submitted the most questionnaires during each phase of the evaluation
received a gift basket. Participants completed Q3 in conjunction with a medical case history form immediately before receiving their first massage therapy session. Q4 was completed by participants immediately following their final massage therapy session, or during the week following the massage program (intervention period) if they did not receive a massage in the final week of the program. Originally, this project was intended to evaluate the effects of a relaxation modality on direct patient care staff only. Q1 and Q2 reflect this intention. However, after further consideration of the evaluation, the sample was expanded to include nondirect patient care staff in Q3, Q4, Q5, and Q6.
The questionnaires contained questions relating to “psychological and social factors at work,” as derived from the constructs developed by the General Nordic Questionnaire for Psychological and Social Factors at Work (QPS Nordic),20–24 which referred to organizational culture, job demands, social interaction, and control at work. Questionnaires Q3 to Q6 also included the Brief Pain Inventory (Appendix).25
A total of 107 subjects participated in the Q1 survey and 81 in Q2. Massage therapy services were offered to 145 healthcare workers immediately after Q3. Participants completed questionnaires postintervention at week 4 (Q4), week 10 (Q5), and week16 (Q6).
Relaxation intervention: Massage therapy sessions
Massage therapy sessions took place in a designated room at the GPC with a waiting area and water cooler adjacent. The treatment room, illuminated by natural and fluorescent light, was divided into 3 sections with curtains that could be drawn around each section. Art decorated the room walls and soft music was played at all times.
Massage therapy sessions were offered for 4 weeks at the facility by a Registered Massage Therapist (RMT), Monday to Friday from 1 to 5 PM. Participants were allowed to sign up for one 20-minute massage therapy session each week. The employer allowed
The Effects of Employer-Provided Massage Therapy 21
FIGURE 1. Evaluation methodology. Q = Questionnaire.
22 HOLISTIC NURSING PRACTICE • JANUARY/FEBRUARY 2009
participants to take a paid break from work (in addition to regular breaks) to attend their session. Sign-up took place in the cafeteria each prior week.
Four RMTs provided massage therapy. For the 4 weeks, 2 RMTs worked Monday to Friday, 1 worked 4 days (Monday to Wednesday and Friday), and 1 worked Thursdays only. Participants were assigned to the next available RMT when they arrived for each session and did not necessarily receive treatment from the same RMT in all their sessions.
At their first session, participants completed a medical case history form to identify contraindications to massage therapy. The massage therapy was performed with participants fully clothed, sitting prone on a massage chair. On the basis of recommendations of the Massage Therapy Association of British Columbia, the RMTs were instructed to use only the following treatment techniques: tapotement (vibration, percussion), effleurage (glide, touch, or stroke lightly), pe ́trissage (kneading, rolling, wringing), passive stretching, grade 1 or 2 joint mobilization and traction, as well as active and passive range of motion. Treatment was limited to the neck, shoulders, upper back, lower back, and arms. These treatment techniques reflected massage therapy for the purposes of general relaxation rather than specific therapy. Areas treated, treatment techniques used, and home treatment recommendations were recorded for each session.
Statistical methods
Standard descriptive statistics (eg, mean, standard deviation, and percentage) were calculated to demonstrate the demographics of subjects and characterize the distribution of variables. Questionnaires Q1, Q2, and Q3, containing 13 items derived from QPS Nordic, were used to construct the domains of the QPS Nordic instrument. An exploratory factor analysis with rotated component matrix for each questionnaire (107 subjects from Q1, 81 from Q2, and 145 from Q3) was conducted by entering all 13 items. The results were consistent across 3 questionnaires and the confirmed 4 domains in terms of loading factors (≥0.50):
• Organizational culture (6 items): [The people I work with encourage each other to work together; consid- ering all by efforts and achievements, I receive the respect I deserve at work; I feel that individual differ- ences (gender, race, education) are respected at work;
I feel that different perspectives are encouraged at work; I feel that I get appreciated for the work I do; I am very satisfied with my job],
• Job demand (4 items): [I feel that my job is phys- ically demanding; I feel that my job is emotionally exhausting; over the past year, my job has become more demanding; I feel frustrated from my work.], and
• Social interaction (2 items): [I feel that there is a lack of recognition for good work; I feel that there is a lack of support from management and control at work (I have the ability to decide how I do my work)].
Internal consistency of the QPS Nordic instrument was tested using Cronbach α coefficient, calculated for each domain of the QPS Nordic instrument. From surveys Q1, Q2, and Q3, Cronbach α coefficients were .787, .790, and .802 for organizational culture; .703, .740 and .707 for job demand; and .731, .893, and .821 for social interaction. Cronbach α coefficients of ≥.70 indicated high internal consistency.8 Test-retest reliability was assessed for the QPS Nordic instrument by establishing the intraclass correlation coefficients (ICCs) for Q1 and Q2 responses. The ICC values were .711, .774, and .789 for organizational culture, job demand, and social interaction, respectively, each meeting the recommended threshold for test-retest reliability (ICCs ≥ .70).8 Total scores were computed for each domain of the QPS Nordic instrument in subjects who answered all of the questions for each domain. Individual questions, such as control at work, feeling exhausted, quality of working life,
willingness to recommend the program, and willingness to participate in the program were analyzed separately.
According to the scoring booklet for the Brief Pain Inventory, the mean of pain severity was computed over 4 severity items; the mean of pain interference was computed over 7 interference items; and pain relief was an individual question expressed as a percentage, with 0% indicating no relief and 100% representing complete relief. The Friedman test, a nonparameter method, was used to test differences for each domain of the QPS Nordic instrument, the control at work and the individual questions, as well as the mean pain severity and mean interference across questionnaires 3, 4, 5, and 6. All tests were 2-sided significance levels of P ≤ .05 estimated from Statistical Package for the Social Sciences version 14 (Chicago, Illinois). Partially missing values were automatically excluded from the analyses.
TABLE 1. Demographic data subjects at baseline survey
Number of subjects
Age 98 (years)
Demographic
Age group, (y) 21–30
31–40
41–50
51–62
Gender Male
Female Job title
RCA
Registered nurse LPN/LRN OT/UC/PT/RA
Affiliation HEU
BCNU HSA BCGEU Other
Job status Full time Part time
Casual Rotating shift
Yes
No
Shift hours
Mean ± SD 46.4 ± 8.9
Number of Subjects
5 20 37 36
21 83
49 16 18 11
19 25 5 30 18
73 31 2
79 26
17
78 >8 3 <8to8 5 8to>8 3
Median Min Max
48 25 62
Percentage (%) of Total
5.1 20.4 37.8 4.7
20.2 79.8
52.1 17.0 19.2 11.7
19.6 25.8 5.2 30.0 18.6
68.9 21.2 1.9
75.2 24.8
16.0 73.6 2.8 4.7 2.8
<8 8 RESULTS Percentages of questionnaires returned were: 69% for Q1; 52% for Q2; 100% for both Q3 and Q4; and 53% for both Q5 and Q6. Table 1 provides demographic information at baseline for 107 subjects. Mean age was 46.4 years, with a standard deviation of 8.9 years. Eighty percent of the participants were women. Most participants (38%) were aged between 41 and 50 years The Effects of Employer-Provided Massage Therapy 23 or between 31 and 40 years (20%). See Table 1 for further demographic results. Number of massage therapy sessions Participants received up to 4 sessions of massage therapy over a 4-week period. The average number of participants receiving massage therapy sessions increased each week: 17.4% (week 1), 25.7% (week 2), 19.4% (week 3), and 37.5% (week 4). Statistical analysis showed that the number of massages received by a participant did not influence their perception of psychosocial constructs. Psychological and social constructs As shown in Figure 2, work culture showed a significant decrease from Q3 to Q6 (P = .01) while massage therapy had no significant impact on job demands, social interaction, or control at work. Data showed trends toward improvement of quality of life associated with the massage intervention, but this decreased after the intervention period, as indicated by responses in Q4 (Fig 3). There was no significant change in staff feeling a lack of recognition in the workplace (Fig 4) although lack of recognition scores increased from Q3 to Q6. Pain severity, pain interference, and pain relief As seen in Table 2, pain severity showed significantly different means between Q3 to Q6 (P = .038). Post hoc analysis showed pain severity decrease significantly between Q3 and Q4 (P = .013). However, pain severity showed an increasing trend from Q4 to Q6. Neither pain interference nor pain relief showed any significant change. When only Q3 and Q4 were considered in paired t test (sample size increased to n = 84) there was still a statistically significant decrease (4.33 vs 3.96, P = .026) in means between Q3 and Q4. Perception of massage therapy In Q3 to Q6, respondents were asked to indicate their perception of massage therapy. Positive perception of massage therapy significantly increased from Q4 to Q6 using χ2 test (P = .002), with 80% of respondents perceiving that massage therapy was effective in Q6 in comparison with 79% in Q5 and 59% in Q4. 24 HOLISTIC NURSING PRACTICE • JANUARY/FEBRUARY 2009 FIGURE 2. Measurement scores of work culture (WC), quality of work life (QOWL), and recognition at George Pearson Centre by survey time. DISCUSSION In recent years, profound changes have taken place in the nature of work.26 The most striking development seems to be its increased psychosocial workload or work stress. Today for many employees, and in healthcare in particular, work poses primarily psychological and emotional demands, instead of physical demands, and the pace of work is more and more dictated by patients, clients, and so on.26,27 It is also evident that the consequences of an increased workload may be expressed in employee adverse health, such as burnout, psychosomatic health complaints, absenteeism, and even disability.28 Although high workload is experienced in healthcare work, there seems to be no adequate compensation in terms of occupational rewards like salary and promotion prospects.29 Finally, the main reasons for work disablement are, among other things, high job demands and poor occupational rewards. Research has shown that this is particularly true for work in the healthcare sector.30 Research on the Canadian workforce has consistently indicated that healthcare workers have a FIGURE 3. Quality of work life scores (out of 5) at George Pearson Centre. greater risk of workplace injuries and more mental health problems than any other occupational group. According to Statistics Canada, in 1999 nursing personnel had a longer duration of time loss and were more likely to miss work each week due to an illness or injury than employees in any other sector or in other types of shift-working occupations.31 Studies with on-site massage therapy programs in healthcare demonstrate that these programs have a positive impact on different aspects of the participants.19 This evaluation endeavored to explore the effects of a wellness intervention on psychological well-being and physical health. Results demonstrated initial benefits in terms of pain severity, with a possible improvement in job satisfaction and morale. Massage therapy appears to have a significant effect on pain severity and, therefore, the greatest benefit on individuals with preexisting musculoskeletal symptoms. However, a long-term effect was not demonstrated. In fact, 6 weeks after the intervention ceased, pain symptoms became worse and, in addition, job satisfaction decreased and lower morale was observed. It is possible that massage therapy sessions led participants to greater body awareness and pain FIGURE 4. Recognition scores (out of 10) by survey time.  TABLE 2. Description and comparison of frontline workers’ pain severity, pain interference, and pain relief among Q 3, 4, 5, and 6 Pain severity Q3 25 Q4 25 Q5 25 Q6 25 Pain interference Q3 25 Q4 25 Q5 25 Q6 25 Pain relief Q3 12 Q4 12 Q5 12 Q6 12 4.55 (2.08) 4.46 (2.13) 5.06 (2.21) 5.08 (2.33) 3.53 (2.14) 3.82 (2.60) 4.33 (2.60) 4.41 (2.74) 42.50 (21.37) 50.83 (20.65) 57.50 (22.21) 53.33 (31.43) .188 .504 N Mean (SD) Min Max Pa .038 0.25 8.50 0.50 8.00 0.00 8.25 0.75 8.00 0.14 7.71 0.00 8.86 0.00 9.14 0.00 9.14 0 80 20 80 20 90 0 90 aP values were derived from Friedman Test, a nonparametric test, and the significant difference is at .05 level. awareness. The contrast between days when massage therapy was received with those when it was not may have become more noticeable. The perception of massage therapy effectiveness increased from Q4 to Q6, possibly due to the decreased number of respondents between Q4 and Q6, with a higher percentage of massage therapy “advocates” responding to the final 2 questionnaires. However, it is also possible that, as time elapsed after the intervention (Q4 to Q6 was 12 weeks), the participants’ realization and perception of the benefits of massage therapy increased. Clinical implications The results of this project indicate that targeted individuals (ie, those with preexisting musculoskeletal signs and symptoms) are most likely to benefit from a massage therapy workplace wellness program. The programmustbesustained,asonlyshort-termpain relief was observed. The short-term effect may be due to using only treatment techniques for general relaxation rather than specific therapy. For further impact, combining a massage therapy program with other health and safety programs is strongly recommended. With an aging workforce who may have chronic conditions, a combination of relaxation techniques with specific therapy techniques may produce longer-lasting effects. A recent study of psychological distress in nurse aides found that work factors explain only a modest part of psychological distress.32 Exposure to role conflicts and high workloads can overcome the benefits of massage therapy, unless the intervention is continuous. This study was conducted using a quasi-experimental time-series methodology, in which baseline data is established to confirm validity of data collected before and after the intervention. Although it is advantageous for identifying systematic patterns from data collected in equally spaced periods of time, it lacks the power of a study involving a control group. A control group was not used in this study because of the difficulty in finding similar participants to compliment the staff at this unique facility. Using different wards at the GPC as a control group for each other was considered. This idea was rejected because of the possibility of communication between staff on these wards influencing the results. Funding limited the length of time of each massage therapy session, as well as the number of weeks of intervention. Longer massage sessions over more weeks may have impacted the results. The massage techniques were intentionally limited but may have influenced the results. We concluded that healthcare occupations are exposed to working conditions that result in injuries and low job satisfaction. Resulting time lost from work or lowered performance can have detrimental consequences for both the worker and their patients. Employers must evaluate methods of lowering work place injuries, tension, and stress to combat such health and safety hazards. Massage therapy holds much potential in benefiting healthcare workers. Future research that probes the efficacy of this alternative work injury prevention method can provide beneficial results for the industry. REFERENCES 1. StatisticsCanada.2006Census:labourmarketactivities,industry,occu- pation, education, language of work, place of work and mode of trans- portation. http://www.statcan.ca/Daily/English/080304/d080304a.htm. Published March 4, 2008. Accessed July 3, 2008. 2. LipscombJ,BorwegenB.HealthCareworkers.In:LevyB,WegmanD, eds. Occupational Health: Recognizing and Preventing Work-Related Disease and Injury. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2000:767–778. 3. Overview: risks and prevention of sharps injuries in healthcare per- sonnel. In: Workbook for Designing, Implementing, and Evaluating a The Effects of Employer-Provided Massage Therapy 25 26 HOLISTIC NURSING PRACTICE • JANUARY/FEBRUARY 2009 Sharps Injury Prevention Program. Centers for Disease Control and Prevention. http://www.cdc.gov/Sharpssafety/. Published February 12, 2004. Accessed March 2007. 4. Bennett J, O’Donovan D. Substance misuse by doctors, nurses and other healthcare workers. Curr Opin Psychiatry. 2001;14(3):195–199. 5. Coggan C, Norton R, Roberts I, Hope V. Prevalence of back pain among nurses. N Z Med J. 1994;107:306–308. 6. Elovainio M, Sinervo T. Psychosocial stressors at work, psychological stress and musculoskeletal symptoms in the care for the elderly. Work Stress. 1997;11:351–361. 7. Armstrong TJ, Buckle P, Fine LJ, et al. A conceptual model for work- related neck and upper-limb musculoskeletal disorders. Scand J Work Environ Health. 1993;19:73–84. 8. Field TM. Massage therapy effects. Am Psychol. 1998;53(12):1270– 1281. 9. Bush E. The use of human touch to improve the well-being of older adults. A holistic nursing intervention. J Holist Nurs. 2001;19(3):256– 270. 10. Moyer C, Rounds J, Hannum J. A meta-analysis of massage therapy research. Psychol Bull. 2004;130(1):3–18. 11. Westhof E, Ernst E. Geschichte der Massage [in German]. Dtsch Med Wschr. 1992;117:150–153. 12. Ernst E. Massage therapy for low back pain: a systematic review. J Pain Symptom Manage. 1999;17(1):65–69. 13. Corner J, Cawley N, Hildebrand S. An evaluation of the use of massage and essential oils on the well-being of cancer patients. Int J Palliat Nurs. 1995;1(2):67–73. 14. Hernandez-Reif M, Field T, Krasnegor J, Theakston H. Lower back pain is reduced and range of motion increased after massage therapy. Int J Neurosci. 2001;106:131–145. among hospital nurses after on-site massage treatments: a pilot study. J Perianesth Nurs. 1999;14(3):128–133. 20. Lindstro ̈m K, Elo A-L, Skogstad A, et al. User’s Guide for the QP- Q1–Q6 For each statement below, circle the number that best describes how you feel. Please circle only one number. 21. SNordic: General Nordic Questionnaire for Psychological and Social Factors at Work. TemaNord. Copenhagen: Nordic Council of Ministers; 2000:603. Dallner M, Elo A-L, Gamberale F, et al. Validation of the General Nordic Questionnaire (QPSNordic) for Psychological and Social Factors at Work. Copenhagen: Nordic Council of Ministers; 2000:12. 22. Leboeuf-Yde C, Axen I, Jones JJ, et al. The Nordic back pain subpop- ulation program: the long-term outcome pattern in patients with low back pain treated by chiropractors in Sweden. J Manipulative Physiol Ther. 2005;28(7):472–478. 23. Smith DR, Wei N, Zhao L, Wang RS. Musculoskeletal complaints and psychosocial risk factors among Chinese hospital nurses. Occup Med. 2004;54(8):579–582. 24. Eriksen W. Service sector and perceived social support at work in Nor- wegian nurses’ aides. Int Arch Occup Environ Health. 2003;76(7):549– 552. Epub August 5, 2003. 25. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23(2):129–138. 26. Marmot M, Siegrist J, Theorell T, Feeney A. Health and the psychoso- cial environment at work. In: Marmot MG, Wilkinson R, eds. Social Determinants of Health. Oxford: Oxford University Press; 1999:105– 132. 27. de Jonge J, Mulder MJ, Nijhuis FJ. The incorporation of different de- mand concepts in the job demand—control model: effects on health care professionals. Soc Sci Med. 1999;48:1149–1160. 28. Schaufeli W, Enzmann D. The Burnout Companion to Study and Prac- tice: A Critical Analysis. London: Taylor & Francis; 1998. 29. Siegrist J. Occupational health and public health in Germany. In: Le Blanc PM, Peeters MCW, Bu ̈ssing A, Schaufeli WB, eds. Organiza- 417. tionalPsychologyandHealthCare:EuropeanContributions.Mu ̈nchen 15. Wilkinson S, Aldridge J, Salmon I, Cain E, Wilson B. An evaluation of aromatherapy massage in palliative care. Palliat Med. 1999;13(5):409– 16. Tsao JCI. Effectiveness of massage therapy for chronic, non-malignant pain: a review. Evid Based Complement Alternat Med. 2007;4(2):165– 179. 17. Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety, and cost of acupuncture, mas- sage therapy, and spinal manipulation for back pain. Ann Intern Med. 2003;138(11):898–906. 18. Brennan MK, De Bate RD. The effect of chair massage on stress per- ception of hospital bedside nurses. Massage Ther J. 2004;43(1):76– 89. 19. Katz J, Wowk A, Culp D, Wakeling H. Pain and tension are reduced Appendix und Mering: Rainer Hampp Verlag; 1999:35–44. 30. Van der Giezen AM. Women, (Working) Conditions, and Work Disable- ment [in Dutch]. Amsterdam: LISV; 2000. 31. Akyeampong EB. Missing work in 1998—industry differences. Statistics Canada Perspectives 1999. http://www.statcan.ca/english/ studies/75-001/archive/1999/pear1999011003s3a04.pdf. Accessed March 2007. 32. Eriksen W, Tambs K, Knardahl S. Work factors and psychological dis- tress in nurses’ aides: a prospective cohort study. BMC Public Health. 2006;6:290. http://www.biomedcentral.com/content/pdf/1471-2458-6- 290.pdf. Accessed March 2007. Construct Job demands Job demands Control at work Org. culture Job demands Strongly Strongly disagree Disagree Neutral Agree agree 1. I feel that my job is physically demanding 2. I feel that my job is emotionally exhausting 3. I have the ability to decide how I do my work 4. The people I work with encourage each other to work together 5. Over the past year, my job has become more demanding 1 2 1 2 1 2. 1 2 1 2 3 4 5 3 4 5 3 4 5 3 4 5 3 4 5  Construct Org. culture Job demands Org. culture Org. culture Org. culture Social interactions Org. culture Org. culture Strongly Strongly disagree Disagree Neutral Agree agree 6. Considering all my efforts and 1 achievements, I receive the respect I deserve at work 7. I feel frustrated from my work 1 8. I feel that individual differences 1 (gender, race, education) are respected at work 9. I feel that different perspectives are 1 encouraged at work 10. I feel that there is a lack of 1 recognition for good work 11. I feel that there is a lack of support 1 from management 12. I feel that I get appreciated for the 1 work I do 13. I am very satisfied with my job 1 2 3 4 5 2 3 4 5 2 3 4 5 2 3 4 5 2 3 4 5 2 3 4 5 2 3 4 5 2 3 4 5 Q1, Q2, Q4, Q5, Q6 14. In general, I rate my health as. . . Please circle only one number where 1 is Poor and 5 is Excellent Q1 The Effects of Employer-Provided Massage Therapy 27 Poor  Excellent 12345 15. After your last workweek, please rank the level of pain you felt in the following body parts (Please rank each body part from 1 to 5 where 1 = minimal pain and 5 = severe pain) Q1–Q6 16. I feel exhausted at the end of my typical shift? Please circle only one number where 1 is strongly disagree and 5 is strongly agree 17. Overall, I would rate the quality of working life at George Pearson Centre as excellent? Please circle only one number where 1 is strongly disagree and 5 is strongly agree Neck Shoulder Upper back Lower back Arms Strongly disagree Disagree Neutral Agree Strongly agree 1 2 3 4 5 Strongly disagree Disagree Neutral Agree Strongly agree 1 2 3 4 5  28 HOLISTIC NURSING PRACTICE • JANUARY/FEBRUARY 2009 18. I would strongly recommend this hospital to a friend looking for a job? Please circle only one number where 1 is strongly disagree and 5 is strongly agree 19. I would be willing to participate in a program designed to improve my personal wellness? Please circle only one number where 1 is strongly disagree and 5 is strongly agree Q1 20. For the list of personal wellness programs below, rank the list from your most preferred (1st) method to your least preferred (4th) method. Strongly disagree Disagree Neutral Agree Strongly agree 1 2 3 4 5 Strongly disagree Disagree Neutral Agree Strongly agree 1 2 3 4 5 Massage Therapy: The treatment and prevention of injury and pain of muscles and joints by manual and physical methods to develop, maintain, rehabilitate, or increase physical function to relieve pain and promote health. Integrative Energy Healing (IEH): The goal is to support multidimensional, human energy field repatterning in order to awaken the body’s innate healing potential. The practitioner places his or her hands directly above the client’s body and moves through the human energy field. Based on this energetic assessment, the practitioner places their hands directly upon, or above, the client’s body in order to shift their energy field into a balanced state. Nap/sleep room: A quiet space will be provided for staff to sleep and rest Nothing Q1 21. For the personal wellness program, how often would you like to receive it? Please check (√) only one box Q2 20. The most preferred relaxation modality selected by direct-care workers at George Pearson Centre in Staff Survey 1 was massage therapy. How often would you prefer to receive a 20-minute massage therapy session per week? Please check (√) only one box. Q2 21. How likely is it that you would come to George Pearson Centre to receive a 20-minute massage therapy session if it was your day off? Once per week  Every other week  Once per month  Twice per week  Once per week  The Effects of Employer-Provided Massage Therapy 29 Please circle only one number where 1 is very unlikely and 5 is very likely If you answered “very unlikely” or “unlikely,” what would be the main reason for your answer? Q1 Work History For each statement below, please indicate the answer that best describes you and your work situation. Very unlikely Unlikely Neutral Likely Very likely 12345 Age (in years): Gender: Male/Female My job title is: My affiliation is: ❏ Manager ❏ B.C.N.U. ❏ BCGEU ❏ H.E.U. ❏ H.S.A ❏ Other Status: ❏ Full time ❏ Part time ❏ Casual Shift: ❏ Less than 8 hours ❏ 8 hour shifts ❏ More than 8 hours Rotating shifts: ❏ Yes ❏ No Total years working at George Pearson Centre:  years Q3–Q6 Brief Pain Inventory (Short Form) 1. Throughout our lives, most of us have had pain from time to time (such as minor headaches, sprains, and toothaches). Have you had pain other than these everyday kinds of pain today? 2. On the diagram, shade in the areas where you feel pain. Put an X on the area that hurts the most. 3. Please rate your pain by circling the one number that best describes your pain at its worst in the last 24 hours. 1. Yes 2. No 0 1 2 3 4 5 6 7 8 9 10 No Pain Pain as bad as you can imagine  30 HOLISTIC NURSING PRACTICE • JANUARY/FEBRUARY 2009 4. Please rate your pain by circling the one number that best describes your pain at its least in the last 24 hours. 5. Please rate your pain by circling the one number that best describes your pain on the average. 6. Please rate your pain by circling the one number that tells how much pain you have right now. 7. What treatments or medications are you receiving for your pain? 8. In the last 24 hours, how much relief have pain treatments or medications provided? Please circle the one percentage that most shows how much relief you have received. 9. Circle the one number that best describes how, during the past 24 hours, pain has interfered with your: A. General activity B. Mood C. Walking ability D. Normal work E. Relations with other people F. Sleep G. Enjoyment of life 0 1 2 3 4 5 6 7 8 9 10 No Pain Pain as bad as you can imagine 0 1 2 3 4 5 6 7 8 9 10 No Pain Pain as bad as you can imagine 0 1 2 3 4 5 6 7 8 9 10 No Pain Pain as bad as you can imagine 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% No relief 100% Complete relier 0 1 2 3 4 5 6 7 8 9 10 Does not interface Completely interfaces 0 1 2 3 4 5 6 7 8 9 10 Does not interface Completely interfaces 0 1 2 3 4 5 6 7 8 9 10 Does not interface Completely interfaces 0 1 2 3 4 5 6 7 8 9 10 Does not interface Completely interfaces 0 1 2 3 4 5 6 7 8 9 10 Does not interface Completely interfaces 0 1 2 3 4 5 6 7 8 9 10 Does not interface Completely interfaces 0 1 2 3 4 5 6 7 8 9 10 Does not interface Completely interfaces  The Effects of Employer-Provided Massage Therapy 31 How did massage therapy help or not help you complete day-to-day tasks? Please give specific examples. Q5 18. Did you participate in the massage therapy program at George Pearson Centre in May and June 2005? ❏ No ❏ Yes Q5, Q6 19. I would like to see a massage therapy program continue at George Pearson Centre. Please circle only one number where 1 is strongly disagree and 5 is strongly agree Please provide comments (for example, how long and how often?). Intake (Q4), Q5, Q6 20. Are you currently receiving massage therapy? a. No b. Yes → If yes, how long and how often are your sessions? Q6 21. Were you receiving massage therapy before this study? a. No b. Yes → If yes, how long and how often were your sessions? Please comment. Q5 22. What positive or negative changes did you notice in your life since the completion of the massage therapy sessions at George Pearson Centre? Please give specific examples. Q6 23. What positive or negative changes did you notice in your life after the massage therapy program at George Pearson Centre was finished in June? Please give specific examples. Intake (Q4), Q5, Q6 18. What is your perception of massage therapy? ❏ It is effective ❏ It is not effective ❏ Don’t know/unsure Q6 1. Please provide any additional comments about the way this study was run.

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May 01 2015

Feasibility and effect of chair massage offered to nurses during work hours on stress-related symptoms: A pilot study

Abstract
This study assessed feasibility and effect of weekly, 15-min chair massages during work for 38 nurses. Mean Perceived Stress Scale-14 (PSS-14), Smith Anxiety Scale (SAS), linear analog self-assessment scale (LASA), and symptom visual analog scale (SX-VAS) scores were tracked at baseline, 5 weeks, and 10 weeks. Of 400 available massage appointments, 329 were used. At 10 weeks, mean PSS-14 score decreased from 17.85 to 14.92 (P = .002); mean SAS score, from 49.45 to 40.95 (P < .001). Mean LASA score increased from 42.39 to 44.84 (P = .006); mean SX-VAS score, from 65.03 to 74.47 (P < .001). Massages for nurses during work hours reduced stress-related symptoms. for all your corporate massages, workplace massages, events massages, australia wide perth, tasmania, melbourne, sydney, brisbane. email us today on www.therapy4u.biz

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Apr 28 2015

its time to book your next corporate massages

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Apr 28 2015

Dalk (Therapeutic Massage) & Their Indication for Musculoskeletal Disorder in Unani Medicine

Abstract

Massage is one of those terms, which are easily understood then expressed. Throughout the history massage has been used not only by sick but also by the healthy people for therapeutic, restorative as well as preventive purposes. Massage is probably one of the oldest healing therapies known to mankind. The message of massage is universal: you can use your hand to help literally anyone. One of the many reasons for its increased popularity is that massage allows us to reach out and to touch each other. It is a formalized touches; giving us a licence to touch within clearly defined boundaries 1. In Unani system of medicine (USM) massage is called as “Dalk” and is frequently used as preventive, curative and rehabilitative purposes since centuries. Here we will discuss the indication of massage for the musculoskeletal disorders.

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Apr 28 2015

The effect of foot massage on long-term care staff working with older people with dementia: a pilot, parallel group, randomized controlled trial

Published by under reflexology,research on massage

Moyle et al. BMC Nursing 2013, 12:5 http://www.biomedcentral.com/1472-6955/12/5
RESEARCH ARTICLE Open Access
Wendy Moyle1,2*, Marie Cooke1,2,3, Siobhan T O’Dwyer1,2, Jenny Murfield1,2, Amy Johnston1,2,4 and Billy Sung1,2
Abstract
Background: Caring for a person with dementia can be physically and emotionally demanding, with many long- term care facility staff experiencing increased levels of stress and burnout. Massage has been shown to be one way in which nurses’ stress can be reduced. However, no research has been conducted to explore its effectiveness for care staff working with older people with dementia in long-term care facilities.
Methods: This was a pilot, parallel group, randomized controlled trial aimed at exploring feasibility for a larger randomized controlled trial. Nineteen staff, providing direct care to residents with dementia and regularly working ≥ two day-shifts a week, from one long-term care facility in Queensland (Australia), were randomized into either a foot massage intervention (n=9) or a silent resting control (n=10). Each respective session lasted for 10-min, and participants could receive up to three sessions a week, during their allocated shift, over four-weeks. At pre- and post-intervention, participants were assessed on self-report outcome measures that rated mood state and experiences of working with people with dementia. Immediately before and after each intervention/control session, participants had their blood pressure and anxiety measured. An Intention To Treat framework was applied to the analyses. Individual qualitative interviews were also undertaken to explore participants’ perceptions of the intervention.
Results: The results indicate the feasibility of undertaking such a study in terms of: recruitment; the intervention; timing of intervention; and completion rates. A change in the intervention indicated the importance of a quiet, restful environment when undertaking a relaxation intervention. For the psychological measures, although there were trends indicating improvement in mood there was no significant difference between groups when comparing their pre- and post- scores. There were significant differences between groups for diastolic blood pressure (p= 0.04, partial η2=0.22) and anxiety (p= 0.02, partial η2=0.31), with the foot massage group experiencing greatest decreases immediately after the session. The qualitative interviews suggest the foot massage was well tolerated and although taking staff away from their work resulted in some participants feeling guilty about taking time out, a 10-min foot massage was feasible during a working shift.
(Continued on next page)
* Correspondence: w.moyle@griffith.edu.au
1Research Centre for Clinical and Community Practice Innovation, Griffith University, 170 Kessels Road, Nathan, Queensland 4111
2Griffith Health Institute, Griffith University, 170 Kessels Road, Nathan, Queensland 4111
Full list of author information is available at the end of the article
© 2013 Moyle et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Moyle et al. BMC Nursing 2013, 12:5 http://www.biomedcentral.com/1472-6955/12/5
Page 2 of 9
(Continued from previous page)
Conclusions: This pilot trial provides data to support the feasibility of the study in terms of recruitment and consent, the intervention and completion rates. Although the outcome data should be treated with caution, the pilot demonstrated the foot massage intervention showed trends in improved mood, reduced anxiety and lower blood pressure in long-term care staff working with older people with dementia. A larger study is needed to build on these promising, but preliminary, findings.
Trial registration: ACTRN: ACTRN12612000659808.
Keywords: Anxiety, Blood pressure, Care staff, Complementary and alternative medicine, Dementia, Long-term care, Massage, Mood state, Pilot, Randomized controlled trial
Background
There are approximately 35.6 million people with dementia worldwide and, with the aging population, this number is expected to double every 20 years [1]. Whilst the majority of older people with dementia live in their own homes, and many developed countries are now prioritizing community- provided services in national policies and initiatives, a significant number still reside in long-term care (LTC) facilities [1]. Although inherently difficult to estimate, current data suggest that approximately 53% of people residing in Australian LTC facilities have dementia [2], while about two-thirds (64%) of people with dementia live in UK care homes [3].
Care staff working in LTC facilities are often under great physical and emotional demands. Research has shown that it is time-consuming to provide care for a person with de- mentia [4], and that many of the behavioral and psycho- logical symptoms of dementia, such as aggression, can lead to increased levels of stress and burnout [5], which can result in more negative attitudes and less empathy [6]. Such findings have worrying implications for the quality of care provided, particularly in terms of the increased risk of abuse and neglect [7,8]. However, there are also implications in relation to the recruitment and retention of staff, which continues to be a challenge for LTC facil- ities [9]. Specialized education and training of LTC staff is the likely means by which these issues will be addressed, and a recent report by the World Health Organization has advocated enhanced workforce education and training programmes on dementia and long-term care issues [1]. Effective interventions and techniques that moderate and reduce stress levels of care staff in the workplace should also play an important role.
Physiological models posit the particular effectiveness of massage therapy for inducing calming and reassuring sensations, with some evidence showing that an increased production of oxytocin positively mediates mood and social emotions [10]. Evidence from studies involving nurses, albeit limited by number and quality, suggest the potential stress alleviating effect of massage therapy when used in the clinical workplace. For example, a once-weekly 15-min back massage significantly reduced psychological symptoms
of anxiety in acute care hospital nurses [11]. A combin- ation of massage, relaxing music and aromatherapy was also shown to be effective in reducing anxiety for emer- gency nurses [12]. Similarly, a combination of tactile mas- sage and hypnosis helped reduce the stress and pain levels, and increase the work ability, of short-term emer- gency ward nurses [13]. Finally, a pilot study, involving healthcare workers at a LTC facility for adults with severe disabilities, found that a once-weekly 20-min massage ini- tially decreased pain severity, and showed some evidence of improving job satisfaction and morale [14]. There is an assumption that a reduction in staff stress will also influ- ence physiological measures such as blood pressure and heart rate.
When exploring the use of massage therapy in the LTC environment specifically, research has focused solely on the effect on residents with dementia. Whilst these studies have been criticized for poor methodological quality, they provide support for the positive effects of massage as a non-pharmacological intervention on agitated behaviors in this population [15]. To our knowledge, however, com- parable research has yet to be undertaken with LTC staff caring for a person with dementia. In light of this, the study described here was designed to assess the feasibility for conducting a larger, powered randomized controlled trial; and explore the potential of foot massage as a benefi- cial tool for the wellbeing of LTC staff providing care for people with dementia. A parallel group, randomized con- trolled trial was employed to ensure rigor, enable more valid and reliable conclusions to be drawn, and overcome methodological criticisms of previous research conducted in the field generally.
For the purposes of this pilot trial, it was hypothesized that when compared with the control group, participants receiving the foot massage would:
(1). demonstrate a greater reduction in negative mood as measured by the Profile of Mood States- Bipolar (POMS-Bipolar)
(2). demonstrate an increased state of relaxation, as measured by the physiologic parameters of blood pressure (BP)
Moyle et al. BMC Nursing 2013, 12:5 http://www.biomedcentral.com/1472-6955/12/5
(3). demonstrate a reduction in anxiety, as measured by the Faces Anxiety Scale,
(4). report an increase in positive experiences of caring for a people with dementia, as measured by the Staff Experience of Working with Demented Residents’ Questionnaire (SEWDRQ).
Methods
Aim
The aims of this pilot trial were to: 1. assess the feasibility of the research design including recruitment of staff, the timing of the intervention and control sessions, and com- pletion rates; 2. compare the effect of foot massage versus a control activity of silent resting on LTC staff members’ BP (a physiological indicator of stress); anxiety; mood state; and experiences of working with people with de- mentia; and 3. review the trends in pre-post physiological measures to determine their use in a larger, powered randomized controlled trial.
Design
This study was originally designed and conducted as a randomized controlled trial with cross-over, so that all participants experienced the foot massage intervention and silent resting control group. However, an unavoid- able change of location in which the intervention and control activities were administered occurred just after cross-over. Participants reported to the Project Manager (PM) a strong dislike for the new room (small with no windows), including some staff reporting feeling claus- trophobic, and initial inspection of results indicated a marked change in all outcome measures immediately after the room change. Because of this suspected extra- neous, stressful influence on care staff, it was considered inappropriate to analyze the data after cross-over. Thus, for the purposes of analyses and reporting, the study assumes a parallel group, randomized controlled trial design.
The study was granted ethical approval by the University Human Research Ethics Committee, and was verbally endorsed by senior management at the partner aged care organization and the nominated LTC facility.
Setting
One LTC facility, located in South-East Queensland (Australia), providing 105 beds for low (assisted), high (nursing home) and respite care to male and female residents, was nominated by the partner aged care organization as a suitable research site. This selection was based on the facility providing mainly high and dementia-specific care, and initial willingness from facil- ity managers and care staff to participate in the research.
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Sample
This study sought a sample of 20 LTC facility care staff. In the absence of a comparable study from which to cal- culate a sample size, this was considered sufficient for an exploration of the feasibility of the foot massage inter- vention and to provide initial pilot data. For convenience five participants who were available during the one-week period following the foot massage interview were asked to participate in a short individual qualitative interview.
The two Clinical Coordinators and the Director of Nursing at the LTC facility identified potential participants and provided them with informed consent materials so they could make a decision whether to participate. Formal enrolment into the research was based on the following inclusion criteria. The member of care staff:
1. providing direct care to residents (e.g., Registered Nurses (RNs), Enrolled Nurses (ENs), Personal Care Workers (PCWs), Assistants In Nursing (AINs))
2. regularly working ≥ two day-shifts a week
3. aged ≥ 18 years
4. willing and able to complete short, self-report scales
on aspects of their health, such as mood
5. willing to have their BP and anxiety measured after
each foot massage and silent resting activity
6. available for work at the facility for the duration of
the project, with no annual leave planned
7. providing written informed consent.
Staff were excluded from participating if they had evi- dence of skin infection or skin tears on one or both feet.
A member of the research team, who was blinded to the identity of eligible participants and not involved with data collection, used a computer program to undertake the permuted-block randomization process, with block sizes set at six. Participants were allocated to either the foot massage intervention or silent resting control group immediately after eligibility was determined and consent provided.
Intervention
The foot massage intervention and silent resting control sessions were administered to participants individually, in a separate room with a closed door displaying a ‘Do not disturb’ sign. Each session lasted 10-min, and staff members could receive up to three sessions a week dur- ing their allocated shift, for four weeks. This meant that each participant could experience up to 12 sessions of either the intervention or control activity over the four- week study period (October- November 2011).
Treatment fidelity was upheld through: recruitment of two intervention Research Assistants (RA) who were prac- ticing massage therapists and had previously been trained in the foot massage technique for another research
Moyle et al. BMC Nursing 2013, 12:5 http://www.biomedcentral.com/1472-6955/12/5
project; comprehensive training of intervention RAs in the implementation of foot massage and silent resting, and in measuring BP and anxiety; recruitment of a Project Manager (PM) to oversee the study; a standardized procedures manual detailing the protocol for both treat- ment and control; and spot-checks of data collection paperwork and the massage technique at regular intervals during the study period (checked by having the interven- tion RA give the foot massage to the trainer).
The intervention was a foot massage delivered by one of two RAs trained by an expert certified therapist in the massage technique. In each session, participants received a standardized five-minute massage on each foot (10-min in total), involving the application of light pressure with long, gliding, rhythmical strokes of the entire foot and ankle, and toe and ankle rotation, flexion and extension [16-19]. Unscented Sorbolene (8-10mls) was applied as a lubricant for the massage.
In the silent resting control sessions participants sat silently with their eyes closed and legs slightly elevated on a beanbag for 10-min. A trained RA stayed outside the room for the 10-min period. The purpose of the silent resting condition was to help isolate whether any observed effects were because of the foot massage specifically, or because the participant received special attention and had the opportunity to be away from the work environment for a quiet time.
Data collection
All participants were assessed on two self-report out- come measures at two main time-points during the study: pre-intervention (baseline) and post-intervention. The PM distributed the outcome measures to each par- ticipant, providing clear verbal and written instructions on how to complete each, and a contact number for any questions. Participants were asked to complete and re- turn the measures to a locked-box located in the LTC facility within one-week:
1. Profile of Mood States- Bipolar (POMS-Bipolar) [20]: a 72-item measure comprising six subscales measuring both positive and negative affects (‘agreeable-hostile’; ‘composed-anxious’; ‘clearheaded-confused’; ‘confident-unsure’; ‘elated- depressed’; and ‘energetic-tired’). Participants rate each item on a four-point scale that ranges from ‘0-much unlike this’ to ‘3-much like this’. Scores greater than 50 indicate more positive mood. This version of the POMS was chosen because of its ability to assess changes in mood in non-clinical situations produced by techniques such as massage [20]. The reliability of the measure and its subscales have been reported to be good, ranging from
α = 0.78 to 0.90 [21]. When used in this study, the
Page 4 of 9
internal consistency was excellent: α = 0.93 at both
pre- and post-intervention.
2. Staff Experience of Working with Demented Residents’
Questionnaire (SEWDRQ) [6]: a 21-item assessment of staff experiences and satisfaction, including their relationship with other staff and relatives of residents with dementia. In the original version, statements are scored on a scale from ‘0 – not at all’ to ‘4 – extremely’, with a total score and six sub-scores summated for the member of staff’s satisfaction with: ‘feedback’; ‘care organization’; ‘one’s own expectations’; ‘patient contact’; ‘expectation of others’; and ‘the environment’. In this study, as done previously [22], the instrument was modified to include culturally appropriate wording (i.e., ‘patient’ changed to ‘resident’). Higher scores indicate greater satisfaction. This modified version of the scale has good reported internal consistency (α = 0.80) [22], and this is confirmed in the current study (pre-intervention α = 0.93 and post- intervention α = 0.87).
In addition to these outcome measures, BP (systolic and diastolic – as a physiological indicator of stress), and a brief assessment of anxiety, were measured by a trained RA immediately before and after each session. BP was measured with a Digital Wrist Blood Pressure Monitor (model #6015) from American Diagnostic Corporation, America. Anxiety was measured using the Faces Anxiety Scale [23]: a validated scale [23] that asks participants to choose from five faces showing varying levels of anxiety.
A range of demographic information was also collected about each participant pre-intervention, including: age, gender, qualifications, role, length of time working in the facility, and number of hours worked.
Qualitative interviews with a subsample of five participants were undertaken post-intervention. As a mean to assess the feasibility of conducting a larger powered trial, the interviews were designed to assess participant’s perceptions of and reactions to the intervention, and their ideas for maximizing the efficacy of the intervention. These interviews sought to explore participants’ perceptions of: the intervention; timing of the intervention; practicalities of engaging staff in such an intervention; and suggestions for improvement.
Data analysis
All quantitative data were entered into PASW Statistics Version 20.0 (SPSS Inc., Chicago, IL, USA) for analysis. To confirm input accuracy, all entries were checked against source, and basic frequencies were run on all outcome measures and demographics to inspect the initial spread of responses, check for outliers and deter- mine the extent of missing data. The success of the
Moyle et al. BMC Nursing 2013, 12:5 http://www.biomedcentral.com/1472-6955/12/5
randomization process was tested on the one pre- intervention variable (age) that permitted statistical analysis (because of the small sample size), via an inde- pendent samples t-test.
An Intention To Treat framework was applied to the analyses, so that all randomized participants were included and the small sample size preserved. Any missing values in the outcome variables were imputed with the respective series mean produced in PASW.
Total scores were computed for the POMS-Bipolar and SEWDRQ (the two self-report measures) at pre- and post- intervention respectively. Two, repeated measure ANOVAs were then undertaken to explore whether there were any differences in the measures when comparing foot massage versus silent resting (i.e., group differences). It was considered inappropriate to analyze the subscales of the POMS-Bipolar and SEWDRQ because excessive statistical analyses of the small sample size would likely increase the risk of a Type I error.
Change scores were calculated for BP (systolic and dia- stolic) and anxiety for each of the 12 foot massage or silent resting sessions (i.e., post- minus pre-intervention). An overall mean change score was then calculated for the foot massage and silent resting groups (i.e., sum of change scores divided by 12). Three, one-way ANOVAs were
Page 5 of 9
undertaken to explore differences in the physiological effect of foot massage versus silent resting (i.e., group differences) on participants’ BP and anxiety.
All statistical tests were considered significant at the level p < 0.05. All statistical tests were undertaken as a means of showing trends in the pilot data and feasibility of the pre-post physiological measures. The qualitative interviews were transcribed verbatim and then analysed using a thematic approach. The transcripts were read several times by members of the team, and emerging issues were discussed and classified into themes. Results The recruitment of staff was successful, in that 19 members of LTC facility staff were formally enrolled into the research, randomized to intervention or control group, and analysed (see Figure 1). Random allocation to treat- ment group was considered successful, as there were no significant differences between groups in terms of age (p=0.50). There was 5.6% missing data in the study overall. Sample characteristics A profile of participant characteristics is displayed in Table 1. To summarise, all participants were female, Assessed for eligibility (n=21) Excluded (n=2) Did not meet inclusion criteria (n=2) Randomized (n=19) Allocated to Foot Massage Intervention (n=9) Received Intervention (n=9) Allocated to Silent Resting Control (n=10) Received control (n=10) Lost before final data collection (n=0) Lost before final data collection (n=0) Figure 1 Flow of participants through study. Analysed (n=19)  Moyle et al. BMC Nursing 2013, 12:5 http://www.biomedcentral.com/1472-6955/12/5 Table 1 Sample characteristics Characteristic Qualifications (n=17) Role (n=19) Time employed at the facility (n=19) Existing health issues (n=19) Current medications (n=19) Smoking status (n=18) Page 6 of 9 n Notes. Total n=19; Participants could tick all that applied for: Qualifications; Existing Health Issues. ranging in age from 23–63 years, with a mean age of 49 (σ=11.437). The majority were AINs/PCWs (n=16), with a Certificate in Aged Care/Nursing (n=14). The length of time participants’ had been employed at the LTC facility ranged from less than 12 months to more than 10 years, with one to three years being the most common (n=7). Participants typically worked four, seven-hour shifts per week. For those allocated to foot massage, the number of sessions they received ranged from 8 to 12, with the average number received being 11. For those allocated to quiet presence, the number of sessions ranged from 7 to 12, and the average number of sessions received was 10. This confirms the feasibility of delivering 12 sessions in the time allocated. In terms of physical health: four participants had hypertension, for which they were taking medication; five had arthritis; four had depression (of which three were taking an antidepressant); three had anxiety; one had diabetes; and one a skin disorder. Five participants regularly took pain relief medication, and five were current smokers. Comparison of POMS-Bipolar and SEWDRQ, pre- and post- intervention The reduction in negative mood hypothesis was supported in this pilot study. A repeated measures ANOVA for POMS indicated there were no significant differences in the interaction between Time (pre/post) and Group (con- trol/intervention; p=0.666) or between the main effect of Time (p=0.875); there was however, a significant differ- ence between the main effect of Group (p=0.03). Given that the POM means were not significantly different between the groups at baseline (independent t-test, p=0.061), and there is a non significant Time effect, the significant group effect appears to be spurious either due to the small sample size and/or the appropriateness of using mood as an outcome measure (See Table 2). The hypothesis that LTC staff would be more satisfied in terms of their experiences of working with people with dementia, was not supported (p =0.06). A repeated measures ANOVA for SEWDRQ indicated there were no significant differences in the interaction between Time (pre/post) and Group (control/intervention; p=0.502), Sub-category Certificate in Aged Care/Nursing Diploma of Nursing Bachelor of Nursing Women’s Health Education Registered Nurse Enrolled Nurse Assistant In Nursing/Personal Care Worker <1 year 1-3 years 4-6 years 7-9 years ≥10 years Hypertension Arthritis Diabetes Skin disorder Depression Anxiety Blood pressure medication Antidepressants Pain relief medication Non-smoker 12 Current smoker 5 Previous smoker: quit in the last five years 1 14 2 2 1 2 1 16 3 7 3 4 2 4 5 1 1 4 3 4 3 5  Moyle et al. BMC Nursing 2013, 12:5 Page 7 of 9 http://www.biomedcentral.com/1472-6955/12/5 Table 2 Repeated measure ANOVAs exploring group differences in mood state and experiences of working with people with dementia Dependent variable POMS-Bipolar SEWDRQ Total scores (σ) Effect of group Pre-intervention Post-intervention Foot massage 53.63 (7.49) 58.56 (10.75) Silent resting 47.11 (6.62) 49.48 (10.14) Overall 50.20 (7.61) 53.78 (11.15) Foot massage 53.91 (7.76) 56.11 (8.22) Silent resting 46.52 (5.02) 48.75 (6.89) Overall F-Value 50.02 5.59 (7.33) 52.24 4.24 (8.25) Significance (p=) 0.03* 0.06 Partial eta squared (η2) 0.25 0.20 Notes. Total n=19; Foot massage n=9; Silent resting n=10; *p<0.05; σ = Standard Deviation; POMS-Bipolar=Profile of Mood States- Bipolar; SEWDRQ=Staff Experience of Working with Demented Residents’ Questionnaire; Increases in POMS-Bipolar total scores indicate increased positive mood state; Increases in SEWDRQ total scores indicate greater satisfaction with working with people with dementia. between the main effect of Time (p=0.220), or between the main effect of Group (p=0.055). Given that the base- line SEWDRQ means were not significantly different be- tween the groups at baseline (independent t-test, p=0.075) these results indicate that the intervention had no signifi- cant effect on the mean SEWDRQ (See Table 2). Comparison of BP and anxiety immediately before and after intervention/control session The hypotheses of a reduction in stress, as measured by BP, and anxiety, as measured by the Faces Anxiety Scale, were supported in this pilot study. There were statistically significant differences in diastolic BP (F(1,17) = 4.79, p= 0.04, partial η2=0.22) and anxiety (F(1,17) = 7.31, p= 0.02, partial η2=0.31) according to group, with those receiving foot massage experiencing greater decreases than their silent resting counterparts (see Table 3). This suggests that foot massage was more effective than silent resting in immediately reducing anxiety and lowering diastolic BP. In terms of systolic BP, although both groups saw a non- significant reduction in mean change scores (p =0.60), this reduction was greatest for those in the silent resting con- trol group (See Table 3). The qualitative interviews found that all participants enjoyed engaging in the foot massage intervention; they described positive experiences of the massage, the break from work, and interactions with the massage staff. Participants reported feeling relaxed after the foot mas- sage and reported that the foot massage had some impact on their work. The impact included: less pain in their feet, feelings of relaxation, increased energy, and increased ability to manage work demands. Although the foot massage was reported as a positive experience taking staff away from their work to participate in the foot massage created feelings of guilt when leaving colleagues short staffed while they were away relaxing. Participants reported potential changes to the interven- tion and these included changes to the location of the massage, potentially the shoulders, hands or neck at alternate sessions to help with body movement; more pressure during the massage; or more time for the massage. Discussion This pilot trial demonstrated the feasibility of conducting a foot-massage intervention for staff working in LTC facil- ities. In terms of recruitment, although the facility was considered to be of an average size (105 beds), and the re- cruitment focused only on day shift staff, an adequate num- ber of staff were willing to be involved and, thus, our estimation of the number we could recruit from one facility was accurate. Recruitment was hampered only by the trial being undertaken in the pre-holiday period when there was Table 3 One-way ANOVAs exploring group differences in blood pressure and anxiety Dependent variable Systolic Blood Pressure Diastolic Blood Pressure Faces Anxiety Scale Mean change scores (σ) Effect of group Foot massage −5.10 (3.34) −5.06 (2.46) −0.72 (0.42) Silent resting −5.88 (2.97) −2.25 (3.05) −0.30 (0.24) Overall F-Value −5.51 0.29 (3.09) −3.58 4.79 (3.07) −0.50 7.31 (0.40) Significance (p=) 0.60 0.04* 0.02* Partial eta squared (η2) 0.02 0.22 0.30 Notes. Total n=19; Foot massage n=9; Silent resting n=10; *p<0.05; σ = Standard Deviation; Change scores were calculated for blood pressure (systolic and diastolic) and anxiety for each of the 12 ft massage or silent resting sessions (i.e., post- minus pre-intervention). An overall mean change score was then calculated for the foot massage and silent resting groups for each measure (i.e., sum of change scores divided by 12). Moyle et al. BMC Nursing 2013, 12:5 http://www.biomedcentral.com/1472-6955/12/5 a large number of staff on leave. Challenges to the research design included the environmental limitations, and this demonstrates the importance of undertaking a relaxation intervention in a room where participants felt comfortable. Outcome measures were not problematic for participants to complete, however, the project manager had to remind participants to complete and return to the locked box. Whilst the generalizability of the study’s findings are hindered by the sample size and the characteristics of the sample, which included 19 women from one LTC facility, this pilot trial provides important initial data on the feasibility and potential efficacy of foot massage for LTC facility staff working with older people with demen- tia. Although there were trends indicating improvement in mood the appropriateness of using POMS-Bipolar or even measuring mood in general is questionable as mood may be too malleable to measure across time. In this research mood appears to have been heavily influenced by the physical demands of the LTC workplace, whereby participant’s reported feelings of guilt at experiencing a pleasurable experience, such as that experienced from the foot massage while others were busy in the workplace. Given the effects of the workplace, and poor physical health on mood, in future research the measurement of general wellbeing may be a more appropriate measure. The study found that members of LTC staff who received the foot massage intervention had significant decreases in diastolic BP and anxiety levels immediately after experiencing a session. These findings support those from previous massage studies involving hospital nurses and healthcare workers [11-14]. Building on these initial findings, a larger study is now needed. The non-significant trend for all participants to be less satisfied with working with residents with dementia after the study period, particularly after experiencing the foot massage intervention, was unexpected. It is possible that the opportunity for 10-min quiet, sitting-down time and, in the case of foot massage, soothing physical touch, gave care staff an opportunity to reflect on the physical and emotional demands of the job of caring for a person with dementia, and the high-stress nature and busyness of their work environment. The time away from their work may have also raised concerns of how they were going to ‘catch-up’ on the tasks they had been unable to complete whilst participating in the study. Such reflections may have then translated into reduced satisfaction scores on the SEWDRQ. Another explanation may center on the use of the instrument chosen to assess staff work experiences, the SEWDRQ. To date, there has been only limited investigation of the scale’s psychometric properties and performance within an Australian context. However, the reliability coefficients produced in this study, and in previous work undertaken by members of the research team [22], have been good to excellent, thus offering some Page 8 of 9 reassurance for suitability of the instrument. More work may be required, however, to validate this scale in an Australian setting. The general trend for systolic and diastolic BP to im- mediately decrease after an intervention or control ses- sion suggests that foot massage produced a physiological relaxation response. However, the fact that decreases in diastolic BP were most marked (and statistically signifi- cant), for the foot massage group, but that the decreases in systolic BP were most marked (but non-significant) for the silent resting group, makes interpretation diffi- cult. The research evidence on the effect of massage therapy on BP is somewhat conflicting [11,24], and the results from this pilot study reinforce the need for fur- ther exploration of whether BP is a useful and clinically meaningful indicator of the effectiveness of foot mas- sage. At this stage, the implications of effects identified in this study are unclear and raise doubts about the feasibility of using physiological measures, such as BP, as a pre-post measure in a short intervention such as a 10- min foot massage. Finally the qualitative interviews suggest the foot mas- sage was well tolerated and although taking staff away from their work resulted in some participants feeling guilty about taking time out, a 10-min foot massage was feasible during a working shift. Conclusions This pilot trial provides feasibility data for undertaking a larger, powered randomized controlled trial, and provides justification for the importance of environment in relax- ation interventions. A larger study is now needed to deter- mine, and isolate, the efficacy of foot massage for LTC staff. Abbreviations AIN: Assistant in nursing; BP: Blood pressure; CAM: Complementary and alternative medicine; EN: Enrolled nurse; LTC: Long-term care; PCW: Personal care worker; PM: Project manager; POMS-Bipolar: Profile of mood states- bipolar; RA: Research assistant; RN: Registered nurse; SEWDRQ: Staff experience of working with demented residents’ questionnaire. Competing interests The authors declare that they have no competing interests. Authors’ contributions WM conceived of the study and its design, oversaw and coordinated the research, trained RAs, and assisted in drafting the manuscript. AJ and MC equally contributed by providing methodological and statistical advice, and in drafting the manuscript. SOD assisted in overseeing the study at the research site, training RAs, providing statistical advice and in drafting the manuscript. JM provided methodological and statistical advice, and took the lead in drafting the manuscript. BS undertook the statistical analysis and assisted in drafting the analysis section of the manuscript. All authors read and approved the final manuscript. No writing assistance was utilized. Acknowledgements This study was wholly funded by the Dementia Collaborative Research Centre – Carers and Consumers, whose sole role was monetary and had no part in designing and undertaking the study, interpreting the findings, Moyle et al. BMC Nursing 2013, 12:5 http://www.biomedcentral.com/1472-6955/12/5 drafting the manuscript, or in the decision to publish. The authors acknowledge support and contributions by Churches of Christ (Queensland), senior management at Lady Small Haven Aged Care Services, and all participating care staff. Specific thanks are also expressed to Ms. Chrystal Gray for her diligent work as PM, and to Ms. Nok Sritoomma for her expertise and time during the training of RAs in the foot massage intervention technique. Author details 1Research Centre for Clinical and Community Practice Innovation, Griffith University, 170 Kessels Road, Nathan, Queensland 4111. 2Griffith Health Institute, Griffith University, 170 Kessels Road, Nathan, Queensland 4111. 3NHMRC Centre of Research Excellence in Nursing Interventions for Hospital Patients, Griffith University, 170 Kessels Road, Nathan, Queensland 4111. 4Eskitis Institute of Cell and Molecular Therapies, Griffith University, Eskitis 2 Building N75 Brisbane Innovation Park, Don Young Road, Nathan, Queensland 4111. Received: 31 July 2012 Accepted: 11 February 2013 Published: 18 February 2013 References 1. World Health Organisation: Dementia: a public health priority. Switzerland: World Health Organisation; 2012. 2. Australian Institute of Health and Welfare: Dementia among aged care residents: first information from the Aged Care Funding Instrument. Canberra: Australian Institute of Health and Welfare; 2011. 3. Society A’s: Dementia 2007. London: Alzheimer’s Society; 2007. 4. Ory MG, Hoffman RR III, Yee JJ, Tennstedt S, Schulz R: Prevalence and impact of care giving: a detailed comparison between dementia and nondementia caregivers. Gerontologist 1999, 39:177–185. 5. Brodaty H, Draper B, Low LF: Nursing home staff attitudes towards residents with dementia: strain and satisfaction with work. J Adv Nurs 2003, 44:583–590. 6. Astrom S, Nilsson M, Norberg A, Sandman P-O, Winblad B: Staff burnout in dementia care: relations to empathy and attitudes. Int J Nurs Stud 1991, 28:65–75. 7. Goergen T: Stress, conflict, elder abuse and neglect in German nursing homes: a pilot study amongst professional caregivers. J Elder Abuse Negl 2001, 13:1–26. 8. von Dras DD, Flittner D, Malcore SA, Pouliot G: Workplace stress and ethical challenges experienced by nursing staff in a nursing home. Educ Gerontol 2009, 35:321–339. 9. Economics A: Nurses in residential aged care. Australia: The Australian Nursing Federation; 2009. 10. Uvnas-Moberg K: Oxytocin may mediate the effect of positive social interaction and emotions. Psychoneuroendocrinology 1998, 23:819–835. 11. Bost N, Wallis M: The effectiveness of a 15 min weekly massage in reducing physical and psychological stress in nurses. Aust J Adv Nurs 2006, 23:28–33. 12. Davis C, Cooke M, Holzhauser K, Jones M, Finucane J: The effect of aromatherapy massage with music on the stress and anxiety levels of emergency nurses. AENJ 2005, 8:43–50. 13. Airosa F, Andersson SK, Falkenberg T, Forsberg C, Nordby-Hörnell E, Öhlén G, Sundberg T: Tactile massage and hypnosis as a health promotion for nurses in emergency care: a qualitative study. BMC Complement Altern Med 2011, 11:83. 14. Back C, Tam H, Lee E, Haraldsson B: The effects of employer-provided massage therapy on job satisfaction, workplace stress and pain and discomfort. Holist Nurs Pract 2009, 23:19–31. 15. Moyle W, Murfield J, O’Dwyer S, Van Wyk S: The effect of massage on agitated behaviours in older people with dementia: a literature review. J Clin Nurs 2012, 22:601–610. 16. Moyle W, Johnston A, O’Dwyer S: Exploring the effect of foot massage on agitated behaviours in older people with dementia: a pilot study. Australas J Ageing 2011, 30:159–161. 17. Nelson D: The power of human touch in alzheimer’s care. MTJ 2004, 43:82–92. 18. Sansome P, Schmitt L: Providing tender touch massage to elderly nursing home residents: a demonstration project. Geriatr Nurs 2000, 21:286–331. Page 9 of 9 19. Tuchtan V: The evidence for massage therapy. In Foundations of massage. 2nd edition. Edited by Tutchan C, Tutchan V, Stelfox D. Sydney: Churchill Livingstone; 2004. 20. Lorr M, McNair D: Profile of Mood States-Bipolar fom (POMS-BI). San Diego, CA: Educational and Industrial Testing Service; 1984:1988. 21. O’Halloran PD, Murphy GC, Webster KE: Reliability of the bipolar form of the profile of mood states using an alternative test protocol. Psychol Rep 2004, 95:459–463. 22. Moyle W, Murfield J, Griffiths S, Venturato L: Care staff attitudes and experiences of working with older people with dementia. Australas J Ageing 2011, 30:186–190. 23. McKinley S, Coote K, Stein-Parbury J: Development and testing of a faces scale for the assessment of anxiety in critically ill patients. J Adv Nurs 2003, 41:73–79. 24. Delaney JP, Leong KS, Watkins A, Brodie D: The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects. J Adv Nurs 2002, 37:364–371. doi:10.1186/1472-6955-12-5 Cite this article as: Moyle et al.: The effect of foot massage on long-term care staff working with older people with dementia: a pilot, parallel group, randomized controlled trial. BMC Nursing 2013 12:5. 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Apr 25 2015

Impact of a Pedometer Program on Nurses Working in a Health-Promoting Hospital

Abstract
Lavoie-Tremblay, Mélanie N.PhD, FRSQ; Sounan, Charles PhD; Trudel, Julie G. PhD; Lavigne, Geneviève L. PhD; Martin, Kara MA; Lowensteyn, Ilka PhD

The aim of this research was to describe the impact of a pedometer-based activity program on a subset of nurses in a university-affiliated, multisite health care center in Canada. This study used a longitudinal design with preintervention-postintervention (8 weeks) and follow-up (6 months). At baseline, 60 nurses participated; 51 (85%) remained for the postprogram assessment and 33 (55%) also completed the follow-up questionnaire. Data were collected through self-administered questionnaires (weight, height, fatigue, insomnia, stress and step data) and blood tests (total cholesterol and low-density lipoprotein and high-density lipoprotein cholesterol). At postprogram, participants reported 12 thinsp;912 steps on average per day. At follow-up, 79% of participants indicated that they maintained their physical activity after the pedometer program. A significant decrease in insomnia was evident in postprogram scores compared with baseline scores, and this decrease was maintained at follow-up. A significant decrease in minutes spent sitting per week was also observed from baseline to postprogram and also maintained at follow-up. Participants’ stress and low-density lipoprotein cholesterol levels decreased from baseline to postprogram (marginally significant). Finally, their weight decreased from baseline to follow-up (marginally significant). The pedometer program generated some positive outcomes for nurses after 6 months.

give these hard working nurses a corporate massage, or workplace massage and you will see much better results . please book one today at www.therapy4u.biz

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Apr 25 2015

Development of a manualized protocol of massage therapy for clinical trials in osteoarthritis

Ali et al. Trials 2012, 13:185 http://www.trialsjournal.com/content/13/1/185
TRIALS
METHODOLOGY Open Access
Ather Ali1*, Janet Kahn2, Lisa Rosenberger3 and Adam I Perlman4
Abstract
Background: Clinical trial design of manual therapies may be especially challenging as techniques are often individualized and practitioner-dependent. This paper describes our methods in creating a standardized Swedish massage protocol tailored to subjects with osteoarthritis of the knee while respectful of the individualized nature of massage therapy, as well as implementation of this protocol in two randomized clinical trials.
Methods: The manualization process involved a collaborative process between methodologic and clinical experts, with the explicit goals of creating a reproducible semi-structured protocol for massage therapy, while allowing some latitude for therapists’ clinical judgment and maintaining consistency with a prior pilot study.
Results: The manualized protocol addressed identical specified body regions with distinct 30- and 60-min protocols, using standard Swedish strokes. Each protocol specifies the time allocated to each body region. The manualized 30- and 60-min protocols were implemented in a dual-site 24-week randomized dose-finding trial in patients with osteoarthritis of the knee, and is currently being implemented in a three-site 52-week efficacy trial of manualized Swedish massage therapy. In the dose-finding study, therapists adhered to the protocols and significant treatment effects were demonstrated.
Conclusions: The massage protocol was manualized, using standard techniques, and made flexible for individual practitioner and subject needs. The protocol has been applied in two randomized clinical trials. This manualized Swedish massage protocol has real-world utility and can be readily utilized both in the research and clinical settings.
Trial registration: Clinicaltrials.gov NCT00970008 (18 August 2009) Keywords: Massage, Manualization, Clinical trial, Manual therapy, Swedish
Background
Among the challenges in research in complementary and alternative medicine (CAM) is the necessity to de- sign clinical trials that are methodologically rigorous as well as consistent with prevailing clinical practice pat- terns [1-3]. This difficulty has been mentioned in trials of botanical medicines [3], mind-body interventions [4], and manual therapies [5,6]. Many CAM disciplines es- pouse patient-centered care that often results in some individualization of treatment. Thus, standardization of interventions for clinical trials poses a particular chal- lenge. Clinical trial design of manual therapies may be
* Correspondence: ather.ali@yale.edu
1Department of Pediatrics, Yale University School of Medicine, 2 Church Street South, New Haven, CT 06519, USA
Full list of author information is available at the end of the article
especially challenging since techniques are often practitioner-dependent as well as patient-oriented [7,8].
Massage therapy is one of the most popular CAM techniques in the USA [9]. Between 2002 and 2007, the 1-year prevalence of use of massage by the US adult population increased from 5% (10 million) to 8.3% (18 million) [9]. Massage is generally used, with some re- search support, to relieve pain from musculoskeletal dis- orders and cancer, rehabilitate sports injuries, reduce stress, increase relaxation, decrease feelings of anxiety and depression, and aid in general wellness [10-24].
The identification of massage therapy for patients with osteoarthritis as a research priority derives directly from a CDC-funded systematic evidence mapping project ap- plied to CAM [25], leading to our pilot study evaluating the safety and efficacy of a 1-h whole body Swedish
© 2012 Ali et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Ali et al. Trials 2012, 13:185 http://www.trialsjournal.com/content/13/1/185
massage in adults with osteoarthritis of the knee [26]. After 8 weeks of massage therapy (biweekly × 4 weeks, weekly × 4 weeks), scores on the Western Ontario and McMaster Universities Arthritis Index (WOMAC) [27] global score improved significantly (55%) from baseline (P <0.001), as did the scores in each subdomain (pain, stiffness, and physical functional disability), with effects persisting 8 weeks after treatment cessation [26]. Swedish massage techniques were chosen for their practical util- ity; being the most widely taught and practiced massage method that is well defined procedurally, and safe when administered by trained massage therapists [28-30]. Manualization was initially developed for the cre- ation of standardized treatment protocols for psycho- therapy, both to help provide methodologic rigor for evaluation, and as a means to provide specificity and guidelines regarding individualized treatment [31]. Massage therapy, as an intervention in clinical trials has similar needs for methodologic rigor to standardize patient-customized treatments and practitioner vari- ation [32,33]. In 2002, Schnyer and Allen published their methodology on developing treatment manuals for acupuncture interventions used in NIH-funded trials. These manuals served as a means to facilitate the training process, enable evaluation of conformity and competence, and increase the ability to identify the active therapeutic ingredients in clinical trials of acupuncture [34]. The Institute of Medicine has noted that manualization is an integral component for rigor- ous research on CAM therapies [35]. This investigative team collaborated again in a 2-year single-blinded randomized controlled dose-finding study, aiming to identify an optimal-practical dose and treat- ment regimen of an 8-week course of Swedish massage for osteoarthritis of the knee. The intervention develop- ment phase of this dose-finding study incorporated a formal manualization process. Here we describe our ap- proach in developing a standardized massage interven- tion tailored to subjects with osteoarthritis of the knee while respectful of the individualized nature of massage therapy [34], as well as the implementation of this man- ualized protocol into two NIH-supported randomized controlled trials. Methods Development of the manualization process, conducted over the course of 2 months, involved the input of methodologic and clinical experts. The manualization process was aided by a committee organized and under the direction of the former Research Director (JK) of the Massage Therapy Research Consortium (MTRC). The MTRC was a consortium of schools in the United States and Canada collaborating to build Page 2 of 6 research capacity and to advance research in the field of massage. Four meetings were held by telephone conference call. Participants included members of the investigative team, massage therapists from both clinical sites, and massage therapy researchers. Each meeting reiterated the over- arching goals of the manualization process: 1. To create a reproducible, semi-structured protocol for massage therapy for osteoarthritis of the knee, while allowing for some latitude based on therapists’ clinical judgment. Four distinct ‘doses’ varying on duration (30 min vs. 60 min) and frequency (weekly or biweekly) to assess dose–response effects. 2. To be consistent with the protocol delivered during the pilot study [26]. Thus, only the Swedish massage techniques of effleurage, petrissage, tapotement, vibration (including rocking or jostling), friction, and skin-rolling were to be used. These are standard Swedish strokes and massage techniques taught in schools accredited by the Commission on Massage Therapy Accreditation (COMTA) [36]. The manualization team tailored the treatment proto- cols to the over-arching goals of subsequent clinical trials; that is to determine the efficacy of a standardized Swedish massage protocol for treatment of patients with osteoarthritis of the knee. The putative mechanisms of massage as related to treating osteoarthritis (relaxation, reducing inflammation, improving flexibility) were con- sidered when designing the protocol. The protocol of the dose-finding study, consent form and all recruitment materials were approved by the In- stitutional Review Boards of the University of Medicine and Dentistry of New Jersey (Newark, NJ, USA), Griffin Hospital (Derby, CT, USA), and the Saint Barnabas Medical Center (Livingston, NJ, USA). The study was conducted in accordance with the Declar- ation of Helsinki [37]. Results The manualized protocol specifies the body regions to be addressed, with distinct 30- and 60-min protocols, as well as the standard Swedish strokes to be used (effleur- age, petrissage, tapotement, vibration, friction, and skin rolling) [38] (see Table 1). Each protocol specifies the time allocated to various body regions (lower/upper limbs, lower/upper back, head, neck, chest) and specific areas of emphasis. The order of body regions, patient position (supine or prone), technique sequence, or technique type is left to the discretion of the therapist to account for individual practitioner preference and patient needs. Ali et al. Trials 2012, 13:185 http://www.trialsjournal.com/content/13/1/185 Table 1 30- and 60-minute massage protocols Page 3 of 6 Allowed Swedish massage techniques: Effleurage, petrissage, tapotement, vibration, friction, and skin rolling Region Lower limbs Upper body Discretionary Lower limbs Upper body Discretionary Time allotted 12 to 15 min (45% to 50% of session) 8 to 12 min (36% to 44% of session) 2 to 5 min (6% to 19% of session) 20 to 27.5 min (45% to 50% of session) 15 to 24 min (36% to 44% of session) 3.5 to 20 min (6% to 19% of session) 30-minute protocol (25 minutes of table time) Distribution From knee down including lower leg, ankle, and foot. From knee up including hips, pelvis, buttocks, and thigh. Lower and upper back; head/neck/chest. Therapist to expand treatment to other affected areas; that is rib cage, flank, upper limbs, et cetera. 60-minute protocol (55 minutes of table timea) From knee down including lower leg, ankle, and foot. From knee up including hips, pelvis, buttocks, and thigh. Lower and upper back; head, neck, and chest. Therapist to expand treatment to other affected areas; that is rib cage, flank, upper limbs, et cetera. aAccounting for time spent in transition including the welcome, transition to the massage room, taking off jewelry, and other preparatory activities. The protocol further specifies intentions/attentions for the study therapists consistent with massage therapy practice, specifically: 1. Assess and address relevant imbalances in posture 2. In general, seek to establish symmetry 3. Strengthen muscles around knee joint 4. Compensate weak muscles 5. Disperse stress to bring balance 6. Decrease sympathetic activity 7. Diffuse inflammation 8. Reduce inhibition in anti-gravity muscles Each study therapist was trained in the protocol, and signed a form attesting to adherence to the manualized massage protocol after each massage session. No devia- tions from the protocol were reported for the duration of the dose-finding trial at either site. The manualization team agreed that the knee must be regarded as a functional unit. Thus, the protocol expli- citly does not specify the percent of time to be spent dir- ectly on structures of the knee. Rather, time variables included the upper and lower leg, both including the knee (see Table 1). The manualized 30- and 60-min protocols were imple- mented in a 24-week randomized dose-finding trial of massage therapy for osteoarthritis of the knee [39]. Sub- jects (n=125) were randomized to one of four regimens of the manualized massage intervention (30 min or 60 min weekly or biweekly) or to a usual care control. Outcomes were assessed at baseline, 8, 16, and 24 weeks and included the WOMAC, visual analog pain scale, range of motion, and time to walk 50 feet. The initial randomization occurred in October 2009 and the last sub- ject completed the 8-week intervention in October 2010. Both 60-min regimens (weekly or biweekly) demon- strated significantly improved WOMAC global scores (24.0 points, 95% CI varied from 15.3 to 32.7) compared to usual care (6.3 points, 95% CI 0.1 to 12.8) at the pri- mary endpoint of 8 weeks. Further, the 60-min regimens demonstrated significant improvements in WOMAC subscales of pain and functionality, as well as the visual analog pain scale compared to usual care. No significant differences were seen in range of motion at 8 weeks, and no significant effects were seen in any outcome measure at 24 weeks compared to usual care. A dose–response curve based on WOMAC global scores shows increasing effect with greater total time of massage; with 60-min doses scoring significantly better than 30-min doses. No significant differences were seen in WOMAC global scores between the 60-min doses (weekly or bi- weekly) [39]. This trial thus established an ‘optimal-practical’ dose (60-min once-weekly) of this manualized Swedish mas- sage regimen for osteoarthritis of the knee. This deci- sion was based on the superiority of the 60-min compared to 30-min regimens, the essentially similar outcomes of the two 60-min doses, the convenience of a once-weekly protocol (compared to biweekly), cost savings, and consistency with a typical real-world mas- sage protocol [39]. This optimized dose of manualized Swedish massage therapy is currently being implemented in a large-scale (n=222) NIH-funded 52-week efficacy trial of massage therapy for osteoarthritis of the knee at three clinical sites[40]. Ali et al. Trials 2012, 13:185 http://www.trialsjournal.com/content/13/1/185 Discussion Clinical trials of massage therapy are inherently chal- lenged by an inability to blind practitioner and recipient. Furthermore, massage practices are heterogeneous with procedures utilized from different schools of massage in- corporating a variety of techniques. Some of these schools include Swedish massage, neuromuscular, myo- fascial, Chinese, other Asian, medical, osteopathic, or na- turopathic manipulative therapies [41]. Massage is a pleasant and desirable intervention and is safe when delivered by trained practitioners using stand- ard Swedish techniques [28]. Demonstrating the efficacy of massage therapy in clinical trials requires reproducible treatment regimens. To our knowledge, this is the first report to describe the manualization of massage therapy. The feasibility of this protocol is demonstrated by implementing this standardized regimen in two clinical sites in the rando- mized dose-finding trial [39], as well as in a larger three-site efficacy trial [40]. A few published reports of implementing standardized Swedish massage regimens in randomized trials exist. Pat- terson et al. published a standardized massage (and con- trol) regimen in a clinical trial assessing fatigue reduction in cancer chemotherapy, though no results have been published [36]. Sharpe et al. published the results of a pilot randomized trial assessing the effects of a standar- dized Swedish massage regimen vs. guided relaxation on stress and wellbeing in a pilot study (n=54) [42], though there are no reports of implementing this regimen in a larger sample. Taylor et al. also report using a standar- dized Swedish massage protocol though the protocol was not described to the point that the intervention could be reproduced [43]. Cherkin et al. assessed a standardized Swedish protocol (‘relaxation massage’) [44], other mas- sage techniques (‘structural massage’), and continuing usual care in a three-arm randomized controlled trial for patients with chronic back pain. Both massage regimens were found to be superior to usual care, with no clinically meaningful differences seen between the relaxation and structural massage arms [7]. Other randomized trials of Swedish massage therapy have not used standardized massage interventions, com- promising external validity and reducing the ability to replicate positive results [45,46]. The concept of ‘dose’ has never been formally defined for massage. Prior to determining specific study protocols, the manualization team had to operationally define ‘dose’ of massage therapy. If dose, for example, was defined only by the length of time, it may be assumed that a single 60-min session and two 30-min sessions would be equiva- lent. This assumption was tested by assessing the effects of frequency of massage therapy. Thus, in our manualiza- tion process, two variables germane to dosing were Page 4 of 6 assessed: frequency of massage therapy and duration of treatment. Frequency was varied between weekly or bi- weekly sessions, based on practicality and current practice standards. Duration of treatment was negotiated by the expert panel to provide a dose that is clinically effective while avoiding possible overtreatment. Finally the team explored the issue of what constituted ‘massage for the knee’. In this study the team chose to view the knee in its functionality and distribute the apportioned time not to specific muscles, tendons or ligaments, but rather to the two regions of the knee and lower leg (ankle, foot, and lower leg) and the knee and upper leg (including hips, pelvis, buttocks, and thighs). Massage treatments are often focused on a particular functional issue or anatomic region, though they typically also include some broader treatment to promote relax- ation [7]. Relaxation has been thought to be helpful to many healing processes, and from a massage therapy per- spective, to aid in whole body integration to supporting proper gait and biomechanics of the joint(s). Thus, the protocol involved regions beyond the knee; time was allot- ted to the upper and lower back, neck, chest, and head. One of the limitations of this manualized Swedish massage protocol is that the protocol may not be as effi- cacious as real-world practice as fully individualized treatment is precluded. In addition, other techniques (that is, neuromuscular and myofascial) may be more ef- fective in altering posture and gait in ways that might affect osteoarthritis symptoms and progression. The one known study comparing Swedish massage with myofas- cial and neuromuscular techniques for treatment of back pain showed no significant difference in ability to affect pain or function [7]. Conclusions The resulting massage protocol was manualized [40], using standard Swedish techniques [26,28], and made flexible for individual subject variability. This manualized Swedish massage protocol has successfully been imple- mented in a dual-site dose-finding clinical trial and a three-site efficacy trial. The manualized Swedish mas- sage protocol has real-world utility and can be readily utilized in clinical trials and clinical practice. Abbreviations CAM: Complementary and Alternative Medicine; CDC: Centers for Disease Control and Prevention; MTRC: Massage Therapy Research Consortium; NCCAM: National Center for Complementary and Alternative Medicine; NIH: National Institutes of Health; WOMAC: Western Ontario and McMaster Universities Arthritis Index. Competing interests The authors declare that they have no competing interests. Authors’ contributions AA led the manualization process, participated in the design and coordination of the study, and drafted the manuscript. JK provided technical Ali et al. Trials 2012, 13:185 http://www.trialsjournal.com/content/13/1/185 expertise in massage therapy. LR assisted in the clinical trial and provided critical review of the manuscript. AP conceived of the study, and participated in its design and coordination, and critically reviewed the manuscript. All authors read and approved the final manuscript. Acknowledgements We thank the study subjects for their participation. Licensed massage therapists Linda Winz, Michael Yablonsky, Susan Kmon, and Lee Stang provided massages for study subjects. Mary Carola, Margaret Rogers, Carl Milak, Anna Davidi, and Dr. Valentine Njike provided technical and administrative support. This publication was made possible by grants R01AT004623 and K23AT006703 from the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCCAM. The sponsors had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Author details 1Department of Pediatrics, Yale University School of Medicine, 2 Church Street South, New Haven, CT 06519, USA. 2College of Medicine, University of Vermont, 240 Maple Street, Burlington, VT 05401, USA. 3Yale-Griffin Prevention Research Center, Griffin Hospital, 130 Division Street, Derby, CT 06418, USA. 4Duke Integrative Medicine, Duke University School of Medicine, 3475 Erwin Road, Durham, NC 27710, USA. Received: 26 April 2012 Accepted: 27 September 2012 Published: 4 October 2012 References 1. Nahin RL: Identifying and pursuing research priorities at the National Center for Complementary and Alternative Medicine. FASEB J 2005, 19:1209–1215. 2. Nahin RL, Straus SE: Research into complementary and alternative medicine: problems and potential. BMJ 2001, 322:161–164. 3. Kinsel JF, Straus SE: Complementary and alternative therapeutics: rigorous research is needed to support claims. Annu Rev Pharmacol Toxicol 2003, 43:463–484. 4. Ospina MB, Bond K, Karkhaneh M, Buscemi N, Dryden DM, Barnes V, Carlson LE, Dusek JA, Shannahoff-Khalsa D: Clinical trials of meditation practices in health care: characteristics and quality. J Altern Complement Med 2008, 14:1199–1213. 5. Hawk C, Long CR, Rowell RM, Gudavalli MR, Jedlicka J: A randomized trial investigating a chiropractic manual placebo: a novel design using standardized forces in the delivery of active and control treatments. J Altern Complement Med 2005, 11:109–117. 6. Vernon H, MacAdam K, Marshall V, Pion M, Sadowska M: Validation of a sham manipulative procedure for the cervical spine for use in clinical trials. J Manipulative Physiol Ther 2005, 28:662–666. 7. Cherkin DC, Sherman KJ, Kahn J, Wellman R, Cook AJ, Johnson E, Erro J, Delaney K, Deyo RA: A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Ann Intern Med 2011, 155:1–9. 8. Frampton S, Charmel P (Eds): Putting Patients First: Designing and Practicing Patient-Centered Care. San Francisco, CA: Jossey-Bass Publishers, Inc; 2008. 9. Barnes PM, Bloom B, Nahin RL: Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Rep 2008, 12:1–23. 10. Wentworth LJ, Briese LJ, Timimi FK, Sanvick CL, Bartel DC, Cutshall SM, Tilbury RT, Lennon R, Bauer BA: Massage therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures. Prog Cardiovasc Nurs 2009, 24:155–161. 11. Listing M, Reisshauer A, Krohn M, Voigt B, Tjahono G, Becker J, Klapp BF, Rauchfuss M: Massage therapy reduces physical discomfort and improves mood disturbances in women with breast cancer. Psychooncology 2009, 18:1290–1299. 12. Kutner JS, Smith MC, Corbin L, Hemphill L, Benton K, Mellis BK, Beaty B, Felton S, Yamashita TE, Bryant LL, Fairclough DL: Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med 2008, 149:369–379. Page 5 of 6 13. Jane S-W, Wilkie DJ, Gallucci BB, Beaton RD, Huang H-Y: Effects of a full-body massage on pain intensity, anxiety, and physiological relaxation in Taiwanese patients with metastatic bone pain: a pilot study. J Pain Symptom Manage 2009, 37:754–763. 14. Hernandez-Reif M, Field T, Krasnegor J, Theakston H: Lower back pain is reduced and range of motion increased after massage therapy. Int J Neurosci 2001, 106:131–145. 15. Frey Law LA, Evans S, Knudtson J, Nus S, Scholl K, Sluka KA: Massage reduces pain perception and hyperalgesia in experimental muscle pain: a randomized, controlled trial. J Pain 2008, 9:714–721. 16. Field T, Figueiredo B, Hernandez-Reif M, Diego M, Deeds O, Ascencio A: Massage therapy reduces pain in pregnant women, alleviates prenatal depression in both parents and improves their relationships. J Bodyw Mov Ther 2008, 12:146–150. 17. Ezzo J, Haraldsson BG, Gross AR, Myers CD, Morien A, Goldsmith CH, Bronfort G, Peloso PM: Massage for mechanical neck disorders: a systematic review. Spine 2007, 32:353–362. 18. Downey L, Diehr P, Standish LJ, Patrick DL, Kozak L, Fisher D, Congdon S, Lafferty WE: Might massage or guided meditation provide "means to a better end"? Primary outcomes from an efficacy trial with patients at the end of life. J Palliat Care 2009, 25:100–108. 19. Corbin LW, Mellis BK, Beaty BL, Kutner JS: The use of complementary and alternative medicine therapies by patients with advanced cancer and pain in a hospice setting: a multicentered, descriptive study. J Palliat Med 2009, 12:7–8. 20. Billhult A, Lindholm C, Gunnarsson R, Stener-Victorin E: The effect of massage on immune function and stress in women with breast cancer–a randomized controlled trial. Auton Neurosci 2009, 150:111–115. 21. Poole AR, Ionescu M, Fitzcharles MA, Billinghurst RC: The assesment of cartilage degradation in vivo: development of and immunoassay for the measurement in body fluids of type II collagen cleaved by collagenases. J Immunol Methods 2004, 294:145–153. 22. Ernst E: Complementary and alternative medicine for pain management in rheumatic disease. Curr Opin Rheumatol 2002, 14:58–62. 23. Back C, Tam H, Lee E, Haraldsson B: The effects of employer-provided massage therapy on job satisfaction, workplace stress, and pain and discomfort. Holist Nurs Pract 2009, 23:19–31. 24. Bauer BA, Cutshall SM, Wentworth LJ, Engen D, Messner PK, Wood CM, Brekke KM, Kelly RF, Sundt TM 3rd: Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study. Complement Ther Clin Pract 2010, 16:70–75. 25. Katz DL, Williams A-l, Girard C, Goodman J, Comerford B, Behrman A, Bracken MB: The evidence base for complementary and alternative medicine: methods of Evidence Mapping with application to CAM. Altern Ther Health Med 2003, 9:22–30. 26. Perlman AI, Sabina A, Williams AL, Njike VY, Katz DL: Massage therapy for osteoarthritis of the knee: a randomized controlled trial. Arch Intern Med 2006, 166:2533–2538. 27. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW: Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988, 15:1833–1840. 28. Ernst E: The safety of massage therapy. Rheumatology 2003, 42:1101–1106. 29. Cambron JA, Dexheimer J, Coe P, Swenson R: Side-effects of massage therapy: a cross-sectional study of 100 clients. J Altern Complement Med 2007, 13:793–796. 30. National Center for Complementary and Alternative Medicine: NCCAM Backgrounder: Massage Therapy: An Introduction. Publication No. D327. Bethesda, MD: NCCAM; 2010. 31. Scaturo DJ: The evolution of psychotherapy and the concept of manualization: an integrative perspective. Pro Psychol Res Prac 2001, 32:522–530. 32. Levin JS, Glass TA, Kushi LH, Schuck JR, Steele L, Jonas WB: Quantitative methods in research on complementary and alternative medicine. A methodological manifesto. NIH Office of Alternative Medicine. Med Care 1997, 35:1079–1094. 33. Carter B: Methodological issues and complementary therapies: researching intangibles? Complement Ther Nurs Midwifery 2003, 9:133–139. 34. Schnyer RN, Allen JJ: Bridging the gap in complementary and alternative medicine research: manualization as a means of promoting Ali et al. Trials 2012, 13:185 http://www.trialsjournal.com/content/13/1/185 standardization and flexibility of treatment in clinical trials of acupuncture. J Altern Complement Med 2002, 8:623–634. 35. Institute of Medicine of the National Academies: Need for innovative designs in research on CAM and conventional medicine. In Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press; 2005:108–128. 36. Patterson M, Maurer S, Adler SR, Avins AL: A novel clinical-trial design for the study of massage therapy. Complement Ther Med 2008, 16:169–176. 37. World Medical Association: World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2000, 284:3043–3045. 38. Geiringer SR, de Lateur BJ: Physiatric therapeutics. 3. Traction, manipulation, and massage. Arch Phys Med Rehabil 1990, 71:S264–S266. 39. Perlman AI, Ali A, Njike VY, Hom D, Davidi A, Gould-Fogerite S, Milak C, Katz DL: Massage therapy for osteoarthritis of the knee: a randomized dose- finding trial. PLoS One 2012, 7:e30248. 40. National Center for Complementary and Alternative Medicine; Duke University: Exploring Massage Benefits for Arthritis of the Knee (EMBARK). In ClinicalTrials.gov [Internet]. Bethesda, MD: National Library of Medicine; 2012. NLM Identifier: NCT01537484. [http://clinicaltrials.gov/show/ NCT01537484]. 41. Cambron JA, Dexheimer J, Coe P: Changes in blood pressure after various forms of therapeutic massage: a preliminary study. J Altern Complement Med 2006, 12:65–70. 42. Sharpe PA, Williams HG, Granner ML, Hussey JR: A randomised study of the effects of massage therapy compared to guided relaxation on well-being and stress perception among older adults. Complement Ther Med 2007, 15:157–163. 43. Taylor AG, Galper DI, Taylor P, Rice LW, Andersen W, Irvin W, Wang XQ, Harrell FE Jr: Effects of adjunctive Swedish massage and vibration therapy on short-term postoperative outcomes: a randomized, controlled trial. J Altern Complement Med 2003, 9:77–89. 44. Cherkin DC, Sherman KJ, Kahn J, Erro JH, Deyo RA, Haneuse SJ, Cook AJ: Effectiveness of focused structural massage and relaxation massage for chronic low back pain: protocol for a randomized controlled trial. Trials 2009, 10:96. 45. Cronfalk BS, Ternestedt BM, Strang P: Soft tissue massage: early intervention for relatives whose family members died in palliative cancer care. J Clin Nurs 2010, 19:1040–1048. 46. Aourell M, Skoog M, Carleson J: Effects of Swedish massage on blood pressure. Complement Ther Clin Pract 2005, 11:242–246. Page 6 of 6 doi:10.1186/1745-6215-13-185 Cite this article as: Ali et al.: Development of a manualized protocol of massage therapy for clinical trials in osteoarthritis. Trials 2012 13:185.  just more proof of how and what massages can do in any situation, but because people work more than 3/4 of their life and mainly in offices you really need to look after yourself. so please visit are website at www.therapy4u.biz to book your corporate massages, workplace massages or event massages.

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Apr 24 2015

It Pays to Invest in Mental Health

Published by under research on massage

We’ve previously examined the hidden nature of mental health issues, and looked at how to bring them out of the shadows.

It’s not simply a problem that applies to some people. Just like physical health, you could see it as a continuum which includes everyone, and where everybody can show improvement if given the right skills, training and environment. Being in a good mood encourages healthy lifestyle choices, just as adding more exercise into your week will improve your mood.

Depression and stress at work

All aspects of health are linked, and when indirect benefits are measured, every dollar you spend on a successful wellbeing program results in a positive return-on-investment. That’s the finding of CBI, a business association in the UK encompassing everything from leading FTSE-listed companies to family-owned enterprises.

They measured costs due to physical illness, mental illness, and absenteeism, finding that “an investment in health and wellbeing can deliver real, tangible savings for a business.” The conclusion is that the monetary benefits to companies of all sizes outweigh the costs of investing in employee health and wellbeing.

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Apr 24 2015

Republished: Stem cells, angiogenesis and muscle healing: a potential role in massage therapies?

Abstract
Skeletal muscle injuries are among the most common and frequently disabling injuries sustained by athletes.

Repair of injured skeletal muscle is an area that continues to present a challenge for sports medicine clinicians and researchers due, in part, to complete muscle recovery being compromised by development of fibrosis leading to loss of function and susceptibility to re-injury.

Injured skeletal muscle goes through a series of coordinated and interrelated phases of healing including degeneration, inflammation, regeneration and fibrosis. Muscle regeneration initiated shortly after injury can be limited by fibrosis which affects the degree of recovery and predisposes the muscle to reinjury. It has been demonstrated in animal studies that antifibrotic agents that inactivate transforming growth factor (TGF)-β1 have been effective at decreasing scar tissue formation. Several studies have also shown that vascular endothelial growth factor (VEGF) can increase the efficiency of skeletal muscle repair by increasing angiogenesis and, at the same time, reducing the accumulation of fibrosis. We have isolated and thoroughly characterised a population of skeletal muscle-derived stem cells (MDSCs) that enhance repair of damaged skeletal muscle fibres by directly differentiating into myofibres and secreting paracrine factors that promote tissue repair. Indeed, we have found that MDSCs transplanted into skeletal and cardiac muscles have been successful at repair probably because of their ability to secrete VEGF that works in a paracrine fashion. The application of these techniques to the study of sport-related muscle injuries awaits investigation. Other useful strategies to enhance skeletal muscle repair through increased vascularisation may include gene therapy, exercise, neuromuscular electrical stimulation and, potentially, massage therapy. Based on recent studies showing an accelerated recovery of muscle function from intense eccentric exercise through massage-based therapies, we believe that this treatment modality offers a practical and non-invasive form of therapy for skeletal muscle injuries. However, the biological mechanism(s) behind the beneficial effect of massage are still unclear and require further investigation using animal models and potentially randomised, human clinical studies.

Correspondence to
Dr Burhan Gharaibeh, Department of Orthopaedic Surgery, University of Pittsburgh, Suite 206, Bridgeside Point II, Pittsburgh,PA 15219, USA; burhan@pitt.edu
Received 14 August 2012
Accepted 30 October 2012

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