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Report on Research

Direct access to obtaining undergraduate and graduate degrees in science and related programs, for massage therapy diploma program graduates, will increase competencies in critical analysis, communication information, research literacy and capacity, technology, organizational leadership and teaching skills,


September 16, 2009
By Massage Therapy Magazine

Topics

The Need for Degree Education

Trish Dryden  M.Ed, RMT

Direct access to obtaining undergraduate and graduate degrees in science and related programs, for massage therapy diploma program graduates, will increase competencies in critical analysis, communication information, research literacy and capacity, technology, organizational leadership and teaching skills, to ensure that massage therapists will better meet the demands of a rapidly changing and increasingly integrated health care system.

1. Trends in health care are creating an understanding in and increased demand for complementary health care services (CAHC) including chiropractic, naturopathy and massage therapy.

2. Massage Therapy has been well taught in both private and public educational institutions
at the diploma level; changes in consumer utilization, health care delivery, information technology and economic trends have created a demand for degree level education. There is broad stakeholder support for this.

3. The evolving educational demands in massage therapy parallel the evolution of other health professions such as nursing, physiotherapy, chiropractic and midwifery, which have evolved from diploma to baccalaureate and in some cases graduate degree preparation.

4. Currently there are no articulation agreements to obtain university degrees for massage therapy graduates in Canada, although there is precedent in other jurisdictions and British Columbia and Ontario are actively seeking articulation agreements.

5. This paper outlines the rationale for developing articulation agreements for baccalaureate, (and ultimately Masters and Doctoral programs), and other health care professional preparation such as chiropractic and naturopathy.

The Economic Rationale and Societal Demand
Health care delivery in Canada is increasingly demanding integration between conventional and complementary and alternative health care (CAHC) practices and products1,2,3.  

Complementary Health Care Practices and Products are health systems, modalities, practices, and natural health products, aimed at helping individuals achieve wellness by preventing and treating illness, pain and disability4.  

CAHC practices include but are not limited to the professions of massage therapy, chiropractic, naturopathy, traditional Chinese medicine, acupuncture, herbalism and homeopathy. Massage therapy, chiropractic, and naturopathy, like conventional health care practices such as nursing, physiotherapy and medicine are regulated health professions, with national organization, well-developed bodies of knowledge and standards of practice, and broad consumer utilization5,6

In collaboration with Human Resources Development Canada (HRDC) and Health Canada, representatives of massage therapy, chiropractic and naturopathy, as the largest providers of complementary and alternative health care in Canada, have been asked to participate in discussions on the feasibility of a health human resources sector study. HRDC recognizes the profound impact of CAHC in general and massage therapy in particular on the Canadian economy and the need for research and planning in human resource development in this sector7.

While the conventional medical model of treatment dominated health care for many decades and created a wide range of barriers to CAHC practices, improved understanding of their efficacy and cost effectiveness has lead to their increased integration into the health care system as evidenced by increased professional standards and acceptance in health plans8.

In addition, better understanding of the role of CAHC practices in treating and preventing illness and injury as well as managing pain, have made them an accepted part of the treatment of musculoskeletal disorders ranging from headaches to low back pain, and many other conditions such as diabetes, cancer, HIV/AIDS, multiple sclerosis, perinatal and palliative care9, 10, 11, 12.
 
As a result of growing acceptance, demographic and social trends, and economic developments, demand has increased from all stakeholders for safe and effective CAHC treatment including massage therapy13.

In the past 10 years, trends in the health care delivery system in Canada and changes in data from population health studies show an unprecedented increase in consumer utilization of complementary and alternative health care practitioners and health care products.
It is estimated that in 1994-95, 15 per cent or 3.3 million Canadians, aged 15 or over, used some form of complementary and alternative health care14 and in the most recent report, 50 per cent of Canadians reported consulting with a CAHC practitioner in 1997, 75 per cent over the course of their life time15.

The use of CAHC is associated with the aging of the population and the increasing prevalence of chronic health conditions in an estimated 55 per cent of Canadians16. This trend is supported by 2001 population health data from Statistics Canada on Health Care in Canada17.

Consumer use of massage therapy as a form of health care is also rapidly growing. In 1998, Collis and Reed conservatively estimated that 2.5 per cent of the Ontario public used massage therapy18; whereas in 1999, the York

University Centre for Health Studies reported that 17 per cent of Canadians use massage therapy19. This data is consistent with the 1999 Fraser Institute report, estimating that 24 per cent of Canadians use massage therapy20 and the Eisenberg study published in the New England Journal of Medicine in 1993, showing similar massage therapy utilization statistics in the United States21. In all these studies, massage therapy is second only to chiropractic in overall preference in CAHC usage. Increasing research examining the costs and benefits associated with CAHC is expected to further fuel consumer demand.

Massage therapists provide health care to a diverse and often high-risk population from antenatal patients and their babies to the terminally ill in hospice care. Massage therapists work in a wide variety of health care settings including: hospitals, pain clinics, obstetrical units, outpatient and inpatient HIV/AIDS units, palliative care, post-surgical and rehab units, neurological, cardiac, and cancer care.

Several recent randomized, controlled clinical trials indicate massage therapy efficacy and cost effectiveness22, 23, 24, 25. Massage therapy treatment for chronic musculoskeletal
low back pain, (one of the most common and costly health complaints in North America), is widely covered by various forms of insurance and is a commonly referred to and effective form of treatment.

Employment Trends in Massage Therapy
As primary health care providers, massage therapists work in private practice, long term care facilities, and in multidisciplinary settings in the community and hospitals26. In most employment settings, registered massage therapists work as independent contractors, on a fee for service basis, with widespread coverage by third party insurers, including employment benefit health care insurance, motor vehicle accident insurance, and workplace safety insurance27.

Good employment statistics are difficult to find given the independent nature of massage therapy practice. The number of massage therapy practitioners in Ontario has increased most significantly between 1989-1997, with annual increases averaging 11 per cent28. Today, there are 5,48529 registered massage therapists in Ontario (compared to about 5500 physiotherapists). There are an estimated 10,000 massage therapists practicing across Canada30. Currently, only British Columbia, Ontario and Newfoundland have government (Ministry of Health) registration for its massage therapy practitioners. However, all other provinces and territories, have strong provincial/territorial associations lobbying for regulation. The Canadian Massage Therapist Alliance currently represents massage therapists across Canada who have obtained the current standard of 2200 hours of education (3000 hours in B.C.).

Current evidence strongly suggests31 that the demands for massage therapy in conventional medical health care settings such as in long term and palliative care, community based multidisciplinary health care clinics and in hospitals will grow dramatically in the next few years32.

The Need for Degree Level Education
Changes in the health status of Canadians, the health care delivery system, technology, the nature of massage therapy practice, and the employment market, have laid the groundwork for the demand for higher educational standards for the massage therapy profession.

Massage therapy is currently regulated as a health care profession in Ontario under the Regulated Health Professions Act33, the same act that covers Nursing, Physiotherapy, Chiropractic, Midwifery, Dentistry, and Medicine and soon-to-be Naturopathy34; and by its regulatory college, the College of Massage Therapists of Ontario (CMTO). Currently massage therapy in Ontario is one of the few health professions regulated by the RHPA that does not have baccalaureate preparation as an entry requirement to the profession.

Physiotherapy, Chiropractic, Midwifery and Massage Therapy may all be accessed directly by consumers or through a medical referral. All of these professions provide primary care to potentially unwell, at risk-of-harm, populations. Therefore, these practitioners must not only be educationally prepared to assess and treat a wide range of conditions but to be able to recognize conditions beyond their scopes of practice and to make appropriate referral. In primary health care, the capacity to assess for risk of harm, involves a highly sophisticated level of education in critical analysis. Educational standards for Physiotherapy, Chiropractic and Midwifery have increased steadily.

Practitioners must be registered under the Regulated Health Professions Act in Ontario to use the term physiotherapist, chiropractor, midwife and massage therapist. To keep pace with consumer and employment demands, in the early nineties, physiotherapy moved towards baccalaureate preparation for entry to practice before being required to do so by their provincial regulatory body.

By 2007 in Canada, and 2002 in the U.S., all physiotherapists will be required to have masters level university preparation for entry to practice. Midwives in Ontario are prepared at the baccalaureate level. Currently, chiropractic schools require a baccalaureate degree for admission to their programs and then provide an additional four years of education. Recently, Nursing has moved from diploma to baccalaureate preparation for similar reasons.

Today’s employers demand a more sophisticated level of information technology and communication skills, research literacy and organizational and business capacity and leadership. Information from community agencies, long-term care facilities, and hospitals, and the profession itself indicates support for increasing massage therapy utilization for the populations they serve and the concurrent need for increased educational preparation35.

It should also be noted that by developing opportunities for increased education for massage therapy at the undergraduate and graduate levels, at least in Ontario, it does not signal a change in the entry to practice requirements (2200 hours) required by the regulatory body, The College of Massage Therapists of Ontario for registration. A variety of options to pursue higher education should be made available to every diploma graduate who chooses to do so. It is also in the best interest of the profession to provide a means by which current massage therapy educators, many of whom are the current leaders in the field, have access to degree preparation at both the undergraduate and graduate level in order to bridge from professional preparation to degrees in education, other academic degrees such as in research, or to gain direct access to additional professional preparation in Chiropractic36 and Naturopathy37.

The similarity in the process of professionalization of Nursing, Physiotherapy, Midwifery, and Massage Therapy is remarkable. Although the timelines vary, the intention and direction are similar. All four professions are regulated under the RHPA in Ontario and come from training/ apprenticeship backgrounds. In each circumstance, the profession has directed the move to an educationally delivered method of practitioner preparation.

For each of the disciplines, education was provided at the diploma level, which was offered in a variety of settings from hospitals schools and private vocational schools to universities. As the professions became organized, the bodies of knowledge described and the research need delineated, the need for the requirement for degree level preparation was apparent.

It is important to note that after many years of offering both a diploma level and baccalaureate level preparation as separate but equally valid entry to practice, Nursing has just moved to the single track of degree level preparation. Diploma level preparation in massage therapy will continue to be an option for many. A variety of models of degree delivery for massage therapy is desirable including integrated diploma/degree programs and post diploma offerings in traditional or distributive learning modes.  

Health Canada recently sponsored a round table assessing research literacy and capacity in CAHC involving representatives from massage therapy, chiropractic and naturopathy38. Senior policy analysts39 in Health Canada and leading academic researchers in CAHC40, all acknowledged that the lack of evidence base, and the limited research literacy and capacity in massage therapy education must be addressed as the Canadian health care system moves towards the increased integration of complementary and  alternative health care and conventional medicine for the benefit of all Canadians.

Continued research in treatment safety, efficacy and cost effectiveness can only be achieved through increased educational preparation to a degree level as well as increased opportunity for professional growth and laddering with other post-secondary educational institutions at the baccalaureate, masters and doctoral level41.



Challenges & Opportunities

By: Kevin D. Willison, BA, MA, PHD Student Department of Public Health Sciences, Faculty of Medicine, University of Toronto.

Among the more popular modalities of complementary/alternative medicine (CAM) being used in North America, is that of massage therapy (Eisenberg et al. 1998; Palinkas et al. 2000). And, among the growing number of users of CAM in general are the elderly (McKenzie and Keller, 2001).

Despite an increase in the use of massage therapy, and reports of greater acceptance towards such by main stream health care professionals, a thorough medical and social scientific literature review clearly indicates a lack of research in this field, especially in Canada.

Registered Massage Therapists are in a unique position to carry out MT research as they know best about their profession, and its possible contraindications.

However, not all MTs are provided training in how to do research. Emphasis on teaching research methodology and techniques to massage therapists in Canada varies from province to province and from school to school. Some massage therapy schools provide a course in the final year of their program and some require their student to write a thesis.

Some provide no training at all. Recently, an evaluation of research literacy amongst MTs was conducted through the CMTA in which all practicing MTs were encouraged to participate.

Results will soon be on the CMTA website www.cmta.ca. Determining the needs of MTs, and how capable they are to do research, is an important first step towards encouraging further
professional development and academic excellence in this area.

Massage Therapists need training on how to conduct research and the encouragement to do so, especially outside of the classroom. Conducting research is a life-long learning process and each project is unique.

It is more effective when cross-disciplinary collaborations with other medically trained professionals are made possible. Research also plays a vital role in the process of professionalization. It enhances the legitimacy and acceptability of all professions.

If Massage Therapists wish to gain even greater acceptance by other medical professionals, they must conduct and disseminate research. Towards this end, support within the profession itself and its teaching institutions, to advocate for and conduct MT research, must be encouraged.

Cited References:

  1. Eisenberg, D.M., Davis R.B., Ettner S.L., Appel S., Wilkey S., Rompay M.V., Kessler R.C. (1998). “Trends in Alternative Medicine Use in the United States, 1990-1997.” JAMA, 280 (18), November 11, 1569-1575.
  2. Palinkas, L.A. and Kabongo, M.L. (2000). The use of complementary and alternative medicine by primary care patients. A SURF*NET study. Journal of Family Practice.
  3. 2000 Dec; 49 (12):1121-30.
  4. McKenzie, J., Keller H.H. (2001). “Vitamin-Mineral Supplementation and Use of Herbal preparations Among Community-Living Older Adults”.  Canadian Journal of Public Health, 92 (4), July/August: 286-290.



Massage Effective In Controlling Chemotherapy-Induced Nausea

• Study By: Tina Ferner, LMT RD*; Buford Lively, PhD; Bhakti Arondekar, MS; Curtis Black, PhD, St. Vincent Mercy Medical Centre*, Toledo, OH and The University of Toledo, College of Pharmacy.

chemo_nausea 

 

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

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

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

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

Procedure:
Massage therapy was provided to the patients in the treatment group approximately 3 times per week in their hospital room. Care was taken to minimize interruptions by posting a “do not disturb” sign on the patient’s door. The phone was turned off, lighting was softened and relaxing instrumental music was played. The massage was given with the intention to provide the patient comfort and relief from nausea. Each session was approximately 20 – 30 minutes in length.

The procedure consisted of head and neck massage, concentrating on releasing tightness and constriction of the sternocleidomastoid (SCM) muscle. The rationale behind this was that a constricted SCM muscle could potentially impinge upon the vagus nerve (which effects gastric function) whose pathway is in close proximity to the SCM muscle. The following craniosacral techniques were also employed: Still Point, Frontal Lift, Spheno-Basilar Compression-Decompression and Temporal Ear Pull. These were all done with the intention of affecting
the sympathetic nervous system and the function of the vagus nerve.

Massage to the leg and thigh was also given post transplant in an attempt to stimulate the bone marrow contained in the femur to reinitiate normal hematopoiesis of stem cells.

chart2 

 

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

Results:

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

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



Massage & The Elderly

• Study by Kevin D. Willison  PhD (Student) Department of Public Health Sciences, Division of Community Health, Faculty of Medicine, University of Toronto.

elderly 

 

Purpose:
The rise in complementary/alternative medicine (CAM) use, such as massage therapy (MT), is especially significant given increased life expectancy, population aging and the growing number of individuals managing chronic illness. As little to no research to date has been conducted in Canada to ascertain what factors may be involved in the utilization of massage therapy by chronically ill older adults (age 60+), this study helps to fill the gap.

Objective:
 To determine the impact of pre-selected socio-economic factors on the use, non-use and former
use of (registered) massage therapy. *Only partial results of the full study are elaborated here.

Eligible respondents:
Of 157 postal questionnaires completed and returned, 141 (90 per cent) met the inclusion criteria (noted below). Of these, 15 per cent (n=21) were Former Users, 41 per cent (n=58) were Non-Users and 44 per cent (n=62) were Users of Massage Therapy.

Instrumentation:
An 84-question (147 possible response item), 15-page self-administered postal questionnaire was developed by the researcher and pre-tested over a three-month time period (n=32) to improve external and internal validity of the instrument.

Inclusion Criteria:
Respondents were required to be 60 years of age or over; be residents of Toronto (Canada); be non-institutionalized; have one or more chronic health conditions (self-reported as on-going for at least six months and diagnosed m=by a medical doctor); be able to understand and communicate in English, and be willing to complete a 15 to 20-minute self-administered postal questionnaire.

Ethical approval was granted by the University of Toronto. Each respondent was requested to sign a consent form and was provided a two-page overview of the study to help ensure informed consent as well as full disclosure of the nature and requirements of the study.

Main Outcome Measures:
Use, Non-Use or Former Use of Massage Therapy.

Conclusions:
Results compare with the existing literature regarding complementary/alternative medicine use in general. In particular, Users of MT typically had more years of education than both Former users and Non-users. As well Users of MT tended to have added
health insurance, higher incomes, and (former) higher occupational status positions. Of interest was that Former Users tended to have lower Socioeconomic Status (SES) overall. Due to the small sample size, generalizations of the results cannot be made.

Greater depth of these findings will be made possible in the next edition.



Migraine Headaches Are Reduced By Massage Therapy

• Study By: Maria Hernandez-Reif, John Dieter, Tiffany Field, Bernard Swerdlow, Miguel Diego,
• University of Miami School of Medicine, University of Central Florida

headache 

 

Objective:
To determine the efficacy of Massage Therapy for reducing symptoms associated with migraine headaches.

Design:
Participants were randomly assigned to Massage Therapy or a wait-list control group. Multiple variables including anxiety level, headache frequency and severity, sleep patterns, and serotonin levels were measured for both groups.

Participants:
26 adults, predominantly caucasian with an average age of 40 years who had chronic headaches for a period of at least six months participated.

chart 

 

Procedure:
The massage group was given massage twice a week for 30 minutes at a time. The massage consisted of a 10-minute routine including fingertip kneading and stroking to the base of the skull, cervical mobilizations, thumb compressions to the suboccipital muscles and along the nuchal ridge. The routine was repeated three times for a total of thirty minutes. The wait-list control group was informed that they would receive massage treatments after a five-week baseline period.

Results:

The results of the study indicate that massage therapy has significant effects on all of the variables evaluated:
• decrease in pain intensity
• decreased anxiety and fewer somatic symptoms
• greater number of headache free days when compared to the wait-list control group
• fewer days of mild headache pain when compared to the wait-list control group
• increase in hours slept per night and a decrease in nightwakings
• increased serotonin levels

Conclusion:
Massage Therapy appears to be an effective, drug-free adjunct to conventional therapeutic approaches for treating individual with migraine headaches.

• To access the complete research study, visit the Touch Research Institute’s website at:
www.miami.edu\touch-research



Trager Therapy & Parkinson’s

By: Christian Duval, Brock University, Denis Lafontaine, Alain Leroux, Concordia University; Michel Panisset, McGill University; Jean P. Boucher; University of Quebec/Montreal

Introduction:
Our research group investigates the effects of complementary therapies on the nervous system of healthy individuals and patients with neurological disease. A previous study by Hébert et al. (1998) showed that gentle rocking motion imparted to the leg could modify the reflex responses of healthy subjects.

Whether this reflex modulation is simply due to changes in local spinal reflex circuitry, or the results of altered brain modulation on these reflexes, remains to be determined. This distinction is important in that any change in brain modulation may imply that the sensation associated with the massage alters brain activity. Trager is a form of manual therapy based on the assumption that the therapist is able to establish a communication between him and the unconscious mind (i.e. central nervous system) of the subject.

The limb of interest is supported by the therapist and put into motion: gentle rhythmic rocking motion is manually imparted to the limb and surrounding soft tissues. This type of movement is not painful: the therapist inquired often to ensure that the subject remains comfortable throughout the treatment session. One approach to verify if a manual therapy such as Trager modifies brain activity is to study its effect on the rigidity of patients with Parkinson’s disease (PD). In PD, reflex circuits are modified by altered neural circuits within the basal ganglia; structures that play an important role in movement.

Goal:
Accordingly, we quantified changes of evoked stretch responses (ESR) in the most rigid arm of patients with PD following Trager therapy. ESR is defined as abnormal electromyographic (EMG) activity when the patient’s muscles are passively stretched.

Methods:
Gentle rocking motion associated with Trager therapy was imparted to the upper limbs and body of thirty patients for twenty minutes. A pre-test and two post-tests (one and eleven minutes after the treatment, respectively) were performed, consisting of EMG recordings of the flexor carpi radialis and extensor digitorum communis while the patient’s wrist was passively flexed and extended with an amplitude of 60º and a frequency of 1 Hz. Patients received the treatment on the most rigid side of their body (ipsi-group) or on the contralateral side (contra-group). Half of patients in each group received the treatment laying supine on a massage table (ipsi- and contra-supine) or sitting in a chair (ipsi- and contra-sitting).

Results:

The above results will be available soon in the peer-reviewed publication: “Journal of Manipulative and Physiological Therapeutics.” In summary, we found that the level of ESR were significantly reduced by 36 per cent immediately following treatment and remained 32 per cent lower than pre-test values eleven minutes after treatment. Patients who received the treatment lying supine benefited from a 42 per cent reduction of ESR. The side on which the treatment was performed did not significantly influence the outcome of the treatment. However, post hoc analysis of the triple interaction indicated the sitting position was much less efficient for sustained contralateral effect.

Conclusions:
Results from the present study strongly suggest that it is possible to modify the level of ESR using Trager therapy. This stretch reflex inhibition is most probably correlated with a reduction of the muscle rigidity seen in these patients. We are presently conducting experiments to quantify directly this reflex modulation following Trager therapy. Our goal is to investigate changes of a specific element of the stretch reflex: the long-latency component. This long-latency reflex is a transcortical reflex that is modified by PD, and believed to by responsible for parkinsonian rigidity. We hope to show that Trager therapy indeed modifies selectively the altered reflexes in PD. Finally, we are in the planning phase (funding search!!!) of a clinical trial that will quantify the long-term effect of Trager therapy on the clinical condition and quality of life of patients with PD. Trager will also be compared with more mainstream complementary therapies such as physiotherapy and exercise. This research is essential if Trager is to ever be considered by physicians as a viable complementary therapy for patients with Parkinson’s disease.



Post-Burn Itch and Pain are Reduced

• Study by: Kimberly Boersen-Gladman, RMT, St. John’s Hospital, To

burn_1 
  

Since the early 1970s, there have been advances in the medical, surgical and rehabilitation management of burn survivors. A multidisciplinary approach is necessary to meet and achieve the highest standard of excellence in burn rehabilitation.

Research has shown that massage therapy can aid in reducing third stage wound healing pain and itching with Swedish massage.

Mr. X is a 26-year-old, non English speaking male who sustained burns to the dorsum of his feet when he slipped and fell into a nickel medium, while at work. Mr. X was wearing steel toed boots which protected the plantar surface of his feet. He was immediately treated on-site by co-workers and medical staff and sent to an emergency facility where he received a skin graft over the dorsum of his feet. Thirty six days later he was sent to St. John’s Rehabilitation hospital’s specialty outpatient burn program where he was under the care of a physician, physiotherapist, nurse and occupational therapist.

 During the third phase of his wound healing (7 months post burn) the patient was referred to massage therapy to reduce pain. During Mr. X’s initial assessment he reported severe pain and itching which was limiting the recovery process. It was determined by an occupational therapist that after he had been standing for approximately 17 minutes, the pain and itching increased so dramatically that it would force him to cease the activity for the remainder of the day. The client also reported periods of morning stiffness.  During the initial assessment, validated measurements of pain were used to objectively track Mr. X’s pain. Once a treatment plan was created, standard methods of massage therapy were incorporated into Mr. X’s daily treatment. The patient was assessed before and after every treatment over a one week period. Due to Mr. X’s report of morning stiffness upon arrival to the multidisciplinary program, 30-minute massage therapy treatments were applied once a day. Pain and itching were measured, and, initially, Mr. X reported his pain as 6 out of 10 on the visual analog scale and 16 on the short form of the McGill pain questionnaire.  

After massage therapy treatment, Mr. X attended Occupational therapy where his standing tolerance was observed to determine any changes in functional ability through the lasting effects of massage treatment.

After the first treatment, Mr. X’s pain decreased to a 4.5 of 10 on the visual analog scale and 6 on the McGill pain questionnaire. His standing tolerance increased to 22 minutes.  By treatment number four, Mr. X reported his pain at 0/10, itching as a 1/10 and the occupational therapist stopped testing the standing tolerance when Mr. X surpassed 90 minutes.

On the final day of treatment both pain and itching were rated at zero and the standing tolerance was tested until 90 minutes. Mr. X was then educated about self massage techniques to help reduce his pain and itching, if they return. A month later, Mr. X began his return to work plan and is currently working full-time.

The purpose of this study was to demonstrate and educate that there are effective alternative measures to reducing pain and itching.  Mr. M was able to hurdle his last barrier to return to work and continues to work on a full time basis.

The study findings were heavily based on qualitative and subjective data, due to the lack of standard methodology procedures and quantitative outcome measures. Future research should incorporate a larger sample size to better illustrate the positive outcomes. More statistical analysis and use of a Burn Index Scale to identify any changes in scar tissue should also be used.

In conclusion, incorporation of massage therapy in the rehabilitation setting plays an integral role in the care and treatment of a burn survivor.

The findings are encouraging because massage therapy can provide a natural and effective alternative for the reduction of pain, itching as well as body image.



International Symposium On The Science of Touch

int_symp 

 

The first International Symposium on the Science of Touch, held May 16-18, 2002 at the University of Quebec in Montreal drew 300 participants, 57 speakers,
20 exhibitors and representation from 12 different countries.

Keynote speakers included: Dr. David Eisenberg, from the Harvard Medical School, Osher Institute in Boston; Dr. Tiffany Field of the Touch Research Institute in Miami; Dr. Janet Kahn, a senior partner with Integrative Consulting; and Dr. Jean Drouin, President of the Quebec Association of Holistic Health. These touch specialists set the tone at the beginning of each day. Dr. Field kicked off the symposium by giving participants an update of the recent research done by the Touch Research Institute on the effects of massage therapy.

Dr. Eisenberg shared his idea of a dream medical team, made up of not only doctors, psychologists and complementary therapies practitioners but massage therapists as well since they play an important role in the prevention of disease and reducing the convalescence time.

Dr. Janet Kahn provided a wonderfully broad overview of the present and future situation in touch therapy.

She shared her vision spanning both worldwide and local issues, raising the important questions as to who benefits and who should benefit from touch therapy, to whom is this treatment available, is it safe, affordable, accessible and understandable by today’s paradigms, is it adapted to the needs of the general population and most importantly, what are its mechanisms?

Finally, Dr. Drouin took us on a fascinating journey through the history of ancient medicines, visiting the shamans and healers of ethnic groups from around the world. He talked about the hand both as a healing instrument and a sensor for diagnosing, from the many pulses skillfully measured in Chinese medicine, to the many tricks of modern medicine.

In addition to the well-known keynote speakers, an array of touch specialists shared their knowledge, research, vision and dreams on a great variety of subjects.

From the traditional ANMA massage practiced by the blind in Japan to the efficacy of workplace-based massage treatment for pain and stress reduction and from massage therapy use for symptom management in cancer to how touch affects our emotions and the benefits of touch on the quality of life of the elderly in hospices in Switzerland, the Symposium opened its doors to all manners of touch and its documented benefits. The goal has been reached: to reunite researchers and touch enthusiasts in order to showcase what is currently being done throughout the world and forge new and exciting relationships and collaborations for future research endeavours.

At the end of the day, the enthusiasm and words of praise and encouragement from all who participated in making this event a complete success, gave the members of the Canadian Touch Research Centre’s Board of Directors the impetus needed to take on the responsibility of organizing the second edition.

We hope to see you at the 2nd International Symposium on the Science of Touch to be held in Montreal from May 13-15, 2004.

– Dr Réal Gaboriault
Chairman, ISST 2004



Massage Therapy Research In New Zealand


By SHELEIGH LAWLER

new_zealand 

 

Almost three years ago I embarked on the process of gaining my PhD in the field of Health Psychology, at the University of Auckland, New Zealand.

The idea of setting up a research program investigating the therapeutic effects of massage for my PhD, formed after reading some of the inspiring work that Tiffany Field undertook with preterm infants (Field, Scafidi & Schanberg, 1987; Kuhn et al, 1991). After further reading, investigation and some very basic training in relaxation massage, I decided that massage therapy indicated potential benefits and healing qualities that warranted further research.

The research programme involves three studies. I have completed the first study, which investigated the effects of massage on stress and coping in university students building up to final examinations. This study compared the effects of watching television to massage therapy, where both groups attended one session a week for three consecutive weeks.

The students who received massage reported lower perceived stress levels and increased coping efficacy at the end of the three weeks. Both groups reported decreases in state anxiety immediately after the session.

The decrease in state anxiety for the television group did not however translate into the changes in stress and coping that were evident for the massage group (Manuscript in preparation).

The second study is currently being conducted, where people who experience migraines are randomly assigned to either a massage therapy or wait-list control group. The intervention involves keeping a daily record of migraines, medication, and sleep behaviour for the duration of the study. This diary is kept for one month before and after the massage intervention sessions. The massage involves one 45-minute session a week for six consecutive weeks.

The massage protocol has been standardized and is similar to the protocol used in a previous study (Hernendez-Reif, Dieter, Field, Diego & Swerdlow, 1998).

A headache history inventory was administered at the beginning of the study. Measures of stress, coping, depression, and state anxiety are given one week before the massage sessions start, after the six massage sessions and again one month later.

The third study is a survey aimed at general practitioners and lay people to investigate their use, attitudes and beliefs about massage therapy. This will allow investigation into referral patterns and reasons of use for massage and other complementary therapies. I am currently collecting data for this study.

When conducting research of this nature there are many issues that need to be taken into consideration. Research is an area that is gaining attention in the massage therapy field, given that one of the main outcomes from the International Symposium on the Science of Touch in Montreal 2002 was that more controlled experimental research is needed.

One possible way this can be achieved is collaboration of interested and expert teams. For example here in New Zealand; our research team consists of collaboration between the university (the research experts) and the New Zealand College of Massage (the massage experts). This is extremely effective, as both teams bring together areas of expertise, where we learn from each other.

A useful approach when you have an idea for research is to investigate what has already been documented and put together a proposal outlining your objectives and procedures for collecting data.

In developing a study, choosing a comparison group that is equivalent to the massage group is important. 

You can see that in my studies I chose watching television as a comparison group as it allowed me to control what programmes they would be watching as well as to be present throughout the session control for the presence of a massage therapist.

In the migraine study the control group is the waitlist control, where this group keeps the daily diary for the study period and at the end of the study they are offered the treatment. Another choice might be to compare massage treatment to a proven treatment, which would allow cost-effectiveness analysis to be done.

In well-controlled research it is important to have clear definitions of protocols and procedures so that the study can be replicated. You need to know it is the massage and not something else that is causing the change, although sometimes it is hard to pinpoint. For example, we use almond oil, as it has no scent, we do not play any music, clinics are all set up the same, same colors and decoration. Also the client will not necessarily receive the same therapist each time so that generally we can control to some extent for therapist variables.

I have only covered very briefly some key issues in research, however if you are interested about learning more or are thinking about conducting a study, I highly recommend that you read “Massage Therapy: The Evidence for Practice” edited by Grant Jewell Rich.

References:
– Field, T., Scafidi, F., Schanberg, S. (1987).
Massage of preterm newborns to improve growth and development. Pediatric Nursing, 13, 385-387.
– Kuhn, C.M., Schanberg, S.M., Field, T., Symanski, R., Zimmerman, E., Scafidi, F., & Roberts, J. (1991). – Tactile-kinesthetic stimulation effects on sympathetic and adrenocortical function in preterm infants. Journal of Pediatrics, 119, 434-440.
– Rich, G.J. (Ed.). (2002). Massage Therapy:
The evidence for practice. Edinburgh: Mosby.
– Hernadez-Reif, M., Field, T.M., Dieter, J., Swerdlow, B., & Diego, M. (1998). Migraine headaches are reduced by massage therapy. International Journal of Neuroscience, 96, 1-11.
– Lawler, S.P., & Cameron, L.D. Massage therapy
as a technique for coping with stress.
(Manuscript in preparation).
• Correspondence email: s.lawler@auckland.ac.nz


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