Features Finance Management
Research: Summer 2007

Introduction
Massage therapy (MT) may be a novel and creative intervention to promote health. This brief essay serves to introduce one area of investigation where the results are compelling and also to show the diversity in populations that may be well served by use of this therapy. First, a brief account of the history and current status of use of MT in Canada will be given. Then a short review of the literature pertaining to MT effects on general clinical disorders will be presented. A more detailed presentation of recent studies relevant to the effects of massage therapy on disorders of mental health will be offered. The essay will conclude that recent research suggests that at least in selected populations the future for positive impact in the community is promising and that more research is needed. 

History
Massage therapy has an interesting history of use in health care in Canada. During World War I nurses were trained in therapeutic massage as an orthopaedic rehabilitation intervention for injured soldiers (Cowall, 2004).

As in much of Western society MT lost ground in Canada to mainstream conventional practices in the last century but along with other complementary and alternative medicine (CAM) practices, MT has experienced resurgence in usage in the population in recent years.  Data reported at the end of the last decade revealed that Canadians’ use of MT as a CAM modality is second only to chiropractic (Ramsay, Walker, & Alexander, 1999).  Data from the Canadian Community Health Survey shows that 8 per cent of Canadians utilize MT (Statistics Canada, 2003a). 

Massage Therapy enjoys largely positive regard within both conventional and integrated medical environments.  Eighty-three percent of physicians interviewed in Alberta stated that massage therapy is a useful adjunct to standard medical care and 71 per cent had referred patients to a massage therapist for treatment (Verhoef & Page, 1998). The interest in the potential of integrating massage therapy into routine community care is evident (Borins, 2005). 

General Review
A review of the literature reveals the publication of research on the usage of MT for diverse and expanding populations.  Massage therapy has been studied in its use with patients with Parkinson’s disease (Rajendran, Thompson, & Reich, 2001), cancer (Corbin, 2005), low back pain (Preyde, 2000; Furlan, Brosseau, Imamura, & Irvin, 2002; Dryden, Baskwill, & Preyde, 2004), children with cerebral palsy (Hurvitz, Leonard, Ayyangar, & Nelson, 2003), patients with dementia, (Hansen, Jorgensen, & Ortenblad, 2006), diabetes (Ezzo, Donner, Nickols, & Cox, 2001), menopause (Newton, Buist, Keenan, Anderson, & LaCroix, 2002), occupational stress (Marine, Ruotsalainen, Serra, & Verbeek, 2006), multiple sclerosis (Huntley & Ernst, 2000) and for infants (Underdown, Barlow, Chung, & Stewart-Brown (2006). One laboratory, (Touch Research Institute at the University of Miami School of Medicine), has conducted over 100 studies on the effects of massage on various clinical conditions (Field, 1998). 

Mental health
There is evidence of interest in MT as a community mental health intervention.  A recent pilot study describes the addition of massage therapy, and other complementary therapies such as acupuncture, to the ongoing treatment of psychotherapy for long-term clients of a community mental health centre with histories of post-traumatic stress disorder, major depression, and anxiety disorders (Collinge, Wentworth, & Sabo, 2005).  The results showed high levels of client satisfaction with the integrated services and significant change in four different dimensions of trauma recovery as measured by self-report on an investigator generated inventory. Collinge et al. (2005) conclude that quality of life through enhanced mental health outcomes may be improved by the addition of MT and other CAM interventions to usual psychotherapeutic care.

A recent meta-analysis of 37 massage therapy studies lead the reviewers to conclude that reductions of trait anxiety and depression provided by therapeutic massage interventions are “similar in magnitude to those of psychotherapy” (Moyer, Rounds, & Hannum, 2004, p.3). Moyer et al. (2004) examined both psychological and physiological effects of massage therapy and constructed the usage of the terms single-dose effects versus multiple-dose effects. Moyer et al. suggest that single-dose effects of MT for examination include variables such as state anxiety, mood, immediate pain relief, and physiological indices such as heart rate, blood pressure, and cortisol levels.  Multiple-dose effects of MT for the purposes of this study were considered to be variables such as trait anxiety, depression, and pain as assessed after a series of MT treatments rather than a single treatment and/or after considerable time passage, post treatment.  State anxiety, blood pressure, and heart rate variables in the meta-analysis revealed statistically significant treatment effects after a single-dose. The most robust effects were reportedly those of pain reduction assessed days or weeks after treatment and as mentioned above on trait anxiety and depression scores.  The authors of this meta-analysis suggest that evidence of effectiveness leads to the possibility of expanded use of this therapy in hospitals, work places, nursing homes, and psychological treatment centres.

Conclusion
Massage therapy may have significant benefits in multiple ways to improve both mental and physical health in populations in need of service. Prevalence rates for depression and anxiety disorders in Canada show that this mental health issue affects as many Canadians as other important health concerns like diabetes and heart disease (Statistics Canada, 2003b). It is predicted that depression will rate as the second leading cause of disability in the world within 20 years (Statistics Canada, 2003b). The interest in MT as a possible health promotion modality for a variety of health impairments is shown by the existence of MT research spanning the evidence levels from pilot studies to systematic reviews with meta-analysis of investigation findings. However, further research is needed to determine the relative utility of this modality. There is need to explore the mechanisms of the effect of massage therapy if it is to be thoughtfully applied as a method to help create conditions to support improvements in health now and in the future. A larger set of high quality scientific investigations should inform decision making at the consumer, practitioner, and policy maker levels. More information is needed to determine if this particular CAM practice could enhance community capacity to solve common health problems through prevention and treatment.

– References available online at www.massagetherapycanada.com