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Research With Massage Therapy Foundation

By Massage Therapy Foundation Contributor

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Reducing Anxiety for Cardiac Catheterization Patients

Contributed by MK Brennan MS, RN, ACM, LMBT; Jolie Haun PhD, EdS, LMT; April Neufeld, BS, LMT

This month's research review focuses on reducing anxiety for patients undergoing cardiac catheterization. Complementary Therapies in Clinical Practice recently published the article, "Anxiety reduction in patients undergoing cardiac catheterization following massage and guided imagery." Armstrong and colleagues published an insightful study in which they suggest massage therapy with or without guided imagery can reduce anxiety for patients preparing for this cardiac procedure.

Anticipating a catheterization can be anxiety producing for patients, as can awaiting the results. With this, there may be changes in blood pressure, an increased need of sedation, and other complications. The authors designed their study using massage therapy with or without guided imagery based on reports that anxiety is one of the top five conditions for which alternative medicine is used as a treatment. Previous studies had mixed results for massage prior to catheterization and good results for guided imagery. The authors chose to use both massage therapy and guided imagery as one arm of the study. The feasibility of providing massage therapy in the pre-catheterization waiting period was also studied.

This pilot study was conducted at a large teaching hospital and was approved by the Institutional Review Board. Subjects were identified from a daily list of patients scheduled for a cardiac catheterization and all were asked if they wanted to participate in the research project. Consent was obtained from those who agreed to participate. Outpatients were seen in a quiet room that was apart from the catheterization center waiting area and inpatients were treated in their hospital rooms.

Cardiac Catheterization - Copyright – Stock Photo / Register Mark Four massage therapists from the Integrative Medicine department provided treatments. The subjects were offered one of the following: 15-minute massage, 20-minute guided imagery session, or massage with guided imagery. The massage treatments were performed using a massage chair or an office side chair for the outpatients and the inpatients received massage to the feet or hands while remaining in their hospital beds prior to the catheterization procedure. The chair massage recipients had their backs, scalps and arms massaged. Swedish massage was used for both groups. Guided imagery was provided using a headset with a relaxation CD. If guided imagery was chosen with massage, the patient listened to the CD either prior to or after the massage depending on the catheterization schedule. Sessions were stopped if the subject had to proceed to the catheterization lab.

Physiological measurements were retrospectively reviewed in the charts and included the subjects' blood pressure and heart rate taken prior to the catheterization. A random group of 55 subjects were chosen retrospectively for the matched comparison group. Data were used in a matched comparison between those who received the interventions and patients who had cardiac catheterizations in the same time period but did not receive massage or guided imagery. Age, gender, type of catheterization, and inpatient/outpatient status were used for the matching. Subjects who participated in the study were provided a four-item survey for reporting their anxiety level using a 10-point analog scale. This was completed pre- and post-intervention and the scores were analyzed using a t-test. Participant demographic differences were also examined.

Results indicated that it was feasible to provide massage and/or guided imagery prior to cardiac catheterization without interrupting the patient flow. Over the 2 and a half months of the study period, 57 patients accepted the invitation to receive one of the interventions and participate in the research. Of the 57, two individuals chose to receive only the guided imagery. Given the low participation in this arm of the study, the data for these two was removed which left 55 patients in the intervention groups, either massage only or massage with guided imagery.

Pre-treatment, self-reported anxiety scores showed no significant difference between the two treatment groups. A t-test analysis confirmed this with data that was completed for 52 participants (three participants were excluded due to incomplete data). Additionally, there were significant reductions in self-reported anxiety for both groups post-intervention with the massage therapy and guided imagery combination showing a more pronounced effect. It is noted that to fully analyze the statistical difference between the two groups, more participants would be needed. No significant differences were noted between females and males in the study in the self–reported anxiety scores.

Blood pressure and heart rates of research participants and the retrospectively formed comparative group were reviewed. These were physiological measures taken when the individuals entered the catheterization center and again just prior to the catheterization. While there were significant differences between the treatment groups and the comparative group in the values taken upon entering the catheterization laboratory, this did not last. There was no significant difference between the values taken immediately before the procedure started.

There were a number of limitations in this pilot study. As with all studies that use convenience sampling, the participants were able to choose if they wanted to be in the research group and what intervention they wanted. There was also a difference in the time between the intervention and the measuring of blood pressure and pulse between the outpatients and inpatients. Since the outpatients were already at the catheterization center, it was a shorter period of time between intervention and testing than the inpatients who received the intervention while still in their hospital rooms. The inpatients then had to be transferred to the catheterization center where their vital signs were taken.

As is the case with feasibility studies, this study's value is looking at the viability of implementing integrative healthcare approaches in a hospital setting as well as the implications for patient satisfaction. This study provides preliminary validation to warrant further research to investigate the use of massage therapy and guided imagery, either together or separate, to reduce anxiety associated with medical procedures.

To learn more about the effects of massage therapy, you can review the Massage Therapy Foundation review article archives, read accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.

Save the date for the 2016 International Massage Therapy Research Conference. The conference will be held May 12-15 at the Renaissance Seattle Hotel. Stay tuned for registration information and a call for presenters. Check out the Massage Therapy Foundation website for updates.


  • K. Armstrong, S. Dixon, S. May, G. Elliott Patrico Anxiety reduction in patients undergoing cardiac catheterization following massage and guided imagery. Complementary Therapies in Clinical Practice journal:
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