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Research With Massage Therapy Foundation

By Massage Therapy Foundation Contributor

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Massage May Contribute to Symptom Improvement for Anorexia Patients

Contributed by Beth Barberree, S. Pualani Gillespie and Jolie Haun

Do you ever wonder why there is limited literature on massage therapy and certain conditions, such as anorexia? Research in the field of massage therapy is relatively new, so it's important to examine the effects of massage on different conditions to determine if large-scale studies are warranted. This is why pilot projects, like the one featured in this month's review by Dr. Caroline Smith and colleagues out of the University of Western Sydney, Australia, are so important. This work was published earlier this year in The Journal of Alternative and Complementary Medicine, and found that although patients with anorexia can be a challenging population, massage therapy had a positive effect on their nutritional health and dietary behaviors.

The research team used a randomized control trial to compare the effect of acupuncture with an active control group, acupressure and massage in a population of inpatients with anorexia nervosa (AN). AN is a chronic illness affecting adolescents and adults, with frequent relapses occurring in many individuals and can result in patients needing hospitalization if the patient's weight drops so low that there is a significant medical threat. Treatment aims focus on restoration of healthy weight, normalization of eating behaviours and often involves a multi-disciplinary care team including nutritionists and psychological support. Smith et al (2014), explained that there is a need for new adjunctive therapies that improve the effectiveness of existing treatments and lead to improved outcomes with this patient population. This motivated their current study, "Acupuncture and Acupressure and Massage Health Outcomes for Patients with Anorexia Nervosa: Findings from a Pilot Randomized Controlled Trial and Patient Interviews."

Potential participants were drawn from inpatients at a private hospital who were over age 15 and had an AN diagnosis. Those who were medically stable and met inclusion criteria were briefed along with the medical team about the study, with 26 patients being randomized to the acupuncture group or the active control group. The two groups were similar in their symptomatology, and most were female, in their early 20's, single and living with their parents. Almost 25% had used complementary medicine in the past.

anorexia - Copyright – Stock Photo / Register Mark Treatment as usual was administered to 20 participants and the intervention was delivered by qualified practitioners twice a week for the first three weeks, followed by weekly treatment for three weeks. The acupuncture group received acupuncture at five common points and additional points based on the Traditional Chinese Medicine diagnosis. The specifics of the acupuncture application are available in the full article. The active control group received acupressure, with conscious and gradual direct pressure to the center of the point being worked on, and light massage. The massage was applied after the acupressure to the back and shoulders using Swedish massage techniques including effleurage (sliding/gliding) with forearms, fingers, the heel of the hand and the whole hand. Tissue depth was both superficial and deep effleurage, depending on the needs of the participant. The movements included circular, longitudinal and transverse strokes.

The primary outcome measure was body–mass index (BMI), and secondary outcomes included eating disorder psychopathology, anxiety and depression. These were measured at baseline and at six weeks following completion of the interventions. A semi-structured interview was conducted, as well asking questions about their interaction with the practitioner, what happened, how they felt, whether it made them feel differently and what they attributed any change to. Between-groups comparison of the acupuncture and active control groups showed no differences in the primary and secondary outcome measures with such a small number of participants. The data do however show a trend of improvement toward normative levels, as well as clinical improvements in participants' quality of life. In addition, clinical patterns of change pertaining to patient behaviors occurred; in the acupuncture group relating to restraint and eating concern in the acupressure and massage active control.

Analysis of the interviews yielded an overreaching theme of seeking and obtaining therapeutic support, which captures the two subthemes of seeking support and positive response to treatment. Overall, the study was viewed as a positive supplement to the usual care normally provided to the patients. Participants described both interventions positively, reported positive experiences regarding the relationship with their practitioner, and experienced a sense of calmness and relaxation. When asked further about what might have contributed to this, the majority of participants could not separate the practitioner from the intervention, and indicated that both were equally important and that it was the combination that worked. Interestingly, a noted difference between groups was that in contrast to the massage group, the effects from acupuncture were broader as they pertained to greater improvement in psychosocial wellbeing.

The authors recommend further research with additional practitioners to examine the complexity of the interventions and impact of patient-therapist interaction. Additionally, a larger sample of participants would provide for more statistical power to tease apart differences between the experimental groups in the treatment of AN.

With new approaches to treatment of AN needed, this study provides good preliminary support for both acupuncture, and also acupressure and massage, to safely improve well-being for patients. The work also supports previous research that suggests massage may be beneficial in treatment of AN, and that a positive therapeutic relationship between patients and practitioners improves patient symptoms.

The findings of the current study not only support the use of massage therapy with patients with anorexia, but also support the growth of the field of massage in general. How so? As researchers continue to examine the efficacy of massage therapy using pilot research, resources can be appropriately allocated to support large scale studies to study the effect of massage therapy with diverse populations, such as patients with anorexia. Continued publication of pilot and large-scale controlled studies that speak to the effects of massage therapy will contribute to a body of conclusive literature. As such, the field will be supported by evidenced-based practice validated with diverse patient and client populations.


Does this article bring to mind a special population of patients who you think could benefit from massage therapy? Why not apply for a Massage Therapy Foundation Community Service Grant by April 1, 2015. Visit www.massagetherapyfoundation.org for more information.

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