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Research With Massage Therapy Foundation

By Massage Therapy Foundation Contributor

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Study Examines Use of Massage on Those with Spinal Cord Injuries

Contributed by MK Brennan MS, RN, LMBT; Renee Stenbjorn, BS, MPA, LMT and Derek R. Austin, PT, DPT, MS, CMT, BCTMB, CSCS

As massage therapy continues to gain recognition as a valid treatment option, studies that focus on its use with special populations or in mainstream medicine centers are more readily available. We at the Massage Therapy Foundation are always looking for new studies that help bring massage to populations who might not generally receive it. This month's review focuses on a feasibility study by Dr. Theresa Chase, Dr. Amitabh Jha, C.A. Brooks, MA and Amanda Allshouse, MS, published in the November 2013 issue of Spinal Cord that provided massage to patients with new spinal cord injuries (SCI) while they were being treated at a rehabilitation hospital.

This study researched the feasibility of integrating massage into the treatment protocols for these patients to address their pain. As the authors wrote, "Pain is not only a problem in itself, but may contribute to other conditions, such as negative mood states, depression, anxiety, sleeplessness and poor sleep quality and these, in turn, may interfere with participation in rehabilitation therapies and overall general well-being."

Working with a licensed massage therapist, a protocol was developed for the two arms of the study, broad compression massage (BCM) and light contact touch (LCT). These two treatment options provided an opportunity to test the effects of varying the amount of pressure during the massage since BCM used two to five pounds of pressure compared to two to three ounces of pressure with LCT. The treatment sessions were provided by 10 registered nurses who worked in the facility and were trained over an 8-hour course that included hands-on practice to provide the BCM and LCT treatments. The study was conducted over an 11-month period at a single site, the rehabilitation facility. Subjects were randomized to either the BCM-LCT group or the LCT-BCM according to the study's crossover design, which allowed all participants to receive the "active" treatment (BCM).

For inclusion in the study, the SCI patients needed to have pain, be medically stable and have an anticipated five week or greater length of stay at the rehab facility. This study highlighted the fact that patients with SCI suffer from pain due to injuries sustained during their trauma. Even patients with paralyzing accidents may be suffering from high amounts of pain. Additionally, the patients needed to be able to provide consent and answer questions in English. If they were participating in another clinical trial, they were excluded from the study. Prior to the start of the study, Institutional Review Board (IRB) approval was gained and all participates consented to be a part of the study.

spinal cord injuries - Copyright – Stock Photo / Register Mark The massage sessions were scheduled to last 20 minutes with limited conversation between the nurse and the patient. Treatments were provided three times a week for two weeks, followed by a one week break in between the BCM-LCT and LCT-BCM switch. A total of 40 adults were enrolled in the study, including seven females. A number of tools were used to gather data pre-treatment including an interview with the subjects by a research assistant to assess pain, fatigue and depressive symptoms. Demographic information, as well as injury severity and medication use for pain, was obtained through a medical chart review. During the study period, assessments were conducted the day after the treatments which may not have effectively captured the immediate effects of the BCM or LCT treatment on pain and fatigue.

Pain intensity was both higher at baseline and reduced more in the LCT-BCM group compared to the BCM-LCT group in the first two-week period (p=0.014). However, this pattern was not found in the second two-week period. LCT and BCM groups did not significantly differ on any secondary measures except the Patient Health Questionnaire-9 (PHQ-9), which measures depressive symptoms. Like pain intensity, the PHQ-9 score was reduced more in the LCT-BCM group in the first period (p=0.0085) though this trend was again not repeated in the second period. There was not a significant difference between the two groups when the first treatment period was analyzed in relation to the second treatment period. Both patients and nurses reported high satisfaction that having 20 minutes of uninterrupted time for the treatment provided, relating that this was usually the longest uninterrupted period of patient care during the day. However, the "researchers on this study believe there were beneficial effects and improvements in patient condition regardless of treatment."

One of the limitations of the study was the lack of balance between the two randomized groups at baseline for pain. Since one group started out with higher pain levels, it is likely that the treatment affected the groups differently. Additionally, the crossover design may have been flawed, as there were carry-over effects with a failure to return to baseline during the one week break in between the treatment sessions. This resulted in a difficulty to do a formal analysis of the cross-over design. Rather, changes in pain intensity were compared within each treatment period for the two groups. Since the type of pain wasn't defined, such as being musculoskeletal or neuropathic, an in-depth analysis was not possible.

One very interesting aspect of this study was the training and utilization of nurses to provide the massage therapy to these subjects. While massage provided by nurses used to be a part of routine patient care, that is not true nowadays. Is there a possibility that by using professionals other than massage therapists, the results may be different since the nurses were only given eight hours of training? Also, is there a possibility that the opportunity to participate in some research studies may not include massage therapists? However, this may indicate a great opportunity to form alliances with nurses. Massage therapists and nurses have similar goals for patients, in that both seek interventions that are beneficial, such as massage.

This pilot study showed that it is possible to integrate massage therapy in an acute rehab program for SCI patients using nurses to provide the sessions. For massage therapists, this provides an opportunity to take the results obtained, along with the items to consider for future studies and create proposals for further study with this patient population. As Massage Therapy Awareness Week starts, reaching out and providing massage to those who would not likely receive it may be worth considering with this study as an inspiration. The full text of the article is available online for free at PubMed Central.

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

Resource:

  1. Chase T, Jha A, Brooks CA, Allshouse A. A pilot feasibility study of massage to reduce pain in people with spinal cord injury during acute rehabilitation. Spinal Cord. 2013 Nov;51(11):847-51. doi: 10.1038/sc.2013.104. Epub 2013 Sep 17. PubMed PMID: 24042991; PubMed Central PMCID: PMC3815956.
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