American Massage Therapy Association^®

AMTA Position Statement Proposal

Date received by Delegate: January 22nd, 2009

August 20, 2009
Note: A typo was discovered in a sentence of the Rationale for this proposal as originally posted. The error has been corrected.

Background information

Anxiety, defined by the Anxiety Disorder Association of America, is “a sense of apprehension and fear often marked by physical symptoms (such as sweating, tension, and increased heart rate)”.¹   According to the National Institute of Mental Health, over 40 million adult American suffer from anxiety disorders².   Anxiety and its disorders shape the quality of life and the health of those it affects.³

Research indicates that massage has been shown to:

• reduce anxiety in healthy adults ⁴
• reduce anxiety in psychiatric patients ⁵
• reduce anxiety during emergency transport treatment ⁶
• reduce anxiety in those with chronic pain ⁷
• reduce anxiety  in those with chronic pain over time ⁷ 
• reduce anxiety and /or depression in cancer patients ^{8, 9, 10, 11}
• reduce anxiety in children with cancer and HIV ^{12, 13}
• reduce anxiety in pregnant women ¹⁴
• reduce anxiety in emergency room nurses ¹⁵ 
• reduce the anxiety and/or depression associated with lower back pain ^{16, 17, 18}
• increase a sense of calm after cardiac surgery ¹⁹

Rationale

Research points to a variety of instances and age groups where incorporating massage into treatment and care can reduce anxiety.  Individuals who seek relief from anxiety may benefit from the structured touch of trained massage therapists working within the therapist’s scope of practice.

The position statement supports the following AMTA Core Values:

• We believe that massage benefits all.
• We are a diverse and nurturing community working with integrity, honesty and dignity.

The 10-30 Year Vivid Descriptions of the AMTA are also supported by the position:

• People recognize the power of touch to affect the mind/body/spirit continuum.
• The role of massage therapy will be expanded in all practice settings
• There will be international recognition for the value of massage.  All societies will be educated and accept massage therapy and AMTA will be a global networking resource for massage therapy and therapists.

Position Statement

It is the position of the American Massage Therapy Association (AMTA) that massage therapy can be effective in reducing anxiety.

References

1. Getting Help Glossary (n.d.). Retrieved April 8, 2009, from Anxiety Disorder Association of America Web site: http://www.adaa.org/gettinghelp/glossary.asp
   
   
2. Anxiety Disorders (n.d.). Retrieved April 8, 2009, from National Institute of Mental Health Web site: http://www.nimh.nih.gov/health/publications/anxiety-disorders/nimhanxiety.pdf
   
   
3. Strine, T.W., Chapman, D.P., Kobau, R., Balluz, L. (2005).  Associations of self-reported anxiety symptoms with health-related quality of life and health behaviors. Soc Psychiatry Psychiatr Epidemiol, 40(8):680.
   
   BACKGROUND: Anxiety disorders affect approximately 19 million American adults annually and have been associated with impaired health-related quality of life (HRQOL), an increased rate of adverse health behaviors, and poor outcomes related to chronic illness in studies conducted in clinical populations. Our study was designed to examine the association of self-reported anxiety symptoms with HRQOL and health behaviors among a representative sample of US community-dwellers.
   
   METHODS: Data were obtained from the Behavioral Risk Factor Surveillance System,an ongoing, state-based, random-digit telephone survey of the noninstitutionalized US population aged > or = 18 years. In 2002, HRQOL measures were administered in 18 states and the District of Columbia.
   
   RESULTS: An estimated 15% of persons reported frequent (> or = 14 days in the past 30 days) anxiety symptoms. After adjusting for frequent depressive symptoms and sociodemographic characteristics, those with frequent anxiety symptoms were significantly more likely than those without to report fair or poor general health (vs. excellent, very good, or good general health), frequent physical distress, frequent activity limitations, frequent sleep insufficiency, infrequent vitality, frequent mental distress, and frequent pain. In addition, they were more likely to smoke, to be obese, to be physically inactive, and to drink heavily.
   
   CONCLUSION: Given their association with impaired HRQOL and adverse health behaviors, our results suggest that assessment of anxiety symptoms should be a facet of routine standard medical examinations.



4. Hatayama, T., Kitamura, S., Tamura, C., Nagano, M., Ohnuki, K. (2008). The facial massage reduced anxiety and negative mood status, and increased sympathetic nervous activity. Biomed Res, 29(6):317-20.
   
   The aim of this study was to clarify the effects of 45 min of facial massage on the activity of autonomic nervous system, anxiety and mood in 32 healthy women. Autonomic nervous activity was assessed by heart rate variability (HRV) with spectral analysis. In the spectral analysis of HRV, we evaluated the high-frequency components (HF) and the low- to high-frequency ratio (LF/HF ratio), reflecting parasympathetic nervous activity and sympathetic nervous activity, respectively. The State Trait Anxiety Inventory (STAI) and the Profile of Mood Status (POMS) were administered to evaluate psychological status. The score of STAI and negative scale of POMS were significantly reduced following the massage, and only the LF/HF ratio was significantly enhanced after the massage. It was concluded that the facial massage might refresh the subjects by reducing their psychological distress and activating the sympathetic nervous system.



5. Garner, B., Phillips, L.J., Schmidt, H.M., Markulev, C., O'Connor, J., Wood, S.J., Berger, G.E., Burnett, P., McGorry, P.D. (2008). Pilot study evaluating the effect of massage therapy on stress, anxiety and aggression in a young adult psychiatric inpatient unit. Aust N Z J Psychiatry , 42(5):414-22.
   
   OBJECTIVE: The aim of the present pilot study was to examine the effectiveness of a relaxation massage therapy programme in reducing stress, anxiety and aggression on a young adult psychiatric inpatient unit.
   
   METHOD: This was a prospective, non-randomized intervention study comparing treatment as usual (TAU) with TAU plus massage therapy intervention (MT) over consecutive 7 week blocks (May-August 2006). MT consisted of a 20 min massage therapy session offered daily to patients during their period of hospitalization. The Kennedy Nurses' Observational Scale for Inpatient Evaluation (NOSIE), the Symptom Checklist-90-Revised (SCL-90-R), the State-Trait Anxiety Inventory (STAI) and stress hormone (saliva cortisol) levels were used to measure patient outcomes at admission and discharge from the unit. The Staff Observation Aggression Scale-Revised (SOAS-R) was used to monitor the frequency and severity of aggressive incidents on the unit.
   
   RESULTS: There was a significant reduction in self-reported anxiety (p < 0.001), resting heart rate (p < 0.05) and cortisol levels (p < 0.05) immediately following the initial and final massage therapy sessions. Significant improvements in hostility (p = 0.007) and depression scores (p < 0.001) on the SCL-90-R were observed in both treatment groups. There was no group x time interaction on any of the measures. Poor reliability of staff-reported incidents on the SOAS-R limited the validity of results in this domain.
   
   CONCLUSIONS: Massage therapy had immediate beneficial effects on anxiety-related measures and may be a useful de-escalating tool for reducing stress and anxiety in acutely hospitalized psychiatric patients. Study limitations preclude any definite conclusions on the effect of massage therapy on aggressive incidents in an acute psychiatric setting. Randomized controlled trials are warranted.



6. Lang, T., Hager, H., Funovits, V., Barker, R., Steinlechner, B., Hoerauf, K., Kober, A. (2007). Prehospital analgesia with acupressure at the Baihui and Hegu points in patients with radial fractures: a prospective, randomized, double-blind trial. Am J Emerg Med, 25 (8 ):887-93 .
   
   BACKGROUND: Pain during transportation is a common phenomenon in emergency medicine. As acupressure has been deemed effective for pain management by the National Institutes of Health, we conducted a study to evaluate its effectiveness in prehospital patients with isolated distal radial fracture.
   
   METHODS: This was a prospective, randomized, double-blind study. Thirty-two patients were enrolled. Acupressure was performed either at "true" points or at "sham" points. Vital signs and pain and anxiety scores were recorded before and after the acupressure treatment. Normally distributed values were compared using the Student t test.
   
   RESULTS: Pretreatment scores for pain and anxiety were similar in the 2 groups (47.6 +/- 8.9 vs 51.2 +/- 8.7 visual analog scale [VAS] score for pain, 52.4 +/- 6.0 vs 47.5 +/- 9.3 VAS score for anxiety). At the hospital, patients in the true-points group had significantly lower pain (36.6 +/- 11.0 vs 56.0 +/- 13.3 VAS score, P < .001) and anxiety scores (34.9 +/- 22.2 vs 53.4 +/- 19.7 VAS score, P = .022).
   
   CONCLUSION: Acupressure in the prehospital setting effectively reduces pain and anxiety in patients with distal radial trauma.



7. Walach, H., Güthlin, C., König, M. (2003).   Efficacy of massage therapy in chronic pain: a pragmatic randomized trial. J Altern Complement Med, 9 (6 ):837-46 .
   
   BACKGROUND: Although classic massage is used widely in Germany and elsewhere for treating chronic pain conditions, there are no randomized controlled trials (RCT).
   
   DESIGN: Pragmatic RCT of classic massage compared to standard medical care (SMC) in chronic pain conditions of back, neck, shoulders, head and limbs.
   
   OUTCOME MEASURE: Pain rating (nine-point Likert-scale; predefined main outcome criterion) at pretreatment, post-treatment, and 3 month follow-up, as well as pain adjective list, depression, anxiety, mood, and body concept.
   
   RESULTS: Because of political and organizational problems, only 29 patients were randomized, 19 to receive massage, 10 to SMC. Pain improved significantly in both groups, but only in the massage group was it still significantly improved at follow-up. Depression and anxiety were improved significantly by both treatments, yet only in the massage group maintained at follow-up.
   
   CONCLUSION: Despite its limitation resulting from problems with numbers and randomization this study shows that massage can be at least as effective as SMC in chronic pain syndromes. Relative changes are equal, but tend to last longer and to generalize more into psychologic domains. Because this is a pilot study, the results need replication, but our experiences might be useful for other researchers.



8. Jane, S.W., Wilkie, D.J., Gallucci, B.B., Beaton, R.D., Huang, H.Y. (2008). Effects of a Full-Body Massage on Pain Intensity, Anxiety, and Physiological Relaxation in Taiwanese Patients with Metastatic Bone Pain: A Pilot Study. J Pain Symptom Manage .
   
   Bone involvement, a hallmark of advanced cancer, results in intolerable pain, substantial morbidity, and impaired quality of life in 34%-45% of cancer patients. Despite the publication of 15 studies on massage therapy (MT) in cancer patients, little is known about the longitudinal effects of MT and safety in cancer patients with bone metastasis. The purpose of this study was to describe the feasibility of MT and to examine the effects of MT on present pain intensity (PPI), anxiety, and physiological relaxation over a 16- to 18-hour period in 30 Taiwanese cancer patients with bone metastases. A quasi-experimental, one-group, pretest-posttest design with repeated measures was used to examine the time effects of MT using single-item scales for pain (PPI-visual analog scale [VAS]) and anxiety (anxiety-VAS), the modified Short-Form McGill Pain Questionnaire (MSF-MPQ), heart rate (HR), and mean arterial pressure (MAP). MT was shown to have effective immediate [t(29)=16.5, P=0.000; t(29)=8.9, P=0.000], short-term (20-30 minutes) [t(29)=9.3, P=0.000; t(29)=10.1, P=0.000], intermediate (1-2.5 hours) [t(29)=7.9, P=0.000; t(29)=8.9, P=0.000], and long-term benefits (16-18 hours) [t(29)=4.0, P=0.000; t(29)=5.7, P=0.000] on PPI and anxiety. The most significant impact occurred 15 [F=11.5(1,29), P<0.002] or 20 [F=20.4(1,29), P<0.000] minutes after the intervention. There were no significant time effects in decreasing or increasing HR and MAP. No patient reported any adverse effects as a result of MT. Clinically, the time effects of MT can assist health care providers in implementing MT along with pharmacological treatment, thereby enhancing cancer pain management. Randomized clinical trials are needed to validate the effectiveness of MT in this cancer population.



9. Imanishi, J., Kuriyama, H., Shigemori, I., Watanabe, S., Aihara, Y., Kita, M., Sawai, K., Nakajima, H., Yoshida, N., Kunisawa, M., Kawase, M., Fukui, K. (2007).   Anxiolytic Effect of Aromatherapy Massage in Patients with Breast Cancer. Evid Based Complement Alternat Med .
   
   We examined how aromatherapy massage influenced psychologic and immunologic parameters in 12 breast cancer patients in an open semi-comparative trial. We compared the results 1 month before aromatherapy massage as a waiting control period with those during aromatherapy massage treatment and 1 month after the completion of aromatherapy sessions. The patients received a 30 min aromatherapy massage twice a week for 4 weeks (eight times in total). The results showed that anxiety was reduced in one 30 min aromatherapy massage in State-Trait Anxiety Inventory (STAI) test and also reduced in eight sequential aromatherapy massage sessions in the Hospital Anxiety and Depression Scale (HADS) test. Our results further suggested that aromatherapy massage ameliorated the immunologic state. Further investigations are required to confirm the anxiolytic effect of aromatherapy in breast cancer patients



10. Chang, S.Y. (2008). Effects of aroma hand massage on pain, state anxiety and depression in hospice patients with terminal cancer . Taehan Kanho Hakhoe Chi , 38(4):493-502.
    
    PURPOSE: The purpose of this study was to examine the effects of aroma hand massage on pain, state anxiety and depression in hospice patients with terminal cancer.
    
    METHODS: This study was a nonequivalent control group pretest-posttest design. The subjects were 58 hospice patients with terminal cancer who were hospitalized. Twenty eight hospice patients with terminal cancer were assigned to the experimental group (aroma hand massage), and 30 hospice patients with terminal cancer were assigned to the control group (general oil hand massage). As for the experimental treatment, the experimental group went through aroma hand massage on each hand for 5 min for 7 days with blended oil-a mixture of Bergamot, Lavender, and Frankincense in the ratio of 1:1:1, which was diluted 1.5% with sweet almond carrier oil 50 ml. The control group went through general oil hand massage by only sweet almond carrier oil-on each hand for 5 min for 7 days.
    
    RESULTS: The aroma hand massage experimental group showed more significant differences in the changes of pain score (t=-3.52, p=.001) and depression (t=-8.99, p=.000) than the control group.
    
    CONCLUSION: Aroma hand massage had a positive effect on pain and depression in hospice patients with terminal cancer.



11. Smith, M., Reeder, F., Daniel, L., Baramee, J., Hagman, J. (2003).  Alternative Therapies in Health and Medicine, 9(1) 40-49.
    
    Participants were patients 18-70 years old who received either an autologous or allogeneic bone marrow transplant (BMT), mostly for breast cancer or lymphoma, but also for leukemias. An autologous BMT involves the collection of the patient's own bone marrow, which is frozen and reinfused; an allogeneic BMT is the transplantation of another person's marrow.
    
    The sample population of 61 patients was stratified and randomly assigned to one of three treatments: massage therapy, Therapeutic Touch, or a control group called the friendly visit.
    
    Subjects in the massage-therapy group received a 30-minute, standardized Swedish massage. Those in the Therapeutic Touch group received a half-hour, standard session, which consisted of conscious energy exchange using the hands as a focus for facilitating healing. Subjects in the friendly visit group spent 30 minutes engaged in social conversation.
    
    Three outcome variables were measured to assess the effects of touch therapies on people who undergo BMTs: time for engraftment, which occurs when newly infused blood-forming cells begin producing blood; complications during treatment, which involved the measurement of 11 specific functions such as food intake, central nervous system/neurological, cardiac and circulation; and patients' perception of the benefit of therapy, which involved a survey asking subjects to rate the degree of feelings such as support, comfort, well-being, pain and anxiety.
    
    In the assessment of complications, researchers found that subjects in the massage-therapy group had significantly lower scores for central nervous system or neurological complications, such as disorientation, agitation, anxiety, numbness, headache and insomnia.
    
    "This diminishing effect on neurological complications is important in enhancing the quality of life during BMT," state the study's authors. "Massage-therapy patients may be able to rest more easily, communicate with their family members, and feel less depressed and anxious during this critical time."
    
    No statistical differences were found among the three groups for time for engraftment. Participants in the massage-therapy group perceived that they received significantly greater benefits from the therapy than those in the friendly visit group. Subjects in both the massage-therapy and the Therapeutic Touch group had comfort scores significantly higher than subjects in the friendly visit group.



12. Hughes, D., Ladas, E., Rooney, D., Kelly, K. (2008). Massage therapy as a supportive care intervention for children with cancer. Oncol Nurs Forum, 35 (3 ):431-42 .
    
    PURPOSE/OBJECTIVES: To review relevant literature about massage therapy to assess the feasibility of integrating the body-based complementary and alternative medicine (CAM) practice as a supportive care intervention for children with cancer.
    
    DATA SOURCES: PubMed, online references, published government reports, and the bibliographies of retrieved articles, reviews, and books on massage and massage and cancer. More than 70 citations were reviewed.
    
    DATA SYNTHESIS: Massage therapy may help mitigate pain, anxiety, depression, constipation, and high blood pressure and may be beneficial during periods of profound immune suppression. Massage techniques light to medium in pressure are appropriate in the pediatric oncology setting.
    
    CONCLUSIONS: Massage is an applicable, noninvasive, therapeutic modality that can be integrated safely as an adjunct intervention for managing side effects and psychological conditions associated with anticancer treatment in children. Massage may support immune function during periods of immunosuppression.
    
    IMPLICATIONS FOR NURSING: Pediatric oncology nurses are vital in helping patients safely integrate CAM into conventional treatment. Pediatric oncology nurses can help maximize patient outcomes by assessing, advocating, and coordinating massage therapy services as a supportive care intervention.



13. Hernandez-Reif, M., Shor-Posner, G., Baez, J., Soto, S., Mendoza, R., Castillo, R., Quintero, N., Perez, E., Zhang, G. (2008). Dominican Children with HIV not Receiving Antiretrovirals: Massage Therapy Influences their Behavior and Development. Evid Based Complement Alternat Med ,  5(3):345-354<
    
    Forty-eight children (M age = 4.8 years) infected with HIV/AIDS and living in the Dominican Republic were randomly assigned to a massage therapy or a play session control group. The children in the massage therapy group received two weekly 20-min massages for 12 weeks; the children in the control group participated in a play session (coloring, playing with blocks) for the same duration and length as the massage therapy group. Overall, the children in the massage therapy group improved in self-help abilities and communication, suggesting that massage therapy may enhance daily functioning for children with HIV/AIDS. Moreover, the HIV infected children who were six or older also showed a decrease in internalizing behaviors; specifically depressive/anxious behaviors and negative thoughts were reduced. Additionally, baseline assessments revealed IQ equivalence below normal functioning for 70% of the HIV infected children and very high incidences of mood problems (depression, withdrawn) for 40% of the children and anxiety problems for 20% of the children, suggesting the need for better monitoring and alternative interventions in countries with limited resources to improve cognition and the mental health status of children infected with HIV/AIDS.



14. Field, T., Figueiredo, B., Hernandez-Reif, M., Diego, M., Deeds, O., Ascencio, A. (2008).   Massage therapy reduces pain in pregnant women, alleviates prenatal depression in both parents and improves their relationships. J Bodyw Mov Ther , 12(2):146-50.
    
    Prenatally depressed women (N=47) were randomly assigned to a group that received massage twice weekly from their partners from 20 weeks gestation until the end of pregnancy or a control group. Self-reported leg pain, back pain, depression, anxiety and anger decreased more for the massaged pregnant women than for the control group women. In addition, the partners who massaged the pregnant women versus the control group partners reported less depressed mood, anxiety and anger across the course of the massage therapy period. Finally, scores on a relationship questionnaire improved more for both the women and the partners in the massage group. These data suggest that not only mood states but also relationships improve mutually when depressed pregnant women are massaged by their partners.



15. Cooke, M., Holzhauser, K., Jones, M., Davis, C., Finucane, J. (2007).  The effect of aromatherapy massage with music on the stress and anxiety levels of emergency nurses: comparison between summer and winter. J Clin Nurs, 16(9):1695-703.
    
    AIMS AND OBJECTIVES: This research aimed to evaluate the use of aromatherapy massage and music as an intervention to cope with the occupational stress and anxiety that emergency department staff experience. The study also aimed to compare any differences in results between a summer and winter 12-week massage plan.
    
    BACKGROUND : Emergency nurses are subjected to significant stressors during their work and it is known that workloads and patient demands influence the role stress has on nurses. The perception that winter months are busier for emergency departments has long been held and there is some evidence that people with cardiac and respiratory dysfunction do present more frequently in the winter months. Massage has been found to decrease staff anxiety.
    
    DESIGN : The study used a one-group pre-test, post-test quasi-experimental design with random assignment.
    
    METHOD : Staff occupational stress was assessed pre- and post- 12 weeks of aromatherapy massage with music and anxiety was measured pre and post each massage session. Sick leave was also measured. Comparisons of summer and winter data were undertaken.
    
    RESULTS : A total of 365 massages were given over two 12-week periods, one during summer and the other during winter. Analysis identified that aromatherapy massage with music significantly reduced anxiety for both seasonal periods. Premassage anxiety was significantly higher in winter than summer. No differences in sick leave and workload were found. There was no difference in the occupational stress levels of nurses following the two 12-week periods of massage.
    
    CONCLUSION : Emergency nurses were significantly more anxious in winter than summer but this cannot be attributed to increased sick leave or workloads. Aromatherapy massage with music significantly reduced emergency nurses' anxiety.
    
    RELEVANCE TO CLINICAL PRACTICE : High levels of anxiety and stress can be detrimental to the physical and emotional health of emergency nurses and the provision of a support mechanism such as on-site massage as an effective strategy should be considered.



16. Brady, L.H., Henry, K., Luth, J.F. 2nd, Casper-Bruett, K.K. (2001). The effects of shiatsu on lower back pain. J Holist Nurs, 19 (1 ):57-70 .
    
    Shiatsu, a specific type of massage, was used as an intervention in this study of 66 individuals complaining of lower back pain. Each individual was measured on state/trait anxiety and pain level before and after four shiatsu treatments. Each subject was then called 2 days following each treatment and asked to quantify the level of pain. Both pain and anxiety decreased significantly over time. Extraneous variables such as gender, age, gender of therapist, length of history with lower back pain, and medications taken for lower back pain did not alter the significant results. These subjects would recommend shiatsu massage for others suffering from lower back pain and indicated the treatments decreased the major inconveniences they experienced with their lower back pain.



17. Hernandez-Reif, M., Field, T., Krasnegor, J., Theakston, H. (2001).  Lower back pain is reduced and range of motion increased after massage therapy.  Int J Neurosci, 106 (3-4 ):131-45 .
    
    STUDY DESIGN: A randomized between-groups design evaluated massage therapy versus relaxation for chronic low back pain.
    
     OBJECTIVES: Treatment effects were evaluated for reducing pain, depression, anxiety and stress hormones, and sleeplessness and for improving trunk range of motion associated with chronic low back pain.
    
    SUMMARY of BACKGROUND DATA: Twenty-four adults (M age=39.6 years) with low back pain of nociceptive origin with a duration of at least 6 months participated in the study. The groups did not differ on age, socioeconomic status, ethnicity or gender.
    
    METHODS: Twenty-four adults (12 women) with lower back pain were randomly assigned to a massage therapy or a progressive muscle relaxation group. Sessions were 30 minutes long twice a week for five weeks. On the first and last day of the 5-week study participants completed questionnaires, provided a urine sample and were assessed for range of motion.
    
    RESULTS: By the end of the study, the massage therapy group, as compared to the relaxation group, reported experiencing less pain, depression, anxiety and improved sleep. They also showed improved trunk and pain flexion performance, and their serotonin and dopamine levels were higher.
    
    CONCLUSIONS: Massage therapy is effective in reducing pain, stress hormones and symptoms associated with chronic low back pain.
    
    PRECIS: Adults (M age=39.6 years) with low back pain with a duration of at least 6 months received two 30-min massage or relaxation therapy sessions per week for 5 weeks. Participants receiving massage therapy reported experiencing less pain, depression, anxiety and their sleep had improved. They also showed improved trunk and pain flexion performance, and their serotonin and dopamine levels were higher.



18. Field, T., Hernandes-Reif, M., Diego, M., Fraser, M. (2007).  Lower back pain and sleep disturbance are reduced following massage therapy.  Journal of Bodywork and Movement Therapies, 11(2) 141-145.
    
    Summary: A randomized between-groups design was used to evaluate massage therapy versus relaxation therapy effects on chronic low back pain. Treatment effects were evaluated for reducing pain, depression, anxiety and sleep disturbances, for improving trunk range of motion (ROM) and for reducing job absenteeism and increasing job productivity. Thirty adults (M age=41 years) with low back pain with a duration of at least 6 months participated in the study. The groups did not differ on age, socioeconomic status, ethnicity or gender. Sessions were 30 min long twice a week for 5 weeks. On the first and last day of the 5-week study participants completed questionnaires and were assessed for ROM. By the end of the study, the massage therapy group, as compared to the relaxation group, reported experiencing less pain, depression, anxiety and sleep disturbance. They also showed improved trunk and pain flexion performance.



19. Hattan, J., King, L., Griffiths, P. (2002). The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial. J Adv Nurs, 37(2):199-207.
    
    BACKGROUND : Because of the widely presumed association between heart disease and psychological wellbeing, the use of so-called 'complementary' therapies as adjuncts to conventional treatment modalities have been the subject of considerable debate. The present study arose from an attempt to identify a safe and effective therapeutic intervention to promote wellbeing, which could be practicably delivered by nurses to patients in the postoperative recovery period following coronary artery bypass graft (CABG) surgery. Aim. To investigate the impact of foot massage and guided relaxation on the wellbeing of patients who had undergone CABG surgery.
    
    METHOD : Twenty-five subjects were randomly assigned to either a control or one of two intervention groups. Psychological and physical variables were measured immediately before and after the intervention. A discharge questionnaire was also administered.
    
    RESULTS : No significant differences between physiological parameters were found. There was a significant effect of the intervention on the calm scores (ANOVA, P=0.014). Dunnett's multiple comparison showed that this was attributable to increased calm among the massage group. Although not significant the guided relaxation group also reported substantially higher levels of calm than control. There was a clear (nonsignificant) trend across all psychological variables for both foot massage and, to a lesser extent, guided relaxation to improve psychological wellbeing. Both interventions were well received by the subjects.
    
    CONCLUSIONS : These interventions appear to be effective, noninvasive techniques for promoting psychological wellbeing in this patient group. Further investigation is indicated.

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