The study question
Previous national surveys have indicated that complementary and alternative medicine (CAM), including massage therapy, is a widely used form of health care in the United States, and that the use of these therapies has increased since such surveys were first conducted in 1990. However, common survey sampling methods have typically excluded active duty military personnel from participation. This study examined CAM use among active duty military personnel to determine the demographic and lifestyle factors associated with CAM use, and compared the results to previous studies in the civilian population.
This study presents the results of a 2013 survey, designed to be representative of the estimated 1.3 million active duty military personnel who receive health care from both the military and civilian systems. The researchers assumed that military personnel face the same health risks as civilians, with the additional physical, emotional and cognitive stresses associated with deployment and combat, and inferred that they might be more likely to seek out additional approaches to maintain and improve health and performance.
The study methods
Forty thousand potential participants were identified using personnel records. Sampling was designed to be globally representative of active duty military personnel in the Army, Navy, Marine Corps and Air Force. Of those potential participants, 30,664 were found eligible and were invited to complete an anonymous questionnaire. The majority of participants completed the lengthy questionnaire in group sessions held at military installations and monitored by a civilian data collection team. Four thousand personnel stationed at small or remote sites received a mailed questionnaire.
The survey gathered information on individual demographic characteristics, such as age, sex and ethnicity, substance use, military experiences, lifestyle and health behaviors, mental health, and use of CAM therapies during the 12 months prior to the survey. The 19 therapies specifically mentioned were grouped into the same five categories used by the National Center for Complementary and Integrative health (NCCIH): alternative medical systems, such as acupuncture and oriental medicine or homeopathy; biologically based therapies, such as herbal medicine, diet and high-dose megavitamins; manipulative and body-based methods, such as chiropractic and massage therapy; mind–body therapies, such as biofeedback, guided imagery, relaxation techniques, exercise or movement therapies, self-help groups, and art/music therapy; and energy therapies, such as Reiki and polarity therapy. Data was analyzed with SUDAAN, specialized software designed for detailed statistical analysis and weighting of survey data.
The study’s total response rate was 51.8 percent, with 16,146 respondents completing the survey. About 45 percent of active duty military personnel reported using at least one type of CAM in the previous year. The most often reported therapy used was “prayer for your own health” at 24.4 percent. When data on self-prayer were omitted, the prevalence of CAM use was approximately 36 percent. After self-prayer, the next most popular therapy was massage therapy, used by 14.1 percent of respondents. Other therapies with high rates of use included relaxation techniques (10.8 percent), herbal medicine (8.9 percent), high-dose megavitamins (8.4 percent), art/music therapy (7.7 percent), exercise/movement therapy (6.8 percent), and chiropractic (5.2 percent).
Women were more no more likely to use CAM overall compared to men, and younger, college-educated personnel were more likely to report use of massage therapy. While civilians participating in the National Health Information Survey previously reported use of massage therapy at 5 percent in 2002 and 8.3 percent in 2007, these results show that by comparison, military personnel use massage therapy at almost double the rate of civilians.
Limitations of the study
The response rate was lower than expected, which may have been due to the high level of personnel deployed at the time the survey was conducted. However, the sample was selected to be representative of the total population of military personnel, which increases confidence that results can be generalized to all military personnel. In addition, statistical adjustments were made to control for non-response bias.
Implications for evidence-informed practice
Leaders in the military have begun to examine the role of CAM—including massage therapy—as a means of providing extended support for stress management and pain to larger numbers of personnel. The majority of CAM use by both civilians and military personnel still occurs outside their respective health care systems. Massage therapy, for the most part, is still not a covered benefit under most health care insurance plans. Hopefully, surveys such as this may spur greater interest in further research on the benefits of massage therapy for stress management, pain, and injury recovery and rehabilitation.
Massage therapists, especially those working near large military bases, are likely to have a number of active duty personnel among their clients. Therapists may want to consider additional, in-depth training in advanced techniques that are especially useful for working with the specific challenges military personnel face.
Goertz C, Marriott BP, Finch MD, Bray RM, Williams TV, Hourani LL, Hadden LS, Colleran HL, Jonas WB. Military report more complementary and alternative medicine use than civilians. J Altern Complement Med. 2013 Jun;19(6):509-17. See the study on PubMed >>
This article originally appeared in the Fall 2015 issue of Massage Therapy Journal (mtj).
More Research on Massage and Military Personnel
- Reinhard MJ, Nassif TH, Bloeser K, Dursa EK, Barth SK, Benetato B, Schneiderma n A. CAM utilization among OEF/OIF veterans: findings from the National Health Study for a New Generation of US Veterans. Med Care. 2014 Dec;52(12 Suppl 5):S45-9. Find more on PubMed >>
- McPherson F, McGraw L. Treating generalized anxiety disorder using complementary and alternative medicine. Altern Ther Health Med. 2013 Sep-Oct;19(5):45-50. Find more on PubMed >>