The second North American Research Conference on Complementary &Integrative Medicine was held May 12–15, 2009, in Minneapolis, Minnesota. The conference was organized by the Consortium of Academic Health Centers for Integrative Medicine (CACHIM). The Consortium's mission is to help transform medicine and health care through rigorous research, new models of clinical care, and innovative educational programs that integrate biomedicine, the complexity of human beings, the intrinsic nature of healing and the rich diversity of therapeutic systems.
Representatives from AMTA attended the conference. Massage therapy organizations participating in the conference included the National Certification Board for Therapeutic Massage and Bodywork and the Massage Therapy Foundation. The Academic Consortium for Complementary and Alternative Health Care (ACCAHC), the complementary and alternative education counterpart to CACHIM that includes several massage therapy education, credentialing and accreditation organizations, also participated. A joint meeting between the research, clinical and education working groups in CACHIM and ACCAHC was held prior to the start of the conference to promote dialogue between the two organizations.
The conference program featured several outstanding plenary sessions with internationally known keynote speakers, including Helene Langevin, MD, who has conducted highly innovative research into the mechanisms of connective tissue. She spoke at some length about her work and the implications of connective tissue states for healthy structure and function in humans. The program also incorporated panel discussions and workshops, with more than 300 oral and poster research presentations. Several presentations focused on topics in clinical massage therapy research, including pediatric massage, ethical considerations of massage with terminally ill patients, and effects of massage on chronic pelvic pain, pain, anxiety and tension in cardiac surgical patients, and chronic low back pain. Brief summaries of several cutting edge studies are described below.
Safety of pediatric massage: a systematic review.
Adams D, Whidden A, Smith K, Sikora S, Dryden T, Vohra S.
This study used a systematic review to evaluate the safety of massage therapy for children and adolescents. While a 2003 review examined the safety of massage therapy for adults, no such review for pediatric populations has been previously published. Fifteen electronic databases from inception to June 2007 were searched, with no language restrictions applied. Articles were included if they met all of the following criteria: (1) Primary study or case report, (2) at least one pediatric patient (0-18 years) in study population, (3) massage intervention was applied, and (4) massage-related adverse event was reported. Out of 11,516 articles, 809 met the inclusion criteria for full-text review. From the 809 articles reviewed, 18 articles met the full inclusion criteria and data was extracted from these articles. Identified adverse events included local pain or soreness, swelling, mild fevers and skin rashes. These appear to be comparatively mild, with few moderate or serious adverse events occurring in pediatric patients.
Family centered integrative medicine interventions at a tertiary care pediatric hospital—massage therapy and energy healing: A preliminary report.
Wang S, Huitema B, Megregian P, Steinhorn D.
Noting that many of the contacts experienced by hospitalized children are painful and unpleasant, the authors of this study hypothesized that positive, nurturing touch through massage or energy healing would afford comfort and help alleviate distress in hospitalized children. Pediatric patients admitted to a general ward were offered opportunities to participate in a study evaluating the impact of massage or energy healing on their distress, pain, discomfort, tension and upset mood. Parents rated their child in these five areas before and after the intervention on a 1–5 scale (least to greatest). Parents also were offered massage and energy healing, and rated their own pre- and post-distress. The safety and acceptability of each intervention was also evaluated.
Results indicated that both pediatric patients (N=425) and parents (N=130) showed highly significant reductions in ratings of distress, pain, discomfort, tension and upset mood, with all outcomes demonstrating statistical significance (all p values were <.001). Interestingly, parents rated themselves higher than they rated their children in all categories before the interventions.
The authors concluded that hospitalization creates physical and psychological stress for both children and their parents. Parents may be a source of comfort for their child if they are calm and focused, or parents may create additional stress if they are anxious and agitated. While most care and supportive services are focused on patients, reducing parental distress may allow them to be more effective in supporting their hospitalized child and creating an environment for optimal healing to occur. The authors also noted that there were no adverse events in more than 500 interventions, and that parents were overwhelmingly enthusiastic about these modalities.
RCT of massage and meditation in patients at the end of life: methodological and ethical considerations in CAM research with terminally ill patients.
Kozak L, Congdon S, Diehr, Downey L, Fisher D, Lafferty W, Patrick D, Standish L.
This randomized controlled trial investigated the effects of massage and meditation as compared to "friendly visits" (the control group) on overall quality of life and pain distress in people at the end of life. Study participants were recruited from hospices, oncology clinics, and other palliative care and oncology providers in the Seattle, Washington, area and were randomly assigned to receive either massage, meditation (both considered active interventions), or "friendly visits" (an attention control condition). Patients were offered treatment twice a week, delivered to the bedside. Massage was offered by licensed massage therapists, meditation was offered by naturopathic doctors and friendly visits were offered by hospice volunteers. Each patient was recruited into the study along with a "study partner" who provided data for baseline and post-death interviews.
Data were collected from 167 patients. Patient pain ratings were assessed through 10 weeks post-enrollment. Study partners' ratings of the quality of the final week of life for 106 patients who died during study participation were analyzed. Surprisingly, data analysis demonstrated no significant treatment effects of either massage or meditation when compared with outcomes of the control group that received visits from hospice-trained volunteers. Authors noted that the study had several limitations, including the ethical considerations of randomizing dying patients to treatment groups, which meant that patients were not allowed to choose their preferred therapy. The attention that patients in the control group received from hospice volunteers also has powerful psycho-social effects, and may have obscured any treatment effect from the two therapies. Despite the study's limitations, the authors suggest that further studies testing the two interventions while addressing some of these limitations are warranted.
Changes in chronic pelvic pain following massage therapy.
Fournier C, Finch P.
This preliminary study was conducted at a Canadian massage school clinic to examine changes in chronic pelvic pain following massage therapy treatment. The study was a retrospective clinical audit of pain scores reported by clients attending a chronic pelvic pain specialty clinic rotation at the Sutherland-Chan School of Massage Therapy in Toronto. Clients booked into the clinic all presented with chronic pelvic pain, which was assessed before and after each treatment.
The study's massage intervention involved one-hour therapeutic massage treatment, and the specifics of each session were determined in accordance with the client's presenting condition. All treatments were delivered by second-year massage therapy students, supervised by a member of the school's faculty, and were aligned with the standards of practice for the massage therapy profession in Ontario. Outcome measures included visual analog pain scales completed before and after each massage treatment. Pre- and post-treatment scores were collated and compared using a paired t-test (one-tailed distribution).
Results showed a statistically significant decrease in pain when pre- and post-treatment pain scores were compared, suggesting that massage therapy can decrease chronic pelvic pain in the immediate, post-treatment period.
Measuring the effect of massage on pain, anxiety, and tension in cardiac surgical patients.
Cutshall S, Bauer B.
While a number of studies have identified the benefits of massage therapy, few have evaluated its benefits for cardiac surgical patients. The purpose of this study was to evaluate the effect of two 20-minute massages on patient-reported pain, anxiety and tension on day two and day four following cardiac surgeries. A secondary aim was to evaluate the feasibility of integrating massage therapy into a busy cardiovascular surgical practice.
The study authors approached 295 patients scheduled for coronary artery bypass graft and/or cardiac valve surgery the day before surgery. Of these, 164 consented to participate, and 113 completed the controlled trial. Subjects were randomized to receive standard care with 20 minutes of quiet time (n=51) or standard care with two 20-minute massages given on day two and day four post-operatively (n=62). The massage was performed by a trained therapist, and pre-post visual analog scales used to record patient-reported measures of pain, anxiety and tension were collected by a study coordinator. Vital signs, amount of sleep, overall satisfaction and length of stay were also recorded.
The results showed that baseline characteristics were similar between the two groups. There was a statistically significant difference in pain, anxiety and tension before and after massage on days two and four. There was a statistically significant difference in pain on day three for those patients who received standard care. There was a statistically significant difference in the change in tension on day two and the change in pain, tension and anxiety on day four between the two treatment groups. No statistically significant differences in vital signs, amount of sleep, overall satisfaction or length of stay between the groups were observed. Clinical staff did not report any problems related to the incorporation of massage therapy into the daily care routines, and patient comments were positive related to the experience of receiving massage.
A randomized trial comparing relaxation massage, focused structural massage, and usual care for chronic low back pain.
Cherkin D, Sherman K, Kahn J, Erro J, Delaney K, Cook A, Deyo R.
The goal of this study was to evaluate effectiveness of two common forms of massage for chronic back pain. Four hundred one adults aged 20 to 65 years who had received care for nonspecific chronic low back pain at an integrated health care delivery system in the Seattle area were recruited and randomly assigned to receive focused structural massage (n=132), full body relaxation massage (n=136) or continued usual care (n=133). Twenty-six experienced licensed massage therapists provided up to 10 treatments of both types over a 10-week period. The primary outcomes, dysfunction and bothersomeness of low back pain were assessed at baseline and 10 weeks after randomization by interviewers masked to treatment. Secondary outcomes included percentage improving by a clinically meaningful amount (3+ points for dysfunction and 2+ points for bothersomeness). Outcomes were also measured after 6 and 12 months.
Ninety percent of participants assigned to a massage treatment made at least eight visits, and 95 percent completed the 10-week interview. There were significant differences among the three treatment groups for both primary outcomes. The two forms of massage had very similar effects, and were both statistically and clinically superior to usual care. The benefits of massage for improved function but not for symptom reduction persisted for at least six months. Data from a 12-month follow-up is pending. The authors concluded that massage is an effective treatment for chronic low back pain, with benefits lasting at least six months. Interestingly, patients who received a conventional full-body relaxation massage benefited as much as those who received a massage focused on treating the structures of the lower back. These results suggest that factors other than focused manipulation of the soft tissues in the back are responsible for the effectiveness of massage.
The summaries just described represent only a small selection of the state-of-the-science research presented at the conference. Held every three years, the NARCCIM meeting has become the preeminent integrative health care research conference in North America. In addition to clinical research, the conference also covers basic science research, methodological research, health services research and education research. The next meeting will be held in May 2012.