Differences in practitioners’ proficiency affect the effectiveness of massage therapy on physical and psychological states

Development of a basic evaluation model for manual therapy learning in rehabilitation students based on the Delphi method

OBJECTIVE

Manual therapy is a crucial component in rehabilitation education, yet there is a lack of models for evaluating learning in this area. This study aims to develop a foundational evaluation model for manual therapy learning among rehabilitation students, based on the Delphi method, and to analyze the theoretical basis and practical significance of this model.

METHODS

An initial framework for evaluating the fundamentals of manual therapy learning was constructed through a literature review and theoretical analysis. Using the Delphi method, consultations were conducted with young experts in the field of rehabilitation from January 2024 to March 2024. Fifteen experts completed three rounds of consultation. Each round involved analysis using Dview software, refining and adjusting indicators based on expert opinions, and finally summarizing all retained indicators using Mindmaster.

RESULTS

The effective response rates for the three rounds of questionnaires were 88%, 100%, and 100%, respectively. Expert familiarity scores were 0.91, 0.95, and 0.95; coefficient of judgment were 0.92, 0.93, and 0.93; authority coefficients were 0.92, 0.94, and 0.94, respectively. Based on three rounds of consultation, the model established includes 3 primary indicators, 10 secondary indicators, 17 tertiary indicators, and 9 quaternary indicators. A total of 24 statistical indicators were finalized, with 8 under the Cognitive Abilities category, 10 under the Practical Skills category, and 6 under the Emotional Competence category.

CONCLUSION

This study has developed an evaluation model for manual therapy learning among rehabilitation students, based on the Delphi method. The model includes multi-level evaluation indicators covering the key dimensions of Cognitive Abilities, Practical Skills, and Emotional Competence. These indicators provide a preliminary evaluation framework for manual therapy education and a theoretical basis for future research.

Differential Effects of Classical vs. Sports Massage on Erector Spinae and Upper Trapezius Muscle Stiffness: A Shear-Wave Elastography Study in Young Women

Classical and sports massages are commonly used interventions, but their comparative effects on muscle stiffness remain unclear. Classical massage is more general and uses light to moderate pressure, and its main purpose is relaxation. Sports massage, on the other hand, is more specialized and targets the unique needs of massaged individuals using moderate to firm pressure. This study aimed to evaluate the impacts of classical and sports massages on the stiffness of the erector spinae (ES) and upper trapezius (UT) muscles. Fifteen recreationally active young women, aged 22.9 ± 1.2 years, underwent a randomized cross-over study (with three conditions). Participants received either a five-minute classical or sports massage or a passive rest as a control on distinct days. Muscle stiffness was assessed using shear-wave elastography. The ES shear modulus displayed a significant time effect (p < 0.001; η2 = 0.515) without noticeable differences between the conditions, and the time × massage-type interactions approached statistical significance (F = 2.014; p = 0.073). There was also a large and statistically significant effect of the time on the UT (F = 11.127; p < 0.001; η2 = 0.443). We could not prove that classical and sports massages reduced muscle stiffness. The absence of significant differences might be attributed to the specific intervention parameters (massage duration of 5 min) and the small, only young women sample size. Given some tendencies towards significant effects, larger sample sizes are needed to further investigate this research question.

Neurophysiology of human touch and eye gaze in therapeutic relationships and healing: a scoping review

Objective:

The primary objective of this scoping review was to examine and map the range of neurophysiological impacts of human touch and eye gaze, and consider their potential relevance to the therapeutic relationship and to healing.

Introduction:

Clinicians, and many patients and their relatives, have no doubt as to the efficacy of a positive therapeutic relationship; however, much evidence is based on self-reporting by the patient or observation by the researcher. There has been little formal exploration into what is happening in the body to elicit efficacious reactions in patients. There is, however, a growing body of work on the neurophysiological impact of human interaction. Physical touch and face-to-face interaction are two central elements of this interaction that produce neurophysiological effects on the body.

Inclusion criteria:

This scoping review considered studies that included cognitively intact human subjects in any setting. This review investigated the neurophysiology of human interaction including touch and eye gaze. It considered studies that have examined, in a variety of settings, the neurophysiological impacts of touch and eye gaze. Quantitative studies were included as the aim was to examine objective measures of neurophysiological changes as a result of human touch and gaze.

Methods:

An extensive search of multiple databases was undertaken to identify published research in the English language with no date restriction. Data extraction was undertaken using an extraction tool developed specifically for the scoping review objectives.

Results:

The results of the review are presented in narrative form supported by tables and concept maps. Sixty-four studies were included and the majority were related to touch with various types of massage predominating. Only seven studies investigated gaze with three of these utilizing both touch and gaze. Interventions were delivered by a variety of providers including nurses, significant others and masseuses. The main neurophysiological measures were cortisol, oxytocin and noradrenaline.

Conclusions:

The aim of this review was to map the neurophysiological impact of human touch and gaze. Although our interest was in studies that might have implications for the therapeutic relationship, we accepted studies that explored phenomena outside of the context of a nurse-patient relationship. This allowed exploration of the boundary of what might be relevant in any therapeutic relationship. Indeed, only a small number of studies included in the review involved clinicians (all nurses) and patients. There was sufficient consistency in trends evident across many studies in regard to the beneficial impact of touch and eye gaze to warrant further investigation in the clinical setting. There is a balance between tightly controlled studies conducted in an artificial (laboratory) setting and/or using artificial stimuli and those of a more pragmatic nature that are contextually closer to the reality of providing nursing care. The latter should be encouraged.

Australian massage therapists' views and practices related to preconception, pregnancy and the early postpartum period

BACKGROUND AND PURPOSE

Massage is commonly used by the Australian public and is often sought by expectant mothers. Despite its popularity there is no regulatory body to enforce minimum educational standards, guidelines or evidence-based best practice for massage therapists. The aim of this paper is to critically examine the views and practices of massage therapists who offer preconception, antenatal or postnatal massage.

MATERIALS AND METHODS

An online survey was administered to Australian massage therapists who provide massage in the preconception, antenatal or postnatal periods.

RESULTS

Ninety-nine therapists completed the survey. The majority of respondents had received training in pregnancy massage (n = 72; 72.7%) only. The most confident respondents were those that had both training and experience.

CONCLUSION

There are potential gaps in training for massage therapists including up-to-date curriculum and a fragmentation around industry training requirements for pregnancy massage, which may impact on the safety and benefits of pregnancy massage.

Effects of Brief Mood-Improving Interventions on Immunity: A Systematic Review and Meta-Analysis

OBJECTIVE

Positive mood has been associated with enhanced immune function. Interventions that improve mood could therefore provide a mechanism for optimizing immune-related health outcomes. Brief interventions that improve mood, also known as mood inductions, potentially offer a pragmatic approach to enhancing immune function for finite periods where this would be beneficial to health (e.g., in advance of vaccination or surgery). This review sought to systematically examine the evidence regarding the effects of brief, single-session positive mood interventions on immunity.

METHODS

Systematic searches of electronic databases were performed from earliest records to July 25, 2018. We identified 42 interventions suitable for inclusion, 6 of which were tested in multiple subpopulations. Random-effects meta-analyses were performed for pre-post experimental group immune outcomes measured in at least five intervention studies.

RESULTS

Although interventions were heterogeneous, 81% resulted in a statistically significant change in at least one immune parameter after the positive mood intervention for one or more of the subpopulations examined. However, studies were, in general, of low-to-moderate quality with small sample sizes (median n = 32) and did not examine the persistence or clinical relevance of the immune changes observed. Random-effects meta-analyses showed a significant medium-sized effect of interventions on increasing secretory IgA concentration (g = 0.65), a small but statistically significant effect for increased Interleukin-6 production (g = 0.12), and nonsignificant effects on natural killer cell activity (g = 0.15).

CONCLUSIONS

The current literature suggests that improvements in mood resulting from brief interventions can influence some immune parameters in ways indicative of enhanced immune function. However, there is a need for higher-quality research in this area that focuses on clinically relevant immune outcomes and mechanisms.

A Regional Analysis of U.S. Insurance Reimbursement Guidelines for Massage Therapy

INTRODUCTION

Massage techniques fall within the scope of many different health care providers. Physical therapists, occupational therapists, and chiropractors receive insurance reimbursement for health care services, including massage. Although many patients pay out of pocket for massage services, it is unclear how the insurance company reimbursement policies factor provider qualifications into coverage. This project examined regional insurance reimbursement guidelines for massage therapy in relation to the role of the provider of massage services.

METHODS

A qualitative content analysis was used to explore guidelines for 26 health insurance policies across seven US companies providing coverage in the northeastern United States. Publicly available information relevant to massage was obtained from insurance company websites and extracted into a dataset for thematic analysis. Data obtained included practice guidelines, techniques, and provider requirements. Information from the dataset was coded and analyzed using descriptive statistics.

RESULTS

Of the policies reviewed, 23% explicitly stated massage treatments were limited to 15-minute increments, 19% covered massage as one part of a comprehensive rehabilitation plan, and 27% required physician prescription. Massage techniques mentioned as qualifying for reimbursement included: Swedish, manual lymphatic drainage, mobilization/manipulation, myofascial release, and traction. Chiropractors, physical therapists, and occupational therapists could directly bill for massage. Massage therapists were specifically excluded as covered providers for seven (27%) policies.

CONCLUSION

Although research supports massage for the treatment of a variety of conditions, the provider type has not been separately addressed. The reviewed policies that served the Northeastern states explicitly stated massage therapists could not bill insurance companies directly. The same insurance companies examined reimbursement for massage therapists in their western U.S. state policies. Other health care providers were able to bill directly for massage services to companies that did not accept direct billing by massage therapists. The specific exclusion of massage therapists as eligible providers violates the Affordable Care Act's non-discriminatory provision. Massage therapists should continue to advocate for reimbursement privileges to spur wider acceptance of massage therapy in health care.

Clarifying Definitions for the Massage Therapy Profession: the Results of the Best Practices Symposium

BACKGROUND

Massage therapists are at times unclear about the definition of massage therapy, which creates challenges for the profession. It is important to investigate the current definitions and to consider the field as a whole in order to move toward clarity on what constitutes the constructs within the profession.

PURPOSE

To determine how a sample of experts understand and describe the field of massage therapy as a step toward clarifying definitions for massage and massage therapy, and framing the process of massage therapy practice.

SETTING

A two-day symposium held in 2010 with the purpose of gathering knowledge to inform and aid in the creation of massage therapy best practice guidelines for stress and low back pain.

PARTICIPANTS

Thirty-two experts in the field of massage therapy from the United States, Europe, and Canada.

DESIGN

Qualitative analysis of secondary cross-sectional data using a grounded theory approach.

RESULTS

Three over-arching themes were identified: 1) What is massage?; 2) The multidimensional nature of massage therapy; and 3) The influencing factors on massage therapy practice.

DISCUSSION

The data offered clarifying definitions for massage and massage therapy, as well as a framework for the context for massage therapy practice. These clarifications can serve as initial steps toward the ultimate goal of creating new theory for the field of massage therapy, which can then be applied in practice, education, research, and policy.

CONCLUSIONS

Foundational research into how experts in the profession understand and describe the field of massage therapy is limited. Understanding the potential differences between the terms massage and massage therapy could contribute to a transformation in the profession in the areas of education, practice, research, policy and/or regulation. Additionally, framing the context for massage therapy practice invites future discussions to further clarify practice issues.

Do Patient Profiles Influence the Effects of Massage? A Controlled Clinical Trial

Considerable scientific evidence has been published on the effectiveness of massage in different conditions, but it remains unclear whether this effectiveness is modulated by the profile of patients. The aim of this study was to compare the effects of a 21-min myofascial therapy protocol on stress responders and nonresponders stressed in the laboratory with a cold pressor test. Dependent variables included heart rate variability (HRV), blood pressure, and salivary markers such as flow rate, cortisol, immunoglobulin A (IgA), and α-amylase activity. A controlled, repeated measures, single-blind trial was conducted in 30 Caucasian students with a mean (SD) age of 20.70 (4.50) years. We found no significant between-group differences in descriptive characteristics or in any preintervention outcome measure. Analysis of covariance revealed significant increases in HRV index (F = 0.18, p = .01), salivary flow rate (F = 0.16, p = .02), and salivary IgA concentration (F = 4.36, p = .04) and significant decreases in the low-frequency domain (F = 0.18, p = .04) and LF-high-frequency ratio (F = 0.18, p = .01) in the stress responder group in comparison to the nonresponder group. In conclusion, a better response to massage was observed in stress responders than in nonresponders across various HRV parameters and salivary measures.

Self Management Behaviors in Rheumatoid Arthritis Patients and Associated Factors in Tehran 2013

INTRODUCTION

Rheumatoid Arthritis (RA) is a systemic, autoimmune and inflammatory disease with an unknown etiology that is associated with progressive joint degeneration, limitation of physical activity and disability. The aim of the study was to evaluate self-management behaviors and their associated factors in RA patients.

MATERIAL & METHOD

This cross-sectional study was performed in 2013 on185 patients in Iran. Data were selected through convenient sampling. The collected data included demographic variables, disease related variables, Arthritis Impact Measurement Scale 2 (AIMS-2SF), and Self-Management Behaviors (SMB). Data were analyzed by SPSS17 using Spearman correlation and logistic regression test.

RESULT

In this study drug management, regular follow-up, and food supplement were used as the most frequently applied SMB and aquatic exercise, diet, massage therapy, and relaxation were the least common SMBs. Age, education, health status, occupation, marital status, sex, DAS28 (Disease Activity Score 28 joints), and PGA (Physician Global Assessment) were significantly related with SMB.

CONCLUSION

The result of the study highlight the influence of demographic variables, health status, and disease related data on SMB. Thus, more studies are required to find factors influencing SMB in order to improve SMB.

Effects of Anma massage therapy (Japanese massage) for gynecological cancer survivors: study protocol for a randomized controlled trial

BACKGROUND

Cancer patients and survivors regularly feel anxious about cancer recurrence or death, even after the conclusion of medical treatment, and they are often highly physiologically and psychologically stressed. Massage therapy is one of the most widely used complementary and alternative therapies used in the hope of alleviating such stress and physical and psychological complaints and to improve health-related quality of life. This randomized phase III, two-armed, parallel group, clinical trial was designed after obtaining positive findings in a preliminary study. The primary objective is to verify the effects of continuous Japanese massage therapy, referred to as Anma therapy, for cancer survivors. The secondary objective is to confirm the immediate effects of a single Anma massage session for cancer survivors.

METHODS/DESIGN

Sixty cancer survivors older than 20 years of age who have had histologically confirmed uterine cervical, endometrial, ovarian, fallopian tube or peritoneal cancer in the past, but with no recurrence for more than 3 years since receiving standard medical treatment, are being recruited by gynecologists in medical facilities. In the coordinating office, they are randomly allocated to two groups (n = 30 each): an Anma massage group receiving a 40-min Anma massage session once weekly over a 2-month intervention period (total of eight Anma massage sessions) and a control group being followed by medical doctors and receiving no Anma massage sessions. The primary end point is the severity of physical subjective symptoms that cancer survivors report in daily life, assessed using a Visual Analogue Scale. Secondary end points are urine and saliva analyses, psychological condition and health-related quality-of-life scores as determined on the basis of a self-report questionnaire.

DISCUSSION

Using the evidence-based findings of this trial, medical professionals should be able to explain the benefits conferred by Anma massage to cancer survivors and provide higher-quality information to better inform patients regarding their decisions about whether to receive such therapy.

TRIAL REGISTRATION

This trial is registered with the UMIN Clinical Trials Registry as UMIN000009097.

Exploring the nature of therapeutic massage bodywork practice

BACKGROUND

Research on therapeutic massage bodywork (TMB) continues to expand, but few studies consider how research or knowledge translation may be affected by the lack of uniformly standardized competencies for most TMB therapies, by practitioner variability from training in different forms of TMB, or from the effects of experience on practice.

PURPOSE

This study explores and describes how TMB practitioners practice, for the purpose of improving TMB training, practice, and research. PARTICIPANTS SETTING: 19 TMB practitioners trained in multiple TMB therapies, in Alberta, Canada.

RESEARCH DESIGN

Qualitative descriptive sub-analysis of interviews from a comprehensive project on the training and practice of TMB, focused on the delivery of TMB therapies in practice.

RESULTS

TWO BROAD THEMES EMERGED FROM THE DATA: (1) every treatment is individualized, and (2) each practitioner's practice of TMB therapies evolves. Individualization involves adapting treatment to the needs of the patient in the moment, based on deliberate and unconscious responses to verbal and nonverbal cues. Individualization starts with initial assessment and continues throughout the treatment encounter. Expertise is depicted as more nuanced and skilful individualization and treatment, evolved through experience, ongoing training, and spontaneous technique exploration. Practitioners consider such individualization and development of experience desirable. Furthermore, ongoing training and experience result in therapy application unique to each practitioner. Most practitioners believed they could not apply a TMB therapy without influence from other TMB therapies they had learned.

CONCLUSIONS

There are ramifications for research design, knowledge translation, and education. Few practitioners are likely able to administer treatments in the same way, and most would not like to practice without being able to individualize treatment. TMB clinical studies need to employ research methods that accommodate the complexity of clinical practice. TMB education should facilitate the maturation of practice skills and self-reflection, including the mindful integration of multiple TMB therapies.

The Greater Value of the CONSORT Statement Guidelines: Guideposts for Designing and Reporting all TMB Research

The IJTMB recommends the use of the CONSORT Statement (Consolidated Standards of Reporting Trials) guidelines for the reporting of randomized, controlled clinical trials (RCTs). A careful review of the guidelines shows important applications of these guidelines to all types of research reporting and design, not just RCTs. There is an Extension to these guidelines specific to nonpharmacologic interventions, including manually applied therapies and complementary medicine, and thus therapeutic massage and bodywork (TMB). Components of the Extension are thus relevant to publication in the IJTMB and should be considered part of standard reporting. As well, while the goals of the CONSORT Statement guidelines are to improve reporting of RCTs, the issues raised in the guidelines and explanatory document are relevant to all forms of TMB research and should be considered in all TMB research manuscripts. Finally, while not their purpose, the guidelines could also be used as an informal checklist when developing robust TMB research.

Interpersonal touch: physiological effects in critical care

INTRODUCTION

Nurses use several forms of touch in patient encounters. Interpersonal touch elicits specific physiological and psychological responses, including neuroendocrine effects and reduction of stress. Critical illness is a state of excessive physiological and psychological stress.

AIMS

To critically review evidence on the effect of touch on physiological outcomes in critically ill individuals. Results of intervention studies in adult critical care settings were reviewed along with supportive evidence from studies in other populations.

METHODS

Critical literature review based on studies published in MEDLINE, PubMed, Cinahl, Embase, and Cochrane databases.

RESULTS

Eleven studies were reviewed. Significant effects of interpersonal touch included lower systolic and diastolic blood pressure and respiratory rate, improved sleep, and decreased pain. Almost no results were replicated owing to discrepancies among studies. Although the effect of touch on cardiovascular autonomic status appears considerable, several confounders must be considered. In noncritically ill populations, replicable findings included increased urinary dopamine and serotonin, natural killer cytotoxic activity, and salivary chromogranin. Effects on plasma cortisol and immune cells were variable. Effects appear to vary according to amount of pressure, body site, duration, and timing: Moderate pressure touch may elicit a parasympathetic response in contrast to light touch, which may elicit a sympathetic response. Moreover, touch effects may be mediated by the density of autonomic innervation received by the body areas involved and repetition of sessions.

CONCLUSION

The physiological pathway mediating the effects of touch is unclear. Although no concrete conclusions can be drawn, research evidence suggests that touch interventions may benefit critically ill individuals.

Zoologic companion animal rehabilitation and physical medicine

Injury and illness in zoologic companion animals can lead to significant pain and debilitation. Recovery can be slow and sometimes frustrating. By augmenting recovery from trauma or disease with physical medicine and rehabilitation techniques, recovery can be more rapid and complete. Physical medicine techniques, such as massage, can augment recovery from a painful injury or surgery by reducing edema, improving postoperative ileus, and decreasing anxiety. Familiarity with the tools of rehabilitation along with focus on pain management, strengthening, and proprioception improve patient care.