Massage therapy effects on depressed pregnant women

Tactile emoticons: Conveying social emotions and intentions with manual and robotic tactile feedback during social media communications

Touch offers important non-verbal possibilities for socioaffective communication. Yet most digital communications lack capabilities regarding exchanging affective tactile messages (tactile emoticons). Additionally, previous studies on tactile emoticons have not capitalised on knowledge about the affective effects of certain mechanoreceptors in the human skin, e.g., the C-Tactile (CT) system. Here, we examined whether gentle manual stroking delivered in velocities known to optimally activate the CT system (defined as 'tactile emoticons'), during lab-simulated social media communications could convey increased feelings of social support and other prosocial intentions compared to (1) either stroking touch at CT sub-optimal velocities, or (2) standard visual emoticons. Participants (N = 36) felt more social intent with CT-optimal compared to sub-optimal velocities, or visual emoticons. In a second, preregistered study (N = 52), we investigated whether combining visual emoticons with tactile emoticons, this time delivered at CT-optimal velocities by a soft robotic device, could enhance the perception of prosocial intentions and affect participants' physiological measures (e.g., skin conductance rate) in comparison to visual emoticons alone. Visuotactile emoticons conveyed more social intent overall and in anxious participants affected physiological measures more than visual emoticons. The results suggest that emotional social media communications can be meaningfully enhanced by tactile emoticons.

A systematic review and multivariate meta-analysis of the physical and mental health benefits of touch interventions

Receiving touch is of critical importance, as many studies have shown that touch promotes mental and physical well-being. We conducted a pre-registered (PROSPERO: CRD42022304281) systematic review and multilevel meta-analysis encompassing 137 studies in the meta-analysis and 75 additional studies in the systematic review (n = 12,966 individuals, search via Google Scholar, PubMed and Web of Science until 1 October 2022) to identify critical factors moderating touch intervention efficacy. Included studies always featured a touch versus no touch control intervention with diverse health outcomes as dependent variables. Risk of bias was assessed via small study, randomization, sequencing, performance and attrition bias. Touch interventions were especially effective in regulating cortisol levels (Hedges' g = 0.78, 95% confidence interval (CI) 0.24 to 1.31) and increasing weight (0.65, 95% CI 0.37 to 0.94) in newborns as well as in reducing pain (0.69, 95% CI 0.48 to 0.89), feelings of depression (0.59, 95% CI 0.40 to 0.78) and state (0.64, 95% CI 0.44 to 0.84) or trait anxiety (0.59, 95% CI 0.40 to 0.77) for adults. Comparing touch interventions involving objects or robots resulted in similar physical (0.56, 95% CI 0.24 to 0.88 versus 0.51, 95% CI 0.38 to 0.64) but lower mental health benefits (0.34, 95% CI 0.19 to 0.49 versus 0.58, 95% CI 0.43 to 0.73). Adult clinical cohorts profited more strongly in mental health domains compared with healthy individuals (0.63, 95% CI 0.46 to 0.80 versus 0.37, 95% CI 0.20 to 0.55). We found no difference in health benefits in adults when comparing touch applied by a familiar person or a health care professional (0.51, 95% CI 0.29 to 0.73 versus 0.50, 95% CI 0.38 to 0.61), but parental touch was more beneficial in newborns (0.69, 95% CI 0.50 to 0.88 versus 0.39, 95% CI 0.18 to 0.61). Small but significant small study bias and the impossibility to blind experimental conditions need to be considered. Leveraging factors that influence touch intervention efficacy will help maximize the benefits of future interventions and focus research in this field.

Swedish massage as an adjunct approach to Help suppOrt individuals Pregnant after Experiencing a prior Stillbirth (HOPES): a convergent parallel mixed-methods single-arm feasibility trial protocol

BACKGROUND

Women experiencing pregnancy after stillbirth experience high levels of anxiety, fear and depression. Standard antenatal care may be emotionally unsuitable for many women at this time, and there is a lack of evidence on what interventions or approaches to care might benefit these women. Therapeutic massage may assist women after stillbirth by decreasing anxiety, worry and stress.

OBJECTIVE

This paper outlines the objectives, methodology, outcome and assessment measures for the Helping suppOrt individuals Pregnant after Experiencing a Stillbirth (HOPES) feasibility trial which evaluates massage as an adjunct approach to care for pregnant women who have experienced a prior stillbirth. It also outlines data collection timing and considerations for analysing the data.

METHODS

HOPES will use a convergent parallel mixed-methods, single-arm repeated measures trial design in trained massage therapists' private clinics across Australia. HOPES aims to recruit 75 individuals pregnant after a previous stillbirth. The intervention is massage therapy treatments, and participants will receive up to five massages within a 4-month period at intervals of their choosing. Primary quantitative outcomes are the feasibility and acceptability of the massage intervention. Secondary outcomes include determining the optimal timing of massage therapy delivery and the collection of measures for anxiety, worry, stress and self-management. A thematic analysis of women's experiences undertaking the intervention will also be conducted. A narrative and joint display approach to integrate mixed-methods data is planned.

DISCUSSION

The HOPES study will determine the feasibility and preliminary evidence for massage therapy as an intervention to support women who are pregnant after a stillbirth.

TRIAL REGISTRATION

CLINICALTRIALS

gov NCT05636553. Registered on December 3, 2022, and the trial is ongoing.

The Effectiveness of Massage in Managing Pregnant Women with Pelvic Girdle Pain: a Randomised Controlled Crossover Feasibility Study

Introduction

Pelvic girdle pain is a common problem experienced during pregnancy, with high incidence rates and significant impacts on quality of life. Remedial massage might be able to provide some reduction in pain.

Aim

This study aimed to investigate the feasibility of conducting a randomised controlled trial on the effectiveness of massage in treating pregnant women with pelvic girdle pain to determine its merits and viability for use in a large-scale study.

Methods

A two-arm pilot randomised feasibility crossover-controlled trial. The two treatment phases were a) remedial pregnancy massage, and b) exercise.

Results

Twenty-four women started the study and 19 women completed the study. Data were collected on recruitment and retention rates, crossover study design methodology, participant sub-characteristics, and acceptability of the outcome measures (pain, quality of life, and disability).

Conclusion

Recruiting participants for a pregnancy-related pelvic girdle pain study is indeed feasible; however, a crossover study design is not appropriate and future studies should consider a mixed methods study design.

Inhalation of Origanum majorana L. essential oil while working reduces perceived stress and anxiety levels of nurses in a COVID-19 intensive care unit: a randomized controlled trial

Background

Nurses caring for patients with coronavirus disease 2019 (COVID-19) experience higher psychosocial distress than other healthcare workers, and this can adversely affect the quality of patient care. There is evidence that inhalation of essential oil from marjoram (Origanum majorana L.) has calming effects, suggesting this intervention may help to reduce the stress and anxiety of nurses working in a COVID-19 intensive care unit (ICU). This study aimed to investigate the effect of inhalation of marjoram essential oil at work on the stress and anxiety levels of nurses in a COVID-19 ICU.

Methods

Nurses (n = 57) working in a single COVID-19 ICU were randomly assigned to inhale 3% marjoram essential oil (marjoram group, n = 29) or almond oil (control group, n = 28) for 2 h while at work. Mean arterial pressure (MAP), heart rate, state anxiety score, and score on a visual analog scale for anxiety (VAS-anxiety) and stress (VAS-stress) were measured before and after the intervention.

Results

The two groups had similar baseline variables. MAP did not have within-group or between-group differences. Heart rate increased significantly in the marjoram group after the intervention (p = 0.031), but it remained within the normal range and the increase was not clinically meaningful. There was no significant between-group difference in the state-anxiety or VAS-anxiety score after the intervention, but the marjoram group had a significantly lower state-anxiety (p = 0.001) and VAS-anxiety (p = 0.037) score at posttest vs. pretest. The VAS-stress score was significantly lower in the marjoram group at the posttest vs. the pretest (p = 0.026).

Conclusion

Nurses caring for patients in a COVID-19 ICU experience significant stress, and strategies are needed to address this important issue. Inhalation of 3% marjoram essential oil while caring for patients in a COVID-19 ICU may be a simple and effective intervention that reduces perceived stress and anxiety in nurses.Clinical Trial Registration: https://cris.nih.go.kr/, KCT0007543.

The influence of laughter yoga on pregnancy symptoms, mental well-being, and prenatal attachment: A randomized controlled study

The researchers' aim was to evaluate the impact of laughter yoga on pregnancy symptoms, mental well-being, and prenatal attachment. They carried out this study on 85 pregnant women randomized in a maternity hospital in the Eastern Anatolia Region of Turkey. The researchers collected data using the Pregnant Introduction Form, Pregnancy Symptom Inventory (PSI), Warwick-Edinburgh Mental Well-being Scale (WEMWBS), and Prenatal Attachment Inventory (PAI). After applying the laughter yoga practice, they found that mental well-being and prenatal attachment levels were higher in pregnant women in the experimental group and the difference was statistically significant. Thus, they concluded that laughter yoga was an effective practice in reducing the frequency of pregnancy symptoms and limiting daily activities by pregnancy symptoms and increasing mental well-being and prenatal attachment levels.

Self-soothing touch and being hugged reduce cortisol responses to stress: A randomized controlled trial on stress, physical touch, and social identity

Background

Being touched by others improves stress coping. However, when touch from others is unavailable, feels uncomfortable, or is not considered to be safe (as in the COVID-19 pandemic), self-touch gestures, like placing a hand on the heart, may provide an alternative way to experience less strain.

Methods and materials

In this study, 159 healthy participants (96 women, 62 men, and 1 non-binary person), aged 18–35 years, were exposed to a standardized psychosocial stressor (Trier Social Stress Test) to investigate whether self-soothing touch or receiving a hug from others has a buffering effect on their stress responses. In addition, the study explored whether the effectiveness of these interventions is moderated by participants' assignment to a “personal” or “social” identity condition. Participants provided salivary cortisol samples, wore an ECG to record their heart rate, and completed self-report measures on stress-related subjective-emotional states during the study.

Results

For cortisol, mixed-effects regression models with Touch and Identity as between-subject factors and Time as the within-subject factor yielded a significant main effect for touch and a significant interaction of Touch x Time indicating that cortisol levels differed between the experimental touch interventions. Post-hoc contrast tests showed that participants in both touch conditions had lower cortisol levels after the stressor than those in the control conditions. Heart rates and self-reported measures of stress neither differed across touch nor identity conditions. The three-way interaction for Touch x Identity x Time was non-significant for either outcome measure.

Discussion

These results are in line with previous work indicating that physical touch has protective effects on physiological stress responses but not necessarily on self-reported stress and suggest that self-soothing touch and receiving hugs are simple and yet potentially powerful means for buffering individuals' resilience against stress.

•

Self-soothing touch gestures reduce cortisol responses to psychosocial stress.

•

Receiving hugs also reduces cortisol responses to psychosocial stress.

•

Benefits from receiving hugs are independent of social identification.

•

Self-soothing touch might reduce stress-responses in times of limited social resources.

Massage During Pregnancy and Postpartum

Massage is systematic touch and manipulation of the soft tissues of the body that is increasingly being used as an adjunctive therapy for stress relief and to promote relaxation and wellbeing during pregnancy and as an alternative to pharmacologic or invasive forms of analgesia during labor. Literature to support the use of massage in pregnancy and labor is limited; however, evidence to support its use has been increasing over the past 30 years. Massage has been shown to be valuable to pregnant women with anxiety, depression, leg, and back pain, and has shown significant benefit in perception of pain during labor.

Widespread Pressure Delivered by a Weighted Blanket Reduces Chronic Pain: A Randomized Controlled Trial

Pleasant sensation is an underexplored avenue for modulation of chronic pain. Deeper pressure is perceived as pleasant and calming, and can improve sleep. Although pressure can reduce acute pain, its effect on chronic pain is poorly characterized. The current remote, double-blind, randomized controlled trial tested the hypothesis that wearing a heavy weighted blanket - providing widespread pressure to the body - relative to a light weighted blanket would reduce ratings of chronic pain, mediated by improvements in anxiety and sleep. Ninety-four adults with chronic pain were randomized to wear a 15-lb. (heavy) or 5-lb. (light) weighted blanket during a brief trial and overnight for one week. Measures of anxiety and chronic pain were collected pre- and post-intervention, and ratings of pain intensity, anxiety, and sleep were collected daily. After controlling for expectations and trait anxiety, the heavy weighted blanket produced significantly greater reductions in broad perceptions of chronic pain than the light weighted blanket (Cohen's f = .19, CI [-1.97, -.91]). This effect was stronger in individuals with high trait anxiety (P = .02). However, weighted blankets did not alter pain intensity ratings. Pain reductions were not mediated by anxiety or sleep. Given that the heavy weighted blanket was associated with greater modulation of affective versus sensory aspects of chronic pain, we propose that the observed reductions are due to interoceptive and social/affective effects of deeper pressure. Overall, we demonstrate that widespread pressure from a weighted blanket can reduce the severity of chronic pain, offering an accessible, home-based tool for chronic pain. The study purpose, targeted condition, study design, and primary and secondary outcomes were pre-registered in ClinicalTrials.gov (NCT04447885: "Weighted Blankets and Chronic Pain"). Perspective: This randomized-controlled trial showed that a 15-lb weighted blanket produced significantly greater reductions in broad perceptions of chronic pain relative to a 5-lb weighted blanket, particularly in highly anxious individuals. These findings are relevant to patients and providers seeking home-based, nondrug therapies for chronic pain relief.

Effects, Side Effects and Contraindications of Relaxation Massage during Pregnancy: A Systematic Review of Randomized Controlled Trials

Healthcare professionals and expecting mothers frequently voice concerns that massages during pregnancy might cause complications or premature labor. This PRISMA review outlines current results on effects, side effects and contraindications of relaxation massage during pregnancy. Inclusion criteria: all randomized controlled trials (RCT) comparing relaxation massage during pregnancy with standard care or standard care plus another intervention (i.e., progressive muscle relaxation). Restrictions were full text availability and English language. Results: 12 RCT were included. Trials had good methodological quality but unknown risk of bias. All women were at least 12 weeks gestation at the start of the study. The main benefits of massage during pregnancy were: reduced stress, back and leg pain, depression and anxiety; increased immune response; increased serotonin and dopamine levels; higher fetal birth weight and reduced risk of preterm delivery. Only 2 RCT reported potential side effects of massage, which were minor and transient. Seven RCT excluded women with difficult pregnancies or preexisting complications, five studies did not report preexisting conditions. Those obstetric or postnatal complications that occurred were most likely unrelated to massage treatments. In healthy pregnant women without complications, relaxation massage has positive effects throughout pregnancy. Precautions for massage during pregnancy (i.e., to prevent pulmonary embolism) are discussed.

Positive Massage: An Intervention for Couples' Wellbeing in a Touch-Deprived Era

COVID-19 has brought not only fear and anxiety, but also legitimate restrictions of communication and consequential touch-deprivation in our daily lives. Couples' relational wellbeing continues to be impacted by these COVID-19 related stressors. Protecting both personal and relational wellbeing is therefore particularly important at this time. Using a preventative intervention approach, the current paper argues the theoretical benefit of the Positive Massage programme and reports a qualitative analysis of stressed but healthy couples' experience of engaging in the programme. Thirty-four participants completed 3 weekly classes and home-based practice of massage exchange. Data from an open text online questionnaire completed every week of the programme and again 3 weeks afterwards were analysed using thematic analysis. The identified themes included "holistic stress relief", "relationship-promotion", and "selves-care skill". Couples perceived Positive Massage as an effective mutual support skill to relax and help one another by de-stressing, both emotionally and physically through verbal and nonverbal communication, creating gratitude, deeper connection and self-efficacy via quality time together and pleasurable touch. Theoretically and experientially, Positive Massage can be an effective preventative selves-care skill. Promoting the concept of selves-care and its practical application through Positive Massage would be beneficial for couples' personal and relational wellbeing in a touch-deprived era.

Key indicators of repetitive overuse-induced neuromuscular inflammation and fibrosis are prevented by manual therapy in a rat model

BACKGROUND

We examined the effectiveness of a manual therapy consisting of forearm skin rolling, muscle mobilization, and upper extremity traction as a preventive treatment for rats performing an intensive lever-pulling task. We hypothesized that this treatment would reduce task-induced neuromuscular and tendon inflammation, fibrosis, and sensorimotor declines.

METHODS

Sprague-Dawley rats performed a reaching and lever pulling task for a food reward, 2 h/day, 3 days/week, for 12 weeks, while simultaneously receiving the manual therapy treatment 3 times per week for 12 weeks to either the task-involved upper extremities (TASK-Tx), or the lower extremities as an active control group (TASK-Ac). Results were compared to similarly treated control rats (C-Tx and C-Ac).

RESULTS

Median nerves and forearm flexor muscles and tendons of TASK-Ac rats showed higher numbers of inflammatory CD68+ and fibrogenic CD206+ macrophages, particularly in epineurium, endomysium and epitendons than TASK-Tx rats. CD68+ and CD206+ macrophages numbers in TASK-Tx rats were comparable to the non-task control groups. TASK-Ac rats had more extraneural fibrosis in median nerves, pro-collagen type I levels and immunoexpression in flexor digitorum muscles, and fibrogenic changes in flexor digitorum epitendons, than TASK-Tx rats (which showed comparable responses as control groups). TASK-Ac rats showed cold temperature, lower reflexive grip strength, and task avoidance, responses not seen in TASK-Tx rats (which showed comparable responses as the control groups).

CONCLUSIONS

Manual therapy of forelimbs involved in performing the reaching and grasping task prevented the development of inflammatory and fibrogenic changes in forearm nerves, muscle, and tendons, and sensorimotor declines.

High Fives: Effekte auf psychophysiologische Parameter und sportliche Leistung

Zusammenfassung. High- und Low-Fives stellen im Sport verbreitete aber unerforschte Phänomene dar. Ziel der Studie ist es, den bislang unklaren Einfluss auf psychophysiologische, soziale und leistungsrelevante Parameter zu untersuchen. In einem Innersubjektdesign nahmen 23 tischtennisaffine Dyaden teil. Vor und nach den Bewegungsmanipulationen (High-Fives alleine; High-Fives mit Partner_in; Low-Fives alleine; Low-Fives mit Partner_in; Kontrollbedingung) gaben Versuchspersonen Auskunft über Motivation, Macht, Affekt und wahrgenommene Nähe zum/zur Partner_in. Ebenfalls gaben sie Speichel zur Erfassung von Cortisol ab. Anschließend wurde die Aufschlagleistung im Tischtennis erhoben. Ergebnisse zeigten weder Unterschiede in der Veränderung der psychophysiologischen Parameter noch in der Leistung zwischen den Bedingungen. Lediglich die wahrgenommene Nähe stieg in den Bedingungen mit Partner_in an. Die Ergebnisse widersprechen den Theorien des Embodiments, was hinsichtlich der unnatürlichen Bewegungsausführung diskutiert wird. Allerdings sind unsere Ergebnisse im Einklang mit Theorien über die Funktionen von Berührungen und zeigen erstmalig für den sportlichen Kontext, dass High- und Low-Fives einen positiven Effekt auf soziale Strukturen haben.

The Roles of Serotonin in Neuropsychiatric Disorders

The serotonergic system extends throughout the central nervous system (CNS) and the gastrointestinal (GI) tract. In the CNS, serotonin (5-HT, 5-hydroxytryptamine) modulates a broad spectrum of functions, including mood, cognition, anxiety, learning, memory, reward processing, and sleep. These processes are mediated through 5-HT binding to 5-HT receptors (5-HTRs), are classified into seven distinct groups. Deficits in the serotonergic system can result in various pathological conditions, particularly depression, schizophrenia, mood disorders, and autism. In this review, we outlined the complexity of serotonergic modulation of physiologic and pathologic processes. Moreover, we provided experimental and clinical evidence of 5-HT's involvement in neuropsychiatric disorders and discussed the molecular mechanisms that underlie these illnesses and contribute to the new therapies.

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.

The effectiveness of massage for reducing pregnant women's anxiety and depression; systematic review and meta-analysis

OBJECTIVE

To critically appraise and synthesize the best available evidence on the effectiveness of massage to reduce antenatal women's anxiety and/ or depression.

DESIGN

Systematic review with meta-analysis PARTICIPANTS, INTERVENTIONS: Pregnant women over the age of 18 years who receive massage interventions.

MEASUREMENTS AND FINDINGS

Eight studies were included in the review; seven were randomized controlled trials. Data were collected via pregnant women's self-reported ratings of anxiety or depression using validated tools. Meta-analysis of four studies revealed a moderate effect of massage therapy on women's depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) (MD = -5.95, 95%CI = -8.11 to -3.80, I² = 0%) compared with usual care. A moderate effect of massage interventions on women's anxiety were also found based on five studies using various measures (SMD = -0.59, 95%CI = -1.06 to -0.12, I² = 75%) when compared with usual care. However, none of the trials had a low risk of bias.

KEY CONCLUSIONS

Non-pharmacologic treatments for mental health symptoms are an important option for women to use during pregnancy. As shown in meta-analysed data, massage therapy might be more effective in reducing pregnant women's anxiety and depression than usual care, although the current results may be prone to bias. Further high-quality research is required to fully evaluate the impact of massage therapy on pregnant women's mental health symptoms in the immediate and also longer term.

IMPLICATIONS FOR PRACTICE

Massage therapy may be an acceptable and feasible approach for pregnant women to employ to reduce their anxiety and depressive symptoms. More research evidence examining the safety and effectiveness of massage is required before practice recommendations can be made.

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.

Maternal mental health and partner-delivered massage: A pilot study

BACKGROUND

Anxiety and depression affects many pregnant women. Massage may be beneficial for supporting mental wellbeing during this time. The aim of this study was to assess the feasibility and acceptability of a partner-delivered relaxation massage program for pregnant women, and its impact on symptoms of antenatal anxiety, stress and depression.

METHODS

A feasibility randomised controlled trial was conducted to compare partner-delivered relaxation massage (intervention) with self-directed stress management (control). Women attended an initial workshop at 28-32 weeks gestation followed by completion of a self-directed massage or stress management program. Qualitative data about the feasibility and acceptability (primary outcomes) were collected via online participant diaries and post-birth interviews. Anxiety, depression and stress symptoms (secondary outcomes) were assessed using the Depression and Anxiety Stress Scale (DASS-21). Birth outcomes were collected at the post- birth interview.

RESULTS

A total of 14 women/partner dyads in the massage group and 13 women in the self-directed stress management group, attended the initial workshops. When interviewed, participants from both groups reported that the programs were feasible and acceptable. Women's mean scores on all subscales of the DASS-21significantly decreased over time in both the intervention and the control group.

CONCLUSION

Pregnant women found the partner-delivered massage program to be feasible and acceptable. Both programs decreased women's symptoms of anxiety, depression and stress with no significant differences identified between the two groups. An adequately powered experimental study with a large representative sample is needed to determine whether partner-delivered relaxation massage reduces pregnant women's symptoms of anxiety, depression and stress.

Pregnancy-related Pelvic Girdle Pain and Pregnancy Massage: Findings from a Subgroup Analysis of an Observational Study

BACKGROUND

Pregnancy-related pelvic girdle pain (PPGP) significantly impacts women's lives both physically and psychologically. Given the severity and impact of PPGP on pregnancy, the authors anticipated that pregnant women with PPGP might respond differently to massage than pregnant women without PPGP.

PURPOSE

The aim of the study was to further analyze a published 2017 study to assess the response of pregnancy massage in participants with and without PPGP.

SETTING

Two massage clinics, one in Sydney and one in Melbourne, recruited participants from December 2016 to December 2017.

PARTICIPANTS

Nineteen women with PPGP and 78 without PPGP.

RESEARCH DESIGN

PPGP and non-PPGP women receiving at least one massage, with outcome measures assessed immediately prior to and after massage, and again one week postmassage.

MAIN OUTCOME MEASURES

Visual analog scales for pain, stress, range of movement, sleep, and self-reported side effects of massage.

RESULTS

Both groups changed significantly and similarly over time for measures of pain, stress, range of motion, and sleep (all p < .05). Post hoc analysis found significant reduction in all outcome measures immediately following massage, but returned to baseline at one week postmassage for all measures except pain, which remained reduced for the PPGP group (49.79±25.68 to 34.75±34.75, p = .03, effect size 0.593), and stress remained reduced in the non-PPGP group (33.36±21.54 to 24.90±19.18, p = .002, effect size 0.373). The PPGP group entered the study with higher baseline levels of pain (p = .01) and a greater restriction in range of motion (p = .006) than the non-PPGP group. There was no difference in the number of side effects experienced between the two groups (p = .130).

CONCLUSIONS

Although PPGP clients report greater pain and restriction in range of motion at baseline than non-PPGP clients, the response to pregnancy massage was similar. Results support a role of pregnancy massage in the management of PPGP. More research on massage for PPGP is needed to confirm a lasting effect of pain reduction from massage.

Maternal distress, HPA activity, and antenatal interventions: A systematic review

BACKGROUND

Elevated antenatal distress has been associated with negative outcomes for both mothers and, as a result, their infants. One mechanism hypothesised to underlie these associations is the maternal hypothalamic pituitary adrenal (HPA) axis. Though research has examined whether biopsychosocial antenatal interventions can reduce maternal HPA activity, only one review has summarized the nature of findings to date. The present study examined randomised control trials (RCTs) specifically; our primary aim was to assess the effectiveness of antenatal interventions in reducing HPA activity in pregnant women, our secondary aim was to examine whether antenatal interventions reduced maternal self-report of depression and/or anxiety.

METHODS

This study systematically reviewed RCTs that evaluated biopsychosocial interventions that reported subjective and objective markers of maternal distress in pregnant women within the clinical population.

RESULTS

Eight studies met inclusion criteria and women were in their second or third trimester. HPA-activity was primarily assessed through salivary cortisol (n = 7) and self-reported maternal distress was assessed using a variety of validated screening measures. Included trials demonstrated significant methodological heterogeneity and small sample sizes, poor treatment adherence, and poor reliability in cortisol measurement indicated low methodological quality.

CONCLUSIONS

Due to the high heterogeneity across studies, small sample sizes, and unreliable sampling methods, firm conclusions about the efficacy and effectiveness of antenatal interventions cannot be drawn. Despite this, interventions which targeted pregnancy-specific influencers of maternal mood were more likely to result in reduced depression and anxiety symptomatology as reported by mothers.

Osteopathic Approach to the Treatment of a Patient With an Atypical Presentation of Coccydynia

A 21-year-old man with atypical coccydynia that radiated bilaterally to his thigh and lower back came for treatment 10 years after coccyx trauma. Pertinent review of systems showed unintentional weight loss of 20 lb over the past 1 to 3 years, a body mass index of 14.94, significant depression, and poor concentration. In addition to treating his pain, we addressed the weight loss and depression that he was experiencing by advising a balanced diet, discovering the origins of what the patient believed caused his depression, and using osteopathic manipulative treatment. The patient was treated with osteopathic manipulative treatment to alleviate somatic dysfunctions diagnosed in the head, cervical, thoracic, lumbar, and sacral regions. At follow-up visits, the patient described a reduction in his pain symptoms from an initial 5 out of 10 to 3 out of 10 on his third visit. This case report outlines the importance of using a holistic approach when treating patients and advocates for using osteopathic manipulative treatment as a viable treatment option for patients with coccydynia.

A Pilot Study of Partner Chair Massage Effects on Perinatal Mood, Anxiety, and Pain

BACKGROUND

Women worldwide experience perinatal mood, anxiety, and pain contributing to pregnancy and birth challenges, maternal and infant bonding, and childhood development. Perinatal women seek massage therapy for relaxation, pain management, and emotional support, but may encounter socioeconomic barriers. Prior studies demonstrated improved perinatal health by teaching partners of pregnant women a side-lying massage.

PURPOSE

This study examined health effects to perinatal mood, anxiety, and pain, by teaching partners of pregnant (PG) women a chair massage.

SETTING

Participant's homes in Tucson, Arizona, USA.

PARTICIPANTS

Twelve PG women with minor mood, anxiety, and pain: 67% white, 33% Hispanic, college educated, married, aged 32 years (± 3.86 SD), 67% expecting a first child, annual incomes ≤ $50,000 (33%), > $50,000 (67%).

RESEARCH DESIGN

A pre/postintervention pilot study in a single group for eight weeks.

INTERVENTION

Twice weekly partner-delivered chair massage and its relation to perinatal mood, anxiety, and pain.

MAIN OUTCOME MEASURES

Pre/poststudy perinatal massage effects were measured with the Edinburgh Depression Scale (mood), the STAI-AD (anxiety), and the VAS (pain). Weekly text messaging tracked dose and frequency, follow-up surveys measured sustainability, and birth outcomes were acquired by texting.

RESULTS

Study retention was 86%, protocol compliance 94%, with couples averaging 10-minute, twice weekly chair massage over the eight-week study period. Paired-sample t tests indicated statistically significant improvements to perinatal mood and anxiety, Cohen's d, a large strength of effect size (p = .012, d = 0.87; p = .004, d = 1.03). A trend was observed for reduced pain, with a medium strength of effect size (p = .071; d = 0.58). Follow-up surveys indicated most couples were sustaining at least weekly massage. Birth outcomes showed healthy infants with no complications, mean birth weight of 7.26 pounds, and mean gestation of 39 weeks.

CONCLUSION

This is the first evidence of partner chair massage as safe and effective complementary home management of perinatal mood, anxiety, and pain.

Opening windows of opportunities: Evidence for interventions to prevent or treat depression in pregnant women being associated with changes in offspring's developmental trajectories of psychopathology risk

Although animal models and correlational studies support a model of fetal programming as a mechanism in the transmission of risk for psychopathology from parents to children, the experimental studies that are required to empirically test the model with the human prenatal dyad are scarce. With a systematic review and meta-analysis of the literature, we critically examined the evidence regarding the neurobiological and behavioral changes in infants as a function of randomized clinical trials to prevent or reduce maternal depression during pregnancy, treating randomized clinical trials as experiments testing the fetal programming model. Based on 25 articles that met inclusion criteria, we found support for interventions designed to change maternal prenatal mood being associated with changes in offspring functioning, but with a very small effect size. Effect sizes ranged broadly, and were higher for younger children. The findings enhance understanding of putative mechanisms in the transmission of risk from women's prenatal depression to infants' vulnerabilities to, and early signs of, the development of psychopathology. We note limitations of the literature and suggest solutions to advance understanding of how preventing or treating depression in pregnant women might disrupt the transmission of risk to the infants.

Effect of stress management training on depression, stress and coping strategies in pregnant women: a randomised controlled trial

INTRODUCTION

Pregnancy is a period of important biological and psychosocial changes and a period that carries high risk of experiencing anxiety and stress. It is important to reduce the depression and stress that is experienced in this period or to reduce the severity of the stress and to increase the stress coping power of the pregnant women. The research was conducted to examine the effect of stress management training on pregnant women's depression, stress and methods for coping with stress.

METHODS

Randomised controlled study of 202 pregnant women (experimental group: 103; control group: 99). The experimental group received stress management training and standard care; the control group received standard care. Data were collected using a Personal Information Form, the Beck Depression Inventory (BDI), Perceived Stress Scale (PSS) and ways of coping inventory (WCI).

RESULTS

Both groups showed a decrease in average BDI score during the study; the decrease was greater in the experimental group (p < 0.05). In the two assessments carried out after training the experimental group had lower average PSS scores than the control group (p < 0.05). At the second and third assessments the experimental group had higher scores than the control group on the self-confident approach and search for social support approach WCI subscales (ps < 0.05).

DISCUSSION

The average BDI and PSS scores of pregnant women in the experimental group decreased after training in coping with stress. Their scores on the self-confident approach, optimistic approach and search for social support WCI subscales increased. Stress management training is an effective method of encouraging pregnant women to take a positive approach to coping with stress.

The Potential Utility for Massage Therapy During Pregnancy to Decrease Stress and Tobacco Use

BACKGROUND

A significant number of women continue to smoke tobacco during pregnancy despite the increased risk of complications to fetal and infant development. Therefore, effective interventions are needed to assist pregnant women with the process of tobacco cessation. Traditional counseling programs have demonstrated some success; however, novel approaches that target stress as a mechanism in the maintenance of addiction would be valuable.

OBJECTIVE

To examine the role of stress in addiction and the utility of massage therapy to decrease stress during pregnancy.

CONCLUSION

Preliminary evidence suggests massage therapy may be beneficial to decreasing tobacco use, and research in pregnant populations is needed.

Construction and Validation of the Touch Experiences and Attitudes Questionnaire (TEAQ): A Self-report Measure to Determine Attitudes Toward and Experiences of Positive Touch

Despite growing interest in the beneficial effects of positive touch experiences throughout our lives, and individual differences in how these experiences are perceived, there is not yet available a contemporary self-report measure of touch experiences and attitudes, for which the factor structure has been validated. This article describes four studies carried out during the construction and validation of the Touch Experiences and Attitudes Questionnaire (TEAQ). The original TEAQ, containing 117 items relating to positive touch experiences was systematically constructed. Principal component analysis reduced this measure to 57 items and identified six components relating to touch experiences during childhood and adult experiences relating to current intimate touch and touch with friends and family. Three attitudinal components were identified relating to attitude to intimate touch, touch with unfamiliar people, and self-care. The structure of this questionnaire was confirmed through confirmatory factor analysis carried out on data obtained from a second sample. Good concurrent and predictive validity of the TEAQ compared to other physical touch measures currently available was identified. Known-group validity in terms of gender, marital status and age was determined, with expected group differences identified. This study demonstrates the TEAQ to have good face validity, internal consistency, construct validity in terms of discriminant validity, known-group validity and convergent validity, and criterion-related validity in terms of predictive validity and concurrent validity. We anticipate this questionnaire will be a valuable tool for the field of physical touch research.

A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression

BACKGROUND

Postnatal depression (PND) is a major depressive disorder in the year following childbirth, which impacts on women, their infants and their families. A range of interventions has been developed to prevent PND.

OBJECTIVES

To (1) evaluate the clinical effectiveness, cost-effectiveness, acceptability and safety of antenatal and postnatal interventions for pregnant and postnatal women to prevent PND; (2) apply rigorous methods of systematic reviewing of quantitative and qualitative studies, evidence synthesis and decision-analytic modelling to evaluate the preventive impact on women, their infants and their families; and (3) estimate cost-effectiveness.

DATA SOURCES

We searched MEDLINE, EMBASE, Science Citation Index and other databases (from inception to July 2013) in December 2012, and we were updated by electronic alerts until July 2013.

REVIEW METHODS

Two reviewers independently screened titles and abstracts with consensus agreement. We undertook quality assessment. All universal, selective and indicated preventive interventions for pregnant women and women in the first 6 postnatal weeks were included. All outcomes were included, focusing on the Edinburgh Postnatal Depression Scale (EPDS), diagnostic instruments and infant outcomes. The quantitative evidence was synthesised using network meta-analyses (NMAs). A mathematical model was constructed to explore the cost-effectiveness of interventions contained within the NMA for EPDS values.

RESULTS

From 3072 records identified, 122 papers (86 trials) were included in the quantitative review. From 2152 records, 56 papers (44 studies) were included in the qualitative review. The results were inconclusive. The most beneficial interventions appeared to be midwifery redesigned postnatal care [as shown by the mean 12-month EPDS score difference of -1.43 (95% credible interval -4.00 to 1.36)], person-centred approach (PCA)-based and cognitive-behavioural therapy (CBT)-based intervention (universal), interpersonal psychotherapy (IPT)-based intervention and education on preparing for parenting (selective), promoting parent-infant interaction, peer support, IPT-based intervention and PCA-based and CBT-based intervention (indicated). Women valued seeing the same health worker, the involvement of partners and access to several visits from a midwife or health visitor trained in person-centred or cognitive-behavioural approaches. The most cost-effective interventions were estimated to be midwifery redesigned postnatal care (universal), PCA-based intervention (indicated) and IPT-based intervention in the sensitivity analysis (indicated), although there was considerable uncertainty. Expected value of partial perfect information (EVPPI) for efficacy data was in excess of £150M for each population. Given the EVPPI values, future trials assessing the relative efficacies of promising interventions appears to represent value for money.

LIMITATIONS

In the NMAs, some trials were omitted because they could not be connected to the main network of evidence or did not provide EPDS scores. This may have introduced reporting or selection bias. No adjustment was made for the lack of quality of some trials. Although we appraised a very large number of studies, much of the evidence was inconclusive.

CONCLUSIONS

Interventions warrant replication within randomised controlled trials (RCTs). Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty.

FUTURE WORK RECOMMENDATIONS

Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. Future research conducting RCTs to establish which interventions are most clinically effective and cost-effective should be considered.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42012003273.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Tuina for children with cerebral palsy: A protocol for a systematic review

BACKGROUND

Cerebral palsy (CP) describes a group of permanent disorders of movement and posture causing activity limitations, leading the most common movement disorder to children. On recovery of various aspects of CP, massotherapy has a good effect in a great many of Chinese clinical trials. Therefore, we plan to conduct a protocol of systematic review aimed at systematically reviewing all the clinical evidence on the effectiveness of massotherapy for treating CP in children.

METHODS

The following electronic databases will be searched from inception to October 1, 2017: Cochrane Library, Web of Science, EBASE, Springer, World Health Organization International Clinical Trials Registry Platform, China National Knowledge Infrastructure, Wan-fang database, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and other sources. All published English and Chinese articles randomized controlled trials (RTCs) will be included. All types of CP of children in the trials will be included in this study and these individuals will be involved as coresearchers to evaluate the efficacy of massothreapy. RevMan V.5.3.5 software will be implemented for the assessment of bias risk, data synthesis, subgroup analysis, and meta-analyses if inclusion conditions are met. Continuous outcomes will be presented as mean difference (MD) or standard mean difference (SMD), while dichotomous data will be expressed as a relative risk.

RESULTS

A high-quality synthesis of current evidence of massothreapy for children with CP will be provided from several aspects, including motor function improvement, intellectual development, improvement of self-care ability, and daily living.

CONCLUSION

This protocol will present the evidence of whether Tuina threapy is an effective intervention for children with CP.

ETHICS AND DISSEMINATION

There is no requirement of ethical approval and it will be in print or disseminated by electronic copies.

PROSPERO REGISTRATION NUMBER

CRD42017080342.

Small Animal Massage Therapy: A Brief Review and Relevant Observations

Massage therapy is becoming increasingly popular in human and animal physiotherapy and rehabilitation. Wider application of the technique led to research efforts aimed at providing scientific support to anecdotal beneficial effects, particularly pain relief. Recent studies have shown that massage therapy alters dopamine and serotonin levels, decreases noradrenaline levels, and modulates the immune system. Psychological effects such as reduction of stress and anxiety, with improvement of depressive patients, have been reported in humans. This article set out to review the major aspects of massage therapy based on recent publications on the topic, and to extrapolate concepts and practical aspects described in human physiotherapy to the veterinary patient, particularly the applicability of different techniques in Small Animal Medicine. Indications of massage therapy in small animals include pain relief, orthopedic rehabilitation, Canine Sports Medicine, intensive care, and management of nonspecific edema. Techniques described in this article were originally intended for use in humans and scientific data supporting anecdotal, beneficial effects in domestic animals are still lacking; this fruitful area for research is therefore open to veterinary professionals.

Fetal behavioral responses to the touch of the mother's abdomen: A Frame-by-frame analysis

The aim of the present study was to examine whether fetuses respond to the touching of the mother's abdomen, and if they do, whether they differentiate based on familiarity and the source of the touch, utilizing 3D real-time (4D) sonography. Behavioral responses of 28 fetuses (20th to 33rd week of gestation; N=15 in the 2nd and N=13 in the 3rd trimester) were frame-by-frame coded using a coding system comprising 20 codes and were analyzed in four conditions, during the touch of the (1) mother, (2) the father, (3) the stranger and in a (4) no-touch, control condition. Fetuses showed differential responses to the touch, in particular in the duration of their reaching out to touch the uterus wall in the four conditions, and self-touch, dependent on the gestational age of the fetus. Fetuses in the 3rd trimester touched the uterus wall significantly longer than fetuses in the 2nd trimester did, when the mother touched compared to the control condition. At the same time, fetuses in the 3rd trimester also touched themselves less during the mother's touch, compared when the stranger touched and also compared to the control condition. This differential response of the older fetuses might be due to the maturation of the central nervous system, and may indicate the emergence of a proprioceptive self-awareness by the 3rd trimester.

The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain: A systematic review with meta-analysis

BACKGROUND

Low back pain and pelvic girth pain are common in pregnancy and women commonly utilize complementary manual therapies such as massage, spinal manipulation, chiropractic, and osteopathy to manage their symptoms.

OBJECTIVE

The aim of this systematically review was to critically appraise and synthesize the best available evidence regarding the effectiveness of manual therapies for managing pregnancy-related low back and pelvic pain.

METHODS

Seven databases were searched from their inception until April 2015 for randomized controlled trials. Studies investigating the effectiveness of massage and chiropractic and osteopathic therapies were included. The study population was pregnant women of any age and at any time during the antenatal period. Study selection, data extraction, and assessment of risk of bias were conducted by 2 reviewers independently, using the Cochrane tool. Separate meta-analyses were conducted to compare manual therapies to different control interventions.

RESULTS

Out of 348 nonduplicate records, 11 articles reporting on 10 studies on a total of 1198 pregnant women were included in this meta-analysis. The therapeutic interventions predominantly involved massage and osteopathic manipulative therapy. Meta-analyses found positive effects for manual therapy on pain intensity when compared to usual care and relaxation but not when compared to sham interventions. Acceptability did not differ between manual therapy and usual care or sham interventions.

CONCLUSIONS

There is currently limited evidence to support the use of complementary manual therapies as an option for managing low back and pelvic pain during pregnancy. Considering the lack of effect compared to sham interventions, further high-quality research is needed to determine causal effects, the influence of the therapist on the perceived effectiveness of treatments, and adequate dose-response of complementary manual therapies on low back and pelvic pain outcomes during pregnancy.

Affectionate Touch to Promote Relational, Psychological, and Physical Well-Being in Adulthood: A Theoretical Model and Review of the Research

Throughout the life span, individuals engage in affectionate touch with close others. Touch receipt promotes well-being in infancy, but the impacts of touch in adult close relationships have been largely unexplored. In this article, we propose that affectionate touch receipt promotes relational, psychological, and physical well-being in adulthood, and we present a theoretical mechanistic model to explain why affectionate touch may promote these outcomes. The model includes pathways through which touch could affect well-being by reducing stress and by promoting well-being independent of stress. Specifically, two immediate outcomes of affectionate touch receipt—relational-cognitive changes and neurobiological changes—are described as important mechanisms underlying the effects of affectionate touch on well-being. We also review and evaluate the existing research linking affectionate touch to well-being in adulthood and propose an agenda to advance research in this area. This theoretical perspective provides a foundation for future work on touch in adult close relationships.

The Effect of Head Massage on the Regulation of the Cardiac Autonomic Nervous System: A Pilot Randomized Crossover Trial

OBJECTIVES

To evaluate the effect of a single 10-minute session of Chinese head massage on the activity of the cardiac autonomic nervous system via measurement of heart rate variability (HRV).

DESIGN

In this pilot randomized crossover trial, each participant received both head massage and the control intervention in a randomized fashion.

SETTINGS/LOCATION

The study was conducted at Children's & Women's Health Centre of British Columbia between June and November 2014.

PARTICIPANTS

Ten otherwise healthy adults (6 men and 4 women) were enrolled in this study.

INTERVENTIONS

The intervention comprised 10 minutes of head massage therapy (HMT) in a seated position compared with a control intervention of sitting quietly on the same chair with eyes closed for an equal amount of time (no HMT).

OUTCOME MEASURES

The primary outcome measures were the main parameters of HRV, including total power (TP), high frequency (HF), HF as a normalized unit, pre-ejection period, and heart rate (HR).

RESULTS

A single short session (10 minutes) of head massage demonstrated an increase in TP continuing up to 20 minutes after massage and reaching statistical significance at 10 minutes after massage (relative change from baseline, 66% for HMT versus -6.6% for no HMT; p = 0.017). The effect on HF also peaked up to 10 minutes after massage (59.4% for HMT versus 4% for no HMT; p = 0.139). Receiving head massage also decreased HR by more than three-fold compared to the control intervention.

CONCLUSION

This study shows the potential benefits of head massage by modulating the cardiac autonomic nervous system through an increase in the total variability and a shift toward higher parasympathetic nervous system activity. Randomized controlled trials with larger sample size and multiple sessions of massage are needed to substantiate these findings.

Fetal Behavioural Responses to Maternal Voice and Touch

BACKGROUND

Although there is data on the spontaneous behavioural repertoire of the fetus, studies on their behavioural responses to external stimulation are scarce.

AIM, METHODS

The aim of the current study was to measure fetal behavioural responses in reaction to maternal voice; to maternal touch of the abdomen compared to a control condition, utilizing 3D real-time (4D) sonography. Behavioural responses of 23 fetuses (21st to 33rd week of gestation; N = 10 in the 2nd and N = 13 in the 3rd trimester) were frame-by-frame coded and analyzed in the three conditions.

RESULTS

Results showed that fetuses displayed more arm, head, and mouth movements when the mother touched her abdomen and decreased their arm and head movements to maternal voice. Fetuses in the 3rd trimester showed increased regulatory (yawning), resting (arms crossed) and self-touch (hands touching the body) responses to the stimuli when compared to fetuses in the 2nd trimester.

CONCLUSION

In summary, the results from this study suggest that fetuses selectively respond to external stimulation earlier than previously reported, fetuses actively regulated their behaviours as a response to the external stimulation, and that fetal maturation affected the emergence of these differential responses to the environment.

A preliminary study of the effects of a single session of Swedish massage on hypothalamic-pituitary-adrenal and immune function in normal individuals

OBJECTIVES

Massage therapy is a multi-billion dollar industry in the United States with 8.7% of adults receiving at least one massage within the last year; yet, little is known about the physiologic effects of a single session of massage in healthy individuals. The purpose of this study was to determine effects of a single session of Swedish massage on neuroendocrine and immune function. It was hypothesized that Swedish Massage Therapy would increase oxytocin (OT) levels, which would lead to a decrease in hypothalamic-pituitary-adrenal (HPA) activity and enhanced immune function.

DESIGN

The study design was a head-to-head, single-session comparison of Swedish Massage Therapy with a light touch control condition. Serial measurements were performed to determine OT, arginine-vasopressin (AVP), adrenal corticotropin hormone (ACTH), cortisol (CORT), circulating phenotypic lymphocytes markers, and mitogen-stimulated cytokine production.

SETTING

This research was conducted in an outpatient research unit in an academic medical center.

SUBJECTS

Medically and psychiatrically healthy adults, 18-45 years old, participated in this study.

INTERVENTION

The intervention tested was 45 minutes of Swedish Massage Therapy versus a light touch control condition, using highly specified and identical protocols.

OUTCOME MEASURES

The standardized mean difference was calculated between Swedish Massage Therapy versus light touch on pre- to postintervention change in levels of OT, AVP, ACTH, CORT, lymphocyte markers, and cytokine levels.

RESULTS

Compared to light touch, Swedish Massage Therapy caused a large effect size decrease in AVP, and a small effect size decrease in CORT, but these findings were not mediated by OT. Massage increased the number of circulating lymphocytes, CD 25+ lymphocytes, CD 56+ lymphocytes, CD4 + lymphocytes, and CD8+ lymphocytes (effect sizes from 0.14 to 0.43). Mitogen-stimulated levels of interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, IL-10, IL-13, and IFN-γ decreased for subjects receiving Swedish Massage Therapy versus light touch (effect sizes from -0.22 to -0.63). Swedish Massage Therapy decreased IL-4, IL-5, IL-10, and IL-13 levels relative to baseline measures.

CONCLUSIONS

Preliminary data suggest that a single session of Swedish Massage Therapy produces measurable biologic effects. If replicated, these findings may have implications for managing inflammatory and autoimmune conditions.

Neurodevelopmental outcome for offspring of women treated for antenatal depression: a systematic review

The aim of this systematic review is to appraise existing literature on the effects of treatments for antenatal depression on the neurodevelopment outcomes of the offspring. We conducted a systematic review of the literature to identify studies on different kinds of treatments for antenatal depression (antidepressants and alternative therapies) and their effects on infants' neurodevelopment. After reading the title, abstract, or full text and applying exclusion criteria, a total of 22 papers were selected. Nineteen papers studied the effects of antidepressant drugs, one on docosahexanoic acid (DHA) (fish oil capsules) and two on massage therapy; however, no studies used a randomized controlled design, and in most studies, the control group comprise healthy women not exposed to depression. Comparisons between newborns exposed to antidepressants in utero with those not exposed showed significant differences in a wide range of neurobehavioral outcomes, although in many cases, these symptoms were transient. Two studies found a slight delay in psychomotor development, and one study found a delay in mental development. Alternative therapies may have some benefits on neurodevelopmental outcomes. Our review suggests that antidepressant treatment may be associated with some neurodevelopmental changes, but we cannot exclude that some of these effects may be due to depression per se.

The effect of physician-based cognitive behavioural therapy among pregnant women with depressive symptomatology: a pilot quasi-experimental trial

OBJECTIVE

The purpose of this pilot study is to evaluate the feasibility of a physician-based cognitive behavioural (CBT) intervention for the treatment of depressive symptomatology among pregnant women.

METHODS

A pilot quasi-experimental trial was conducted in a family practice health centre in Toronto, Canada. Pregnant women (n = 42) were identified as having depressive symptomatology according to the Edinburgh Postnatal Depression Scale (EPDS) and allocated to either a control group (standard prenatal) or an intervention group. The intervention group received standard prenatal plus brief CBT, initiated between the 20th and 28th gestation week prenatal visit, from their obstetrical physician. Follow-up assessments were conducted at 38 weeks gestation and 6 weeks post-partum to examine depressive symptomatology, anxiety symptomatology, health-care utilization, medication utilization and overall treatment satisfaction.

RESULTS

The delivery of the CBT intervention was feasible, acceptable and produced relatively high rates of treatment adherence. Of the 21 women in the intervention group who evaluated their CBT experience, 90% were satisfied. Although not sufficiently powered to detect differences between the study groups, trends in the clinical outcome data favoured the intervention group where mean depression and anxiety scores were lower for those who received the brief CBT intervention than those in the control group.

CONCLUSION

Results suggest that brief physician-based CBT may be a feasible antenatal depression treatment option. The high satisfaction with, and acceptance of, the intervention by study participants and physicians suggests that a larger randomized trial is warranted.

Recommendations for physical therapists on the treatment of lumbopelvic pain during pregnancy: a systematic review

STUDY DESIGN

Systematic review of the literature.

OBJECTIVES

To review and assess the peer-reviewed literature on the effectiveness of physical therapy interventions in treating lumbopelvic pain during pregnancy.

BACKGROUND

Current guidelines on interventions for lumbopelvic pain during pregnancy differ in their recommendations for assessment and intervention. Recent publications may allow revising current recommendations for the treatment of this complex problem.

METHODS

An electronic search strategy was conducted in PubMed, PEDro, Scopus, and CINAHL of literature published from January 1992 to November 2013. Two authors independently assessed all abstracts for eligibility. Articles were independently rated for quality by 2 authors, using the Cochrane Back Review Group criteria for methodological quality. Where possible, effect sizes were calculated for the different interventions.

RESULTS

A total of 22 articles (all randomized controlled trials) reporting on 22 independent studies were included. Overall, the methodological quality of the studies was moderate. Data for 4 types of interventions were considered: a combination of interventions (7 studies, n = 1202), exercise therapy (9 studies, n = 2149), manual therapy (5 studies, n = 360), and material support (1 study, n = 115).

CONCLUSION

All included studies on exercise therapy, and most of the studies on interventions combined with patient education, reported a positive effect on pain, disability, and/or sick leave. Evidence-based recommendations can be made for the use of exercise therapy for the treatment of lumbopelvic pain during pregnancy.

LEVEL OF EVIDENCE

Therapy, level 1a-. J Orthop Sports Phys Ther 2014;44(7):464-473. Epub 10 May 2014. doi:10.2519/jospt.2014.5098.

The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial

OBJECTIVE

To evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn.

METHOD

One hundred and forty-six burn patients with hypertrophic scar(s) were randomly divided into an experimental group and a control group. All patients received standard rehabilitation therapy for hypertrophic scars and 76 patients (massage group) additionally received burn scar rehabilitation massage therapy. Both before and after the treatment, we determined the scores of visual analog scale (VAS) and itching scale and assessed the scar characteristics of thickness, melanin, erythema, transepidermal water loss (TEWL), sebum, and elasticity by using ultrasonography, Mexameter(®), Tewameter(®), Sebumeter(®), and Cutometer(®), respectively.

RESULTS

The scores of both VAS and itching scale decreased significantly in both groups, indicating a significant intragroup difference. With regard to the scar characteristics, the massage group showed a significant decrease after treatment in scar thickness, melanin, erythema, TEWL and a significant intergroup difference. In terms of scar elasticity, a significant intergroup difference was noted in immediate distension and gross skin elasticity, while the massage group significant improvement in skin distensibility, immediate distension, immediate retraction, and delayed distension.

CONCLUSION

Our results suggest that burn rehabilitation massage therapy is effective in improving pain, pruritus, and scar characteristics in hypertrophic scars after burn.

Antenatal psychosomatic programming to reduce postpartum depression risk and improve childbirth outcomes: a randomized controlled trial in Spain and France

Background

Postpartum depression (PPD) and poor childbirth outcomes are associated with poverty; these variables should be addressed by an adapted approach. The aim of this research was to evaluate the impact of an antenatal programme based on a novel psychosomatic approach to pregnancy and delivery, regarding the risk of PPD and childbirth outcomes in disadvantaged women.

Methods

A multi-centre, randomized, controlled trial comparing a novel to standard antenatal programme. Primary outcome was depressive symptoms (using EPDS) and secondary outcome was preterm childbirth (fewer 37 weeks). The sample comprised 184 couples in which the women were identified to be at PPD risk by validated interview. The study was conducted in three public hospitals with comparable standards of perinatal care. Women were randomly distributed in to an experimental group (EG) or a control group (CG), and evaluated twice: during pregnancy (T1) and four weeks post-partum (T2). At T2, the variables were compared using the chi square test. Data analysis was based on intention to treat. The novel programme used the Tourné psychosomatic approach focusing on body awareness sensations, construction of an individualized childbirth model, and attachment. The 10 group antenatal sessions each lasted two hours, with one telephone conversation between sessions. In the control group, the participants choose the standard model of antenatal education, i.e., 8 to 10 two-hour sessions focused on childbirth by obstetrical prophylaxis.

Results

A difference of 11.2% was noted in postpartum percentages of PPD risk (EPDS ≥ 12): 34.3% (24) in EG and 45.5% (27) in CG (p = 0.26). The number of depressive symptoms among EG women decreased at T₂ (intragroup p = 0.01). Premature childbirth was four times less in EG women: three (4.4%) compared to 13 (22.4%) among CG women (p = 0.003). Birth weight was higher in EG women (p = 0.01).

Conclusions

The decrease of depressive symptoms in women was not conclusive. However, because birth weight was higher and the rate of preterm childbirth was lower in the EG, our results suggest that the psychosomatic approach may be more helpful to the target population than the standard antenatal programs.

Complementary and alternative medicine therapies for perinatal depression

Complementary and alternative medicine therapies are increasingly sought out by people with psychiatric disorders. In this chapter, we review the evidence for several commonly used CAM therapies (i.e. omega-3 fatty acids, folate, S-adenosyl-methionine, St John's Wort, bright light therapy, exercise, massage, and acupuncture) in the treatment of perinatal depression. A number of these treatments may be reasonable to consider for women during pregnancy or postpartum, but the safety and efficacy of these relative to standard treatments must still be systematically determined. Evidence-based use of complementary and alternative medicine therapies treatments for perinatal depression is discussed. Adequately powered systematic studies are necessary to determine the role of complementary and alternative medicine therapies in the treatment of perinatal depression.

Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression

BACKGROUND

A meta-analysis of 21 studies suggests the mean prevalence rate for depression across the antenatal period is 10.7%, ranging from 7.4% in the first trimester to a high of 12.8% in the second trimester. Due to maternal treatment preferences and potential concerns about fetal and infant health outcomes, diverse non-pharmacological treatment options are needed.

OBJECTIVES

To assess the effect of interventions other than pharmacological, psychosocial, or psychological interventions compared with usual antepartum care in the treatment of antenatal depression.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2013), scanned secondary references and contacted experts in the field to identify other published or unpublished trials.

SELECTION CRITERIA

All published and unpublished randomised controlled trials of acceptable quality evaluating non-pharmacological/psychosocial/psychological interventions to treat antenatal depression.

DATA COLLECTION AND ANALYSIS

Both review authors participated in the evaluation of methodological quality and data extraction. Results are presented using risk ratio (RR) for categorical data and mean difference (MD) for continuous data.

MAIN RESULTS

Six trials were included involving 402 women from the United States, Switzerland, and Taiwan. For most comparisons a single trial contributed data and there were few statistically significant differences between control and intervention groups.In a trial with 38 women maternal massage compared with non-specific acupuncture (control group) did not significantly decrease the number of women with clinical depression or depressive symptomatology immediately post-treatment (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.25 to 2.53; mean difference (MD) -2.30, 95% CI -6.51 to 1.91 respectively). In another trial with 88 women there was no difference in treatment response or depression remission rates in women receiving maternal massage compared with those receiving non-specific acupuncture (RR 1.33, 95% CI 0.82 to 2.18; RR 1.14, 95% CI 0.59 to 2.19 respectively).In a trial with 35 women acupuncture specifically treating symptoms of depression, compared with non-specific acupuncture, did not significantly decrease the number of women with clinical depression or depressive symptomatology immediately post-treatment (RR 0.47, 95% CI 0.11 to 2.13; MD -3.00, 95% CI -8.10 to 2.10). However, women who received depression-specific acupuncture were more likely to respond to treatment compared with those receiving non-specific acupuncture (RR 1.68, 95% CI 1.06 to 2.66).In a trial with 149 women, maternal massage by a woman's significant other, compared with standard care, significantly decreased the number of women with depressive symptomatology immediately post-treatment (MD -6.70, 95% CI -9.77 to -3.63). Further, women receiving bright light therapy had a significantly greater change in their mean depression scores over the five weeks of treatment than those receiving a dim light placebo (one trial, n = 27; MD -4.80, 95% CI -8.39 to -1.21). However, they were not more likely to have a treatment response or experience a higher remission rate (RR 1.79, 95% CI 0.90 to 3.56; RR 1.89, 95% CI 0.81 to 4.42).Lastly, two trials examined the treatment effect of omega-3 oils. Women receiving omega-3 had a significantly lower mean depression score following eight weeks of treatment than those receiving a placebo (one trial, n = 33; MD -4.70, 95% CI -7.82 to -1.58). Conversely, in a smaller trial (21 women) there was no significant difference in the change in mean depression scores for women receiving omega-3 and those receiving a placebo (MD 0.36, 95% CI -0.17 to 0.89), and women who received omega-3 were no more likely to respond to treatment (RR 2.26, 95% CI 0.78 to 6.49) or have higher remission rates (RR 2.12, 95% CI 0.51 to 8.84). Women in the placebo group were just as likely to report a side effect as those in the omega-3 group (RR 1.12, 95% CI 0.56 to 2.27).

AUTHORS' CONCLUSIONS

The evidence is inconclusive to allow us to make any recommendations for depression-specific acupuncture, maternal massage, bright light therapy, and omega-3 fatty acids for the treatment of antenatal depression. The included trials were too small with non-generalisable samples, to make any recommendations.

Yoga and social support reduce prenatal depression, anxiety and cortisol

The purpose of this study was to compare the effects of yoga (physical activity) versus social support (verbal activity) on prenatal and postpartum depression. Ninety-two prenatally depressed women were randomly assigned to a yoga or a social support control group at 22 weeks gestation. The yoga group participated in a 20-min group session (only physical poses) once per week for 12 weeks. The social support group (a leaderless discussion group) met on the same schedule. At the end of the first and last sessions the yoga group reported less depression, anxiety, anger, back and leg pain as compared to the social support group. At the end of the last session the yoga group and the support group did not differ. They both had lower depression (CES-D), anxiety (STAI), and anger (STAXI) scores and improved relationship scores. In addition, cortisol levels decreased for both groups following each session. Estriol and progesterone levels decreased after the last session. At the postpartum follow-up assessment depression and anxiety levels were lower for both groups.

Tai chi/yoga reduces prenatal depression, anxiety and sleep disturbances

Ninety-two prenatally depressed pregnant women were randomly assigned to a tai chi/yoga or a waitlist control group at an average of 22 weeks gestation. The tai chi/yoga group participated in a 20-min group session per week for 12 weeks. At the end of the treatment period the tai chi/yoga group had lower summary depression (CES-D) scores, as well as lower negative affect and somatic/vegetative symptoms subscale scores on the CES-D, lower anxiety (STAI) scores and lower sleep disturbances scores.