Massage Therapy (Therapeutic Massage)
Library of Research Articles on Veterans and CIH Therapies
Library of Research Articles on Veterans and Complementary and Integrative Health Therapies and Chiropractic Care
January 2021 Edition
Massage Therapy (Therapeutic Massage)
Boyd H. The Integrative Therapy Nurse: A Valuable Player in Symptom Management. Am J Nurs. 2018 Nov;118(11):64-69.
With the support of colleagues and hospital management, the author, an RN with board certification in therapeutic massage and bodywork, developed and implemented the role of the integrative therapy nurse on the spinal cord injury and disorders unit at the Minneapolis Veterans Affairs Medical Center. The goal of this initiative was to provide patients with additional nonpharmacologic options for addressing their symptoms through the creation of an integrative therapy nurse role within the existing interdisciplinary team of physicians, NPs, psychologists, registered dieticians, physical therapists, occupational therapists, speech pathologists, and staff nurses. This article outlines the process of creating this role, discusses implications for practice, and reports the outcomes of three years of its implementation. The outcomes of decreased pain and increased relaxation among the veterans who participated in this initiative warrant its further expansion to additional clinical settings.
Collinge W, Kahn J, Soltysik R. Promoting reintegration of National Guard veterans and their partners using a self-directed program of integrative therapies: a pilot study. Mil Med. 2012 Dec;177(12):1477-85.
This article reports pilot data from phase I of a project to develop and evaluate a self-directed program of integrative therapies for National Guard personnel and significant relationship partners to support reintegration and resilience after return from Iraq or Afghanistan. Data are reported on 43 dyads. Intervention was an integrated multimedia package of guided meditative, contemplative, and relaxation exercises (CD) and instruction in simple massage techniques (DVD) to promote stress reduction and interpersonal connectedness. A repeated measures design with standardized instruments was used to establish stability of baseline levels of relevant mental health domains (day 1, day 30), followed by the intervention and assessments 4 and 8 weeks later. Significant improvements in standardized measures for post-traumatic stress disorder, depression, and self-compassion were seen in both veterans and partners; and in stress for partners. Weekly online reporting tracked utilization of guided exercises and massage. Veterans reported significant reductions in ratings of physical pain, physical tension, irritability, anxiety/worry, and depression after massage, and longitudinal analysis suggested declining baseline levels of tension and irritability. Qualitative data from focus groups and implications for continued development and a phase II trial are discussed.
Fletcher CE, Mitchinson AR, Trumble EL, Hinshaw DB, Dusek JA. Perceptions of other integrative health therapies by Veterans with pain who are receiving massage. J Rehabil Res Dev. 2016;53(1):117-26. doi: 10.1682/JRRD.2015.01.0015. PubMed PMID: 27004453; PubMed Central PMCID: PMC4829362.
Veterans are increasingly using complementary and integrative health (CIH) therapies to manage chronic pain and other troubling symptoms that significantly impair health and quality of life. The Department of Veterans Affairs (VA) is exploring ways to meet the demand for access to CIH, but little is known about Veterans' perceptions of the VA's efforts. To address this knowledge gap, we conducted interviews of 15 inpatients, 8 receiving palliative care, and 15 outpatients receiving CIH in the VA. Pain was the precipitating factor in all participants' experience. Participants were asked about their experience in the VA and their opinions about which therapies would most benefit other Veterans. Participants reported that massage was well-received and resulted in decreased pain, increased mobility, and decreased opioid use. Major challenges were the high ratio of patients to CIH providers, the difficulty in receiving CIH from fee-based CIH providers outside of the VA, cost issues, and the role of administrative decisions in the uneven deployment of CIH across the VA. If the VA is to meet its goal of offering personalized, proactive, patient-centered care nationwide then it must receive support from Congress while considering Veterans' goals and concerns to ensure that the expanded provision of CIH improves outcomes.
Haun JN, Ballistrea LM, Melillo C, Standifer M, Kip K, Paykel J, Murphy JL, Fletcher CE, Mitchinson A, Kozak L, Taylor SL, Glynn SM, Bair M. A Mobile and Web-Based Self-Directed Complementary and Integrative Health Program for Veterans and Their Partners (Mission Reconnect): Protocol for a Mixed-Methods Randomized Controlled Trial. JMIR Res Protoc. 2019 May 13;8(5):e13666. doi: 10.2196/13666.
Complementary and integrative health (CIH) is a viable solution to PTSD and chronic pain. Many veterans believe CIH can be performed only by licensed professionals in a health care setting. Health information technology can bring effective CIH to veterans and their partners.
This paper describes the rationale, design, and methods of the Mission Reconnect protocol to deliver mobile and Web-based complementary and integrative health programs to veterans and their partners (eg, spouse, significant other, caregiver, or family member).
This three-site, 4-year mixed-methods randomized controlled trial uses a wait-list control to determine the effects of mobile and Web-based CIH programs for veterans and their partners, or dyads. The study will use two arms (ie, treatment intervention arm and wait-list control arm) in a clinical sample of veterans with comorbid pain and posttraumatic stress disorder, and their partners. The study will evaluate the effectiveness and perceived value of the Mission Reconnect program in relation to physical and psychological symptoms, global health, and social outcomes.
Funding for the study began in November 2018, and we are currently in the process of recruitment screening and data randomization for the study. Primary data collection will begin in May 2019 and continue through May 2021. Projected participants per site will be 76 partners/dyads, for a total of 456 study participants. Anticipated study results will be published in November 2022.
This work highlights innovative delivery of CIH to veterans and their partners for treatment of posttraumatic stress disorder and chronic pain.
Juberg M, Jerger KK, Allen KD, Dmitrieva NO, Keever T, Perlman AI. Pilot study of massage in veterans with knee osteoarthritis. J Altern Complement Med. 2015 Jun;21(6):333-8. doi: 10.1089/acm.2014.0254.
To (1) assess the feasibility and acceptability of Swedish massage among Department of Veterans Affairs (VA) health care users with knee osteoarthritis (OA) and (2) collect preliminary data on efficacy of Swedish massage in this patient group.
Experimental pilot study.
Duke Integrative Medicine clinic and VA Medical Center, Durham, North Carolina.
Twenty-five veterans with symptomatic knee OA.
Eight weekly 1-hour sessions of full-body Swedish massage.
Primary: Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and global pain (Visual Analog Scale [VAS]). Secondary: National Institutes of Health Patient Reported Outcomes Measurement Information System-Pain Interference Questionnaire 6b (PROMIS-PI 6b), 12-Item Short-Form Health Survey (SF-12 v1) and the EuroQol health status index (EQ-5D-5L), knee range of motion (ROM), and time to walk 50 feet.
Study feasibility was established by a 92% retention rate with 99% of massage visits and 100% of research visits completed. Results showed significant improvements in self-reported OA-related pain, stiffness and function (30% improvement in Global WOMAC scores; p=0.001) and knee pain over the past 7 days (36% improvement in VAS score; p<0.001). PROMIS-PI, EQ-5D-5L, and physical composite score of the SF-12 also significantly improved (p<0.01 for all), while the mental composite score of the SF-12 and knee ROM showed trends toward significant improvement. Time to walk 50 feet did not significantly improve.
Results of this pilot study support the feasibility and acceptability of Swedish massage among VA health care users as well as preliminary data suggesting its efficacy for reducing pain due to knee OA. If results are confirmed in a larger randomized trial, massage could be an important component of regular care for these patients.
Kozak L, Vig E, Simons C, Eugenio E, Collinge W, Chapko M. A feasibility study of caregiver-provided massage as supportive care for Veterans with cancer. J Support Oncol. 2013 Sep;11(3):133-43.
To assess the feasibility of using a multimedia program to teach caregivers of Veterans with cancer how to offer basic massage for supportive care at home.
Feasibility was assessed according to partner availability, compliance with watching training materials and practicing massage regularly, compliance with data collection; perceived study materials burden; clarity of instructional and other study materials. Pre- and post-massage changes in patients' symptom scores were measured using a numerical rate scale. A semistructured exit interview was answered by patient and caregiver at the end of the study.
A total of 27 dyads were recruited. Veterans were 78% male. Forty-eight percent were diagnosed with hematologic malignancies (85%, advanced stage); 52% were diagnosed with solid tumors (64% advanced stage). Caregivers were 78% female; 81% were spouses. Out of the 27 pairs, 11 completed 8 weeks of data and practiced massage weekly. The majority of attrition (69%) was due to caregivers' burden. Caregivers reported instructional materials were clear, high quality, and easy to use. Patients were highly satisfied with receiving touch from their partners regularly. Post-massage symptom scores showed statistically significant decreases in pain, stress/anxiety, and fatigue. Perceived burden of data collection instruments was high, particularly for patients.
It is feasible to use the TCC program to train caregivers of Veterans with cancer to offer massage for supportive care at home. Future studies should evaluate ways of providing support to caregivers, including offering massage to them, and easing the burden of data collection for patients.
Miake-Lye I, Lee J, Lugar T, Taylor S, Shanman R, Beroes J, Shekelle P. Massage for Pain: An Evidence Map [Internet]. Washington (DC): Department of Veterans Affairs (US); 2016 Sep. Available From http://www.ncbi.nlm.nih.gov/books/NBK424144/PubMed PMID: 28211657.
Given the widespread use of various massage therapies for pain, we conducted an evidence mapping process to determine the distribution of evidence available for various pain indications as well as different forms of massage therapy, identify gaps in evidence, and inform future research priorities. This mapping project provides a visual overview of the distribution of evidence for massage therapy for indications of pain, as well as an accompanying narrative that will help stakeholders interpret the state of evidence to inform policy and clinical decision-making.
We searched PubMed, Embase, and Cochrane for systematic reviews reporting pain outcomes for massage therapy. Abstracted data included: number of studies included in the review that report massage as the intervention and pain as an outcome; total number of studies included in the review; descriptions of the massage style, provider, co-interventions, duration, and comparators; pain type; main findings relevant to massage for pain; and whether the systematic review focused solely on massage as the intervention or included a variety of interventions, of which massage was one. Quality of each systematic review was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria. We used a bubble plot to visually depict the number of included articles, pain indication, effect of massage for pain, and strength of findings for each included systematic review.
We identified 31 systematic reviews, of which 21 were considered high-quality. Systematic reviews varied in the amount of detail they collected in describing the massage therapy. Some common massage types included Swedish massage, myofascial therapies, Shiatsu, Chinese traditional massage, Thai massage, slow stroke massage, and more general descriptions of massage. The most common type of pain included in systematic reviews was neck pain (n=6). Findings from high-quality systematic reviews describe potential benefits of massage for pain indications including labor, shoulder, neck, back, cancer, fibromyalgia, and temporomandibular disorder. However, no findings were rated as moderate- or high-strength.
More research is needed to establish confidence in the effect of massage for pain. Primary studies often do not provide adequate details of the massage therapy provided, especially in the descriptions of provider type. Few primary studies of large samples with rigorous methods have been conducted, as noted by many of the systematic review authors included in this evidence map.
Mitchinson A, Fletcher CE, Kim HM, Montagnini M, Hinshaw DB. Integrating massage therapy within the palliative care of veterans with advanced illnesses: an outcome study. Am J Hosp Palliat Care. 2014 Feb;31(1):6-12. doi: 10.1177/1049909113476568. Epub 2013 Feb 18.
To describe the integration of massage therapy into a palliative care service and to examine the relationship between massage and symptoms in patients with advanced illnesses.
Between April 1, 2009, and July 31, 2010, 153 patients received massage at the VA Ann Arbor Health Care System. Data on pain, anxiety, dyspnea, relaxation, and inner peace were collected pre and post massage. Diagnoses, chronic pain, and social support were also abstracted. Analysis of covariance was used to examine changes over time.
All short-term changes in symptoms showed improvement and all were statistically significant. Pain intensity decreased by 1.65 (0-10 scale, P < .001), anxiety decreased by 1.52 (0-10 scale, P < .001), patients' sense of relaxation increased by 2.92 (0-10 scale, P < .001), and inner peace improved by 1.80 (0-10 scale, P < .001).
Massage is a useful tool for improving symptom management and reducing suffering in palliative care patients.
Mitchinson AR, Kim HM, Rosenberg JM, Geisser M, Kirsh M, Cikrit D, Hinshaw DB. Acute postoperative pain management using massage as an adjuvant therapy: a randomized trial. Arch Surg. 2007 Dec;142(12):1158-67; discussion 1167. doi: 10.1001/archsurg.142.12.1158.
Adjuvant massage therapy improves pain management and postoperative anxiety among many patients who experience unrelieved postoperative pain. Pharmacologic interventions alone may not address all of the factors involved in the experience of pain.
Randomized controlled trial.
Department of Veterans Affairs hospitals in Ann Arbor, Michigan, and Indianapolis, Indiana.
Six hundred five veterans (mean age, 64 years) undergoing major surgery from February 1, 2003, through January 31, 2005.
Patients were assigned to the following 3 groups: (1) control (routine care), (2) individualized attention from a massage therapist (20 minutes), or (3) back massage by a massage therapist each evening for up to 5 postoperative days. Main Outcome Measure Short- and long-term (> 4 days) pain intensity, pain unpleasantness, and anxiety measured by visual analog scales.
Compared with the control group, patients in the massage group experienced short-term (preintervention vs postintervention) decreases in pain intensity (P = .001), pain unpleasantness (P < .001), and anxiety (P = .007). In addition, patients in the massage group experienced a faster rate of decrease in pain intensity (P = .02) and unpleasantness (P = .01) during the first 4 postoperative days compared with the control group. There were no differences in the rates of decrease in long-term anxiety, length of stay, opiate use, or complications across the 3 groups.
Massage is an effective and safe adjuvant therapy for the relief of acute postoperative pain in patients undergoing major operations.
Taylor SL, Hoggatt KJ, Kligler B. Complementary and Integrated Health Approaches: What Do Veterans Use and Want. J Gen Intern Med. 2019 Jul;34(7):1192-1199. doi: 10.1007/s11606-019-04862-6. Epub 2019 Apr 22.
Non-pharmacological treatment options for common conditions such as chronic pain, anxiety, and depression are being given increased consideration in healthcare, especially given the recent emphasis to address the opioid crisis. One set of non-pharmacological treatment options are evidence-based complementary and integrative health (CIH) approaches, such as yoga, acupuncture, and meditation. The Veterans Health Administration (VHA), the nation's largest healthcare system, has been at the forefront of implementing CIH approaches, given their patients' high prevalence of pain, anxiety, and depression. We aimed to conduct the first national survey of veterans' interest in and use of CIH approaches.
Using a large national convenience sample of veterans who regularly use the VHA, we conducted the first national survey of veterans' interest in, frequency of and reasons for use of, and satisfaction with 26 CIH approaches (n = 3346, 37% response rate) in July 2017.
In the past year, 52% used any CIH approach, with 44% using massage therapy, 37% using chiropractic, 34% using mindfulness, 24% using other meditation, and 25% using yoga. For nine CIH approaches, pain and stress reduction/relaxation were the two most frequent reasons veterans gave for using them. Overall, 84% said they were interested in trying/learning more about at least one CIH approach, with about half being interested in six individual CIH approaches (e.g., massage therapy, chiropractic, acupuncture, acupressure, reflexology, and progressive relaxation). Veterans appeared to be much more likely to use each CIH approach outside the VHA vs. within the VHA.
Veterans report relatively high past-year use of CIH approaches and many more report interest in CIH approaches. To address this gap between patients' level of interest in and use of CIH approaches, primary care providers might want to discuss evidence-based CIH options to their patients for relevant health conditions, given most CIH approaches are safe.