Massage Perceptions and Experiences for Individuals with Amputations

Niki Munk, PhD, LMT
School of Health and Rehabilitation Sciences
Indiana University
Indianapolis, IN

The 2016 Massage Therapy Foundation Research Grant award will support the completion of a developing amputation related therapeutic massage and bodywork (TMB) research program for early career TMB practitioner researcher, Dr. Niki Munk and will be conducted at the Indiana University’s School of Health and Rehabilitation Sciences.
Evidence informed practice is built from clinical experience, patient preferences, and the best research evidence available. Currently, little to no published research exists to elucidate TMB application, effect, or theoretical approach for individuals with amputations compromising the three-legged evidence based practice stool. Approximately 1.6 million people currently live with an amputation in the U.S. and this rate will double by 2050. Those with amputation face many chronic and/or reoccurring pain conditions and many with amputation related pain do not receive satisfactory relief through the typical opioid and anticonvulsant treatment regime. Massage therapy is a treatment self-reported by those with amputation as moderately-extremely effective, but no research has specifically examined efficacy or effectiveness in this regard. In order for meaningful and translatable TMB research to be conducted, an understanding of how and to what effect TMB is actually used for amputation related sequelae is needed. The overall aims for the developing research is to 1) explore and describe how, what, and why professional TMB care is sought by or applied to individuals with amputations and 2) explore and describe perceived treatment outcomes of professionally delivered TMB for individuals with amputations and to what and why perceived outcomes are attributed, from the perspectives of both TMB practitioners and the amputation population. Step I of the study, TMB practitioner perspective, has been completed with results currently in dissemination. Step II of the study (supported by the current award) will focus on the perspective of individuals with amputations and has three specific aims and one exploratory aim:
Specific Aim 1: Describe general perceptions of TMB and usage for individuals with amputations.
Specific Aim 2: Explore and describe the reasons or not adults with at least one amputation seek professional TMB care.
Specific Aim 3: Explore and describe perceived treatment outcomes of professionally delivered TMB for adults with at least one amputation.
Exploratory Aim: Generate potential relationship hypotheses between TMB usage and self-reported health for individuals with amputation.
To meet study aims, we are conducting a mixed methods study using a modified convergent parallel design in two amputation specific populations: those who have received TMB treatments (TMB Experienced) and those who have not received TMB treatments (TMB Naïve).
Stage III of the developing research program efforts will combine data from Stages I and II to identify alignment, divergent, and gaps between TMB practitioner and amputation population perspectives regarding TMB for amputation related sequelae. The whole of our efforts will be used to inform evidence based recommendations to TMB researchers, practitioners, and educators.

AWARD YEAR:  2016

Massage Impact on Chronic Pain in Opioid Dependent Patients

Katharina Wiest, PhD, MSPH
CODA, Inc., Portland, OR
$29,998

Katherina Wiest was interviewed about her research study for Massage Today. Click here for the article.

Chronic pain is a common cause of health care utilization and represents a major health concern. For patients beginning substance use treatment, chronic pain is more prevalent among patients with opioid dependence relative to patients with other dependences. Previous scientific research has not connected massage, chronic pain and substance use treatment success. Although massage has been demonstrated to alleviate chronic pain symptoms, its use as an adjunctive therapy to modify chronic pain during opioid treatment is absent from the literature. Given the strong biologic basis for the efficacy of massage and the high level of massage acceptance in opioid dependent patients, this trial may provide insight into massage’s potential as a non-pharmacologic chronic pain treatment. The study uses a prospective, randomized, intent-to-treat, clinical trial to assess the relative efficacy of Swedish massage on chronic pain in opioid dependent adult patients receiving methadone treatment. The primary aim is to measure the effect of massage on pain intensity. Eligible participants will be randomized to either (1) intervention arm of 8 weekly 1 hour Swedish massage sessions + treatment as usual (TAU) (n=25) or (2) TAU alone (n=25). At 4 weeks after the last study visit for both massage and TAU groups, a follow-up assessment is conducted to assess durability of treatment effect. Data elements pertaining to pain and potential confounders are collected and analyzed. Findings from this trial should be viewed as preliminary. Massage may offer an exciting non-pharmacologic option as part of the treatment arsenal for opioid dependence.

AWARD YEAR:  2011

The Effects of Massage Therapy in Conjunction with Exercise Training on Weight

Mark Blegen, PhD, FACSM
St. Catherine University, St. Paul, MN
$30,000

Obesity rates are at epidemic levels in the United States, and novel techniques are needed to combat the issue. Sometimes overweight individuals discontinue exercise programs and fail to reach their weight loss goals. The present study builds on previous research; suggesting weekly massage therapy sessions, as a reward, promote weight management. This research will investigate the intersection of massage therapy with structured and monitored exercise to promote weight management in an overweight population. Participants will be randomly assigned into one of four groups: weekly massage therapy only, weekly massage therapy and structured exercise, structured exercise only, and control. Measures such as bodyweight, body fat percentage, status of emotional eating, salivary cortisol (a physical measurement of stress levels), and psychological measures of stress, anxiety, and mood will be evaluated.

AWARD YEAR:  2012

Use of Therapeutic Massage to Treat Chemotherapy-Induced Peripheral Neuropathy (CIPN)

Joan E. Cunningham, PhD
Medical University of South Carolina, Charleston, SC
$29,986
Funded by a grant from the Palmer Foundation

Chemotherapy-induced peripheral neuropathy (CIPN) is a common debilitating side effect of many standard drugs used in cancer treatment. Research supporting the use of effective treatments for CIPN is lacking and the underlying physiologic mechanisms of CIPN are poorly understood. This one-year feasibility study will test the effects of therapeutic massage in relieving symptoms associated with CIPN. This work will provide the groundwork for clinical trials focused on the physiological processes involved in CIPN, and establish the feasibility of using massage to treat the symptoms of this condition. This non-randomized controlled study will be conducted with 15-18 patients with cancer. The protocol includes 12 therapeutic massage treatments in a 5-week period. Patient changes in CIPN signs, symptoms, pain and quality of life will be measured. Statistical methods will include standard summary statistics, multivariate generalized linear models and correlations between changes in outcome measures.

AWARD YEAR:  2012

The Effect of Massage Therapy on Cancer Related Fatigue in Breast Cancer Survivors

Paulette Swanson, PT, DPT, MS, cert. MDT
Middlesex Hospital Cancer Center, Middletown, CT
$30,000

Despite being experienced by 80-100% of cancer patients, Cancer Related Fatigue (CRF) is not well managed in traditional care settings. This has led to an increase in use of alternative modalities such as massage to manage and minimize its effects, which is supported by a promising yet limited body of scientific evidence. The Middlesex Hospital Cancer Center’s randomized, controlled pilot study will further examine the efficacy of Swedishstyle therapeutic massage in alleviating CRF in posttreatment breast cancer survivors. Severity of fatigue, the primary response variable, will be measured using the Brief Fatigue Inventory, a validated, tenitem tool from the MD Anderson Cancer Center.

Treatment group members will receive four, one hour massages over consecutive weeks; fatigue will be measured one week before the initial massage, immediately before and 24 hours after each massage, and four weeks after the final therapy session. Control group participants will not undergo massage while enrolled in the study but will complete BFIs on the same schedule as the treatment group. The delivery schedule of the BFI will allow for analysis of both short and longer term severity of fatigue.

Click here to view Paulette Swanson’s research study featured on CBS-WFSB in Connecticut.

AWARD YEAR:  2013

Blood Flow Within Active Myofascial Trigger Points Following Massage

Albert Moraska, PhD
University of Colorado at Denver
Aurora, CO
$30,000

Myofascial pain syndromes are associated with a high percentage of chronic pain disorders and are characterized by the presence of myofascial trigger points (MTrPs). Massage therapy has been shown to be effective at alleviating myofascial pain presenting as back pain or tension-type headache and specifically reduce point tenderness associated with MTrPs. However, mechanisms by which massage therapy exerts an effect are poorly understood. The MTrP is a tightly contacted nodule within skeletal muscle and research evidence suggests it impedes blood flow, subsequently causing tissue distress and production of pain evoking chemicals. The purpose of this research study is to investigate blood flow at the MTrP following massage to provide inroads into a mechanism of action for massage in the treatment of myofascial pain and MTrPs. Research subjects with myofascial pain expressed as tension-type headache and an active MTrP in the upper trapezius muscle will be randomly assigned to receive trigger point release massage or a control treatment at the MTrP. Interstitial fluid within the MTrP will be collected before and after massage from which markers to assess blood flow will be determined.

AWARD YEAR:  2014

Impact of Massage Therapy on Spasticity in People with Multiple Sclerosis

Deborah Backus, PT, PhD
Shepherd Center, Atlanta, GA
$29, 998

The purpose of this pilot study is to assess the effectiveness of massage therapy for decreasing fatigue, pain, and spasticity in people with multiple sclerosis, in order to improve their health perception and quality of life. Participants will receive a standardized routine of massage therapy by a licensed massage therapist one time a week for 6 weeks. Measures of fatigue (primary outcome measure), and pain, spasticity, and quality of life (secondary outcome measures) will be collected before and immediately after the completion of the 6-week intervention phase.

Click here to view Dr. Backus and her research featured on CBS-WTAJ in central PA.

Click here to view another story that features Dr. Backus and her research.

AWARD YEAR:  2014

Impact of Massage Therapy on Well-Being for Parents of Children Recovering From Traumatic Injury

Natalie Williams, PhD
University of Nebraska-Lincoln
Lincoln, Nebraska

 

The purpose of this research project is to examine the effects of massage therapy as an intervention strategy to improve parents’ well-being in the context of child rehabilitation from severe injury/illness. Although the symptomatic benefits of therapeutic massage have been documented, massage represents a novel intervention to promote physical and psychological wellbeing among caregivers of children recovering from severe injury or illness. Participants for this study include parents of 40 children receiving inpatient rehabilitation for severe injury or illness at Alexis Verzal Children’s Rehabilitation Hospital in Lincoln, Nebraska. Following enrollment, participants are randomized to receive either three massage sessions per week for two weeks, or one massage session per week for two weeks. For all participants, regardless of group assignment, study outcomes are assessed pre-intervention (occurring at enrollment, prior to randomization) and post-intervention (occurring two weeks post enrollment). Primary outcomes include self-report measures of psychological functioning (positive and negative mood, anxiety, depression) and perceived stress. For our secondary outcomes, saliva samples are collected to assess the effects of massage on salivary cortisol (to measure stress response) and salivary alpha-amylase (to measure autonomic nervous system activation) reactivity during a verbal stress task. Participants’ sleep is also measured using actigraphy.

AWARD YEAR:  2015

Blood Flow Within Active Myofascial Trigger Points Following Massage

Albert Moraska, PhD
University of Colorado at Denver
Aurora, CO
$30,000

Myofascial pain syndromes are associated with a high percentage of chronic pain disorders and are characterized by the presence of myofascial trigger points (MTrPs). Massage therapy has been shown to be effective at alleviating myofascial pain presenting as back pain or tension-type headache and specifically reduce point tenderness associated with MTrPs. However, mechanisms by which massage therapy exerts an effect are poorly understood. The MTrP is a tightly contacted nodule within skeletal muscle and research evidence suggests it impedes blood flow, subsequently causing tissue distress and production of pain evoking chemicals. The purpose of this research study is to investigate blood flow at the MTrP following massage to provide inroads into a mechanism of action for massage in the treatment of myofascial pain and MTrPs. Research subjects with myofascial pain expressed as tension-type headache and an active MTrP in the upper trapezius muscle will be randomly assigned to receive trigger point release massage or a control treatment at the MTrP. Interstitial fluid within the MTrP will be collected before and after massage from which markers to assess blood flow will be determined.

AWARD YEAR:  2014

Impact of Massage Therapy on Spasticity in People with Multiple Sclerosis

Deborah Backus, PT, PhD
Shepherd Center, Atlanta, GA
$29, 998

The purpose of this pilot study is to assess the effectiveness of massage therapy for decreasing fatigue, pain, and spasticity in people with multiple sclerosis, in order to improve their health perception and quality of life. Participants will receive a standardized routine of massage therapy by a licensed massage therapist one time a week for 6 weeks. Measures of fatigue (primary outcome measure), and pain, spasticity, and quality of life (secondary outcome measures) will be collected before and immediately after the completion of the 6-week intervention phase.

Click here to view Dr. Backus and her research featured on CBS-WTAJ in central PA.

Click here to view another story that features Dr. Backus and her research.

AWARD YEAR:  2014

The Effect of Massage Therapy on Cancer Related Fatigue in Breast Cancer Survivors

Paulette Swanson, PT, DPT, MS, cert. MDT
Middlesex Hospital Cancer Center, Middletown, CT
$30,000

Despite being experienced by 80-100% of cancer patients, Cancer Related Fatigue (CRF) is not well managed in traditional care settings. This has led to an increase in use of alternative modalities such as massage to manage and minimize its effects, which is supported by a promising yet limited body of scientific evidence. The Middlesex Hospital Cancer Center’s randomized, controlled pilot study will further examine the efficacy of Swedishstyle therapeutic massage in alleviating CRF in posttreatment breast cancer survivors. Severity of fatigue, the primary response variable, will be measured using the Brief Fatigue Inventory, a validated, tenitem tool from the MD Anderson Cancer Center.

Treatment group members will receive four, one hour massages over consecutive weeks; fatigue will be measured one week before the initial massage, immediately before and 24 hours after each massage, and four weeks after the final therapy session. Control group participants will not undergo massage while enrolled in the study but will complete BFIs on the same schedule as the treatment group. The delivery schedule of the BFI will allow for analysis of both short and longer term severity of fatigue.

Click here to view Paulette Swanson’s research study featured on CBS-WFSB in Connecticut.

AWARD YEAR:  2013

Efficacy of Massage Therapy in Attenuating Vascular Dysfunction after Exertion-Induced Muscle Injury

Nina C. Franklin, LMT, Ph.D. (Cand)
University of Illinois at Chicago
$30,000

Exertion-induced muscle injury is a recurrent problem that most frequently results from strenuous physical work or exercise involving eccentric contractions and clinically presents as pain and discomfort lasting up to 7 days. Research suggests that muscle injury triggers a local inflammatory response. Production of pro-inflammatory mediators by neutrophils, during the early phase of this response, may initiate systemic inflammation characterized by enhanced adhesion of neutrophils to the endothelium, excess reactive oxygen species production, and consequently, vascular dysfunction. Currently, there is no universally accepted treatment for exertion-induced muscle injury, however, massage therapy is often recommended for reducing associated symptoms.

The purpose of this research project is to determine the efficacy of massage therapy in attenuating vascular dysfunction in healthy sedentary young adults following acute exposure to exertion-induced muscle injury. Individuals who meet inclusion criteria will be assigned to one of three groups: 1) massage therapy treatment following exposure to exertion-induced muscle injury, 2) a control condition of exertion-induced muscle injury without massage therapy, or 3) a control condition of massage therapy without exertion-induced muscle injury. Our studies will employ an integrated approach with in-vivo and in-vitro physiologic methods to address independent and dual effects of exertion-induced muscle injury and massage therapy treatment on vascular function. The hypothesis to be tested is that massage therapy treatment performed after acute exposure to exertion-induced muscle injury will protect against vascular dysfunction and oxidative stress.

This research has been published in the Archives of Physical Medicine and Rehabilitation Journal (article titled “Massage Therapy Restores Peripheral Vascular Function Following Exertion”). You can view the original press release and video here.

AWARD YEAR:  2010