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Patient Education And Outcomes!

Posted on September 27, 2015 at 11:20 AM Comments comments (7225)



Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].




Does structured patient education improve the recovery and clinical outcomes of patients with neck pain? A systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration


Review published: 2014.



Bibliographic details: Yu H, Cote P, Southerst D, Wong JJ, Varatharajan S, Shearer HM, Gross DP, van der Velde G, Carroll LJ, Mior S, Ameis A, Jacobs C, Taylor-Vaisey A. Does structured patient education improve the recovery and clinical outcomes of patients with neck pain? A systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine Journal 2014: epub. [PubMed]





BACK GROUND CONTEXT: In 2008, the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders recommended patient education for the management of neck pain. However, the effectiveness of education interventions has recently been challenged.


PURPOSE: To update the findings of the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders and evaluate the effectiveness of structured patient education for the management of patients with whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD).


STUDY DESIGN/SETTING: Systematic review of the literature and best-evidence synthesis.


PATIENT SAMPLE: Randomized controlled trials that compared structured patient education with other conservative interventions.


OUTCOME MEASURES: Self-rated recovery, functional recovery (eg, disability, return to activities, work, or school), pain intensity, health-related quality of life, psychological outcomes such as depression or fear, or adverse effects.


METHODS: We systematically searched eight electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials, DARE, PubMed, and ICL) from 2000 to 2012. Randomized controlled trials, cohort studies, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Scientifically admissible studies were summarized in evidence tables and synthesized following best-evidence synthesis principles.


RESULTS: We retrieved 4,477 articles. Of those, nine were eligible for critical appraisal and six were scientifically admissible. Four admissible articles investigated patients with WAD and two targeted patients with NAD. All structured patient education interventions included advice on activation or exercises delivered orally combined with written information or as written information alone. Overall, as a therapeutic intervention, structured patient education was equal or less effective than other conservative treatments including massage, supervised exercise, and physiotherapy. However, structured patient education may provide small benefits when combined with physiotherapy. Either mode of delivery (ie, oral or written education) provides similar results in patients with recent WAD.


CONCLUSIONS: This review adds to the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders by defining more specifically the role of structured patient education in the management of WAD and NAD. Results suggest that structured patient education alone cannot be expected to yield large benefits in clinical effectiveness compared with other conservative interventions for patients with WAD or NAD. Moreover, structured patient education may be of benefit during the recovery of patients with WAD when used as an adjunct therapy to physiotherapy or emergency room care. These benefits are small and short lived.


Copyright © 2014 Elsevier Inc. All rights reserved.




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CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.


Copyright © 2014 University of York.


PMID: 24704678


Effects of Massage Therapy in Depressed People!

Posted on September 27, 2015 at 11:15 AM Comments comments (1347)



Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].




Treatment effects of massage therapy in depressed people: a meta-analysis


Review published: 2010.



Bibliographic details: Hou WH, Chiang PT, Hsu TY, Chiu SY, Yen YC. Treatment effects of massage therapy in depressed people: a meta-analysis. Journal of Clinical Psychiatry 2010; 71 (7) : 894-901. [PubMed]





OBJECTIVE: To systematically investigate the treatment effects of massage therapy in depressed people by incorporating data from recent studies.


DATA SOURCES: A meta-analysis of randomized controlled trials (RCTs) of massage therapy in depressed people was conducted using published studies from PubMed, EMBASE, PsycINFO, and CINAHL electronic database from inception until July 2008. The terms used for the search were derived from medical subheading term (MeSH) massage combined with MeSH depression. Hand searching was also checked for bibliographies of relevant articles. Retrieval articles were constrained to RCTs/clinical trials and human subjects. No language restrictions were imposed.


STUDY SELECTION: We included 17 studies containing 786 persons from 246 retrieved references. Trials with other intervention, combined therapy, and massage on infants or pregnant women were excluded.


DATA EXTRACTION: Two reviewers independently performed initial screen and assessed quality indicators by Jadad scale. Data were extracted on publication year, participant characteristics, and outcomes by another single reviewer.


DATA SYNTHESIS: All trials showed positive effect of massage therapy on depressed people. Seventeen RCTs were of moderate quality, with a mean quality score of 6.4 (SD = 0.85). The pooled standardized mean difference in fixed- and random-effects models were 0.76 (95% CI, 0.61-0.91) and 0.73 (95% CI, 0.52-0.93), respectively. Both indicated significant effectiveness in the treatment group compared with the control group. The variance between these studies revealed possible heterogeneity (tau(2) = 0.06, Cochran chi-squared(16) = 25.77, P = .06).


CONCLUSIONS: Massage therapy is significantly associated with alleviated depressive symptoms. However, standardized protocols of massage therapy, various depression rating scales, and target populations in further studies are suggested.


(c) Copyright 2010 Physicians Postgraduate Press, Inc.




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CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.


Copyright © 2014 University of York.

Safety of Massage Therapy

Posted on September 27, 2015 at 11:15 AM Comments comments (1357)



The safety of massage therapy


Review published: 2003.



Bibliographic details: Ernst E. The safety of massage therapy. Rheumatology 2003; 42(9): 1101-1106. [PubMed]





OBJECTIVES: After many years out of the limelight, massage therapy is now experiencing a revival. The aim of this systematic review is to evaluate its potential for harm.


METHODS: Computerized literature searches were carried out in four databases. All articles reporting adverse effects of any type of massage therapy were retrieved. Adverse effects relating to massage oil or ice were excluded. No language restrictions were applied. Data were extracted and evaluated according to predefined criteria.


RESULTS: Sixteen case reports of adverse effects and four case series were found. The majority of adverse effects were associated with exotic types of manual massage or massage delivered by laymen, while massage therapists were rarely implicated. The reported adverse events include cerebrovascular accidents, displacement of a ureteral stent, embolization of a kidney, haematoma, leg ulcers, nerve damage, posterior interosseous syndrome, pseudoaneurism, pulmonary embolism, ruptured uterus, strangulation of neck, thyrotoxicosis and various pain syndromes. In the majority of these instances, there can be little doubt about a cause-effect relationship. Serious adverse effects were associated mostly with massage techniques other than 'Swedish' massage.


CONCLUSION: Massage is not entirely risk free. However, serious adverse events are probably true rarities.




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CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.


Massage Therapy Benefits and Effectiveness in Treating Fibromyalgia

Posted on September 27, 2015 at 11:10 AM Comments comments (1202)



Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].




Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis


Review published: 2014.



Bibliographic details: Yuan SL, Matsutani LA, Marques AP. Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis. Manual Therapy 2014: epub. [PubMed]





The systematic review aimed to evaluate the effectiveness of massage in fibromyalgia. An electronic search was conducted at MEDLINE, SCiELO, EMBASE, ISI, PEDro, SPORTDiscus, CINAHL, Cochrane CENTRAL and LILACS (Jan 1990-May 2013). Ten randomized and non-randomized controlled trials investigating the effects of massage alone on symptoms and health-related quality of life of adult patients with fibromyalgia were included. Two reviewers independently screened records, examined full-text reports for compliance with the eligibility criteria, and extracted data. Meta-analysis (pooled from 145 participants) shows that myofascial release had large, positive effects on pain and medium effects on anxiety and depression at the end of treatment, in contrast with placebo; effects on pain and depression were maintained in the medium and short term, respectively. Narrative analysis suggests that: myofascial release also improves fatigue, stiffness and quality of life; connective tissue massage improves depression and quality of life; manual lymphatic drainage is superior to connective tissue massage regarding stiffness, depression and quality of life; Shiatsu improves pain, pressure pain threshold, fatigue, sleep and quality of life; and Swedish massage does not improve outcomes. There is moderate evidence that myofascial release is beneficial for fibromyalgia symptoms. Limited evidence supports the application of connective tissue massage and Shiatsu. Manual lymphatic drainage may be superior to connective tissue massage, and Swedish massage may have no effects. Overall, most styles of massage therapy consistently improved the quality of life of fibromyalgia patients.


Copyright © 2014 Elsevier Ltd. All rights reserved.




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CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.


Copyright © 2014 University of York.


PMID: 25457196


Massage Treatments for Neck Pain

Posted on September 27, 2015 at 11:05 AM Comments comments (1501)


Massage for mechanical neck pain


This version published: 2013; Review content assessed as up-to-date: February 07, 2012.


Link to full article: [Cochrane Library]




Plain language summary


Neck pain is common and can limit a person's ability to participate in normal daily activities. Massage is a widely used treatment for neck pain. In this review, it was defined as touching or manipulating the soft tissues surrounding the neck with the hand, foot, arm or elbow. There are a number of different types of massage. This review included studies that looked at Traditional Chinese massage, ischaemic compression, self‐administered ischaemic pressure using a J‐knob cane, conventional Western massage and occipital release, among other techniques. It did not include studies that examined techniques such as Reiki or Polarity.


We included 15 trials in this review that assessed whether massage could help reduce neck pain and improve function. Results showed that massage is safe, and any side effects were temporary and benign. However, massage did not show a significant advantage over other comparison groups. Massage was compared with no treatment, hot packs, active range‐of‐movement exercises, acupuncture, exercises, sham laser, manual traction, mobilization, and education.


There were a number of challenges with this review. Overall, the quality of the studies was poor and the number of participants in most trials was small. Most studies lacked a clear definition, description, or rationale for the massage technique used. Details on the credentials or experience of the person giving the massage were often missing. There was such a range of massage techniques and comparison treatments in the studies that we could not combine the results to get an overall picture of the effectiveness of massage. Therefore, no firm conclusions could be drawn and the effectiveness of massage for improving neck pain and function remains unclear.





Background: The prevalence of mechanical neck disorders (MND) is known to be both a hindrance to individuals and costly to society. As such, massage is widely used as a form of treatment for MND.


Objectives: To assess the effects of massage on pain, function, patient satisfaction, global perceived effect, adverse effects and cost of care in adults with neck pain versus any comparison at immediate post‐treatment to long‐term follow‐up.


Search methods: We searched The Cochrane Library (CENTRAL), MEDLINE, EMBASE, MANTIS, CINAHL, and ICL databases from date of inception to 4 Feburary 2012.


Selection criteria: Studies using random assignment were included.


Data collection and analysis: Two review authors independently conducted citation identification, study selection, data abstraction and methodological quality assessment. Using a random‐effects model, we calculated the risk ratio and standardised mean difference.


Main results: Fifteen trials met the inclusion criteria. The overall methodology of all the trials assessed was either low or very low GRADE level. None of the trials were of strong to moderate GRADE level. The results showed very low level evidence that certain massage techniques (traditional Chinese massage, classical and modified strain/counterstrain technique) may have been more effective than control or placebo treatment in improving function and tenderness. There was very low level evidence that massage may have been more beneficial than education in the short term for pain bothersomeness. Along with that, there was low level evidence that ischaemic compression and passive stretch may have been more effective in combination rather than individually for pain reduction. The clinical applicability assessment showed that only 4/15 trials adequately described the massage technique. The majority of the trials assessed outcomes at immediate post‐treatment, which is not an adequate time to assess clinical change. Due to the limitations in the quality of existing studies, we were unable to make any firm statement to guide clinical practice. We noted that only five of the 15 studies reported side effects. All five studies reported post‐treatment pain, discomfort and soreness as a side effect and one study (Irnich 2001) showed that 22% of the participants experienced low blood pressure following treatment.


Authors' conclusions: No recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain.


As a stand‐alone treatment, massage for MND was found to provide an immediate or short‐term effectiveness or both in pain and tenderness. Additionally, future research is needed in order to assess the long‐term effects of treatment and treatments provided on more than one occasion.




Editorial Group: Cochrane Back Group.



Publication status: Edited (no change to conclusions).


Citation: Patel KC, Gross A, Graham N, Goldsmith CH, Ezzo J, Morien A, Peloso PMJ. Massage for mechanical neck disorders. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD004871. DOI: 10.1002/14651858.CD004871.pub4. Link to Cochrane Library. [PubMed


CAM Therapies in treating non-specific LOW BACK PAIN

Posted on September 27, 2015 at 11:05 AM Comments comments (1322)




Complementary and Alternative Therapies for Back Pain II


Evidence Reports/Technology Assessments, No. 194


Investigators: Andrea D Furlan, MD, PhD, Fatemeh Yazdi, BScPT, MSc, Alexander Tsertsvadze, MD, MSc, Anita Gross, BScPT, MSc, Maurits Van Tulder, PhD, Lina Santaguida, BScPT, PhD, Dan Cherkin, PhD, Joel Gagnier, ND, PhD, Carlo Ammendolia, DC, PhD, Mohammed T Ansari, MBBS, MMedSc, MPhil, Thomas Ostermann, PhD, Trish Dryden, RMT, MEd, Steve Doucette, MSc, Becky Skidmore, MLS, Raymond Daniel, BA, Sophia Tsouros, BHKin, Laura Weeks, PhD, and James Galipeau, PhD.


University of Ottawa Evidence-based Practice Center


Rockville (MD): Agency for Healthcare Research and Quality (US); 2010 Oct.

Report No.: 10(11)-E007


Copyright and Permissions




Structured Abstract



Back and neck pain are important health problems with serious societal and economic implications. Conventional treatments have been shown to have limited benefit in improving patient outcomes. Complementary and Alternative Medicine (CAM) therapies offer additional options in the management of low back and neck pain. Many trials evaluating CAM therapies have poor quality and inconsistent results.



To systematically review the efficacy, effectiveness, cost-effectiveness, and harms of acupuncture, spinal manipulation, mobilization, and massage techniques in management of back, neck, and/or thoracic pain.


Data Sources:

MEDLINE, Cochrane Central, Cochrane Database of Systematic Reviews, CINAHL, and EMBASE were searched up to 2010; unpublished literature and reference lists of relevant articles were also searched.


Study Selection:

All records were screened by two independent reviewers. Primary reports of comparative efficacy, effectiveness, harms, and/or economic evaluations from randomized controlled trials (RCTs) of the CAM therapies in adults (age ≥ 18 years) with back, neck, or thoracic pain were eligible. Non-randomized controlled trials and observational studies (case‐control, cohort, cross-sectional) comparing harms were also included. Reviews, case reports, editorials, commentaries or letters were excluded.


Data Extraction:

Two independent reviewers using a predefined form extracted data on study, participants, treatments, and outcome characteristics.


Data Analysis:

Included studies were stratified by the region, cause, and duration of pain. Evidence was summarized qualitatively and RCTs were pooled according to the post-treatment followup at which the outcomes were measured. Subgroup and sensitivity analyses were planned a priori. Publication bias was examined through visual inspection of funnel plot and a regression-based method.



265 RCTs and 5 non-RCTs were included. Acupuncture for chronic nonspecific low back pain was associated with significantly lower pain intensity than placebo but only immediately post-treatment (VAS: -0.59, 95 percent CI: -0.93, -0.25). However, acupuncture was not different from placebo in post-treatment disability, pain medication intake, or global improvement in chronic nonspecific low back pain. Acupuncture did not differ from sham-acupuncture in reducing chronic non-specific neck pain immediately after treatment (VAS: ‐0.24, 95 percent CI: -1.20, 0.73). Acupuncture was superior to no treatment in improving pain intensity (VAS: -1.19, 95 percent CI: 95 percent CI: -2.17, -0.21), disability (PDI), functioning (HFAQ), well-being (SF-36), and range of mobility (extension, flexion), immediately after the treatment. In general, trials that applied sham-acupuncture tended to produce negative results (i.e., statistically non-significant) compared to trials that applied other types of placebo (e.g., TENS, medication, laser). Results regarding comparisons with other active treatments (pain medication, mobilization, laser therapy) were less consistent Acupuncture was more cost-effective compared to usual care or no treatment for patients with chronic back pain.


For both low back and neck pain, manipulation was significantly better than placebo or no treatment in reducing pain immediately or short-term after the end of treatment. Manipulation was also better than acupuncture in improving pain and function in chronic nonspecific low back pain. Results from studies comparing manipulation to massage, medication, or physiotherapy were inconsistent, either in favor of manipulation or indicating no significant difference between the two treatments. Findings of studies regarding costs of manipulation relative to other therapies were inconsistent.


Mobilization was superior to no treatment but not different from placebo in reducing low back pain or spinal flexibility after the treatment. Mobilization was better than physiotherapy in reducing low back pain (VAS: -0.50, 95 percent CI: -0.70, -0.30) and disability (Oswestry: -4.93, 95 percent CI: -5.91, -3.96). In subjects with acute or subacute neck pain, mobilization compared to placebo significantly reduced neck pain. Mobilization and placebo did not differ in subjects with chronic neck pain.


Massage was superior to placebo or no treatment in reducing pain and disability only amongst subjects with acute/sub-acute low back pain. Massage was also significantly better than physical therapy in improving back pain (VAS: -2.11, 95 percent CI: -3.15, -1.07) or disability. For subjects with neck pain, massage was better than no treatment, placebo, or exercise in improving pain or disability, but not neck flexibility. Some evidence indicated higher costs for massage use compared to general practitioner care for low back pain.


Reporting of harms in RCTs was poor and inconsistent. Subjects receiving CAM therapies reported soreness or bleeding on the site of application after acupuncture and worsening of pain after manipulation or massage. In two case-control studies cervical manipulation was shown to be significantly associated with vertebral artery dissection or vertebrobasilar vascular accident.



Evidence was of poor to moderate grade and most of it pertained to chronic nonspecific pain, making it difficult to draw more definitive conclusions regarding benefits and harms of CAM therapies in subjects with acute/subacute, mixed, or unknown duration of pain. The benefit of CAM treatments was mostly evident immediately or shortly after the end of the treatment and then faded with time. Very few studies reported long-term outcomes. There was insufficient data to explore subgroup effects. The trial results were inconsistent due probably to methodological and clinical diversity, thereby limiting the extent of quantitative synthesis and complicating interpretation of trial results. Strong efforts are warranted to improve the conduct methodology and reporting quality of primary studies of CAM therapies. Future well powered head to head comparisons of CAM treatments and trials comparing CAM to widely used active treatments that report on all clinically relevant outcomes are needed to draw better conclusions.


Massage and Heat effects on Autonomic Nervous System

Posted on August 21, 2015 at 10:15 AM Comments comments (2025)



Yonsei Med J. 2011 Nov 1; 52(6): 982–989.


Published online 2011 Oct 20. doi: 10.3349/ymj.2011.52.6.982



PMCID: PMC3220246


The Effects of Heat and Massage Application on Autonomic Nervous System



Young-Hee Lee, Bit Na Ri Park, and Sung Hoon Kim corresponding author


Author information ► Article notes ► Copyright and License information ►


This article has been cited by other articles in PMC.









The objective of this study is to evaluate the effects of heat and massage application on autonomic nervous system.



Materials and Methods


One hundred thirty-nine subjects volunteered and completed this study. Heat and massage was daily applied for 40 minutes,

5 days a week for 2 weeks. Primary-dependent measures included heart rate variability, sympathetic skin response, and

serum cortisol and norepinephrine levels.





Serum cortisol levels were significantly decreased at 2 weeks compared to baseline (p=0.003). Plasma norepinephrine levels

at 4 weeks were significantly decreased compared to baseline (p=0.010). Heart rate, using the power spectra, increased

significantly after 2 weeks compared to baseline. Of autonomic nerve conduction measures, latency was significantly

increased at 2 and 4 weeks compared to baseline (p=0.023, 0.012), and amplitude was significantly decreased at 4 weeks

compared to baseline (p=0.008). There were no serious adverse events such as burns or other major complications.





The results of this study suggest that heat and massage applications provide relaxation to the autonomic nervous system

without serious adverse effects.

Feasibility and effect of chair massage offered to nurses during work hours on stress-related symptoms

Posted on June 19, 2014 at 10:25 AM Comments comments (984)

Feasibility and effect of chair massage offered to nurses during work hours on stress-related symptoms: a pilot study.

Engen DJ1, Wahner-Roedler DL, Vincent A, Chon TY, Cha SS, Luedtke CA, Loehrer LL, Dion LJ, Rodgers NJ, Bauer BA.


This study assessed feasibility and effect of weekly, 15-min chair massages during work for 38 nurses. Mean Perceived Stress Scale-14 (PSS-14), Smith Anxiety Scale (SAS), linear analog self-assessment scale (LASA), and symptom visual analog scale (SX-VAS) scores were tracked at baseline, 5 weeks, and 10 weeks. Of 400 available massage appointments, 329 were used. At 10 weeks, mean PSS-14 score decreased from 17.85 to 14.92 (P = .002); mean SAS score, from 49.45 to 40.95 (P < .001). Mean LASA score increased from 42.39 to 44.84 (P = .006); mean SX-VAS score, from 65.03 to 74.47 (P < .001). Massages for nurses during work hours reduced stress-related symptoms.

Copyright © 2012 Elsevier Ltd. All rights reserved.

Effect of massage therapy for post surgical mastectomy recipients.

Posted on June 19, 2014 at 10:25 AM Comments comments (1125)

Effect of massage therapy for postsurgical mastectomy recipients.

Drackley NL1, Degnim AC, Jakub JW, Cutshall SM, Thomley BS, Brodt JK, Vanderlei LK, Case JK, Bungum LD, Cha SS, Bauer BA, Boughey JC.


This quality improvement pilot study evaluated the effect of massage therapy on pain, anxiety, and overall well-being in women who received mastectomies at a busy hospital practice. Participants reported a significant reduction in pain, stress, and muscle tension, as well as an increase in relaxation. Oncology nurses should consider the feasibility of massage therapy as a valuable nonpharmcologic pain management strategy.

Effect of massage on pain management for thoracic surgery patients

Posted on June 19, 2014 at 10:20 AM Comments comments (2792)

Effect of massage on pain management for thoracic surgery patients.

Dion L1, Rodgers N, Cutshall SM, Cordes ME, Bauer B, Cassivi SD, Cha S.


Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Thoracic surgery patients undergo long procedures and commonly have postoperative back, neck, and shoulder pain.


Given the promising effects of massage therapy for alleviation of pain, we studied the effectiveness and feasibility of massage therapy delivered in the postoperative thoracic surgery setting.


Patients who received massage in the postoperative setting had pain scores evaluated pre and post massage on a rating scale of 0 to 10 (0 = no pain, 10 = worst possible pain).


In total, 160 patients completed the pilot study and received massage therapy that was individualized. Patients receiving massage therapy had significantly decreased pain scores after massage (p ≤ .001), and patients' comments were very favorable. Patients and staff were highly satisfied with having massage therapy available, and no major barriers to implementing massage therapy were identified.


Massage therapy may be an important additional pain management component of the healing experience for patients after thoracic surgery.