Case studies on the effects of relieving stress in the work place, through therapeutic treatments.
Massage Studies for Stress Management/Reducing Anxiety, and the Treatment of Back/Neck Pain
Cooke, M., et al (2007). The effect of aromatherapy massage with music on the stress and anxiety levels of emergency nurses: comparison between summer and winter. Journal of Clin Nursing, 16(9), 695-1703.
OBJECTIVES: This research aimed to evaluate the use of aromatherapy massage and music as an intervention to cope with the occupational stress and anxiety that emergency department nursing staff experience. The study also aimed to compare any differences in results between a summer and winter 12-week massage plan. lllf
METHOD: Staff occupational stress was assessed pre- and post- 12 weeks of aromatherapy massage with music and anxiety was measured pre and post each massage session. Sick leave was also measured. Comparisons of summer and winter data were undertaken.
RESULTS: A total of 365 massages were given over two 12-week periods, one during summer and the other during winter. Analysis identified that aromatherapy massage with music significantly reduced anxiety for both seasonal periods. Premassage anxiety was significantly higher in winter than summer. No differences in sick leave and workload were found. There was no difference in the occupational stress levels of nurses following the two 12-week periods of massage.
CONCLUSIONS: Emergency nurses were significantly more anxious in winter than summer but this cannot be attributed to increased sick leave or workloads. Aromatherapy massage with music significantly reduced emergency nurses' anxiety. High levels of anxiety and stress can be detrimental to the physical and emotional health of emergency nurses and the provision of a support mechanism such as on-site massage as an effective strategy should be considered.
Furlan AD, Brosseau L, Imamura M, Irvin E. Research, Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, Canada, M5G 2E9. firstname.lastname@example.org
BACKGROUND: Low-back pain is one of the most common and costly musculoskeletal problems in modern society. Proponents of massage therapy claim it can minimize pain and disability, and speed return to normal function.
OBJECTIVES: To assess the effects of massage therapy for non-specific low-back pain.
SEARCH STRATEGY: We searched Medline, Embase, Cochrane Controlled Trials Register, HealthSTAR, CINAHL and Dissertation abstracts from their beginning to May 2001 with no language restrictions. References in the included studies and in reviews of the literature were screened. Contact with content experts and massage associations was also made.
SELECTION CRITERIA: The studies had to be randomized or quasi-randomized trials investigating the use of any type of massage (using the hands or a mechanical device) as a treatment for non-specific low-back pain.
DATA COLLECTION AND ANALYSIS: Two reviewers blinded to authors, journal and institutions selected the studies, assessed the methodological quality using the criteria recommended by the Cochrane Back Review Group, and extracted the data using standardized forms. The studies were analysed in a qualitative way due to heterogeneity of population, massage technique, comparison groups, timing and type of outcome measured.
MAIN RESULTS: Nine publications reporting on eight randomized trials were included. Three had low and five had high methodological quality scores. One study was published in German and the rest in English. Massage was compared to an inert treatment (sham laser) in one study that showed that massage was superior, especially if given in combination with exercises and education. In the other seven studies, massage was compared to different active treatments. They showed that massage was inferior to manipulation and TENS; massage was equal to corsets and exercises; and massage was superior to relaxation therapy, acupuncture and self-care education. The beneficial effects of massage in patients with chronic low-back pain lasted at least one year after the end of the treatment. One study comparing two different techniques of massage concluded in favour of acupuncture massage over classic (Swedish) massage.
REVIEWER'S CONCLUSIONS: Massage might be beneficial for patients with subacute and chronic non-specific low-back pain, especially when combined with exercises and education. The evidence suggest that acupuncture massage is more effective than classic massage, but this need confirmation. More studies are needed to confirm these conclusions and to assess the impact of massage on return-to-work, and to measure longer term effects to determine cost-effectiveness of massage as an intervention for low-back pain.
Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations. Touch Research Institute, University of Miami School of Medicine, Florida 33101, USA. Field T, Ironson G, Scafidi F, Nawrocki T, Goncalves A, Burman I, Pickens J, Fox N, Schanberg S, Kuhn C.
Twenty-six adults were given a chair massage and 24 control group adults were asked to relax in the massage chair for 15 minutes, two times per week for five weeks. On the first and last days of the study they were monitored for EEG, before, during and after the sessions. In addition, before and after the sessions they performed math computations, they completed POMS Depression and State Anxiety Scales and they provided a saliva sample for cortisol. At the beginning of the sessions they completed Life Events, Job Stress and Chronic POMS Depression Scales. Group by repeated measures and post hoc analyses revealed the following: 1) frontal delta power increased for both groups, suggesting relaxation; 2) the massage group showed decreased frontal alpha and beta power (suggesting enhanced alertness); while the control group showed increased alpha and beta power; 3) the massage group showed increased speed and accuracy on math computations while the control group did not change; 4) anxiety levels were lower following the massage but not the control sessions, although mood state was less depressed following both the massage and control sessions; 5) salivary cortisol levels were lower following the massage but not the control sessions but only on the first day; and 6) at the end of the 5 week period depression scores were lower for both groups but job stress score were lower only for the massage group.
The Effectiveness of Massage Therapy Intervention on Reducing Anxiety in the Workplace. Journal of Applied Behavioral Science 32.2. (1996): 160-173. Shulman, Karen R, and Gwen E. Jones.
The effectiveness of an on-site chair massage therapy program in reducing anxiety levels of employees was evaluated. The study found significant reductions in anxiety levels among employees receiving 15-minute weekly massages for 6 weeks. A control group of employees, who received a 15-minute break weekly, experienced no such effect.
Patterns and perceptions of care for treatment of back and neck pain: results of a national survey. Wolsko PM, Eisenberg DM, Davis RB, Kessler R, Phillips RS. Center for Alternative Medicine Research and Education, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA, USA.
STUDY DESIGN: We conducted a nationally representative random household telephone survey to assess therapies used to treat back or neck pain.
OBJECTIVES: The main outcome was complementary therapies used in the last year to treat back or neck pain.
SUMMARY OF BACKGROUND DATA: Back pain and neck pain are common medical conditions that cause substantial morbidity. Despite the presumed importance of complementary therapies for these conditions, studies of care for back and neck pain have not gathered information about the use of complementary therapies.
METHODS: Our nationally representative survey sampled 2055 adults. The survey gathered detailed information about medical conditions, conventional and complementary therapies used to treat those conditions, and the perceived helpfulness of those therapies.
RESULTS: We found that of those reporting back or neck pain in the last 12 months, 37% had seen a conventional provider and 54% had used complementary therapies to treat their condition. Chiropractic, massage, and relaxation techniques were the most commonly used complementary treatments for back or neck pain (20%, 14%, and 12%, respectively, of those with back or neck pain). Chiropractic, massage, and relaxation techniques were rated as "very helpful" for back or neck pain among users (61%, 65%, and 43%, respectively), whereas conventional providers were rated as "very helpful" by 27% of users. We estimate that nearly one-third of all complementary provider visits in 1997 (203 million of 629 million) were made specifically for the treatment of back or neck pain.
CONCLUSIONS: Chiropractic, massage, relaxation techniques, and other complementary methods all play an important role in the care of patients with back or neck pain. Treatment for back and neck pain was responsible for a large proportion of all complementary provider visits made in 1997. The frequent use and perceived helpfulness of commonly used complementary methods for these conditions warrant further investigation.
The most popular alternative therapies for low back pain are spinal manipulation, acupuncture, and massage. (Ref. 51) Although clinical trials suggest that spinal manipulation has some efficacy, systematic reviews have found little support for acupuncture. (Ref. 41,42,52) Massage has rarely been studied, but promising preliminary results of clinical trials suggest that research on massage therapy should be assigned a high priority.
The Journal of Applied Behavioral Science, Vol. 32, No. 2, 160-173 (1996); The Effectiveness of Massage Therapy Intervention on Reducing Anxiety in the Workplace; Karen R. Shulman, Gwen E. Jones, Bowling Green State University
This study evaluated the effectiveness of an on-site chair massage therapy program in reducing anxiety levels of employees. A quasi-experimental pretest/posttest control group design was used to determine changes in anxiety levels due to the massage therapy intervention. Eighteen subjects participated in the chair massage therapy program for 6 weeks. Fifteen control group subjects participated in break therapy. For 15 minutes weekly, subjects either received a massage or were allowed a break, depending on their assignment to either the treatment or control condition. Participants' stress levels were measured with the State-Trait Anxiety Inventory Self-Assessment Questionnaire. This measure was administered twice during pretest, posttest, and delayed posttest to achieve stable measures. Significant reductions in anxiety levels were found for the massage group.
Psychological Bulletin 2004, Vol. 130, No. 1, 18; A Meta-Analysis of Massage Therapy Research; Christopher A. Moyer, James Rounds, and James W. Hannum; University of Illinois
Massage therapy (MT) is an ancient form of treatment that is now gaining popularity as part of the
complementary and alternative medical therapy movement. A meta-analysis was conducted of studies
that used random assignment to test the effectiveness of MT. Mean effect sizes were calculated from 37 studies for 9 dependent variables. Single applications of MT reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level. Multiple applications reduced delayed assessment of pain. Reductions of trait anxiety and depression were MT's largest effects, with a course of treatment providing benefits similar in magnitude to those of psychotherapy.
Nonpharmacological Treatments for Musculoskeletal Pain. Special Topic Series
Clinical Journal of Pain. 17(1):33-46, March 2001. Wright, Anthony Ph.D. ; Sluka, Kathleen A. Ph.D.
Background: Several types of physical therapy are used in the management of painful musculoskeletal disorders. These treatment modalities can be broadly categorized as electrotherapy modalities (e.g., transcutaneous electrical nerve stimulation), acupuncture, thermal modalities (e.g., moist heat, ultrasound), manual therapies (e.g., manipulation or massage), or exercise. Within each of these broad categories significant variations in treatment parameters are possible.
Objective: To consider the evidence base for each of these main categories of physical therapy in the management of musculoskeletal pain.
Method: To consider the available evidence related to clinical effectiveness and then to review evidence from basic science studies evaluating potentially therapeutic effects of the various therapies.
Results: There seems to be evidence from basic science research to suggest that many of the therapies could have potentially therapeutic effects. However, there appears to be limited high-quality evidence from randomized clinical trials to support the therapeutic effectiveness of several of the therapies.
Conclusions: There is some preliminary evidence to support the use of manual therapies, exercise, and acupuncture in the management of some categories of musculoskeletal pain.
Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial; Michele Preyde, Faculty of Social Work, University of Toronto.
Background: The effectiveness of massage therapy for low-back pain has not been documented. This randomized controlled trial compared comprehensive massage therapy (soft-tissue manipulation, remedial exercise and posture education), 2 components of massage therapy and placebo in the treatment of subacute (between 1 week and 8 months) low-back pain.
Methods: Subjects with subacute low-back pain were randomly assigned to 1 of 4 groups: comprehensive massage therapy (n = 25), soft-tissue manipulation only (n = 25), remedial exercise with posture education only (n = 22) or a placebo of sham laser therapy (n = 26). Each subject received 6 treatments within approximately 1 month. Outcome measures obtained at baseline, after treatment and at 1-month follow-up consisted of the Roland Disability Questionnaire (RDQ), the McGill Pain Questionnaire (PPI and PRI), the State Anxiety Index and the Modified Schober test (lumbar range of motion).
Results: Of the 107 subjects who passed screening, 98 (92%) completed post-treatment tests and 91 (85%) completed follow-up tests. Statistically significant differences were noted after treatment and at follow-up. The comprehensive massage therapy group had improved function (mean RDQ score 1.54 v. 2.86-6.5, p < 0.001), less intense pain (mean PPI score 0.42 v. 1.18-1.75, p < 0.001) and a decrease in the quality of pain (mean PRI score 2.29 v. 4.55-7.71, p = 0.006) compared with the other 3 groups. Clinical significance was evident for the comprehensive massage therapy group and the soft-tissue manipulation group on the measure of function. At 1-month follow-up 63% of subjects in the comprehensive massage therapy group reported no pain as compared with 27% of the soft-tissue manipulation group, 14% of the remedial exercise group and 0% of the sham laser therapy group.
Interpretation: Patients with subacute low-back pain were shown to benefit from massage therapy, as regulated by the College of Massage Therapists of Ontario and delivered by experienced massage therapists.