Full Title: Quantitative application of transverse friction massage and its neurological effects on flexor carpi radialis

The purpose of the study was to determine the effects of transverse friction massage (TFM) on flexor carpi radialis (FCR) motoneuron (MN) pool excitability. Twenty-eight healthy subjects were randomly assigned into massage and control groups. Pre- vs post-TFM H-reflex data were collected. Controls received a rest period instead of massage. Massage dose was standardized by a novel electronic method which recorded the massage rate, momentary pressure and total cumulative pressure (energy). Two-way ANOVA of H/M ratios derived from maximal amplitudes of Hoffman reflexes (Hmax) and motor responses (Mmax) was used to analyze neurological effects and group differences. Analysis of pressure/time curve data showed: mean massage rate was 0.501+/-0.005 Hz; mean duration of massage sessions was 184.6+/-26.4s; mean peak pressure was 4.990+/-1.006 psi. Hmax/Mmax ratios declined from 14.3% to 10.3% for massage (P<0.01) but showed no change for controls (P>0.05). In conclusion a novel quantitative approach to the study of massage has been demonstrated while testing the effects of TFM on FCR MN pool excitability. TFM appears to reduce MN pool excitability. The novel method of quantifying massage permits more rigorous testing of client-centered massage in future research.

Man Ther. 2009 Oct;14(5):501-7. Epub 2008 Nov 22. Lee HM, Wu SK, You JY. Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan, ROC. hmlee@isu.edu.tw

Full Title: Use of sonographic elastography of the masseter muscles for optimizing massage pressure: a preliminary study

To examine the stiffness of the masseter muscle using sonographic elastography and to investigate its relationship with the most comfortable massage pressure in the healthy volunteers. In 16 healthy volunteers (10 men and 6 women), the Masseter Stiffness Index (MSI) was measured using EUB-7000 real-time tissue elastography. They underwent massages at three kinds of pressures using the Oral Rehabilitation Robot (WAO-1). A subjective evaluation regarding the comfort of each massage was recorded on the visual analogue scale. Elastography was also performed in two patients with temporomandibular joint dysfunction with the myofascial pain. The mean MSI of the right and left muscles in the healthy volunteers were 0.85 +/- 0.44 and 0.74 +/- 0.35 respectively. There was no significant difference between the right and left MSI in the healthy volunteers. The MSI was related to massage pressure at which the healthy men felt most comfortable. The two temporomandibular disorder patients had a large laterality in the MSI. The MSI was related to the most comfortable massage pressure in the healthy men. The MSI can be one index for determining the massage pressure.

J Oral Rehabil. 2009 Sep;36(9):627-35. Epub 2009 Jul 7. Ariji Y, Katsumata A, Hiraiwa Y, Izumi M, Iida Y, Goto M, Sakuma S, Ogi N, Kurita K, Ariji E. Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, Chikusa-ku, Nagoya, Japan. yoshiko@dpc.agu.ac.jp

Full Title: The existential experiences of receiving soft tissue massage in palliative home care--an intervention

BACKGROUND: Soft tissue massage is currently used in palliative care for the relief of anxiety and pain. Only few studies have focused on patients' deeper experience of receiving the massage. AIM: The purpose of this study was to explore how patients with cancer in palliative home care experienced soft tissue massage. MATERIALS AND METHODS: Twenty-two patients received soft tissue massage (hand or foot) nine times over a period of 2 weeks. Each session lasted for 25 min. Following the last massage session, a qualitative interview was conducted. The analysis was performed using a hermeneutic approach. FINDINGS: Soft tissue massage generated feelings of existential respite with perceptions of being released from illness for a while. Two categories constituted the basis of the experiences: (1) "an experience of thoughtful attention" and (2) "a sensation of complete tranquility" resulting in the overarching theme "A time of existential respite." CONCLUSION: The patients experienced the massage to give meaning and to be important as it generated feelings of an inner respite. RELEVANCE TO CLINICAL PRACTICE: Soft tissue massage appears to be an appreciated source of support to dying patients in palliative home care. The method is easy to comprehend and relatively short (25 min) which may imply that it is a suitable complement in nursing care for this patient group.

Support Care Cancer. 2009 Sep;17(9):1203-11. Epub 2009 Jan 28. Cronfalk BS, Strang P, Ternestedt BM, Friedrichsen M. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. berit.cronfalk@ki.se

This paper describes an observational study describing how Tactile Massage (TM) was integrated into Swedish clinical medical care, the impact of this initiative suggests a foundation for future research. Subjects completed three questionnaires pre- and post-tactile massage. These were: Sense of Coherence (SOC), an enlarged Health Index (HI) and the Borg CR10 scale. RESULTS: A convenience sample of forty-three subjects (37 women and 6 men) were referred to TM treatment for a range of problems including for pain, sleep disorders, inability to move, headache and tense body. Patients received 10 TM treatments, each lasting approx. 1h in length. The enlarged HI questionnaire indicated that eleven out of fourteen parameters were significantly affected according (p-values between 0.0015 and <0.001). These included energy, mood, tiredness, sleep, pain, movement, health, general health and physical health. Pain reduction was also significantly reduced using the Borg CR10 scale (p<0.001). CONCLUSION: TM seems to affect several dimensions of health, and this should be explored more fully in future research.

Complement Ther Clin Pract. 2009 Aug;15(3):158-60. Andersson K, Törnkvist L, Wändell P. Center for Family and Community Medicine, Karolinska Institutet, SE-141 83 Huddinge, Sweden. katarina.andersson5@comhem.se

Full Title: The culture of massage therapy: valued elements and the role of comfort, contact, connection and caring

OBJECTIVE: To explore the attributes of the therapy encounter valued by repeat users of health-related massage therapy. DESIGN: A qualitative design with telephone focus group methodology was used. A total of 19 repeat users of massage therapy participated in three telephone focus groups where audiotaped semi-structured interviews were conducted. SETTING: Telephone focus group with massage clients from a range of provincial and urban regions in New Zealand. MAIN OUTCOME MEASURES: Summary of reported themes of the massage experience. Data were thematically analysed using the general inductive approach. RESULTS: Six valued elements of the massage encounter (time for care and personal attention, engaging and competent therapist, trust partnership, holism and empowerment, effective touch and enhancing relaxation), four modulators (comfort, contact, connection and caring) and two themes relating to adding experiential value (enjoyment, escapism) characterize the massage therapy culture. CONCLUSIONS: The culture of massage therapy care incorporates a number of characteristics that are congruent with the complementary and alternative medicine approach to health. In addition, massage specific factors were identified. The humanistic aspects of the therapy encounter valued by clients offer insight into the growing use of massage therapy and the success of massage therapy outcomes.

Complement Ther Med. 2009 Aug;17(4):181-9. Smith JM, Sullivan SJ, Baxter GD. Massage Department, Southern Institute of Technology, Private Bag 90114, Invercargill 9840, New Zealand. jo.smith@sit.ac.nz

Full Title: Might massage or guided meditation provide "means to a better end"? Primary outcomes from an efficacy trial with patients at the end of life

This article reports findings from a randomized controlled trial of massage and guided meditation with patients at the end of life. Using data from 167 randomized patients, the authors considered patient outcomes through 10 weeks post-enrollment, as well as next-of-kin ratings of the quality of the final week of life for 106 patients who died during study participation. Multiple regression models demonstrated no significant treatment effects of either massage or guided meditation, delivered up to twice a week, when compared with outcomes of an active control group that received visits from hospice-trained volunteers on a schedule similar to that of the active treatment arms. The authors discuss the implications of their findings for integration of these complementary and alternative medicine therapies into standard hospice care.

Palliat Care. 2009 Summer;25(2):100-8. Downey L, Diehr P, Standish LJ, Patrick DL, Kozak L, Fisher D, Congdon S, Lafferty WE. Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA.

Full Title: Massage for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Back Review Group

STUDY DESIGN.: Systematic Review. OBJECTIVES.: To assess the effects of massage therapy for nonspecific low back pain. SUMMARY OF BACKGROUND DATA.: 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. METHODS.: We searched MEDLINE, EMBASE, CINAHL from their beginning to May 2008. We also searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, issue 3), HealthSTAR and Dissertation abstracts up to 2006. There were no language restrictions. References in the included studies and in reviews of the literature were screened. 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 nonspecific low back pain. Two review authors selected the studies, assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group, and extracted the data using standardized forms. Both qualitative and meta-analyses were performed. RESULTS.: Thirteen randomized trials were included. Eight had a high risk and 5 had a low risk of bias. One study was published in German and the rest in English. Massage was compared to an inert therapy (sham treatment) in 2 studies that showed that massage was superior for pain and function on both short- and long-term follow-ups. In 8 studies, massage was compared to other active treatments. They showed that massage was similar to exercises, and massage was superior to joint mobilization, relaxation therapy, physical therapy, acupuncture, and self-care education. One study showed that reflexology on the feet had no effect on pain and functioning. The beneficial effects of massage in patients with chronic low back pain lasted at least 1 year after the end of the treatment. Two studies compared 2 different techniques of massage. One concluded that acupuncture massage produces better results than classic (Swedish) massage and another concluded that Thai massage produces similar results to classic (Swedish) massage. CONCLUSION.: Massage might be beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education. The evidence suggests that acupuncture massage is more effective than classic massage, but this need confirmation. More studies are needed to confirm these conclusions, to assess the impact of massage on return-to-work, and to determine cost-effectiveness of massage as an intervention for low back pain.

Spine (Phila Pa 1976). 2009 Jun 25. Furlan AD, Imamura M, Dryden T, Irvin E. From the *Institute for Work & Health, Toronto, ON; daggerDepartment of Medicine, University of Toronto, Toronto, ON; double daggerToronto Rehabilitation Institute, Toronto, ON; section signDivision of Physical Medicine and Rehabilitation, Department of Orthopaedics and Traumatology, University of São Paulo School of Medicine, São Paulo, Brazil; and paragraph signCentennial College, Applied Research Centre, Toronto, ON.

BACKGROUND: Associated with decreases in quality of life, constipation is a relatively common problem. Abdominal massage appears to increase bowel function, but unlike laxatives with no negative side effects. Because earlier studies have methodological flaws and cannot provide recommendations, more research is needed. OBJECTIVE: This study investigates the effects of abdominal massage on gastrointestinal functions and laxative intake in people who have constipation. DESIGN: Randomized controlled trial. PARTICIPANTS AND METHOD: A sample of 60 people with constipation was included and randomized in two groups. The intervention group received abdominal massage in addition to an earlier prescribed laxative and the control group received only laxatives according to earlier prescriptions. Gastrointestinal function was assessed with Gastrointestinal Symptoms Rating Scale (GSRS) on three occasions; at baseline, week 4 and week 8. The statistical methods included linear regression, Wilcoxon sign rank test, and Mann-Whitney U-test. RESULT: Abdominal massage significantly decreased severity of gastrointestinal symptoms assessed with GSRS according to total score (p=.003), constipation syndrome (p=.013), and abdominal pain syndrome (p=.019). The intervention group also had significant increase of bowel movements compared to the control group (p=.016). There was no significant difference in the change of the amount of laxative intake after 8 weeks. CONCLUSIONS: Abdominal massage decreased severity of gastrointestinal symptoms, especially constipation and abdominal pain syndrome, and increased bowel movements. The massage did not lead to decrease in laxative intake, a result that indicates that abdominal massage could be a complement to laxatives rather than a substitute.

Int J Nurs Stud. 2009 Jun;46(6):759-67. Lämås K, Lindholm L, Stenlund H, Engström B, Jacobsson C. Department of Nursing, Umeå University, Umeå, Sweden. kristina.lamas@nurs.umu.se

Full Title: Massage and mobilization of the feet and ankles in elderly adults: Effect on clinical balance performance

The aim of this study was to evaluate the effects of a session of plantar massage and joint mobilization of the feet and ankles on clinical balance performance in elderly people. A randomized, placebo-controlled, cross-over trial was used to examine the immediate effects of manual massage and mobilization of the feet and ankles. Twenty-eight subjects, aged from 65 to 95 years (78.8+/-8.5 years - mean+/-SD) were recruited from community nursing homes. Main outcome measures were the performances in three tests: One Leg Balance (OLB) test, Timed Up and Go (TUG) test and Lateral Reach (LR) test. Results demonstrated a significant improvement after massage and mobilization compared with placebo for the OLB test (1.1+/-1.7s versus 0.4+/-1.2s, p<0.01) and the TUG test (0.9+/-2.6s versus 0.2+/-1.2s, p<0.05). Conversely, performances in the LR test did not improve significantly. These results emphasise the positive impact of a single session of manual therapy applied to the feet and ankles on balance in elderly subjects.

Man Ther. 2009 May 7.Vaillant J, Rouland A, Martigné P, Braujou R, Nissen MJ, Caillat-Miousse JL, Vuillerme N, Nougier V, Juvin R. Laboratoire Santé Plasticité Motricité, Université Joseph Fourier-Grenoble 1, Grenoble, France; Ecole de Kinésithérapie du Centre Hospitalier Universitaire de Grenoble, France; Service de Rhumatologie du Centre Hospitalier Universitaire de Grenoble, France.

Environmental enrichment (EE) was shown recently to accelerate brain development in rodents. Increased levels of maternal care, and particularly tactile stimulation through licking and grooming, may represent a key component in the early phases of EE. We hypothesized that enriching the environment in terms of body massage may thus accelerate brain development in infants. We explored the effects of body massage in preterm infants and found that massage accelerates the maturation of electroencephalographic activity and of visual function, in particular visual acuity. In massaged infants, we found higher levels of blood IGF-1. Massage accelerated the maturation of visual function also in rat pups and increased the level of IGF-1 in the cortex. Antagonizing IGF-1 action by means of systemic injections of the IGF-1 antagonist JB1 blocked the effects of massage in rat pups. These results demonstrate that massage has an influence on brain development and in particular on visual development and suggest that its effects are mediated by specific endogenous factors such as IGF-1.

J Neurosci. 2009 May 6;29(18):6042-51. Guzzetta A, Baldini S, Bancale A, Baroncelli L, Ciucci F, Ghirri P, Putignano E, Sale A, Viegi A, Berardi N, Boldrini A, Cioni G, Maffei L. Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, I-56128 Calambrone, Pisa, Italy.

OBJECTIVE: The aim of this study was to evaluate the effects of massage with or without kinesthetic stimulation on weight gain and length of hospital stay in the preterm infant. STUDY DESIGN: A prospective randomized clinical trial was conducted evaluating the effects of massage with or without kinesthetic stimulation (KS) on weight gain and length of stay (LOS) in medically stable premature (<1500 g and/or and <1000 g) was also performed. RESULT: A total of 60 premature infants were recruited for this study; 20 infants in each group. Average daily weight gain and LOS were similar between the groups after controlling for covariates. For infants with BW>1000 g, average daily weight gain was increased in the intervention groups compared to control. This effect was mainly attributable to the M/KS group. CONCLUSION: Massage with KS is a relatively simple and inexpensive intervention that can improve weight gain in selected preterm infants. Length of hospital stay is not impacted by massage with or without KS. Further studies are needed to evaluate the effect of massage in the extremely low BW(<1000 g) infant.

J Perinatol. 2009 May;29(5):352-7. Massaro AN, Hammad TA, Jazzo B, Aly H. Department of Neonatology, Children's National Medical Center, Washington, DC 20010, USA. anguyenm@cnmc.org

Full Title: The effect of massage on immune function and stress in women with breast cancer - A randomized controlled trial

OBJECTIVES: To examine the short-term effects of light pressure effleurage on circulating lymphocytes by studying the number and activity of peripheral blood natural killer (NK) cells in patients with breast cancer compared to a control group. Furthermore, the effect of light pressure effleurage on salivary cortisol levels, heart rate and blood pressure was studied. DESIGN: Single centre, prospective, randomized and controlled study. METHODS: Thirty women, aged 50 to 75 years (mean 61 sd=7.2) with breast cancer undergoing radiation therapy in a hospital in southwestern Sweden were enrolled in the study. They were allocated to either receive massage in the form of a full-body light pressure effleurage treatment, or a control visit where they were given an equal amount of attention. Blood samples, saliva, notation of heart rate and blood pressure were collected before and after massage/control visit. Differences in change over time between groups were analyzed by Student's t-test. RESULTS: Light pressure effleurage massage decreased the deterioration of NK cell activity occurring during radiation therapy. Furthermore it lowered heart rate and systolic blood pressure. No effects were demonstrated on cortisol and diastolic pressure. CONCLUSIONS: A single full-body light pressure effleurage massage has a short-term effect on NK cell activity, systolic blood pressure and heart rate in patients with breast cancer. However, the long-term clinical importance of these findings needs to be further investigated.

Auton Neurosci. 2009 Apr 17. Billhult A, Lindholm C, Gunnarsson R, Stener-Victorin E. Institute of Neuroscience and Physiology/Physiotherapy, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden; Research and Development Unit in Primary Health Care, Södra Alvsborg County, Sweden.

Full Title: Effects of the intelligent-turtle massage on the physical symptoms and immune functions in patients with chronic fatigue syndrome

OBJECTIVE: To evaluate the effects of the intelligent-turtle massage on the physical symptoms and immune functions in patients with chronic fatigue syndrome (CFS). METHODS: 182 cases of CFS were randomly divided into an experimental group of 91 cases treated by the intelligent-turtle massage, and a control group of 91 cases treated with the conventional massage method. After 2 courses of treatment, the therapeutic effects were statistically analyzed with the accumulated score for the improved clinical symptoms; and the changes of IgA, IgM and IgG were compared in 96 cases. RESULTS: There was a significant difference between the two groups in the accumulated scores for improvement of the symptoms (P<0.05). A remarkable difference was found in the therapeutic effect. And there was a significant difference in the IgA, IgM and IgG levels between the two groups (P<0.05). CONCLUSION: The intelligent-turtle massage is an effective therapy for relieving the physical symptoms of CFS, and it may show certain effects on the immune functions.

J Tradit Chin Med. 2009 Mar;29(1):24-8 Wang JH, Chai TQ, Lin GH, Luo L. The First Hospital Affiliated to Guangzhou TCM University, Guangzhou 510405, China.

Full Title: Effects of therapeutic massage on the quality of life among patients with breast cancer during treatment

OBJECTIVE: Therapeutic massage has demonstrated positive physical and emotional benefits to offset the effects of treatments associated with breast cancer. The goal of this study was to assess the impact of therapeutic massage on the quality of life of patients undergoing treatment for breast cancer. DESIGN: Using a pre/post intervention assessment design, this prospective, convenience sample pilot study measured anxiety, pain, nausea, sleep quality, and quality of life. Treatment consisted of one 30-minute treatment per week for 3 consecutive weeks. OUTCOME MEASURES: Instruments selected for this study were used in previous massage therapy studies to measure quality of life/health status and have documented validity and reliability. RESULTS: Participants experienced a reduction in several quality of life symptom concerns after only 3 weeks of massage therapy. Respondents' cumulative pre- and post-massage mean for state anxiety, sleep quality, and quality of life/functioning showed significant improvement. Among study participants, there was variability in reported episodes of nausea, vomiting, and retching; although participants reported decreased pain and distress, changes were non-significant. CONCLUSIONS: Therapeutic massage shows potential benefits for ameliorating the effects of breast cancer treatment by reducing side affects of chemotherapy and radiation and improving perceived quality of life and overall functioning.

J Altern Complement Med. 2009 Apr;15(4):373-80. Sturgeon M, Wetta-Hall R, Hart T, Good M, Dakhil S. Integrative Therapies Inc., Wichita, KS, USA.

Full Title: Effects of a full-body massage on pain intensity, anxiety, and physiological relaxation in Taiwanese patients with metastatic bone pain: a pilot study

Bone involvement, a hallmark of advanced cancer, results in intolerable pain, substantial morbidity, and impaired quality of life in 34%-45% of cancer patients. Despite the publication of 15 studies on massage therapy (MT) in cancer patients, little is known about the longitudinal effects of MT and safety in cancer patients with bone metastasis. The purpose of this study was to describe the feasibility of MT and to examine the effects of MT on present pain intensity (PPI), anxiety, and physiological relaxation over a 16- to 18-hour period in 30 Taiwanese cancer patients with bone metastases. A quasi-experimental, one-group, pretest-post-test design with repeated measures was used to examine the time effects of MT using single-item scales for pain (PPI-visual analog scale [VAS]) and anxiety (anxiety-VAS), the modified Short-Form McGill Pain Questionnaire (MSF-MPQ), heart rate (HR), and mean arterial pressure (MAP). MT was shown to have effective immediate [t(29)=16.5, P=0.000; t(29)=8.9, P=0.000], short-term (20-30 minutes) [t(29)=9.3, P=0.000; t(29)=10.1, P=0.000], intermediate (1-2.5 hours) [t(29)=7.9, P=0.000; t(29)=8.9, P=0.000], and long-term benefits (16-18 hours) [t(29)=4.0, P=0.000; t(29)=5.7, P=0.000] on PPI and anxiety. The most significant impact occurred 15 [F=11.5(1,29), P<0.002] or 20 [F=20.4(1,29), P<0.000] minutes after the intervention. There were no significant time effects in decreasing or increasing HR and MAP. No patient reported any adverse effects as a result of MT. Clinically, the time effects of MT can assist health care providers in implementing MT along with pharmacological treatment, thereby enhancing cancer pain management. Randomized clinical trials are needed to validate the effectiveness of MT in this cancer population.

J Pain Symptom Manage. 2009 Apr;37(4):754-63. Jane SW, Wilkie DJ, Gallucci BB, Beaton RD, Huang HY. Department of Nursing, Chang Gung Institute of Technology, Tao-Yuan, Taiwan. swjane@gw.cgit.edu.tw

Full Title: Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinical trials

INTRODUCTION: Massage is a popular adjunct to cancer palliation. This systematic review is aimed at critically evaluating all available randomised clinical trials of massage in cancer palliation. MATERIALS AND METHODS: Six databases were searched to identify all trials of classical massage for cancer patients. Studies of other types of massage, e.g. reflexology, aromatherapy, were excluded. Fourteen trials met all inclusion criteria. DISCUSSION: Collectively, they suggest that massage can alleviate a wide range of symptoms: pain, nausea, anxiety, depression, anger, stress and fatigue. However, the methodological quality of the included studies was poor, a fact that prevents definitive conclusions. CONCLUSION: The evidence is, therefore, encouraging but not compelling. The subject seems to warrant further investigations which avoid the limitations of previous studies.

Support Care Cancer. 2009 Apr;17(4):333-7. Ernst E. Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK. Edzard.Ernst@pms.ac.uk

This was a prospective study designed to examine the potential of massage to reduce agitation in cognitively impaired nursing home residents. Subjects were identified as susceptible to agitation by nursing home staff or by Minimum Data Set (MDS) report. Data was collected during baseline (3 days), intervention (6 days), and at follow-up. Five aspects of agitation were assessed: Wandering, Verbally Agitated/Abusive, Physically Agitated/Abusive, Socially Inappropriate/Disruptive, and Resists Care. At each observation, agitation was scored 5 times during the 1-hour window of observation. Subjects' agitation was lower during the massage intervention than at baseline (2.05 vs. 1.22, P < .001), and remained lower at follow-up. Of the 5 agitated behaviors examined in this study, massage was associated with significant improvement for 4: Wandering (0.38 vs. 0.16, P < .001), Verbally Agitated/Abusive (0.59 vs. 0.49, P = .002), Physically Agitated/Abusive (0.82 vs. 0.40, P < .001), and Resists Care (0.10 vs. 0.09, P = .022). When analysis was restricted to residents with significant levels of agitation at baseline, the observed effects of massage on agitation increased. Massage is an accessible, easily learned intervention that is effective in controlling some types of agitation in elders with cognitive impairment. Massage should be studied further as a nonpharmacological intervention in such patients.

Geriatr Nurs. 2009 Mar-Apr;30(2):108-17. Holliday-Welsh DM, Gessert CE, Renier CM. Holliday Welsh & Associates, Duluth, MN, USA.

by Ernesto Ortiz LMT, CST

Bamboo is one of the must multifaceted plants in our planet. It has earned its reputation from its noble and soft appearance as well as its perseverance under harsh conditions. In the Orient, bamboo symbolizes strength, fertility, youth, prosperity and peace.

Bamboo is certainly one of the most versatile plants. It has spiritual, mythological and many practical applications. It is eaten, used in home construction and decoration, as well as for the creation of utensils and herbal remedies.

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The effectiveness of massage for postexercise recovery remains unclear, despite numerous studies on this issue. The aim of this study was to determine the effect of massage on endocrine and immune functions of healthy active volunteers after intense exercise. After repeated Wingate tests, the effects of whole-body massage and placebo on salivary cortisol, immunoglobulin A (IgA), and total protein levels were compared using a between-group design. Sixty healthy active subjects (23 women, 37 men) underwent 2 exercise protocol sessions at least 2 weeks apart and at the same time of day. The first session familiarized participants with the protocol. In the second session, after a baseline measurement, subjects performed a standardized warm-up followed by three 30-second Wingate tests. After active recovery, subjects were randomly allocated to massage (40-minute myofascial induction) or placebo (40-minute sham electrotherapy) group. Saliva samples were taken before and after the exercise protocols and after recovery. In both groups, the exercise protocol induced a significant increase in cortisol (p < 0.001), decrease in salivary IgA (sIgA) (p < 0.001), and increase in total proteins (p = 0.01) in saliva. Generalized estimating equations showed a significant effect of massage on sIgA rate (p = 0.05), a tendency toward significant effect on salivary total protein levels (p = 0.10), and no effect on salivary flow rate (p = 0.55) or salivary cortisol (p = 0.39). The sIgA secretion rate was higher after the recovery intervention than at baseline among women in the massage group (p = 0.03) but similar to baseline levels among women in the placebo group (p = 0.29). Massage may favor recovery from the transient immunosuppression state induced by exercise in healthy active women, of particular value between high-intensity training sessions or competitions on the same day.

J Strength Cond Res. 2009 Mar;23(2):638-44. Arroyo-Morales M, Olea N, Ruíz C, del Castilo Jde D, Martínez M, Lorenzo C, Díaz-Rodríguez L. Department of Physical Therapy, University of Granada, High Performance Sports Center at Altitude, Sierra Nevada, Granada, Spain. marroyo@ugr.es

Massotherapy, the therapeutic use of massage, is used to treat various chronic pain syndromes. One type of massotherapy, pressure stimulus applied over trigger points (TPs), is reported to have excellent therapeutic effects. Its effect is possibly mediated through changes in the autonomic nervous system although little research has been conducted to assess autonomic activity during TP compression. We have investigated how compression applied over TPs affects the autonomic nervous system. Six healthy young adult females whose daily working routine was carried out predominantly in a standing position were enrolled in the study cohort. After a day's work, the subjects were asked to rest supine, and electrocardiograms (ECGs), instantaneous lung volume (ILV) and systolic and diastolic blood pressures (SBP, DBP) were measured before and after pressure application over the TPs in those lower limb muscles where the subjects felt muscle fatigue or discomfort. The subjects were also asked to coordinate breathing with the beeping sounds. The therapeutic effects of TP compression were assessed by a subjective fatigue scale. Parasympathetic nervous activity was also assessed by spectral analysis of heart rate (HR) variability. The transfer function from ILV to HR was evaluated using linear analysis. The results indicated that TP compression (1) decreased HR, SBP and DBP, (2) increased parasympathetic activity, (3) increased the gain from ILV to HR, and (4) improved the fatigue scores. These findings suggest that an increase in parasympathetic nervous activity after the TP compression induced a reduction of fatigue. The therapeutic mechanisms of TP compression to enhance parasympathetic nervous system are discussed.

J Physiol Sci. 2009 Feb 21. Takamoto K, Sakai S, Hori E, Urakawa S, Umeno K, Ono T, Nishijo H. System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Sugitani 2630, Toyama, 930-0194, Japan.

Generalised anxiety disorder (GAD) is common in the western world with a lifetime prevalence of 4.3 to 5.9% and is twice as common in women as in men. GAD can have a decisive impact on a patient's everyday life as it is surrounded by unfocused worries and the severe anxiety may interfere with normal social functions. The treatments include cognitive behavioural therapy and/or psychopharmacological drugs. In previous studies the positive effects of massage on anxiety have been shown. The present study described the experience of receiving massage for eight patients with GAD. Findings revealed that the patients were able to rediscover their own capacity during the massage period. This was illuminated by the experience of being relaxed in body and mind, the experience of unconditional attention, the experience of decreased anxiety and the experience of increased self-confidence. The paper ends with a discussion of clinical implications.

Complement Ther Clin Pract. 2009 May;15(2):96-101. Billhult A, Määttä S. FoU-enheten i Södra Alvsborg, Sven Eriksonsplatsen 4, S- 503 38 Borås, Sweden.

Heart rate (HR) responses to the removal of a monitoring lead were assessed in 56 preterm infants who received moderate pressure, light pressure or no massage therapy. The infants who received moderate pressure massage therapy exhibited lower increases in HR suggesting an attenuated pain response. The heart rate of infants who received moderate pressure massage also returned to baseline faster than the heart rate of the other two groups, suggesting a faster recovery rate.

Infant Behav Dev. 2009 Apr;32(2):226-9. Epub 2009 Jan 30. Diego MA, Field T, Hernandez-Reif M. Touch Research Institute, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33101, USA. mdiego@med.miami.edu

This randomized controlled trial investigated the short-term effects of massage therapy on youth with SCD and their parents. METHODS: Thirty-four children and adolescents, and their parents were assigned to a massage therapy or an attention control group. Parents were trained in massage in their homes once a week for 4 weeks, with instructions to provide nightly massages. Families in the control group were visited weekly by a research assistant. Participants completed measures of depression and anxiety, functional status, pain intensity, medication use, and service utilization. RESULTS: Parents in the massage therapy group reported higher levels of depression and anxiety following the intervention. Youth in this group showed higher levels of functional status, and lower levels of depression, anxiety, and pain. Health service utilization rates were unchanged from pre- to post-intervention. CONCLUSIONS: These results offer preliminary support for parent-delivered massage therapy as an intervention for SCD pain.

J Pediatr Psychol. 2009 Mar 12. Lemanek KL, Ranalli M, Lukens C. Ohio State University College of Medicine and Children's Hospital of Philadelphia.

FULL TITLE: Muscular load to the therapist's shoulder during three alternative techniques for trigger point therapy

To compare the muscular load (level of muscle activity) to the shoulder during alternative approaches to trigger point therapy (TPT). METHOD: Massage therapy students (n=7) applied a predetermined level of force to an artificial contact surface. Changes in five pairs of superficial shoulder muscles (indicated by surface electromyography) were recorded while the student performed the single-arm technique (SAT), the double-arm technique (DAT) and the treatment-tool technique (TTT) using TriggerMate, a new treatment tool. RESULTS: For the contact arm, muscle activity was significantly decreased using the TTT compared to the SAT (p<0.05) but was not significantly different between the TTT and DAT. For the non-contact arm, none of the test techniques led to significant differences in muscle activity. CONCLUSIONS: While there is evidence that the TTT decreases the muscular load to the shoulder of the contact arm, there is no indication of where this load is redistributed.

J Bodyw Mov Ther. 2009 Apr;13(2):171-81. Smith EK, Magarey M, Argue S, Jaberzadeh S. School of Health Sciences, Division of Health Sciences, University of South Australia, North Terrace, Adelaide 5000, South Australia. Emily.Smith6@hotmail.com

Twenty healthy adults were randomly assigned to a moderate pressure or a light pressure massage therapy group, and EKGs were recorded during a 3-min baseline, during the 15-min massage period and during a 3-min postmassage period. EKG data were then used to derive the high frequency (HF), low frequency (LF) components of heart rate variability and the low to high frequency ratio (LF/HF) as noninvasive markers of autonomic nervous system activity. The participants who received the moderate pressure massage exhibited a parasympathetic nervous system response characterized by an increase in HF, suggesting increased vagal efferent activity and a decrease in the LF/HF ratio, suggesting a shift from sympathetic to parasympathetic activity that peaked during the first half of the massage period. On the other hand, those who received the light pressure massage exhibited a sympathetic nervous system response characterized by decreased HF and increased LF/HF.

Int J Neurosci. 2009;119(5):630-8. Diego MA, Field T. Touch Research Institute, Department of Pediatrics, University of Miami School of Medicine, Miami, Florida, USA. mdiego@med.miami.edu

Little is known about the effectiveness of therapeutic massage, one of the most popular complementary medical treatments for neck pain. A randomized controlled trial was conducted to evaluate whether therapeutic massage is more beneficial than a self-care book for patients with chronic neck pain. METHODS: Sixty-four such patients were randomized to receive up to 10 massages over 10 weeks or a self-care book. Follow-up telephone interviews after 4, 10, and 26 weeks assessed outcomes including dysfunction and symptoms. Log-binomial regression was used to assess whether there were differences in the percentages of participants with clinically meaningful improvements in dysfunction and symptoms (ie, >5-point improvement on the Neck Disability Index; >30% improvement from baseline on the symptom bothersomeness scale) at each time point. RESULTS: At 10 weeks, more participants randomized to massage experienced clinically significant improvement on the Neck Disability Index [39% vs. 14% of book group; relative risk (RR)=2.7; 95% confidence interval (CI), 0.99-7.5] and on the symptom bothersomeness scale (55% vs. 25% of book group; RR=2.2; 95% CI, 1.04-4.2). After 26 weeks, massage group members tended to be more likely to report improved function (RR=1.8; 95% CI, 0.97-3.5), but not symptom bothersomeness (RR=1.1; 95% CI, 0.6-2.0). Mean differences between groups were strongest at 4 weeks and not evident by 26 weeks. No serious adverse experiences were reported. CONCLUSIONS: This study suggests that massage is safe and may have clinical benefits for treating chronic neck pain at least in the short term. A larger trial is warranted to confirm these results.

Clin J Pain. 2009 Mar-Apr;25(3):233-8. Sherman KJ, Cherkin DC, Hawkes RJ, Miglioretti DL, Deyo RA. Group Health Center for Health Studies, Seattle, WA 98101, USA. sherman.k@ghc.org

The use of massage in nursing practice has declined through the years in favor of high-tech interventions. This article describes a project using active learning to teach nursing students massage with dementia residents in assisted living. Students participated in a workshop to practice basic relaxation massage techniques with the guidance of their clinical instructor and then provided massages to resident volunteers. Afterward, students discussed their experience and completed a resident assessment form. The students requested more such activities, and the residents and facility management invited the students to return for another session. The instructor observed growth in the students' assessment skills and in their confidence. Use of massage to teach nursing students how to care for and relate to older adults with cognitive impairment is recommended. Further research is needed on the use of massage as an active learning method for nursing students in long-term care.

J Holist Nurs. 2009 Mar;27(1):51-6. Adler PA. Cleveland Clinic, and Case Western Reserve University, adlerp@ccf.org.

This pilot study aimed to determine the feasibility of providing massage to children with cancer to reduce symptoms in children and anxiety in parents. Twenty-three children/parent dyads were enrolled; 17 completed all data points. Children with cancer, ages 1 to 18 years, received at least 2 identical cycles of chemotherapy, and one parent, participated in the 2-period crossover design in which 4 weekly massage sessions alternated with 4 weekly quiet-time control sessions. Changes in relaxation (heart and respiratory rates, blood pressure, and salivary cortisol level) and symptoms (pain, nausea, anxiety, and fatigue) were assessed in children; anxiety and fatigue were measured in parents. Massage was more effective than quiet time at reducing heart rate in children, anxiety in children less than age 14 years, and parent anxiety. There were no significant changes in blood pressure, cortisol, pain, nausea, or fatigue. Children reported that massage helped them feel better, lessened their anxiety and worries, and had longer lasting effects than quiet time. Massage in children with cancer is feasible and appears to decrease anxiety in parents and younger children.

J Pediatr Oncol Nurs. 2009 Jan-Feb;26(1):16-28. Post-White J, Fitzgerald M, Savik K, Hooke MC, Hannahan AB, Sencer SF. University of Minnesota. postw001@umn.edu.

OBJECTIVE: This research examined the relationship between plasma oxytocin (OT), arginine vasopressin (AVP), cortisol, and anxiety before, during, and after a massage in healthy adult men. DESIGN: A randomized, controlled, crossover, repeated-measures, prospective experimental design with subjects acting as their own controls was used. SETTING: The research was conducted at a Midwestern University. SUBJECTS: Fourteen (14) healthy men between the ages of 19 and 45 years of age were randomly assigned to the order of two conditions: a 20-minute massage (experimental condition) or a 20-minute reading period (control condition). METHODS: Blood samples were collected at time intervals during each data collection session. Plasma OT, AVP, and cortisol levels were evaluated by enzyme immunoassay (EIA). The Spielberger State Anxiety Inventory (SAI) and autonomic measures were recorded pre- and postcondition. RESULTS: Both experimental (massage) and control (reading) conditions elicited a significant increase in plasma OT levels (p < 0.05) and a decrease in SAI score (p < 0.05) from pre- to postintervention. A significant positive correlation was detected between plasma AVP and plasma cortisol (r = 0.63, n = 24, p = 0.001) in the massage group, whereas a significant positive correlation between plasma AVP and the SAI (r = 0.47, n = 25, p = 0.016) was observed in the reading group. No significant differences were observed for the autonomic measures between conditions. CONCLUSIONS: The finding that plasma OT levels increased in both the massage and reading groups, suggests that tactile stimulus is not necessary for OT release. The results suggest that another unknown factor associated with reduction of anxiety may be involved.

Bello D, White-Traut R, Schwertz D, Pournajafi-Nazarloo H, Carter CS. Baxter Healthcare Corporation, Deerfield, IL 60015, USA. debra_bello@baxter.com J Altern Complement Med. 2008 May;14(4):387-94.

Although massage administered between workouts has been suggested to improve recovery and subsequent performance, its application between bouts of repetitive supramaximal anaerobic efforts within a given workout has received little attention. The purpose of the study compared different forms of very short rest periods administered between resistance exercise sets of individual workouts on subsequent performance. With a within-subjects design methodology, subjects (n = 30) performed three workouts that were identical in terms of the exercises (45 degrees leg press, prone leg curl, seated shoulder press, standing barbell curl), number of sets, and the resistance employed. For each workout, subjects received one of the following treatments between sets: 1 minute of rest as they stood upright, 30 seconds of rest as they stood upright, or 30 seconds of concurrent massage and body part elevation (MBPE), which entailed petrassage of the exercised limbs in a raised and supported position in an attempt to abate fatigue and enhance recovery from the previous set. Subjects were instructed to perform as many repetitions as possible for each set. For each exercise, two dependent variables were calculated: a total work/elapsed time ratio and the cumulative number of repetitions performed. For each exercise, one-way repeated-measures analysis of variance and Tukey's post hoc test revealed the following total work/elapsed time results: 1 minute rest <30 seconds' rest, 30 seconds' MBPE. For each exercise, cumulative repetition results were as follows: 1 minute rest >30 seconds' rest, 30 seconds' MBPE. Results imply that rest period duration exerts more influence on resistance exercise performance than MBPE. Those who seek improved resistance exercise performance should pay particular attention to rest period durations.

Caruso JF, Coday MA. Exercise Science Program, University of Tulsa, Tulsa, Oklahoma, USA. john-caruso@utulsa.edu J Strength Cond Res. 2008 Mar;22(2):575-82.

Massage therapy is increasingly available as a supportive therapy to patients in medical centers providing cancer treatment. This article provides an overview of the evidence base relevant to the use of massage with the intended goal of alleviating symptoms and side effects experienced by cancer patients. Collectively, the available data support the view that massage, modified appropriately, offers potential beneficial effects for cancer patients in terms of reducing anxiety and pain and other symptoms. Replication of preliminary studies with larger, more homogeneous patient samples and rigorous study designs will help to clarify which massage modalities have the most potential benefit for which patients before, during, and after specific types of cancer treatment.

Myers CD, Walton T, Small BJ. Integrative Medicine, Health Outcomes and Behavior Program, Moffitt Cancer Center, 12902 Magnolia Drive, MRC-PSY, Tampa, FL 33612, USA. Hematol Oncol Clin North Am. 2008 Aug;22(4):649-60.

OBJECTIVES: To develop and test the feasibility and acceptability of a structured design for a massage therapy clinical trial that included a treatment arm designed to control for the non-specific effects of a massage therapy intervention. DESIGN: Pilot randomized controlled clinical trial. SETTING: University-integrated medicine research clinic. INTERVENTIONS: Participants were randomized to a structured Swedish-style massage therapy intervention, a light-touch bodywork control intervention, or usual medical care. Details of the interventions are provided. MAIN OUTCOME MEASURES: The primary outcome measures were the adherence of the participants to the study protocol and the perception of the intervention experience. RESULTS: Forty-four participants were randomized. Participants often found adherence to the twice-weekly outpatient bodywork interventions to be somewhat difficult; while, overall, 84% of participants completed the study, only 76% of those in an intervention arm successfully completed the trial. Participants randomized to the massage arm expressed uniformly positive attitudes both before and after the intervention. While some participants randomized to the light-touch bodywork arm initially expressed some reservations about their randomization assignment, all participants available for interview were pleased with their experience after the intervention period. CONCLUSIONS: The proposed design was found to be relatively straightforward to implement and acceptable to participants. Early disappointment with not receiving massage therapy expressed by the light-touch intervention participants dissipated quickly. Twice-weekly outpatient intervention appointments were found to be highly burdensome for many patients actively undergoing chemotherapy, thus reducing adherence.

Patterson M, Maurer S, Adler SR, Avins AL. Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA. Complement Ther Med. 2008 Jun;16(3):169-76.

Although massage administered between workouts has been suggested to improve recovery and subsequent performance, its application between bouts of repetitive supramaximal anaerobic efforts within a given workout has received little attention. The purpose of the study compared different forms of very short rest periods administered between resistance exercise sets of individual workouts on subsequent performance. With a within-subjects design methodology, subjects (n = 30) performed three workouts that were identical in terms of the exercises (45 degrees leg press, prone leg curl, seated shoulder press, standing barbell curl), number of sets, and the resistance employed. For each workout, subjects received one of the following treatments between sets: 1 minute of rest as they stood upright, 30 seconds of rest as they stood upright, or 30 seconds of concurrent massage and body part elevation (MBPE), which entailed petrassage of the exercised limbs in a raised and supported position in an attempt to abate fatigue and enhance recovery from the previous set. Subjects were instructed to perform as many repetitions as possible for each set. For each exercise, two dependent variables were calculated: a total work/elapsed time ratio and the cumulative number of repetitions performed. For each exercise, one-way repeated-measures analysis of variance and Tukey's post hoc test revealed the following total work/elapsed time results: 1 minute rest <30 seconds' rest, 30 seconds' MBPE. For each exercise, cumulative repetition results were as follows: 1 minute rest >30 seconds' rest, 30 seconds' MBPE. Results imply that rest period duration exerts more influence on resistance exercise performance than MBPE. Those who seek improved resistance exercise performance should pay particular attention to rest period durations.

Caruso JF, Coday MA. Exercise Science Program, University of Tulsa, Tulsa, Oklahoma, USA. john-caruso@utulsa.edu J Strength Cond Res. 2008 Mar;22(2):575-82.

Research on massage therapy for maternal pain and anxiety in labour is currently limited to four small trials. Each used different massage techniques, at different frequencies and durations, and relaxation techniques were included in three trials. Given the need to investigate massage interventions that complement maternal neurophysiological adaptations to labour and birth pain(s), we designed a pilot randomised controlled trial (RCT) to test the effects of a massage programme practised during physiological changes in pain threshold, from late pregnancy to birth, on women's reported pain, measured by a visual analogue scale (VAS) at 90min following birth. To control for the potential bias of the possible effects of support offered within preparation for the intervention group, the study included 3 arms - intervention (massage programme with relaxation techniques), placebo (music with relaxation techniques) and control (usual care). The placebo offered a non-pharmacological coping strategy, to ensure that use of massage was the only difference between intervention and placebo groups. There was a trend towards slightly lower mean pain scores in the intervention group but these differences were not statistically significant. No differences were found in use of pharmacological analgesia, need for augmentation or mode of delivery. There was a trend towards more positive views of labour preparedness and sense of control in the intervention and placebo groups, compared with the control group. These findings suggest that regular massage with relaxation techniques from late pregnancy to birth is an acceptable coping strategy that merits a large trial with sufficient power to detect differences in reported pain as a primary outcome measure.

Eur J Pain. 2008 Feb 25 Kimber L, McNabb M, Mc Court C, Haines A, Brocklehurst P. Horton Maternity Unit, Oxford Road, Banbury, Oxfordshire 0X16 9AL, UK.

The care of patients with cancer not only involves dealing with its symptoms but also with complicated information and uncertainty; isolation; and fear of disease progression, disease recurrence, and death. Patients whose treatments require them to go without human contact can find a lack of touch to be an especially distressing factor. Massage therapy is often used to address these patients' need for human contact, and findings support the positive value of massage in cancer care. Several reviews of the scientific literature have attributed numerous positive effects to massage, including improvements in the quality of patients' relaxation, sleep, and immune system responses and in the relief of their fatigue, pain, anxiety, and nausea. On the basis of these reviews, some large cancer centers in the United States have started to integrate massage therapy into conventional settings. In this paper, we recognize the importance of touch, review findings regarding massage for cancer patients, describe the massage therapy program in one of these centers, and outline future challenges and implications for the effective integration of massage therapy in large and small cancer centers.

J Altern Complement Med. 2008 Mar;14(2):209-14. Russell NC, Sumler SS, Beinhorn CM, Frenkel MA. Integrative Medicine Program, Unit 145, The University of Texas M.D. Anderson Cancer Center, Houston, TX.

In the present study, we describe the effects of deep tissue massage on systolic, diastolic, and mean arterial blood pressure. Materials and methods: The study involved 263 volunteers (12% males and 88% females), with an average age of 48.5. Overall muscle spasm/muscle strain was described as either moderate or severe for each patient. Baseline blood pressure and heart rate were measured via an automatic blood pressure cuff. Twenty-one (21) different soothing CDs played in the background as the deep tissue massage was performed over the course of the study. The massages were between 45 and 60 minutes in duration. The data were analyzed using analysis of variance with post-hoc Scheffe's F-test. Results: Results of the present study demonstrated an average systolic pressure reduction of 10.4 mm Hg (p < 0.06), a diastolic pressure reduction of 5.3 mm Hg (p < 0.04), a mean arterial pressure reduction of 7.0 mm Hg (p < 0.47), and an average heart rate reduction of 10.8 beats per minute (p < 0.0003), respectively.

J Altern Complement Med. 2008 Mar;14(2):125-8. Kaye AD, Kaye AJ, Swinford J, Baluch A, Bawcom BA, Lambert TJ, Hoover JM. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA.

Background: People with depressive disorders or subsyndromal symptoms of depression (SSD) often use complementary and alternative therapies, including massage therapy (MT). This systematic review evaluates the evidence, from randomised clinical trials (RCTs), for the effectiveness of multiple sessions of classical European (Swedish) MT for the treatment of depression. Methods: Eligible RCTs were identified via eight electronic databases and manual searches of references. Two reviewers independently selected trials, assessed trial quality and extracted data. Results: Four RCTs met our inclusion criteria. Three of these RCTs compared MT with relaxation therapies, but provided insufficient data and analyses to contribute meaningfully to the evaluation of MT for depression. The fourth included RCT used MT as a control condition to evaluate a depression-specific acupuncture treatment. This trial provided limited evidence that, in the early stages of treatment, MT is less effective than acupuncture for treating depression, a treatment which itself is not accepted for this condition. Conclusions: Despite previous research suggesting that MT may be an effective treatment for depression, there is currently a lack of evidence to support this assertion from RCTs that have selected participants for depression or SSD.

Int J Clin Pract. 2008 Feb;62(2):325-33. Coelho HF, Boddy K, Ernst E. Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK.

There has been a growing emphasis on evaluating and improving the experience of the hospitalized patient. In 2004, the Cardiovascular Surgery team at Mayo Clinic Rochester, though achieving a high level of technical expertise and clinical outcomes, recognized that patients were not rating their overall hospital experience as highly as was expected. After a systematic evaluation of the hospital experience, tension, stress, pain, and anxiety were identified as key challenges for patients. A multidisciplinary team was created to evaluate pain management practices and explore methods for reducing pain, anxiety, and tension. An extensive review of the literature and site visits to other institutions provided the foundation for the program. The term "Healing Enhancement" was coined to identify the goals of this emerging paradigm that focused on all aspects of the patient's experience-mind, body, and spirit. Integrated therapies such as music, massage, guided imagery, and relaxation training were explored to measure their role in patient care.

Complement Ther Clin Pract. 2007 Nov;13(4):217-23. Cutshall SM, Fenske LL, Kelly RF, Phillips BR, Sundt TM, Bauer BA. Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

To determine predictors of complementary and alternative medicine (CAM) use, we used a cohort of 1445 non-institutionalized Mexican Americans aged 65 and older from the first wave (1993-1994) of the Hispanic Established Population for the Epidemiologic Study of the Elderly, followed until 2000-2001. The main outcome was use of any CAM (herbal medicine, chiropractic, acupuncture, massage therapy, relaxation techniques or spiritual healing) in the past 12 months and was assessed at 7 years of follow-up. Potential predictors of CAM use at baseline included sociodemographics, acculturation factors, and medical conditions. The overall rate of CAM use among older Mexican Americans was 31.6%. Independent predictors of higher CAM use were female gender, being on Medicaid, frequent church attendance and higher number of medical conditions. In contrast, subjects who were born in US and spoke either Spanish or English at interview had lower CAM use compared with subjects who were born in Mexico.

Complement Ther Clin Pract. 2007 Nov;13(4):224-31. Loera JA, Reyes-Ortiz C, Kuo YF. Department of Internal Medicine-Geriatrics Division, University of Texas Medical Branch, Galveston, TX 77555-0460, USA.

The purpose of this study was to acquire a theoretical understanding of what it is like to work as a tactile massage therapist (TMT). There is insufficient knowledge in this area-despite increasing demand and implementation of tactile massage; so 26 female TMTs were interviewed (6 interview groups in Stockholm County). Grounded theory was used to analyse the data. The analysis resulted in a theoretical model that explains how TMTs individually underwent a transformation in which they learned about the energy-controlling system (energy takers, energy returners, and energy controllers) and managed to implement this demanding treatment, while maintaining health and inner balance in order to have total presence during treatment sessions. Results showed that total presence was crucial for implementing high-quality treatment, and inability to control energy may pose a risk to inner balance and health among TMTs.

Complement Ther Clin Pract. 2007 Nov;13(4):258-65. Andersson K, Wändell P, Törnkvist L. Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden.