Massage & Bodywork

May | June 2014

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I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 57 SOMATIC RESE ARCH making them benefi cial to massage therapists, as they can be used in any clinical practice and the results can be compared with those in the research study. Subjects were assessed at the beginning of the study and at 10, 26, and 52 weeks. Treatment stopped at the end of 10 weeks, aligning with the fi rst post-treatment assessment. The measures at 26 and 52 weeks were used to determine long-term effectiveness. Most comparative effectiveness trials will have several post-treatment outcome measures to determine the immediate effects of treatment as well as the lasting effects. Timing of outcome measures may greatly affect the results. Results are assessed statistically to determine if there are any group differences. Some researchers also focus on the clinical signifi cance of their results. Clinical signifi cance deals with the amount of improvement or the clinical effectiveness of treatment. Statistical signifi cance and clinical signifi cance are two very different aspects of a study. Results could be statistically signifi cant without having any clinical signifi cance. In the Cherkin study, the researchers defi ned clinical signifi cance in regards to dysfunction as an improvement of at least 2 points on a scale of 0 to 23, with 23 being the most dysfunctional. In regards to pain, a clinically signifi cant change was defi ned as an improvement of at least 1.5 points on a scale of 0 to 10, with 10 indicating the most bothersome pain. Even if the study did not meet statistical signifi cance, clinically signifi cant changes would still be important. In our clinical practices, we only focus on clinical signifi cance. Studies that discuss levels of clinical signifi cance are helpful to clinicians in that we can determine if our clients are reaching the same level of improvement when using the same measures. RESULTS In the Cherkin study, 402 subjects were randomized into three different groups. All groups improved in pain and dysfunction over the 10 weeks, but the improvement was statistically signifi cantly greater in both massage groups compared to usual care. There was also a clinically signifi cant change in dysfunction with an improvement of 3.6 (on a scale of 0 to 23) in the structural massage group and an improvement of 5.6 in the relaxation massage group. There was a clinically signifi cant change in pain of 1.8 out of 10 in the structural massage group and 2.1 in the relaxation massage group. No such clinically signifi cant change occurred in the usual care group. The results of this comparative effectiveness study indicate that both relaxation and structural massage treatments are benefi cial for individuals with chronic low-back pain. These results can be directly applied to a massage practice by sharing this information with prospective clients, as well as with referring physicians. These results can also be compared to the results achieved within your own practice when using the massage protocols described in this study. However, as a comparative effectiveness trial, these results do not give us an indication that one massage treatment is better than another. When compared, the two massage groups proved to be equally effective, even though most of us would have expected massage techniques tailored to the individual would have better results than a standardized massage protocol. These results raise many questions: Does the type of massage really matter in terms of treatment effectiveness? Should all therapists use predetermined massage protocols for treatment of chronic low-back pain? Would another form of massage treatment have been more effective than the types included in this study? These questions will certainly lead to additional comparative effectiveness trials. But in the meantime, both relaxation massage and structural massage have been demonstrated to be benefi cial for chronic low-back pain; therefore, either form of massage can be recommended. Note 1. Daniel C. Cherkin et al., "A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain: A Randomized, Controlled Trial," Annals of Internal Medicine 155, no. 1 (July 5, 2011): 1–9. Jerrilyn Cambron, DC, PhD, MPH, LMT, is an educator at the National University of Health Sciences and president of the Massage Therapy Foundation. Contact her at jcambron@nuhs.edu.

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