Massage & Bodywork

MARCH | APRIL 2018

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A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 51 massage equipment (table and linens), were dimly lit, and utilized a sound machine to mask environmental noise. Each 45-minute SMT and LT session began with participants supine as the therapist began at participants' shoulders and worked down to their feet. Participants turned onto their stomachs for the second half of the intervention and therapists worked from participants' feet through to their back, arms, shoulders, and head. SMT sessions included effleurage, petrissage, and tapotement techniques/strokes, and the LT sessions provided a light, laying-on-of-hands for the same amount of time and in the same sequence as the SMT sessions. RESULTS Three standardized measures were used to assess CRF and quality of life and were collected for all participants at baseline and six weeks. The study's main outcome was the multidimensional fatigue inventory (MFI), which is a 20-item self-report Likert-based questionnaire used in research to quantify the subjective experience of fatigue. 8 The MFI is used quite a bit in studies examining CRF and was scored for this study with a range of 20–100 points (with each question worth 1–5 points each; higher scores indicate more fatigue). The MFI has five four- question domains that assess general fatigue, physical fatigue, fatigue-related activity reduction, fatigue-related motivation reduction, and mental fatigue. A minimal clinically important difference has been established for the scale as 10 points, or two points per component. 9 Question samples from each domain include: "I feel tired," "Physically I feel I am in an excellent condition," "I think I do very little in a day," "I can concentrate well," and "I feel like doing all sorts of nice things." The PROMIS Fatigue Short Form 7a was also used in the study, as well as the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q; available at www.outcometracker.org/ library/Q-LES-Q-SF.pdf ). 10 The Q-LES-Q is a 16-item Likert survey asking respondents to consider the last week and indicate how satisfied they've been with things like their physical health, mood, work, and other activities and relationships. Data from 57 evaluable participants were included in the analysis. Study results for the MFI and Q-LES-Q found that each group had significant changes from baseline to six weeks, but only those in the Swedish massage and light touch groups had significant improvements from baseline. Participants randomized to the no-treatment control group actually had significant negative changes in their CRF and quality of life from baseline to six weeks. When treatment outcomes were compared between the three groups, results for those is associated with higher levels of disability and is particularly challenging to address. 4 Pharmaceutical options for CRF (e.g., Paxil, Provigil, Armodafinil, Ritalin) are available but are not first-option treatments because they have been determined to be less effective than exercise and psychological interventions, 5 both of which (importantly) introduce no additional pharmacological burden to cancer survivors. Massage therapy has also been identified as an effective, nonpharmacological approach to manage cancer treatment-related side- effects such as CRF, and this column's highlighted research study points to positive massage outcomes specifically for postcancer treatment CRF. 6 MASSAGE THERAPY FOR CANCER-RELATED FATIGUE Becky Kinkead, PhD, and Mark Rapaport, MD, lead the research group at Emory University's School of Medicine, and their efforts are the first randomized controlled clinical trial focused on massage therapy for CRF in breast cancer survivors. The results of the NIH- funded early-phase trial were recently published in the scientific journal Cancer and provide exciting results to inform evidence-based massage practice. 7 Specifically, the study found that a course of weekly, 45-minute Swedish massage therapy sessions over six weeks significantly decreased CRF in breast cancer survivors compared to both no treatment and active treatment control groups. The single-masked controlled trial randomized 66 women, 18–72 years old, who were three months to four years posttreatment for stage 0–III breast cancer into three groups: a once-weekly Swedish massage therapy (SMT) group, a once-weekly light touch (LT) group, or a waitlist/no-treatment control group. To be eligible to participate, breast cancer survivors could not have used or be actively using massage therapy, and had to experience close to moderate or higher CRF, as assessed by a nine-item rapid fatigue severity assessment. Only the study's principal investigator, physicians, and statistician were blinded to intervention randomization. For the study, licensed massage therapists were vetted and/or provided by the Atlanta School of Massage Therapy and were trained to perform all SMT and LT study interventions. Both the SMT and LT interventions were manualized, meaning each session was the same with regard to length (45 minutes), timing per area of the body addressed, and progression. Massage therapists followed scripts for all participant interactions and additional conversation was kept to a minimum. Research intervention rooms emulated typical massage treatment rooms in that they were private, contained standard

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