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I am so pleased to be writing my first Somatic Research column for Massage & Bodywork! Last issue (November/December 2017, "Real-World Massage Research," page 44), Jerrilyn Cambron's departing article highlighted several aspects of the University of Kentucky's real-world massage therapy study examining chronic low-back pain (CLBP) recently published in Pain Medicine. 1 The research was an NIH-funded study to examine the effectiveness of massage therapist-directed treatment for primary-care patients with CLBP. Study participants were referred by their primary-care provider to the study and matched with a community massage therapist who practiced near where they lived or worked. Study therapists were allowed to provide 10 one-hour massage treatments over 12 weeks as part of the study and managed all aspects of appointment scheduling, timing, and delivery. 2 The study used a repeated-measures design and collected data prior to any intervention (baseline); 12 weeks after baseline, during which participants received up to 10 one-hour massage therapy treatments (12 weeks); and 12 weeks after the massage intervention window to provide a follow-up of lasting effects (24 weeks). The study's general outcomes indicated that a course of real-world massage therapy reduced low-back pain with disability and improved functional related quality of life for real-world, complex CLBP patients referred from primary-care providers. While treatment benefits did generally recede for participants from data collected at 12 weeks and 24 weeks, baseline to 24 weeks comparisons were still significant for most of the study's primary outcomes, indicating overall improvement and lasting effects for many in the study. This column will answer four specific questions arising from the Pain Medicine article and highlight the study results' finer points that are of applicable interest to massage therapists and their practices: (1) If massage benefits after a course of massage reduce three months later, does that mean massage wasn't beneficial? (2) What is the Oswestry Disability Index (the study's main outcome measure) and can it be used in massage therapy practice? (3) What is the difference between statistically and clinically meaningful outcomes? (4) What participant characteristics may have influenced massage effectiveness and lasting benefit? 1. CURATIVE VERSUS MANAGEMENT CONSIDERATIONS A majority of study participants experienced meaningful decreases in their pain with disability after the massage intervention. Seventy-five percent of those reporting meaningful improvement at 12 weeks still had meaningful improvement at 24 weeks. The question becomes: If not everyone experienced benefit in the first place, and some who had benefit lost it after massage was discontinued, can it be said that massage therapy is effective for CLBP? The short answer derived from this study's data is yes; for many, massage therapy was beneficial for CLBP and related disabilities. A point at the heart of this question, however, is the difference between a curative and management massage approach. The way this and most other research studies are designed examines an intervention's ability to cure a condition. A set amount of treatment is given to address a condition— in this case CLBP, after the treatment is concluded, the intervention's lasting effects are assessed. What this design approach does not account for is the fact that many people's chronic pain (including some with CLBP) comes from conditions that are 46 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 8 education SOMATIC RESEARCH 4 Points Arising from Low-Back Pain Study For MTs and Their Practices By Niki Munk, PhD

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