Issue link: https://www.massageandbodyworkdigital.com/i/918051
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 49 clinically meaningful. These findings may suggest a couple of interesting items for massage therapists within their practices. First, those who are older have potentially been managing chronic-pain conditions for longer, perhaps making them better able to appreciate massage therapy's benefit. These clients may also be more inclined or able (not something investigated in this study) to make adjustments to their daily lives and behaviors that may perpetuate or add to their CLBP experience. While self-care advice was not something examined in this study, it is well-known (and practiced) in the massage and bodywork field that practitioners will give clients "homework" or other self-care advice. It is also well documented in the medical literature that older patients are more compliant to prescribed medical care than younger patients when cognitive issues are absent. 7 Such compliance-related age differences may have been a factor in this study's older participants responding better to massage if study therapists provided self-help recommendations in addition to the massage treatment. Second, the differences in age-outcome findings could also have been from older people having a more realistic expectation of, and appreciation for, chronic-condition management. Those who have experienced chronic-pain conditions longer are inherently older and, given the longer pain experience duration, may interpret benefits in more pronounced ways than those who have not endured pain for as long. Exploratory analysis also found interesting differences in outcomes based on obesity status. Although those who were obese had more pronounced benefits postmassage intervention than those who were not obese, the changes overall from baseline to follow-up (24 weeks) was smaller for obese individuals compared to non-obese participants, indicating that pronounced benefit postintervention was not retained once massage therapy stopped. These findings could suggest that those who are obese should consider massage therapy as a management approach for their CLBP unless interventions to address weight (which can also contribute to CLBP) 8 are included in their CLBP treatment strategy. CONTINUING THE DISCUSSION The real-world massage therapy for CLBP study recently published in Pain Medicine provides several aspects that are clinically relevant to massage and bodywork practice. In addition to reporting research results conducted in practice settings reflective of the massage field, it also introduces massage and bodywork practitioners to an easy tool to measure pain with disability for those with acute or chronic back pain and provides a discussion example for clinical versus statistical significance and curative versus management intervention approaches. I look forward to continuing these and other pertinent themes' discussion and application to massage practice and education in future Somatic Research columns as we critically consider current massage research together. Notes 1. Real world essentially means what it implies: as it happens or occurs in the real world, in real applications. The words pragmatic and effectiveness are related research terms that indicate, along with real world, that the research does not seek to examine interventions or make observations in controlled settings. Our study design was real world from several perspectives. We had a very open inclusion criteria, which allowed for medically complex participants who are often excluded from research or controlled studies. For example, we did not have an upper age limit for participants, which allowed us to include much older participants who, up to that point, had been excluded from large clinical trials examining massage for back pain. We also allowed chronic low-back pain patients with comorbidities such as diabetes, hypertension, depression, and obesity to participate, as well as patients who were on scheduled medications such as opioids. Essentially, the participants in this study reflect the real world: complex individuals who massage therapists work with every day in a variety of practice settings, all across the country; W. G. Elder and N. Munk et al., "Real-World Massage Therapy Produces Meaningful Effectiveness Signal for Primary Care Patients with Chronic Low Back Pain: Results of a Repeated Measures Cohort Study," Pain Medicine 18 (2017): 1,394–405. SOMATIC RESE ARCH 2. N. Munk et al., "Intersection of Massage Practice and Research: Community Massage Therapists as Research Personnel on an NIH-Funded Effectiveness Study," International Journal of Therapeutic Massage & Bodywork 7, no. 2 (2014): 10–19. 3. J. C. Fairbank and P. B. Pynsent, "The Oswestry Disability Index," Spine 25, no. 22 (2000): 2,940–52; I. Holm et al., "Measuring Self-Reported Functional Status and Pain in Patients with Chronic Low Back Pain by Postal Questionnaires: A Reliability Study," Spine 28, no. 8 (2003): 828–33; M. Roland and J. C. Fairbank, "The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire," Spine 25, no. 24 (2000): 3,115–24. 4. J. C. Fairbank and P. B. Pynsent, "The Oswestry Disability Index." 5. J. Tonosu et al., "The Normative Score and the Cut-Off Value of the Oswestry Disability Index (ODI)," European Spine Journal 21, no. 8 (2012): 1,596–602, doi: 10.1007/s00586-012-2173-7. 6. J. Tonosu et al., "The Normative Score and the Cut-Off Value of the Oswestry Disability Index"; U. Muller et al., "Condition-Specific Outcome Measures for Low Back Pain. Part I: Validation," European Spine Journal 13, no. 4 (2004): 301–13, doi: 10.1007/s00586-003-0665-1. 7. J. Jin et al., "Factors Affecting Therapeutic Compliance: A Review from The Patient's Perspective," Therapeutics and Clinical Risk Management 4, no. 1 (February 2008): 269–86. 8. A. Okifuji and B. D. Hare, "The Association Between Chronic Pain and Obesity," Journal of Pain Research 8 (2015): 399–408. Niki Munk, PhD, LMT, is an assistant professor of health sciences at Indiana University's School of Health and Rehabilitation Sciences, a Kentucky licensed massage therapist, a visiting research fellow with the Australian Research Centre in Complementary and Integrative Medicine, and mother of two young daughter-scientists. Munk's research explores real-world massage therapy for chronic pain, trigger point self-care, massage for amputation-related sequelae, and the reporting and impact of massage-related case reports.