Review of Literature
Copyright © December 2004 Ted Nissen
TABLE OF
CONTENTS
1 TRI Research
1.1 Introduction
1.1.1 111 research papers directed by Tiffany Fields (whose name is on all of the papers) funded by Johnson & Johnson and Gerber and Colgate-Palmolive companies at Touch Research Institute (TRI University of Miami) were completed between 1986 and 2004. The most productive years were 1996 (14), 1997 (10), 1998 (14), 2001 (14), and 2002 (11).
1.1.2 These studies focused on the effects of massage therapy performed by professional Massage Therapist volunteers (68%), Others (25%), and or Non-Professionals (15%). The aforementioned categories are in some cases overlapping as some studies have more than one treatment administered differently.
1.1.3 The frequency of treatment varied No treatment specified (68%), monthly (15%), Daily (11%), or Brief Sessions (6%). Massage Therapy was performed mostly on Children (57%) and Adults (30%).
1.1.4 Most of the patients seen for treatment were children (68%) although a significant minority of adults (29%) were also included in the studies.
1.1.5 The effects of Massage therapy varied in 12 categories (Emotion, Sensory, Lab, Neurological, Behavioral, Task/Test, Psychological/Social, Orthopedic, Cardio-Pulmonary, Gastrointestinal, Risk, and Activities of Daily Living (ADL). There were 321 positive research effects of the 144 dependent variables and no negative research effects noted in the 111 summary reviews. The most common positive effects of Massage Therapy were Improved Emotions (24%), Improved Behavioral Problems (22%), and Stress Reduction/Improved Immune Function (14%). Of the 321 positive research effects of the 144 dependent variables among the most notable are; Reduced Anxiety (11%), Reduced Depression (8%), Reduced Pain (5%), Reduced Stress Hormones (7%), Weight Gain (Pre-term Infants) (5%), and Improved Sleep (4%).
1.1.6 Articles by Subjects
1.1.6.1 The last chart under this section illustrates the TRI research articles by subject matter which then can be compared to the 3500+ massage research articles which cannot be analysed further as there is no summary (abstract) available. The 111 TRI research articles covered 10 categories with the most frequent being Disease (27%), Infants (23%), Behavior (18%), and Emotion (11%). The least frequently researched subjects include Orthopedic (3%), Miscellaneous (3%), and Cardiovascular (1%). For more detail with regards to the subject matter under each category you can refer to the research summary sheet below in the next section.
1.2 Research Articles
1.2.1 Research Summary Sheet
1.2.1.1 Summary
1.2.2 Excel Data Sheet
1.2.2.1 Data Sheet
1.3 Future Studies
1.3.1 None of the TRI studies lasted more than a couple of months, which would suggest the need for long-term studies to determine the longitudinal effects of Massage Therapy. More studies should be conducted on adults since most of the TRI studies were done with children (68%). None of the summary reviews suggested an attempt to measure whether the effects of Massage Therapy are lasting (Curative Effect) even after treatment is withdrawn. More studies then, need to be done which measure the Curative Effect of Massage Therapy. Although many medical treatments can only offer temporary relief, (for example anti-inflammatory or antidepressant medications may only last as long as you take the pill), pharmacology may be easier and cheaper for most patients than massage therapy. If studies reveal the curative effect of massage therapy with fewer pharmacological side effects then increased utilization of massage by the medical community and reimbursement by the insurance industry is more likely. The techniques although not described in the summary reviews appear to be of a generic variety (Circulatory Massage) and only (5%) of the articles by subject had a reference to technique in their title. Studies, which measure the relative effectiveness of more specifically defined massage techniques, are indicated. Technique may detract from, enhance, or make no difference in the curative outcome. Knowing this will enhance training and clinical practice.
1.4 Chart Illustrations
1.4.1 Treatments
1.4.2 FREQUENCY
1.4.3 PATIENTS
1.4.4 YEAR OF PUBLICATION TOTAL=111
1.4.5 Results
1.4.6 Articles by Subjects
2 All Research
2.1 Introduction
2.1.1 There are over 3700 articles in the massage literature (1917-2004) and in this section is a non-random sample of 311 articles. Because this is a non-random the conclusions should be viewed tentatively. 60% of these articles have abstracts (summary of the research). Only 5 (2%) of the 311 articles have free full text access online and 2 require payment for article access. The average cost (best guesstimate) for limited viewing access is around $30 per article. This cost and limited availability restricts online access to the average practitioner who wishes to use evidenced based therapy in their practice. Simply put evidenced based practice utilizes known valid research to guide therapy. Articles that have abstracts can be analysed by both subject matter and the independent variables (treatment) and dependant variables (what the treatment is supposed to help). This then can tell you about the results of treatment but not whether those results are valid. When full text access is available the research design (how the research was conducted) can be analysed to determine the relative validity (determined by assessing a accepted research design factors) of the research. 98% of the articles do not have full text access, which limits the massage therapist’s ability to determine the validity of the research.
2.1.2 One solution to the problem of having no cost, easy to use accessible research which is evaluated for validity is the Physiotherapy professions PEDro (Physiotherapy Evidence Database). This is an initiative of the Centre for Evidence-Based Physiotherapy (CEBP). In the PEDro database a summary of the research is provided and a validity rating system is applied. The PEDro database is fully searchable and FREE. A practitioner can quickly look up research as an aide to applied practice.
2.1.3 Another solution is the Massage Therapy Foundation database, which is also free but contains citations only. This means that no abstracts, or full text articles are available nor is the research rated. Currently this is only a partial solution to the practitioner who wishes to use evidenced based therapy in their practice. The American Massage Therapy Association (AMTA) founded the Massage Therapy Foundation in 1990 and in June 1998 the AMTA awarded the Foundation an initial grant to begin compiling a database to include articles and books about massage therapy. The database was begun in 2000 and now has over 3700 citations, which are updated every 6 months. The database is also searchable.
2.1.4 A third solution is put forth above and below where I have attempted to take the citations found in the Massage Therapy Foundation database and from other sources such as National Library of Medicine’s PubMed and a variety of other database sources including the above mentioned PEDro and add as much additional information as possible including abstracts and full text articles. Then to take a sample 311 and analyse it from the available information. I will continue to gather data beyond the 311 references and add those references to the analysis. In addition, I will seek to obtain full text articles from the library and include these in the data reference. The disadvantage of this is twofold 1.) This process is slow since the project is currently unfunded and I’m the only one working on it. 2.) Excel worksheets are used to store the data, which may prove cumbersome as the number of citations increase. The advantage of using excel is that there its ease of use and sorting capability. So this by necessity is a partial attempt at a solution to providing an evidenced based research database for the massage therapy profession which is easily accessible online.
2.1.5 The charts and graphs in these pages are the result of that attempt. Since so few full text articles are available no attempt will be made to determine the validity of the research. Where the research title is available articles will be analysed by subject matter only. 40% of the articles have only an article title. 60% of the articles have abstracts.
2.1.6 Many of these articles, which have abstracts, were described in the TRI research section, which was separated because it is a continuous block of research all with abstracts, and produced by the same institution. The next section outlines the statistics.
2.1.7 Statistics
2.1.7.1 Total with abstracts=60%=187 out of a sample of 311, TRI abstracts=111, Non TRI abstracts=76
2.1.8 The 76 non TRI research will be analysed separately by treatment type, frequency, patients and results (dependant variables)as was the TRI research in the first section of this tract and then both will be analysed together.
2.1.9 The next section contains data sheets (which are searchable using the find function in your Web Browser) with an ever expanding list of research articles, publications that print them and when available the research institutions that produce the articles. You will also notice in subsequent sections charts, which contain information on the subject, and the top 20 journals, which published massage articles.
2.2 Research Articles, Publications, and Institutions
2.2.1 All Research List
2.2.1.1 All Research
2.2.2 Research Publications Summary
2.2.2.1 Publications
2.2.3 Research Institutions
2.2.3.1 Research Institutions
2.3 Analysis
2.3.1 The 311 research articles covered 11 subject categories with the most frequent being Technique (22%), Disease (20%), Miscellaneous (19%), and Infants (11%). The least frequently researched subjects include Emotion (4%), Medical Research (2%), and Pregnancy (2%).
2.3.2 When the 311 research articles are sorted by year from 1917 to 2004 the following results are obtained. The years 1917-1959, 1960-1979, and 1980-1984 were combined for brevity since during most of the years only 1-4 research papers were produced. As a result only papers produced on or after 1985 are included in the following analysis. The most productive years were 1996 (27), 1997 (20), 1998 (37), 1999 (20), and 2001 (17). As was previously stated between 1917 and 1984 most years produced between 1-4 research papers on massage. 1985 saw an increase in research interest in massage producing between 4-12 papers, which continued until 1995 a ten-year period. Then in 1996 and until 1999 we see a dramatic rise in the numbers where 20-37 papers were produced each year. This pace began to wane in 2000 until 2004 where 6-17 research papers on massage were produced. The increase or decrease in the number of research papers on massage produced each year may be related to Cultural (Increased interest by the public in Alternative Medicine) and or Economic (Corporations fund more research during boon times) factors.
2.3.3 167 Journals (Publications) published 311 massage research articles with 20 journals publishing 120 of those articles, which ranged 3-20 articles per journal. 147 journals published the additional 191 articles, which ranged 1-2 articles per journal. These articles were produced between 1917 and 2004 an 87-year time span. It is unknown how many total articles these same journals produced over the same time span but it is expected that massage articles represent a tiny fraction. Although massage may have curative benefit for many conditions (massage’s increased public popularity may indicate this) more research is needed to establish how and when. Based on this research evidence practitioners can provide more effective therapy and other professions may increase their utilization of massage as a viable treatment.
2.4 Chart Illustrations
2.4.1 Articles by Subjects
2.4.2 YEAR OF PUBLICATION TOTAL=311
2.4.3 Abstracts
2.4.4 ONLINE ARTICLE ACCESS
2.4.5 TOP 20 JOURNALS PUBLISHING MASSAGE ARTICLES
