Research Examines Effectiveness of Thai Massage and Physical Therapy

By Massage Therapy Foundation Contributor

Contributed by April V. Neufeld, BS, LMP; Jolie Haun, PhD, EdS, LMT; & Renee Stenbjorn, MPA, LMT

If you have ever plunged into the details of an original published research article, then you know how tedious some research can be to read.

However, if you have ever been too afraid to explore an original article, then let this month's Massage Therapy Foundation research column review be a call to face your fears! The research in a recent publication of Clinical Interventions in Aging is a great place to start exploring scientific writing. "The efficacy of traditional Thai massage in decreasing spasticity in elderly stroke patients" is an easy read compared to most research papers, and although it has it's fair share of statistics and graphs, the authors do an excellent job of explaining their process.

The purpose of this study was to compare the effectiveness of traditional Thai massage to traditional physical therapy for decreasing muscle spasticity in stroke patients over the age of 50 years. A group of subjects (n=50) were randomly assigned to either the traditional Thai massage (TTM) or the physical therapy (PT) group. Since muscle spasticity causes pain and can limit functional abilities affecting posture and joint contracture, this condition often affects quality of life (QoL) and emotional states. The researchers measured anxiety and depression, activities of daily living (ADL), limb motor function and muscle spasticity. Functional abilities in self care and mobility were measured with the Barthel Index (BI), where a high score (0-20) means better function. The modified Ashworth Scale (MAS) measured spasticity (0 = no increase in muscle tone and 4 = the effected body part is ridged in flexion or extensions).

The study outlines the participant exclusion process and presents a clear flowchart (Figure 1) to illustrate their approach to screening 220 people at study onset to the final follow-up at week 6 of the 50 subjects. For readers who might be considering creating their own research study, this figure in conjunction with the methods section provides an excellent illustration of how small sample sizes can result in useful research. It's often difficult to find willing volunteers; volunteers who are not excluded for various risk factors and who are dedicated to finishing the study protocol. If you read through Figure 1, you will see that of the 26 people assigned to the PT group, 4 of them did not complete the final follow-up due to "inconvenience." This is fairly common in research studies involving any volunteers.

The TTM routine was standardized by an unnamed Thai massage organization and performed by certified practitioners. Often research articles do not describe the massage therapy techniques being studied in clear enough detail for replication. Fortunately, this publication (see Table S1) described the TTM routine, areas and duration of treatment (in minutes). Unfortunately, the PT description was lacking similar detail. Both groups (TTM n=24, PT n=26) received one hour treatments, twice a week for six weeks.

If you read the original article, the statistical analysis and results sections may seem intimidating at first, but I encourage you to read through them. The authors provide simple and accurate descriptions of their findings and provide an excellent discussion of the study limitations. If you do read through the study and if you do not have training in statistics the results may appear to you to support TTM over PT, but for each test category the study found no statistical difference between PT and TTM groups.

Here is an outline of the results at week six:

• MAS score (spasticity) decreased in both groups (70.8% in TTM vs. 61.9% in PT group), but statistically there was no difference between the groups.
• BI scores (mobility & self care) increased significantly in both groups but again there was no statistical difference between the TTM & PT groups. It is important to note that as the BI scores improved likely subjects actually moved their limbs more in daily life and so improved their QoL.
• QoL increased in both groups.
• Functional mobility increased significantly in both groups.
• Depression and anxiety test scores decreased in the TTM group, while scores increased in the PT group, but again, there was not a statistically significant difference between the groups.
• Patient satisfaction showed less satisfaction with the TTM group than the PT (75% satisfied compared to 90.5%). However, this may have been due to the amount of adverse events (muscle pain, stiffness, and soreness) that occurred with the TTM group. And with a sample size so small, no significant difference was found between the groups.

The authors do an excellent job discussing the limitations of this study, suggesting future research is needed with larger sample sizes. Also they suggest subjects with a low functional mobility score (low BI at the beginning of the study) could have indicated a higher likelihood of developing spasticity and a lower likelihood of recovery. This study did not evaluate the long-term effects of either TTM or PT on spasticity.

Based on the findings, you may be wondering what the benefit is for stroke patients receiving TTM when the standard treatment is equally effective. First, it is important for patients and healthcare providers to know that alternative (TTM) and traditional (PT) options of treatment are available which produce similar outcomes. This can support individualized treatments plans based on personal preferences. Second, in a world of challenges with insurance and billing, increasingly treatment options are directed by effectiveness of treatment and cost. Although this study does not address this subject, cost of TTM and PT should be considered. In general, the health care industry is in need of cost effective options, as such cost comparison studies are needed to determine how much could potentially be saved, in the case where different treatment options may not produce statistically different outcomes.

Overall, this study provides an example of bodywork therapy research that is clearly illustrated and mostly replicable, making an important contribution to the field of massage therapy research. For those readers interested in case reports, this study could potentially be used as a roadmap for writing your own report. The methods used to evaluate effects of TTM on spasticity (measuring spasticity, QoL, depression, anxiety, and functional ability) could be used to measure the efficacy of TTM on other conditions or massage therapy's effect on spasticity.

Are you a massage therapy student who has an interesting case of your own? The deadline to submit to the MTF Student Case Report Contest is June 1, 2015. If you or your students are interested in learning how to write and submit a case report of your own, check out the MTF's five-part case report webinar series to learn the how to write a winning case report.

To learn more about the effects of massage therapy, you can review the Massage Therapy Foundation review article archives, read accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.

Reference:

1. Thanakiatpinyo, T, Suwannatrai, S, Suwannatrai, U, Khumkaew, P, Wiwattamongkol D, Vannabhum, M, Pianmanakit, S, and Kuptniratsaikul, V. The efficacy of traditional Thai massage in decreasing spasticity in elderly stroke patients. Clinical Interventions in Aging (2014:9 1311-1319).