Is Myofascial Release Therapy Cost-Effective When Compared With Manual Therapy to Treat Workers' Mechanical Neck Pains?

OBJECTIVE: The aim of this study was to do a cost-benefit analysis of myofascial release therapy (MRT) compared to manual therapy (MT) for treating occupational mechanical neck pain. METHODS: Variables regarding the outcomes of the intervention were intensity of neck pain, cervical disability, quality of life, craniovertebral angle, and ranges of cervical motion. Costs were assessed based on a social perspective using diary costs. Between-groups differences in average cost, cost-effectiveness, and cost-utility ratios were assessed using bootstrap parametric techniques. The economic cost-benefit evaluation was with regard to an experimental parallel group study design. There were 59 participants. RESULTS: Myofascial released therapy showed significant improvement over MT for cervical mobility (side bending, rotation, and craniovertebral angle). The total cost of MRT was approximately 20% less (-$519.81; 95% confidence interval, -$1193.67 to $100.31) than that of MT, although this was not statistically significant. Cost-effectiveness and cost-utility ratios showed that MRT could be associated with lower economic costs. CONCLUSION: With probabilities of 93.9% and 95.8%, MRT seems to be cost-effective for treating mechanical neck pain without the need to add any additional cost to obtain a better clinical benefit. Consequently, we believe it could be included in the clinical practice guidelines of different Spanish health care institutions.

A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial.

BACKGROUND: Few studies have evaluated the effectiveness of massage for chronic low back pain. OBJECTIVE: To compare the effectiveness of 2 types of massage and usual care for chronic back pain. DESIGN: Parallel-group randomized, controlled trial. Randomization was computer-generated, with centralized allocation concealment. Participants were blinded to massage type but not to assignment to massage versus usual care. Massage therapists were unblinded. The study personnel who assessed outcomes were blinded to treatment assignment. (ClinicalTrials.gov registration number: NCT00371384) SETTING: An integrated health care delivery system in the Seattle area. PATIENTS: 401 persons 20 to 65 years of age with nonspecific chronic low back pain. INTERVENTION: Structural massage (n = 132), relaxation massage (n = 136), or usual care (n = 133). MEASUREMENTS: Roland Disability Questionnaire (RDQ) and symptom bothersomeness scores at 10 weeks (primary outcome) and at 26 and 52 weeks (secondary outcomes). Mean group differences of at least 2 points on the RDQ and at least 1.5 points on the symptom bothersomeness scale were considered clinically meaningful. RESULTS: The massage groups had similar functional outcomes at 10 weeks. The adjusted mean RDQ score was 2.9 points (95% CI, 1.8 to 4.0 points) lower in the relaxation group and 2.5 points (CI, 1.4 to 3.5 points) lower in the structural massage group than in the usual care group, and adjusted mean symptom bothersomeness scores were 1.7 points (CI, 1.2 to 2.2 points) lower with relaxation massage and 1.4 points (CI, 0.8 to 1.9 points) lower with structural massage. The beneficial effects of relaxation massage on function (but not on symptom reduction) persisted at 52 weeks but were small. LIMITATION: Participants were not blinded to treatment. CONCLUSION: Massage therapy may be effective for treatment of chronic back pain, with benefits lasting at least 6 months. No clinically meaningful difference between relaxation and structural massage was observed in terms of relieving disability or symptoms. PRIMARY FUNDING SOURCE: National Center for Complementary and Alternative Medicine.

Abdominal massage for people with constipation: a cost utility analysis.

AIM: This paper is a report of a study conducted to evaluate change in health-related quality of life for people with constipation receiving abdominal massage and to estimate the cost-effectiveness of two alternative scenarios developed from the original trial. BACKGROUND: Constipation is a common problem and is associated with decrease in quality of life. Abdominal massage appears to decrease the severity of gastrointestinal symptoms, but its impact on health-related quality of life has not been assessed. METHODS: A randomized controlled trial including 60 participants was conducted in Sweden between 2005 and 2007. The control group continued using laxatives as before and the intervention group received additional abdominal massage. Health-related quality of life was assessed using the EQ-5D and analyzed with linear regression. Two scenarios were outlined to conduct a cost utility analysis. In the self-massage scenario patients learned to give self-massage, and in the professional massage scenario patients in hospital received abdominal massage from an Enrolled Nurse. RESULTS: Linear regression analysis showed that health-related quality of life was statistically significantly increased after 8 weeks of abdominal massage. About 40% were estimated to receive good effect. For 'self-massage', the cost per quality adjusted life year was euro75,000 for the first 16 weeks. For every additional week of abdominal massage, the average dropped and eventually approached euro8300. For 'professional massage', the cost per quality adjusted life year was euro60,000 and eventually dropped to euro28,000. CONCLUSION: Abdominal massage may be cost-effective in the long-term and it is relevant to consider it when managing constipation. A crucial aspect will be to identify those who will benefit.

Deep tissue massage, strengthening and stretching exercises, and a combination of both compared with advice to stay active for subacute or persistent non-specific neck pain: A cost-effectiveness analysis of the Stockholm Neck trial (STONE).

OBJECTIVE: To evaluate the cost-effectiveness of deep tissue massage ('massage'), strengthening and stretching exercises ('exercises') or a combination of both ('combined therapy') in comparison with advice to stay active ('advice') for subacute and persistent neck pain, from a societal perspective. METHODS: We conducted a cost-effectiveness analysis alongside a four-arm randomized controlled trial of 619 participants followed-up for one year. Health-related quality of life was measured using EQ-5D-3L and costs were calculated from baseline to one year. The interventions were ranked according to quality adjusted life years (QALYs) in a cost-consequence analysis. Thereafter, an incremental cost per QALY was calculated. RESULTS: In the cost-consequence analysis, in comparison with advice, exercises resulted in higher QALY gains, and massage and the combined therapy were more costly and less beneficial. Exercises may be a cost-effective treatment compared with advice to stay active if society is willing to pay 17 640 EUR per QALY. However, differences in QALY gains were minimal; on average, participants in the massage group, spent a year in a state of health valued at 0.88, exercises: 0.89, combined therapy: 0.88 and, advice: 0.88. CONCLUSIONS: Exercises are cost-effective compared to advice given that the societal willingness to pay is above 17 640 EUR per year in full health gained. Massage and a combined therapy are not cost-effective. While exercise appeared to have the best cost/benefit profile, even this treatment had only a modest benefit and treatment innovation is needed. Advice to stay active remains as a good therapeutic alternative from an economical perspective.

Complementary and alternative medicine use and cost in functional bowel disorders: a six month prospective study in a large HMO.

BACKGROUND: Functional Bowel Disorders (FBD) are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care. There are currently no data on the types of Complementary and Alternative Medicine (CAM) used for FBDs other than Irritable Bowel Syndrome (IBS), or on the economic costs of CAM treatments. The aim of this study is to determine prevalence, types and costs of CAM in IBS, functional diarrhea, functional constipation, and functional abdominal pain. METHODS: 1012 Patients with FBD were recruited through a health care maintenance organization and followed for 6 months. Questionnaires were used to ascertain: Utilization and expenditures on CAM, symptom severity (IBS-SS), quality of life (IBS-QoL), psychological distress (BSI) and perceived treatment effectiveness. Costs for conventional medical care were extracted from administrative claims. RESULTS: CAM was used by 35% of patients, at a median yearly cost of $200. The most common CAM types were ginger, massage therapy and yoga. CAM use was associated with female gender, higher education, and anxiety. Satisfaction with physician care and perceived effectiveness of prescription medication were not associated with CAM use. Physician referral to a CAM provider was uncommon but the majority of patients receiving this recommendation followed their physician's advice. CONCLUSION: CAM is used by one-third of FBD patients. CAM use does not seem to be driven by dissatisfaction with conventional care. Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate.

Abdominal massage plus advice, compared with advice only, for neurogenic bowel dysfunction in MS: a RCT.

BACKGROUND: Between 50% and 80% of people with multiple sclerosis (PwMS) experience neurogenic bowel dysfunction (NBD) (i.e. constipation and faecal incontinence) that affects quality of life and can lead to hospitalisation. OBJECTIVES: To determine the clinical effectiveness and cost-effectiveness of abdominal massage plus advice on bowel symptoms on PwMS compared with advice only. A process evaluation investigated the factors that affected the clinical effectiveness and possible implementation of the different treatments. DESIGN: A randomised controlled trial with process evaluation and health economic components. Outcome analysis was undertaken blind. SETTING: The trial took place in 12 UK hospitals. PARTICIPANTS: PwMS who had 'bothersome' NBD. INTERVENTION: Following individualised training, abdominal massage was undertaken daily for 6 weeks (intervention group). Advice on good bowel management as per the Multiple Sclerosis Society advice booklet was provided to both groups. All participants received weekly telephone calls from the research nurse. MAIN OUTCOME MEASURES: The primary outcome was the difference between the intervention and control groups in change in the NBD score from baseline to week 24. Secondary outcomes were measured via a bowel diary, adherence diary, the Constipation Scoring System, patient resource questionnaire and the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). RESULTS: A total of 191 participants were finalised, 189 of whom were randomised (two participants were finalised in error) (control group, n = 99; intervention group, n = 90) and an intention-to-treat analysis was performed. The mean age was 52 years (standard deviation 10.83 years), 81% (n = 154) were female and 11% (n = 21) were wheelchair dependent. Fifteen participants from the intervention group and five from the control group were lost to follow-up. The change in NBD score by week 24 demonstrated no significant difference between groups [mean difference total score -1.64, 95% confidence interval (CI) -3.32 to 0.04; p = 0.0558]; there was a significant difference between groups in the change in the frequency of stool evacuation per week (mean difference 0.62, 95% CI 0.03 to 1.21; p = 0.039) and in the number of times per week that participants felt that they emptied their bowels completely (mean difference 1.08, 95% CI 0.41 to 1.76; p = 0.002), in favour of the intervention group. Of participant interviewees, 75% reported benefits, for example less difficulty passing stool, more complete evacuations, less bloated, improved appetite, and 85% continued with the massage. A cost-utility analysis conducted from a NHS and patient cost perspective found in the imputed sample with bootstrapping a mean incremental outcome effect of the intervention relative to usual care of -0.002 quality-adjusted life-years (QALYs) (95% CI -0.029 to 0.027 QALYs). In the same imputed sample with bootstrapping, the mean incremental cost effect of the intervention relative to usual care was £56.50 (95% CI -£372.62 to £415.68). No adverse events were reported. Limitations include unequal randomisation, dropout and the possibility of ineffective massage technique. CONCLUSION: The increment in the primary outcome favoured the intervention group, but it was small and not statistically significant. The economic analysis identified that the intervention was dominated by the control group. Given the small improvement in the primary outcome, but not in terms of QALYs, a low-cost version of the intervention might be considered worthwhile by some patients. FUTURE WORK: Research is required to establish possible mechanisms of action and modes of massage delivery. TRIAL REGISTRATION: Current Controlled Trials ISRCTN85007023 and NCT03166007. FUNDING: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 58. See the NIHR Journals Library website for further project information.

Eurythmy therapy in chronic disease: a four-year prospective cohort study.

BACKGROUND: Many patients with chronic diseases use complementary therapies, often provided by their physicians. In Germany, several physician-provided complementary therapies have been reimbursed by health insurance companies as part of health benefit programs. In most of these therapies, the patient has a predominantly passive role. In eurythmy therapy, however, patients actively exercise specific movements with the hands, the feet or the whole body. The purpose of this study was to describe clinical outcomes in patients practising eurythmy therapy exercises for chronic diseases. METHODS: In conjunction with a health benefit program, 419 outpatients from 94 medical practices in Germany, referred to 118 eurythmy therapists, participated in a prospective cohort study. Main outcomes were disease severity (Disease and Symptom Scores, physicians' and patients' assessment on numerical rating scales 0-10) and quality of life (adults: SF-36, children aged 8-16: KINDL, children 1-7: KITA). Disease Score was documented after 0, 6 and 12 months, other outcomes after 0, 3, 6, 12, 18, 24, and (SF-36 and Symptom Score) 48 months. RESULTS: Most common indications were mental disorders (31.7% of patients; primarily depression, fatigue, and childhood emotional disorder) and musculoskeletal diseases (23.4%). Median disease duration at baseline was 3.0 years (interquartile range 1.0-8.5). Median number of eurythmy therapy sessions was 12 (interquartile range 10-19), median therapy duration was 119 days (84-188). All outcomes improved significantly between baseline and all subsequent follow-ups (exceptions: KITA Psychosoma in first three months and KINDL). Improvements from baseline to 12 months were: Disease Score from mean (standard deviation) 6.65 (1.81) to 3.19 (2.27) (p < 0.001), Symptom Score from 5.95 (1.75) to 3.49 (2.12) (p < 0.001), SF-36 Physical Component Summary from 43.13 (10.25) to 47.10 (9.78) (p < 0.001), SF-36 Mental Component Summary from 38.31 (11.67) to 45.01 (11.76) (p < 0.001), KITA Psychosoma from 69.53 (15.45) to 77.21 (13.60) (p = 0.001), and KITA Daily Life from 59.23 (21.78) to 68.14 (18.52) (p = 0.001). All these improvements were maintained until the last follow-up. Improvements were similar in patients not using diagnosis-related adjunctive therapies within the first six study months. Adverse reactions to eurythmy therapy occurred in 3.1% (13/419) of patients. No patient stopped eurythmy therapy due to adverse reactions. CONCLUSION: Patients practising eurythmy therapy exercises had long-term improvement of chronic disease symptoms and quality of life. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that eurythmy therapy can be useful for patients motivated for this therapy.

Massage Therapy in Outpatient Cancer Care: A Metropolitan Area Analysis.

Massage offers cancer patients general quality of life benefits as well as alleviation of cancer-related symptoms/cancer-treatment-related symptoms including pain, anxiety, and fatigue. Little is known about whether massage is accessible to cancer patients who receive treatment in the outpatient setting and how massage is incorporated into the overall cancer treatment plan. Outpatient cancer centers (n = 78) in a single metropolitan area were included this mixed-methods project that included a systematic analysis of website information and a telephone survey. Massage was offered at only 40 centers (51.3% of total). A range of massage modalities were represented, with energy-based therapies (Reiki and Therapeutic Touch) most frequently provided. Although massage therapists are licensed health care providers in the states included in this analysis, massage was also provided by nurses, physical therapists, and other health care professionals.

Beneficial Effects of Guided Imagery or Clinical Massage on the Status of Patients in a Progressive Care Unit.

BACKGROUND: Patients in the progressive care unit typically experience high levels of pain and anxiety and exhibit difficulty sleeping. OBJECTIVE: To determine whether either clinical massage or guided imagery could reduce pain and anxiety and improve sleep. METHODS: This study included 288 inpatients on 2 floors of a progressive care unit. On 1 floor, each patient was offered daily a 15-minute complimentary clinical massage, whereas the patients on the other floor were provided access to a 30-minute guided-imagery recording. Patients were asked to rate their pain and anxiety levels immediately before and after the massage intervention or were asked whether the guided-imagery intervention was helpful for pain, anxiety, or insomnia. RESULTS: The massage intervention showed an immediate and significant reduction in self-reported pain and anxiety (P < .001); likewise, a significant number of patients self-reported that guided imagery helped alleviate pain, anxiety, and insomnia (P < .001). CONCLUSION: The results of this study indicate that clinical massage and guided imagery can benefit patients in the progressive care unit.

The Concept of "Chair Massage" in the Workplace as Prevention of Musculoskeletal Overload and Pain.

BACKGROUND: Accumulation of musculoskeletal overload experienced daily over a long period, for months or even years may lead to serious health problems. Simple, quick and easy-to-administer prophylactic and therapeutic interventions not involving complicated medical procedures can bring tangible benefits for sufferers. The aim of the study was to evaluate the efficacy and effects of a massage programme performed during breaks at work among persons exposed to long-term overload of the spinal column and areas around the spine. MATERIAL AND METHODS: We studied 50 office workers (20 women and 30 men, mean age 34.04 years). The subjects were randomly divided into an experimental group (massage, 25 people) and a control group (25 people). The study was completed in four weeks, during which 8 massage sessions took place (twice a week for 15 minutes). Subjective assessment tools were used, namely the IPAQ-short version for evaluation of physical activity, Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) for assessment of musculoskeletal pain and a survey to assess the participants' satisfaction with the massage programme. An objective assessment tool was an algometric evaluation of the pain threshold (kg/cm2) in selected muscle trigger points. Statistical significance of differences was set at p <0.05. RESULTS: The level of physical activity was comparable between the groups, with 42% of the experimental group and 40% in the control group declaring a high level of physical activity. According to the CMDQ, the biggest differences after massage were noted with regard to the reduction of pain in the lower and upper spine and the right arm (p <0.001), while slightly smaller improvements were noted in the right shoulder and left forearm (p <0.05). In other parts of the body and in the control group, the changes were not statistically significant. The pain threshold assessed by algometry increased at all points examined in the experimental group, with pain sensitivity decreasing the most in the trapezius and supraspinous muscles on the left side of the spine (p <0.001). In the control group, the changes were not significant. CONCLUSIONS: 1. The proposed programme of chair massage in the workplace proved to be effective in relieving musculoskeletal overload and discomfort of the spine and upper limbs. 2. The advantages of this method include its accessibility, cost-effectiveness, ease of administration in different places and short treatment time. It seems advisable to popularise it and increase its use in practice in the prevention of physical and mental work-related overload.

Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain.

BACKGROUND: Because the value of popular forms of alternative care for chronic back pain remains uncertain, we compared the effectiveness of acupuncture, therapeutic massage, and self-care education for persistent back pain. METHODS: We randomized 262 patients aged 20 to 70 years who had persistent back pain to receive Traditional Chinese Medical acupuncture (n = 94), therapeutic massage (n = 78), or self-care educational materials (n = 90). Up to 10 massage or acupuncture visits were permitted over 10 weeks. Symptoms (0-10 scale) and dysfunction (0-23 scale) were assessed by telephone interviewers masked to treatment group. Follow-up was available for 95% of patients after 4, 10, and 52 weeks, and none withdrew for adverse effects. RESULTS: Treatment groups were compared after adjustment for prerandomization covariates using an intent-to-treat analysis. At 10 weeks, massage was superior to self-care on the symptom scale (3.41 vs 4.71, respectively; P =.01) and the disability scale (5.88 vs 8.92, respectively; P<.001). Massage was also superior to acupuncture on the disability scale (5.89 vs 8.25, respectively; P =.01). After 1 year, massage was not better than self-care but was better than acupuncture (symptom scale: 3.08 vs 4.74, respectively; P =.002; dysfunction scale: 6.29 vs 8.21, respectively; P =.05). The massage group used the least medications (P<.05) and had the lowest costs of subsequent care. CONCLUSIONS: Therapeutic massage was effective for persistent low back pain, apparently providing long-lasting benefits. Traditional Chinese Medical acupuncture was relatively ineffective. Massage might be an effective alternative to conventional medical care for persistent back pain.

A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain.

BACKGROUND: Few treatments for back pain are supported by strong scientific evidence. Conventional treatments, although widely used, have had limited success. Dissatisfied patients have, therefore, turned to complementary and alternative medical therapies and providers for care for back pain. PURPOSE: To provide a rigorous and balanced summary of the best available evidence about the effectiveness, safety, and costs of the most popular complementary and alternative medical therapies used to treat back pain. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. STUDY SELECTION: Systematic reviews of randomized, controlled trials (RCTs) that were published since 1995 and that evaluated acupuncture, massage therapy, or spinal manipulation for nonspecific back pain and RCTs published since the reviews were conducted. DATA EXTRACTION: Two authors independently extracted data from the reviews (including number of RCTs, type of back pain, quality assessment, and conclusions) and original articles (including type of pain, comparison treatments, sample size, outcomes, follow-up intervals, loss to follow-up, and authors' conclusions). DATA SYNTHESIS: Because the quality of the 20 RCTs that evaluated acupuncture was generally poor, the effectiveness of acupuncture for treating acute or chronic back pain is unclear. The three RCTs that evaluated massage reported that this therapy is effective for subacute and chronic back pain. A meta-regression analysis of the results of 26 RCTs evaluating spinal manipulation for acute and chronic back pain reported that spinal manipulation was superior to sham therapies and therapies judged to have no evidence of a benefit but was not superior to effective conventional treatments. CONCLUSIONS: Initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy.

Social work in health care when conventional meets complementary: nonspecific back pain and massage therapy.

Through years of engagement within health, the profession of social work has worked diligently to influence and incorporate the professional values of holism and biopsychosocial-spiritual approaches into mainstream health care to support health care consumers. Continuing education supports social workers' specialized knowledge of health conditions as well as issues affecting health care systems and delivery. Two pressing and current issues in health of concern to social work are (1) nonspecific back pain and (2) the fastest growing consumer trend in North America--integration of complementary and alternative medicine. This article offers information relevant to social workers in practice about the complex and multifactoral condition of chronic nonspecific back pain and the integration of complementary and alternative medicine, in particular, massage therapy, as an effective evidence-based integrated approach.

An evaluation system for financial compensation in traditional Chinese medicine services.

OBJECTIVES: To describe the major factors influencing financial compensation in traditional Chinese medicine (TCM) and prioritize what TCM services should be compensated for. DESIGN AND SETTING: Two structured questionnaires-a TCM service baseline questionnaire and a service cost questionnaire-were used to collect information from TCM public hospitals on TCM services provided in certain situations and service cost accounting. The cross-sectional study examined 110 TCM services provided in four county TCM public hospitals in Shandong province. From the questionnaire data, a screening index system was established via expert consultation and brainstorming. Comprehensive evaluation of TCM services was performed using the analytic hierarchy process method. MAIN OUTCOME MEASURES: Weighted coefficients were used to measure the importance of each criterion, after which comprehensive evaluation scores for each service were ranked to indicate what services should receive priority for financial compensation. RESULTS: Economy value, social value, and efficacy value were the three main criteria for screening for what TCM services should be compensated for. The economy value local weight had the highest value (0.588), of which the profit sub-criterion (0.278) was the most important for TCM financial compensation. Moxibustion was tied for the highest comprehensive evaluation scores, at 0.65 while Acupuncture and Massage Therapy were tied for the second and third highest, with 0.63 and 0.58, respectively. CONCLUSIONS: Government and policymakers should consider offer financial compensation to Moxibustion, Acupuncture, Massage Therapy, and TCM Orthopedics as priority services. In the meanwhile, it is essential to correct the unreasonable pricing, explore compensation methods, objects and payment, and revise and improve the accounting system for the costs of TCM services.

[Clinical study of cervical spondylotic radiculopathy treated with massage therapy combined with Magnetic sticking therapy at the auricular points and the cost comparison].

OBJECTIVE: To compare the clinical efficacy on cervical spondylotic radiculopathy between the combined therapy of massage and magnetic-sticking at the auricular points and the simple massage therapy, and conduct the health economics evaluation. METHODS: Seventy-two patients of cervical spondylotic radiculopathy were randomized into a combined therapy group, and a simple massage group, 36 cases in each one. Finally, 35 cases and 34 cases were met the inclusive criteria in the corresponding groups separately. In the combined therapy group, the massage therapy and the magnetic sticking therapy at auricular points were combined in the treatment. Massage therapy was mainly applied to Fengchi (GB 20), Jianjing (GB 21), Jianwaishu (SI 14), Jianyu (LI 15) and Quchi (LI 11). The main auricular points for magnetic sticking pressure were Jingzhui (AH13), Gan (On12) Shen (CO10), Shenmen (TF4), Pizhixia (AT4). In the simple massage group, the simple massage therapy was given, the massage parts and methods were the same as those in the combined therapy group. The treatment was given once every two days, three times a week, for 4 weeks totally. The cervical spondylosis effect scale and the simplified McGill pain questionnaire were adopted to observe the improvements in the clinical symptoms, clinical examination, daily life movement, superficial muscular pain in the neck and the health economics cost in the patients of the two groups. The effect was evaluated in the two groups. RESULTS: The effective rate and the clinical curative rate in the combined therapy group were better than those in the control group [100. 0% (35/35) vs 85. 3% (29/34), 42. 9% (15/35) vs 17. 6% (6/34), both P<0. 05]. The scores of the spontaneous symptoms, clinical examnation, daily life movement and superficialmuscular pain in the neck were improved apparently after treatment as compared with those before treatment in the patients of the two groups (all P<0. 001). In terms of the improvements in the spontaneous symptoms, clinical examination total scores and superficial muscular pain in the' neck were more significant in the combined therapy group as compared with those in the simple massage group (P<0. 05, P<0. 01, P<0. 001). The cost at the unit effect in the combined therapy group was lower than that in the simple massage group (P<0. 05). CONCLUSION: Compared with the simple massage therapy, the massage therapy combined with magnetic sticking therapy at auricular points achieves the better effect and lower cost in health economics.

The effect of massage therapy and/or exercise therapy on subacute or long-lasting neck pain--the Stockholm neck trial (STONE): study protocol for a randomized controlled trial.

BACKGROUND: Neck pain is a major health problem in populations worldwide and an economic burden in modern societies due to its high prevalence and costs in terms of health care expenditures and lost productivity. Massage and exercise therapy are widely used management options for neck pain. However, there is a lack of scientific evidence regarding their effectiveness for subacute and long-lasting neck pain. This study protocol describes a randomized controlled trial aiming to determine the effect of massage and/or exercise therapy on subacute and long-lasting neck pain over the course of 1 year. METHODS/DESIGN: A randomized controlled trial in which at least 600 study participants with subacute or long-lasting nonspecific neck pain will be recruited and randomly allocated to one of four treatment arms: massage therapy (A), exercise therapy (B), exercise therapy plus massage therapy (C) and advice to stay active (D). The study has an E-health approach, and study participants are being recruited through advertising with a mix of traditional and online marketing channels. Web-based self-report questionnaires measure the main outcomes at 7, 12, 26 and 52 weeks after inclusion. The primary outcomes are a clinically important improvement in pain intensity and pain-related disability at follow-up, measured with a modified version of the Chronic Pain Questionnaire (CPQ). The secondary outcomes are global improvement, health-related quality of life (EQ-5D), sick leave, drug consumption and healthcare utilization. Adverse events are measured by questionnaires at return visits to the clinic, and automated text messages (SMSes) survey neck pain intensity and pain-related disability every week over one year. DISCUSSION: The results of this study will provide clinicians and stakeholders much needed knowledge to plan medical care for subacute and long-lasting neck pain disorders. TRIAL REGISTRATION: Current Controlled Trials ISRCTN01453590. Date of registration: 3 July 2014.

Do Sexually Oriented Massage Parlors Cluster in Specific Neighborhoods? A Spatial Analysis of Indoor Sex Work in Los Angeles and Orange Counties, California.

OBJECTIVE: Social determinants of health may be substantially affected by spatial factors, which together may explain the persistence of health inequities. Clustering of possible sources of negative health and social outcomes points to a spatial focus for future interventions. We analyzed the spatial clustering of sex work businesses in Southern California to examine where and why they cluster. We explored economic and legal factors as possible explanations of clustering. METHODS: We manually coded data from a website used by paying members to post reviews of female massage parlor workers. We identified clusters of sexually oriented massage parlor businesses using spatial autocorrelation tests. We conducted spatial regression using census tract data to identify predictors of clustering. RESULTS: A total of 889 venues were identified. Clusters of tracts having higher-than-expected numbers of sexually oriented massage parlors ("hot spots") were located outside downtowns. These hot spots were characterized by a higher proportion of adult males, a higher proportion of households below the federal poverty level, and a smaller average household size. CONCLUSION: Sexually oriented massage parlors in Los Angeles and Orange counties cluster in particular neighborhoods. More research is needed to ascertain the causal factors of such clusters and how interventions can be designed to leverage these spatial factors.

The development of a massage service for cancer patients.

Despite major technological advances in the treatment of cancer, many patients are dissatisfied with conventional biomedical interventions. This is largely because they fail to resolve long term intractable problems such as chronic pain or stress. More emphasis is now being placed on quality of life. This shift in attitude has opened the door for complementary therapies as adjuvants to traditional models of cancer care. Changes within the NHS have facilitated this transition, by the creation of the 'internal market' and the development of central funding to individual clinical directorates. To exploit these opportunities, complementary, therapists must develop new skills and be prepared to adopt NHS standards of assessment to evaluate the efficacy of their work. Standards are a component of 'Quality assurance'. They are observable, achievable and measurable, and contribute towards an acceptable evaluation process. Standards are used by health care purchasers to assess which therapies should be made available to patients within the NHS. This paper describes the development of a massage service that has been integrated into the Hammersmith Oncology Department. The massage standard is seen to be fundamental and essential to the continued development and evaluation of the project.

Postoperative arm massage: a support for women with lymph node dissection.

PURPOSE/OBJECTIVE: To evaluate the usefulness of arm massage from a significant other following lymph node dissection surgery. DESIGN: Randomized clinical trial with a pretest-posttest design. Data were collected prior to surgery, within 24 hours post surgery, within 10 to 14 days post surgery, and 4 months post surgery. SAMPLE: 59 women, aged 21 to 78 undergoing lymph node dissection surgery and who had a significant other with them during the postoperative period. METHODS: Subjects were randomly assigned to intervention and control groups. Subjects' significant others in the intervention group were first taught, then performed arm massage as a postoperative support measure. RESEARCH MAIN VARIABLES: Variables included postoperative pain, family strengths and stressors, range of motion, and health related costs. FINDINGS: Participants reported a reduction in pain in the immediate postoperative period and better shoulder function. CONCLUSION: Arm massage decreased pain and discomfort related to surgery, and promoted a sense of closeness and support amongst subjects and their significant other. IMPLICATION FOR NURSING PRACTICE: Postoperative massage therapy for women with lymph node dissection provided therapeutic benefits for patients and their significant other. Nurses can offer effective alternative interventions along with standard procedures in promoting optimal health.

Utilization, patient satisfaction, and cost implications of acupuncture, massage, and naturopathic medicine offered as covered health benefits: a comparison of two delivery models.

CONTEXT: Increasing numbers of health plans in the United States offer complementary and alternative medicine (CAM) benefits despite limited information. OBJECTIVE: To determine the utilization rates and costs associated with providing CAM services in 2 benefit designs, and to determine the satisfaction of patients in both plans. DESIGN: Two health plans were identified: a traditional indemnity plan offered through a defined preferred provider organization (PPO) of CAM providers and a health maintenance organization (HMO). Costs and utilization rates for CAM services were compared during a 1-year period of coverage beginning November 1, 1996. SETTING AND PARTICIPANTS: 1091 patients in both plans who used CAM services during the month of May 1997 in Washington state. RESULTS: Only 1% of all patients covered for CAM accessed these services during the study period. A significantly higher percentage of patients in the PPO plan (1.2%) used CAM services compared to the HMO plan (0.6%) (P < .001). However, the average total cost of annual CAM services (plan benefit + user contribution) was similar ($347 in the HMO and $376 in the PPO), and the price per member per month was nearly identical ($0.20 in the HMO and $0.19 in the PPO). Most users perceived these services as helpful. CONCLUSIONS: Utilization of CAM services and per member per month costs were lower than expected given the high interest in CAM services reported in consumer surveys. The high level of satisfaction with CAM services and self-reported decrease in the use of pain medications suggests the need for prospective studies examining the effect of CAM treatments.