Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial

Adam I Perlman, Ather Ali, Valentine Yanchou Njike, David Hom, Anna Davidi, Susan Gould-Fogerite, Carl Milak, David L Katz, Adam I Perlman, Ather Ali, Valentine Yanchou Njike, David Hom, Anna Davidi, Susan Gould-Fogerite, Carl Milak, David L Katz

Abstract

Background: In a previous trial of massage for osteoarthritis (OA) of the knee, we demonstrated feasibility, safety and possible efficacy, with benefits that persisted at least 8 weeks beyond treatment termination.

Methods: We performed a RCT to identify the optimal dose of massage within an 8-week treatment regimen and to further examine durability of response. Participants were 125 adults with OA of the knee, randomized to one of four 8-week regimens of a standardized Swedish massage regimen (30 or 60 min weekly or biweekly) or to a Usual Care control. Outcomes included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analog pain scale, range of motion, and time to walk 50 feet, assessed at baseline, 8-, 16-, and 24-weeks.

Results: WOMAC Global scores improved significantly (24.0 points, 95% CI ranged from 15.3-32.7) in the 60-minute massage groups compared to Usual Care (6.3 points, 95% CI 0.1-12.8) at the primary endpoint of 8-weeks. WOMAC subscales of pain and functionality, as well as the visual analog pain scale also demonstrated significant improvements in the 60-minute doses compared to usual care. No significant differences were seen in range of motion at 8-weeks, and no significant effects were seen in any outcome measure at 24-weeks compared to usual care. A dose-response curve based on WOMAC Global scores shows increasing effect with greater total time of massage, but with a plateau at the 60-minute/week dose.

Conclusion: Given the superior convenience of a once-weekly protocol, cost savings, and consistency with a typical real-world massage protocol, the 60-minute once weekly dose was determined to be optimal, establishing a standard for future trials.

Trial registration: ClinicalTrials.gov NCT00970008.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Participant Flow Diagram.
Figure 1. Participant Flow Diagram.
Figure 2. Dose-Response Curve.
Figure 2. Dose-Response Curve.
Dose-response curve plotting dose (total minutes over the course of 8-weeks of massage) (x-axis) vs. improvement (change in WOMAC Global scores after 8-weeks). Dose-response effects plateaued at 480-minutes (Group 3), with no significant improvements noted in the 720-minute (Group 4) dose.
Figure 3. Improvement in WOMAC-Global Scores at…
Figure 3. Improvement in WOMAC-Global Scores at Assigned Doses of Massage.

References

    1. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58:26–35.
    1. Arden N, Nevitt M. Osteoarthritis:epidemiology. Best Pract Res Clin Rheumatol. 2006;20:3–25.
    1. Matchaba P, Gitton X, Krammer G, Ehrsam E, Sloan VS, et al. Cardiovascular safety of lumiracoxib: A meta-analysis of all randomized controlled trials 1 week and up to 1 year in duration of patients with osteoarthritis and rheumatoid arthritis. Clin Ther. 2005;27:1196–1214.
    1. Kato T, Xiang Y, Nakamura H, Nishioka K. Neoantigens in osteoarthritic cartilage. Curr Opinion Rheumatol. 2004;16:604–608.
    1. Fisher N, Pendergast D. Reduced muscle function in patients with osteoarthritis. Scand J Rehab Med. 1997;29:213–221.
    1. Messier S, Loeser R, Hoover J, Semble E, Wse C. Osteoarthritis of the knee:Effects on gait, strength, and flexibility. Arch Phys Med Rehabil. 1992;73:29–36.
    1. Felson D. An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin North Am. 2004;42:1–9.
    1. Richmond J, Hunter D, Irrgang J, Jones MH, Levy B, et al. Treatment of osteoarthritis of the knee (nonarthroplasty). J Am Acad Orthop Surg. 2009;17:591–600.
    1. Hunter DJ, Felson DT. Osteoarthritis. BMJ. 2006;332:639–642.
    1. Naesdal J, Brown K. NSAID-associated adverse effects and acid control aids to prevent them: A review of current treatment options. Drug Saf. 2006;29:119–132.
    1. Kotlarz H, Gunnarsson CL, Fang H, Rizzo JA. Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data. Arthritis Rheum. 2009;60:3546–3553.
    1. Ernst E. Complementary and alternative medicine for pain management in rheumatic disease. Curr Opin Rheum. 2002;14:58–62.
    1. National Center for Complementary and Alternative Medicine. 2010. NCCAM Backgrounder: Massage Therapy: An Introduction.
    1. Barnes PM, Bloom B, Nahin RL, Barnes PM, Bloom B, et al. Complementary and alternative medicine use among adults and children: United States, 2007. National health statistics reports. 2008:1–23.
    1. Perlman A, Meng C. Rheumatology. In: Leskowitz E, editor. Complementary and Alternative Medicine in Rehabilitation. St. Louis: Harcourt Heath Sciences; 2003. pp. 352–362.
    1. Perlman A, Spierer M. Osteoarthritis. In: Rakel D, editor. Integrative Medicine. Orlando: W.B. Saunders Co; 2003. pp. 414–422.
    1. Perlman A, Weisman R. Own Your Own Health - The Best of Alternative and Conventional Medicine. Pain Deerfield Beach, FL: Health Communications, Inc; 2006.
    1. Perlman AI, Sabina A, Williams AL, Njike VY, Katz DL. Massage therapy for osteoarthritis of the knee: a randomized controlled trial. Arch Intern Med. 2006;166:2533–2538.
    1. Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern Med. 2003;138:898–906.
    1. Preyde M. Effectiveness of massage therapy for subacute low-back pain: A randomized controlled trial. CMAJ. 2000;162:1815–1820.
    1. Hernandez-Reif M, Field T, Krasnegor J, Theakston H. Lower Back Pain is Reduced and Range of Motion Increased After Massage Therapy. International Journal of Neuroscience. 2001;106:131–145.
    1. Sherman KJ, Cherkin DC, Hawkes RJ, Miglioretti DL, Deyo RA. Randomized trial of therapeutic massage for chronic neck pain. Clinical Journal of Pain. 2009;25:233–238.
    1. Wentworth LJ, Briese LJ, Timimi FK, Sanvick CL, Bartel DC, et al. Massage therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures. Progress in Cardiovascular Nursing. 2009;24:155–161.
    1. Listing M, Reisshauer A, Krohn M, Voigt B, Tjahono G, et al. Massage therapy reduces physical discomfort and improves mood disturbances in women with breast cancer. Psycho-Oncology. 2009;18:1290–1299.
    1. Kutner JS, Smith MC, Corbin L, Hemphill L, Benton K, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Annals of Internal Medicine. 2008;149:369–379.
    1. Jane S-W, Wilkie DJ, Gallucci BB, Beaton RD, Huang H-Y. Effects of a full-body massage on pain intensity, anxiety, and physiological relaxation in Taiwanese patients with metastatic bone pain: a pilot study. Journal of Pain & Symptom Management. 2009;37:754–763.
    1. Frey Law LA, Evans S, Knudtson J, Nus S, Scholl K, et al. Massage reduces pain perception and hyperalgesia in experimental muscle pain: a randomized, controlled trial. Journal of Pain. 2008;9:714–721.
    1. Field T, Figueiredo B, Hernandez-Reif M, Diego M, Deeds O, et al. Massage therapy reduces pain in pregnant women, alleviates prenatal depression in both parents and improves their relationships. Journal of Bodywork & Movement Therapies. 2008;12:146–150.
    1. Ezzo J, Haraldsson BG, Gross AR, Myers CD, Morien A, et al. Massage for mechanical neck disorders: a systematic review. Spine. 2007;32:353–362.
    1. Downey L, Diehr P, Standish LJ, Patrick DL, Kozak L, et al. Might massage or guided meditation provide “means to a better end”? Primary outcomes from an efficacy trial with patients at the end of life. Journal of Palliative Care. 2009;25:100–108.
    1. Corbin LW, Mellis BK, Beaty BL, Kutner JS. The use of complementary and alternative medicine therapies by patients with advanced cancer and pain in a hospice setting: a multicentered, descriptive study. Journal of Palliative Medicine. 2009;12:7–8.
    1. Billhult A, Lindholm C, Gunnarsson R, Stener-Victorin E, Gunnarsson R. The effect of massage on immune function and stress in women with breast cancer–a randomized controlled trial. Autonomic Neuroscience-Basic & Clinical. 2009;150:111–115.
    1. Back C, Tam H, Lee E, Haraldsson B. The effects of employer-provided massage therapy on job satisfaction, workplace stress, and pain and discomfort. Holistic Nursing Practice. 2009;23:19–31.
    1. Bauer BA, Cutshall SM, Wentworth LJ, Engen D, Messner PK, et al. Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study. Complementary Therapies in Clinical Practice. 2010;16:70–75.
    1. Sherman KJ, Ludman EJ, Cook AJ, Hawkes RJ, Roy-Byrne PP, et al. Effectiveness of therapeutic massage for generalized anxiety disorder: a randomized controlled trial. Depression & Anxiety. 2010;27:441–450.
    1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, et al. Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–1049.
    1. Bellamy N. The WOMAC knee and hip osteoarthritis indices: Development, validation, globalization and influence on the development of the AUSCAN hand osteoarthritis indices. Clin Exp Rheumatol. 2005;23:S148–153.
    1. Bellamy N, Buchanan W, Goldsmith C, Campbell J, Stitt L. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatology. 1988;15:1833–1840.
    1. Anagnostis C, Mayer TG, Gatchel RJ, Proctor TJ. The million visual analog scale: its utility for predicting tertiary rehabilitation outcomes. Spine. 2003;28:1051–1060.
    1. Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. Cortisol decreases and serotonin and dopamine increase following massage therapy. International Journal of Neuroscience. 2005;115:1397–1413.
    1. Perlman A, Sabina A, Williams AL, Yanchou Njike V, Katz D. Massage Therapy for osteoarthritis of the knee. Arch Intern Med. 2006;166:2533–2538.
    1. Schnyer RN, Allen JJ. Bridging the gap in complementary and alternative medicine research: manualization as a means of promoting standardization and flexibility of treatment in clinical trials of acupuncture. Journal of Alternative & Complementary Medicine. 2002;8:623–634.
    1. Ernst E. The safety of massage therapy. Rheumatology (Oxford) 2003;42:1101–1106.
    1. McConnell S, Kolopack P, Davis A. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum. 2001;45:453–461.
    1. Price DD, Bush FM, Long S, Harkins SW. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain. 1994;56:217–226.
    1. Angst F, Aeschlimann A, Michel BA, Stucki G. Minimal clinically important rehabilitation effects in patients with osteoarthritis of the lower extremities. J Rheumatol. 2002;29:131–138.
    1. Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, et al. Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage. 2007;15:273–280.
    1. Bouchet C, Guillemin F, Briancon S. Nonspecific effects in longitudinal studies: impact on quality of life measures. J Clin Epidemiol. 1996;49:15–20.
    1. Kaptchuk TJ. Powerful placebo: the dark side of the randomised controlled trial. Lancet. 1998;351:1722–1725.
    1. Kirby BS, Carlson RE, Markwald RR, Voyles WF, Dinenno FA. Mechanical influences on skeletal muscle vascular tone in humans: insight into contraction-induced rapid vasodilatation. J Physiol. 2007;583:861–874.
    1. Sefton JM, Yarar C, Berry JW, Pascoe DD. Therapeutic massage of the neck and shoulders produces changes in peripheral blood flow when assessed with dynamic infrared thermography. J Altern Complement Med. 2010;16:723–732.
    1. Cambron JA, Dexheimer J, Coe P, Swenson R. Side-effects of massage therapy: a cross-sectional study of 100 clients. Journal of Alternative & Complementary Medicine. 2007;13:793–796.
    1. Nayak S, Matheis R, Agostinelli S, Shifleft S. The use of complementary and alternative therapies for chronic pain following spinal cord injury: A pilot survey. J Spinal Cord Med. 2001;24:54–62.
    1. Billhult A, Maatta S, Billhult A, Maatta S. Light pressure massage for patients with severe anxiety. Complementary Therapies in Clinical Practice. 2009;15:96–101.
    1. Diego MA, Field T. Moderate Pressure Massage Elicits a Parasympathetic Nervous System Response. International Journal of Neuroscience. 2009;119:630–638.
    1. Stringer J, Swindell R, Dennis M. Massage in patients undergoing intensive chemotherapy reduces serum cortisol and prolactin. Psycho-Oncology. 2008;17:1024–1031.
    1. Field T, Ironson G, Scafidi F, Nawrocki T, Goncalves A, et al. Massage Therapy Reduces Anxiety and Enhances Eeg Pattern of Alertness and Math Computations. International Journal of Neuroscience. 1996;86:197–205.
    1. Diego M, Field T, Sanders C, Hernandez-Reif M. Massage therapy of moderate and light pressure and vibrator effects on EEG and heart rate. International Journal of Neuroscience. 2004;114:31.
    1. Rapaport MH, Schettler P, Bresse C. A Preliminary Study of the Effects of a Single Session of Swedish Massage on Hypothalamic–Pituitary–Adrenal and Immune Function in Normal Individuals. Journal of Alternative & Complementary Medicine. 2010;16:1–10.
    1. Billhult A, Lindholm C, Gunnarsson R, Stener-Victorin E, Gunnarsson R. The effect of massage on cellular immunity, endocrine and psychological factors in women with breast cancer – a randomized controlled clinical trial. Autonomic Neuroscience-Basic & Clinical. 2008;140:88–95.
    1. Field T, Diego M, Hernandez-Reif M. Moderate Pressure is Essential for Massage Therapy Effects. International Journal of Neuroscience. 2010;120:381–385.
    1. Smith M, Kutner J, Hemphill L, Yamashita T, Felton S. Developing treatment and control conditions in a clinical trial of massage therapy for advanced cancer. Journal Of The Society For Integrative Oncology. 2007;5:139–146.
    1. Poole A, Ionescu M, Fitzcharles M, Billinghurst R. The assesment of cartilage degradation in vivo: development of and immunoassay for the measurement in body fluids of type II collagen cleaved by collagenases. J Immunol Methods. 2004;294:145–153.
    1. Schaible H-G, Grubb B. Afferent and spinal mechanisms of joint pain. Pain. 1993;55:5–54.
    1. Ahles TA, Tope DM, Pinkson B, Walch S, Hann D, et al. Massage therapy for patients undergoing autologous bone marrow transplantation. Journal of Pain and Symptom Management. 1999;18:157.
    1. Diego M, Field T, Hernandez-Reif M, Shaw K, Friedman L, et al. HIV adolescents show improved immune function following massage therapy. International Journal of Neuroscience. 2001;106:35.
    1. Sagar SM, Dryden T, Myers C. Research on therapeutic massage for cancer patients: potential biologic mechanisms. Journal Of The Society For Integrative Oncology. 2007;5:155–162.
    1. Sherman KJ, Cherkin DC, Kahn J, Erro J, Hrbek A, et al. A survey of training and practice patterns of massage therapists in two US states. BMC Complement Altern Med. 2005;5:13.
    1. Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren