Massage Therapy for Osteoarthritis of the Knee: A Randomized Dose-Finding Trial

Abstract

BackgroundIn 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.MethodsWe 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.ResultsWOMAC 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.ConclusionGiven 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 RegistrationClinicalTrials.gov NCT00970008

Generational Differences in Complementary and Alternative Medicine (CAM) Use in the Context of Chronic Diseases and Pain: Baby Boomers versus the Silent Generation

“…While the prevalence of neck and low-back pain were comparable between the 2 generations, the baby boomers were more likely to report head and facial pain. Several nonpharmacological interventions, such as acupuncture, 33 tai chi, 34 yoga, 35 and massage, 36 have shown evidence in managing chronic pain.…”

Massage Therapy: Intervention Frequency and Cost Survey (IFACS) Data with Policy Implications for Nonpharmacologic Treatment of Chronic Pain

“…In response to this demand, the center of gravity of massage therapy studies has moved from basic efficacy trials to more translational research, testing detailed dosing protocols to optimize clinical outcomes for specific conditions [34]. One barrier to progressing along this translational pathway to realworld conditions is developing effective payment models that include massage therapy, allowing access to more people who suffer from chronic pain.…”

“…Two features of massage therapy that are aligned with these current national recommendations are: 1) its low side-effect profile and 2) its capacity to simultaneously treat co-morbid conditions such as chronic pain and anxiety. Massage therapy has minimal side-effects, moderate cost, and has been shown to be effective for anxiety [19][20][21][22][23][24][25][26] as well as chronic back, neck, and knee pain due to OA [27,28].…”

Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain

“…In 2 small studies, Haas et al 30,31 found greater improvement for back pain and cervicogenic headache among patients who received 3 or 4 chiropractic treatments per week for 3 weeks than among those receiving fewer treatment per week. In a 5-arm, 8-week trial of massage for persons with osteoarthritis, Perlman et al 32 found that 60 minutes of weekly or twice weekly massage was clearly superior to usual care and appeared better than 30 minutes of twice weekly massage.…”