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Item Adaptation of the CARE Guidelines for Therapeutic Massage and Bodywork Publications: Efforts To Improve the Impact of Case Reports(2014-09) Munk, Niki; Boulanger, KarenCase reports provide the foundation of practice-based evidence for therapeutic massage and bodywork (TMB), as well as many other health-related fields. To improve the consistency of information contained in case reports, the CARE (CAse REport) Group developed and published a set of guidelines for the medical community to facilitate systematic data collection (http://www.care-statement.org/#). Because of the differences between the practice of medicine and TMB, modifying some sections of the CARE guidelines is necessary to make them compatible with TMB case reports. Accordingly, the objectives of this article are to present the CARE guidelines, apply each section of the guidelines to TMB practice and reporting with suggested adaptations, and highlight concerns, new ideas, and other resources for potential authors of TMB case reports. The primary sections of the CARE guidelines adapted for TMB case reports are diagnostic assessment, follow-up and outcomes, and therapeutic intervention. Specifically, because diagnosis falls outside of the scope of most TMB practitioners, suggestions are made as to how diagnoses made by other health care providers should be included in the context of a TMB case report. Additionally, two new aspects of the case presentation section are recommended: a) assessment measures, which outline and describe the outcome measures on which the case report will focus, and b) a description of the TMB provider (i.e., scope of practice, practice environment, experience level, training, credentialing, and/or expertise) as part of the intervention description. This article culminates with practical resources for TMB practitioners writing case reports, including a TMB Case Report Template—a single document that TMB practitioners can use to guide his or her process of writing a case report. Once the template is adopted by authors of TMB case reports, future efforts can explore the impact on the quality and quantity of case reports and how they impact TMB practice, research, education and, ultimately, the clients.Item Considerations for Psychologically Informed Therapeutic Massage for Headache(Liebert, 2024-04) Nabity, Paul S.; Farrokhi, Shawn; Finnell, John S.; McGeary, Donald D.; Munk, Niki; Health Sciences, School of Health and Human SciencesItem Massage Effectiveness for Primary Care Patients with Chronic Low Back Pain and Below Normal SF-36v2 Mental Health Scores: Secondary Analysis(2014-05) Munk, Niki; Elder, William; Love, MargaretPurpose: The challenging condition of chronic low back pain (CLBP) is often complicated by negative mental health factors. Non-pharmacological approaches to address CLBP alone and in combination with mental health issues are needed. A recently completed NIH funded study examined the effectiveness of clinical massage therapy (CMT) on functional health outcomes for CLBP patients referred to CMT by their PCP regardless of mental health status save psychosis. CMT was found to have significant and clinically meaningful effectiveness for patients (N=85) in the primary outcomes: Oswestry Disability Index, SF-36v2 mental and physical components and pain domain (in review). The purpose this study's secondary analysis is to determine the extent to which participants that began the study below normal in the SF-36v2 mental health component had clinically meaningful change. Methods: CLBP patients referred by their PCP were assigned to community massage practitioners (CMPs) to receive up to ten, 1-hour CMT sessions over 12-weeks. Individual treatment plans were formulated by study CMPs. Secondary data analyses were conducted examining a subpopulation (n=41) of those beginning the study at below normal (<45) for the SF-36v2 mental health component score. Results: Mean change for thoseItem Massage therapy in palliative care populations: a narrative review of literature from 2012 to 2022(AME, 2023-09) Cates, Cal; Jordan, Kerry; Munk, Niki; Farrand, Rory; Kennedy, Ann Blair; Groninger, Hunter; Health Sciences, School of Health and Human SciencesBackground and Objective: Patients living with serious illness are often eligible for palliative care and experience physical symptoms including pain or dyspnea and psychological distress that negatively impacts health-related quality of life and other outcomes. Such patients often benefit from massage therapy to reduce symptom burden and improve quality of life when such treatment is available. At present, no synthesis or review exists exploring massage therapy specifically provided with palliative care patient populations. This review is needed because those with serious illness are a growing and important vulnerable population. Massage therapy is used frequently and in many healthcare delivery contexts, but the body of research has not led to its systematic integration or broad acceptance. Methods: PubMed search for clinical research focused on massage therapy for palliative care-eligible populations from 2012 and 2022. Search terms included keywords: massage, massage therapy, serious illness, advanced illness, and palliative care. Key Content and Findings: Thirteen unique articles were identified through the PubMed database search and from a manual review of references. Study designs of included articles were one pilot, one quasi-experimental single-arm study, one mixed-methods study, two qualitative (both with hospital-based palliative care populations), seven randomized controlled trials, and one retrospective cohort analysis in a major Veterans Health Administration health care facility. Conclusions: Variability was found in study design, scope, sample size, and outcomes for related articles published in the last ten years. Few eligible interventions reflected real-world massage therapy delivery suggesting more clinical research is needed to examine massage provided by massage therapists trained to work with palliative care populations. Gaps in the current body of existing evidence supports the need for this review and recommendations for the direction of future related research.Item Mechanical stimulation of human dermal fibroblasts regulates pro-inflammatory cytokines: potential insight into soft tissue manual therapies(BMC, 2020) Anloague, Aric; Mahoney, Aaron; Ogunbekun, Oladipupo; Hiland, Taylor A.; Thompson, William R.; Larsen, Bryan; Loghmani, M. Terry; Hum, Julia M.; Lowery, Jonathan W.; Physical Therapy, School of Health and Rehabilitation SciencesObjective Soft tissue manual therapies are commonly utilized by osteopathic physicians, chiropractors, physical therapists and massage therapists. These techniques are predicated on subjecting tissues to biophysical mechanical stimulation but the cellular and molecular mechanism(s) mediating these effects are poorly understood. Previous studies established an in vitro model system for examining mechanical stimulation of dermal fibroblasts and established that cyclical strain, intended to mimic overuse injury, induces secretion of numerous pro-inflammatory cytokines. Moreover, mechanical strain intended to mimic soft tissue manual therapy reduces strain-induced secretion of pro-inflammatory cytokines. Here, we sought to partially confirm and extend these reports and provide independent corroboration of prior results. Results Using cultures of primary human dermal fibroblasts, we confirm cyclical mechanical strain increases levels of IL-6 and adding long-duration stretch, intended to mimic therapeutic soft tissue stimulation, after cyclical strain results in lower IL-6 levels. We also extend the prior work, reporting that long-duration stretch results in lower levels of IL-8. Although there are important limitations to this experimental model, these findings provide supportive evidence that therapeutic soft tissue stimulation may reduce levels of pro-inflammatory cytokines. Future work is required to address these open questions and advance the mechanistic understanding of therapeutic soft tissue stimulation.Item A Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) Examination of a Recent Study of Massage and Relaxation Therapy Effectiveness(2014-05) Elder, William; Munk, NikiPurpose: This presentation will discuss the pragmatic methodological approach of a recently completed NIH sponsored study of clinical massage therapy (CMT) and progressive muscle relaxation (PMR). While CMT and PMR have demonstrated efficacy for chronic low back pain (CLBP), their effectiveness in the real world of health care practice is only now being evaluated. Pragmatic studies have been recommended by NIH and the Institute of Medicine to address effectiveness questions. Methods: Critical discussion among 2 key study team members and 2 outside reviewers analyzed the study protocol for accordance with pragmatic vs. explanatory characteristics developed in the PRECIS tool by Thorpe et al. (2009). Scores for each of 10 domains were used to create an overall visual representation of the extent to which this study reflects a pragmatic research approach. Results: The visual wagon wheel reflecting the current study's “standing” on the Thorpe model will be presented. The study most strongly reflected a pragmatic approach in the following domains: Eligibility Criteria, Flexibility of Experimental Intervention, Practitioner Expertise, Outcomes, and Participant Compliance. Areas that the current study neutrally reflected a pragmatic approach or reflects more of an explanatory approach included Follow-up Intensity, Analysis of the Primary Outcome, and Practitioner Adherence. Conclusion: To our knowledge, this is the first CAM related research trail that has retrospectively critiqued its study design utilizing the PRECIS tool. CAM investigators may utilize this self-critique and the PRECIS tool to develop study designs and prospectively critique the extent to which pragmatic approaches apply. Audience participants will gain understanding of methodologies and techniques of pragmatic studies.