Niki Munk

Noninvasively measuring the hemodynamic effects of massage on skeletal muscle: a novel hybrid near-infrared diffuse optical instrument.

Increase in tissue blood flow is one of the most acknowledged potential effects of massage; however, actual research studies examining this phenomenon are inconsistent and inconclusive. One possible reason for continued uncertainty regarding this topic is methodology, specifically how tissue blood flow is measured because limitations exist in previously utilized technologies. Near-infrared spectroscopy (NIRS) affords massage researchers a versatile and non-invasive measurement option by providing dynamic information on oxy- and deoxy-hemoglobin concentrations, total hemoglobin concentration, and blood oxygen saturation in deep tissue. Near-infrared diffuse correlation spectroscopy (DCS) is an innovative technique for continuous non-invasive measurement of blood flow in deep tissue. The combination of these two technologies has resulted in a novel hybrid diffuse optical instrument for simultaneous measurement of limb muscle blood flow and oxygenation. The purposes of this short report are to review previous blood flow measurement techniques and limitations in massage therapy research, introduce a novel hybrid near-infrared diffuse optical instrument that addresses previous limitations in the assessment of hemodynamic properties, outline a proposed massage therapy pilot study utilizing the novel measurement technology, and present sample data from a pilot participant using the introduced novel technology.

Massage Therapy Usage and Reported Health in Older Adults Experiencing Persistent Pain

BACKGROUND Persistent pain is a frequent complaint among older adults and can greatly decrease quality of life while also contributing to other negative outcomes such as poor health, increased pharmaceutical medication usage, increased rates of depression, and cognitive decline. OBJECTIVE The current study (N = 69) examines the potential impact of massage therapy (MT) in older adults (60+ years) with persistent pain, by comparing self-reported health outcome scores among those who have and have not utilized massage therapy in the past year. DESIGN The current study was derived from a larger study that collected data as part of a one-time, self-report, mail-in survey. PARTICIPANTS Lexington, Kentucky area adults, 60 and older who reported persistent pain were eligible to participate in the study. OUTCOME MEASURES The RAND 36-Item Health Survey was used to determine participant health-related quality of life. RESULTS The current study demonstrated that for older adults experiencing persistent pain, massage is associated with self-report of less limitation due to physical or emotional issues, better emotional health, more energy/less fatigue, better social functioning, and better overall health. Age, education, cumulative morbidities, number of areas in which participants reported experiencing persistent pain, and number of complementary and alternative medicine options in addition to MT utilized in the past year did not affect the association between receipt of massage and better self-reports in those domains. CONCLUSIONS While many causes of pain for older adults elude cure, further study is warranted that examines MT as an intervention to improve coping in older adults with persistent pain.

Relationship between massage therapy usage and health outcomes in older adults

Physical and emotional decline in older adults is a serious issue affecting not only quality of life but also susceptibility to injury. Non-pharmacological interventions addressing the needs of older adults are important for reducing medication burden and possible drug interactions. This study (N=144) examines the potential of massage therapy as such an intervention for older adults by comparing self-reported health outcome scores among adults 60 and older who have and have not utilized massage therapy in the past year. When controlling for age and cumulative morbidities, older adults who reported massage therapy usage in the past year had significantly better health outcome scores in the following domains: 1) emotional well-being, 2) limitations due to physical issues, and 3) limitations due to emotional issues. Because previous massage therapy research has not included or focused on older adults, studies examining massage therapy and emotional health, specifically among this population, are warranted.

Using the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) Model in Clinical Research: Application to Refine a Practice-based Research Network (PBRN) Study

Background: Pragmatic clinical trials (PCTs) are increasingly recommended to evaluate interventions in real-world conditions. Although PCTs share a common approach of evaluating variables from actual clinical practice, multiple characteristics can differ. These differences affect interpretation of the trial. The Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) model was developed in 2009 by the CONSORT Work Group on Pragmatic Trials, published by Thorpe et al, to aid in trial design. PRECIS provides clarity about the generalizability and applicability of a trial by depicting multiple study characteristics. We recently completed a National Institutes of Health–sponsored pilot study examining health-related outcomes for 2 complementary therapies for chronic low back pain in patients referred by primary care providers in the Kentucky Ambulatory Network. In preparation for a larger study, we sought to characterize the pragmatic features of the study to aid in our design decisions. The purpose of this article is to introduce clinical researchers to the PRECIS model while demonstrating its application to refine a practice based research network study. Method: We designed an exercise using an audience response system integrated with a Works in Progress presentation to experienced researchers at the University of Kentucky to examine our study methodologies of parameters suggested by the PRECIS model. Results: The exercise went smoothly and participants remained engaged throughout. The study received an overall summary score of 30.17 (scale of 0 to 48; a higher score indicates a more pragmatic approach), with component scores that differentiate design components of the study. A polar chart is presented to depict the pragmatism of the overall study methodology across each of these components. Conclusions: The study was not as pragmatic as expected. The exercise results seem to be useful in identifying necessary refinements to the study methodology that may benefit future study design and increase generalizability. Readers can identify how the PRECIS model may be used to provide clarity and transparency for proposed or existing studies and may wish to replicate our exercise in planning their own studies.

Management of psychiatric appointments by telephone

Psychiatric treatments fail to produce positive outcomes when patients miss their appointments. Unfortunately, only about half of all patients needing psychiatric treatment actively engage in recommended treatment regimens. 1 The reasons for non-engagement include stigma, ageism (i.e. mental health problems are perceived to be a normal part of ageing) and absence of patient condition insight (denial).2,3 On the other hand, reasons to attend psychiatric appointments are treatment readiness, recognition of treatment benefits, collaborative physicians and positive psychiatric treatment history.4 This implies a need for more patient-centred strategies to increase psychiatric treatment engagement. Simple mail and telephone reminders are an efficient way of increasing treatment awareness and subsequently attendance, but treatment attendance rates vary, depending on the source, time frame and level of automation (approximately 6–84% treatment attendance).5 Thus, a telephone-based intervention modelled on brief motivational interviewing (BMI6) that focuses on individual patient experiences and principles was developed to increase psychiatric treatment engagement. The present study examined a system for psychiatric appointment management (PAM) in community outpatients.