Title by Presenter Name Questions Establishing an Integrative Care Center Dr Brent Bauer Dr Adam Perlman Thursday October 4th 3031090 2 From CAM to Integrative Medicine at Mayo Clinic Research Informing Practice and Improving Care ID: 769894
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Title by Presenter Name Questions? Establishing an Integrative Care Center Dr. Brent Bauer Dr. Adam Perlman Thursday , October 4th
3031090- 2 From CAM to Integrative Medicine at Mayo Clinic Research Informing Practice and Improving Care Brent A. Bauer MD Director, Complementary and Integrative Medicine Program Mayo Clinic Department of Medicine
3031090- 3 Decreased Massage Therapy – Mayo Clinic Pilot Trial 58 cardiac surgery patients Cutshall, Comp. Therap.Clin. Practice, 2009 Pain Anxiety Tension Massage therapy quiet relaxation vs
3031090- 4 Massage Therapy after CV Surgery 10 8 6 4 2 0 Before After V A S Anxiety Level Control group (n=28) 10 8 6 4 2 0 Before After Massage group (n=30)
3031090- 5 Massage Therapy after CV Surgery 10 8 6 4 2 0 Before After V A S Pain level Control group (n=28) 10 8 6 4 2 0 Before After Massage group (n=30)
3031090- 6 Massage Therapy – Mayo Clinic Randomized – Controlled Trial 113 cardiac surgery patients MT therapy days 2,4 vs. quiet relaxation Decreased pain P<0.001 Decreased anxiety P<0.001 Decreased tension P<0.001 Increased relaxation P<0.001 Bauer, Comp. Therap. Clin. Practice, 2010
3031090- 7 Massage Therapy at Mayo Clinic Other Studies MT for colo-rectal surgery patients 2009 MT prior to cardiac interventions 2009 MT for thoracic surgery patients 2011 MT for breast cancer surgery pts 2012 MT for cardiologists and nurses 2010 MT for cardiac ultrasonographers 2011 MT for in-patient nurses 2012
3031090- 8 Massage Therapy at Mayo Clinic The Impact Massage therapy now routine at MC Domino effect Small investment > “snowball” returns 48 hospitals in US 7 international hospitals Australia, Austria, China, Ireland, Switzerland, Turkey
3031090- 9 Massage Therapy at Mayo Clinic The Vision Massage therapy routinely available to all Continue to use the Mayo experience to transform health care in the U.S. and around the world Hospitalized patients at Mayo Clinic Family members Staff
3031090- 10 Questions bauer.brent@mayo.edu
Bibliography Effect of massage therapy for postsurgical mastectomy recipients. Drackley NL, Degnim AC, Jakub JW, Cutshall SM, Thomley BS, Brodt JK, Vanderlei LK, Case JK, Bungum LD, Cha SS, Bauer BA, Boughey JC. Clin J Oncol Nurs. 2012 Apr;16(2):121-4. PMID:22459520 Feasibility and effectiveness of massage therapy for symptom relief in cardiac catheter laboratory staff: a pilot study. Keller SR, Engen DJ, Bauer BA, Holmes DR Jr, Rihal CS, Lennon RJ, Loehrer LL, Wahner-Roedler DL. Complement Ther Clin Pract. 2012 Feb;18(1):4-9. Epub 2011 Sep 23. PMID:22196566 Effect of massage on pain management for thoracic surgery patients. Dion L, Rodgers N, Cutshall SM, Cordes ME, Bauer B, Cassivi SD, Cha S. Int J Ther Massage Bodywork. 2011;4(2):2-6. Epub 2011 Jun 29. PMID:21847428Massage therapy after cardiac surgery. Wang AT, Sundt TM 3rd, Cutshall SM, Bauer BA. Semin Thorac Cardiovasc Surg. 2010 Autumn;22(3):225-9. Review. PMID:21167456 The effect of chair massage on muscular discomfort in cardiac sonographers: a pilot study. Engen DJ, Wahner-Roedler DL, Nadolny AM, Persinger CM, Oh JK, Spittell PC, Loehrer LL, Cha SS, Bauer BA. BMC Complement Altern Med. 2010 Sep 16;10:50. PMID:20846441 3031090- 11
Bibliography Effect of massage therapy on pain, anxiety, and tension in cardiac surgical patients: a pilot study. Cutshall SM, Wentworth LJ, Engen D, Sundt TM, Kelly RF, Bauer BA. Complement Ther Clin Pract. 2010 May;16(2):92-5. Epub 2009 Nov 14. PMID:20347840 Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study. Bauer BA, Cutshall SM, Wentworth LJ, Engen D, Messner PK, Wood CM, Brekke KM, Kelly RF, Sundt TM 3rd. Complement Ther Clin Pract. 2010 May;16(2):70-5. Epub 2009 Jul 14. PMID:20347836Massage therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures. Wentworth LJ, Briese LJ, Timimi FK, Sanvick CL, Bartel DC, Cutshall SM, Tilbury RT, Lennon R, Bauer BA. Prog Cardiovasc Nurs. 2009 Dec;24(4):155-61. PMID:20002340 Value of massage therapy for patients in a breast clinic. Pruthi S, Degnim AC, Bauer BA, DePompolo RW, Nayar V. Clin J Oncol Nurs. 2009 Aug;13(4):422-5. PMID:19648098 3031090- 12
Title by Presenter Name Questions?
American Massage Therapy Association October 4, 2012 Adam Perlman, MD, MPH Executive Director Duke Integrative Medicine
At the Beginning
New Jersey Siegler Center for Integrative Medicine Services Offered Who do you hire Research
Pilot Study (2006) Randomized controlled trial; n=68 Massage vs. wait list Intervention: Whole body, Swedish massage for 8 weeks Standard techniques of petrissage, effleurage, and tapotement 60 min twice weekly x 4 weeks 60 min once weekly x 4 weeks Outcomes: function (WOMAC), pain (VAS), ROM, 50-ft walk Results: well tolerated, decreased pain, and improved function Effects persisted for weeks after cessation of massage 1. Archives of Internal Med. 2006;166:2533-2538
UMDNJ Serving the underserved Institute for Therapeutic Massage Research
Dose-finding study (2009-2011) 2-Year study to define the ‘ optimal practical ’ dose of massage for OA of the knee Designed to inform a future, more definitive trial Randomized, wait list-controlled, clinical trial 5-arm trial 4 different ‘ doses ’ of standardized, whole body Swedish wait list controlSupported by NCCAM grant R01 AT004623Trial Registration: clinicaltrials.gov NCT00970008
Dose-finding study - Design Four distinct ‘ doses ’ 1. 30 min/week x 8 weeks (240 min total) 2. 30 min biweekly x 4 weeks, 30 min weekly x 4 weeks (360 min total) 3. 60 min/week x 8 weeks (480 min total) 4. 60 min biweekly x 4 weeks, 60 min weekly x 4 weeks (720 min total) 5. Usual Care (no massage) Included: Adults with radiographically confirmed OA of the kneeSelf-reported pain between 4-9 on VAS Excluded: RA, fibromyalgia, intraarticular injections, knee replacementAssessed: baseline, 8-, 16-, and 24-weeks Outcomes: WOMAC, VAS, ROM, 50-ft walk
Manualization Goal: to produce a study protocol that was tailored to subjects with OA of the knee, while respectful of the individualized nature of massage therapy How to standardize an inherently individualized intervention?CAM/nonphamacological research dilemma2-month process Massage therapists from pilot studyInvestigative teamMassage scientists ConstraintsStandard techniquesReproducibilityFlexible for individual subject variability
Manualized protocols
Results Recruitment completed two months ahead of schedule Free massages…And more free massages!125 enrolled 119 completed 8-week assessments115 completed entire trial Intervention delivered: 11/2009 – 10/2010
Conclusions Winner: 60-min once weekly ‘Optimal-practical’= best bang for the buckproducing the greatest ratio of desired effect compared to costs costs = time, labor, and convenienceReinforced results of pilot study Dose used for current study -
Duke Shifting the model AccessForging relationship DCIResearch
Current Study Phase 2b Efficacy Trial Using 60-min once weekly doseMassage vs. light touch vs. wait list52-week follow-upN=219 at three sites: Duke, UMDNJ, Yale Cost-effectivenessBiomarkers‘ Unanticipated Benefits’Modeled on studies by Cherkin et al. (Seattle)Qualitative study Participants of dose-finding study ‘ What else?’
The good, the bad, and the ugly.