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Effect of massage therapy on pain, anxiety, and tension after cardiac surgery:
A randomized study
Brent A. Bauer a, *, Susanne M. Cutshall b, Laura J. Wentworth c, Deborah Engen d, Penny K. Messner c,
Christina M. Wood e, Karen M. Brekke f, Ryan F. Kelly g, Thoralf M. Sundt, III g
a
Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
Department of Surgery, Mayo Clinic, Rochester, MN, USA
Department of Nursing, Mayo Clinic, Rochester, MN, USA
d
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
e
Division of Biomedical Informatics and Biostatistics, Mayo Clinic, Rochester, MN, USA
f
Cardiovascular Research, Mayo Clinic, Rochester, MN, USA
g
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
b
c
a b s t r a c t
Keywords:
Alternative medicine
Analgesia
Postoperative pain
Relaxation
Integrative therapies such as massage have gained support as interventions that improve the overall
patient experience during hospitalization. Cardiac surgery patients undergo long procedures and
commonly have postoperative back and shoulder pain, anxiety, and tension. Given the promising effects
of massage therapy for alleviation of pain, tension, and anxiety, we studied the efcacy and feasibility of
massage therapy delivered in the postoperative cardiovascular surgery setting. Patients were randomized
to receive a massage or to have quiet relaxation time (control). In total, 113 patients completed the study
(massage, n 62; control, n 51). Patients receiving massage therapy had signicantly decreased pain,
anxiety, and tension. Patients were highly satised with the intervention, and no major barriers to
implementing massage therapy were identied. Massage therapy may be an important component of the
healing experience for patients after cardiovascular surgery.
2009 Elsevier Ltd. All rights reserved.
1. Introduction
or procedures, including patients with cancer,19,3539 hospitalization after acute myocardial infection,40 patients with dementia,41
preterm neonates,15,42 men positive for human immunodeciency
virus,43 patients undergoing abdominal surgery44 or bone marrow
transplantation,4 and patients recovering after cardiac surgery.45
The literature suggests that massage therapy can be provided
safely in the hospital setting and potentially has substantial clinical
benet. However, many studies examining the efcacy of massage
therapy have attempted to demonstrate a benet by using nonexperimental designs, anecdotal outcome measures, poor measurement tools, small sample sizes, no control groups, and
nonstandardized interventions. Dose level and frequency of
massage often are inconsistent. This lack of scientic rigor is
a common theme in critical reviews of the clinical effectiveness of
massage therapy.46,47
We designed the current study to overcome many of the challenges identied in prior investigations. The primary objective was
to evaluate the effect of two, 20-min massage therapy sessions on
patient-reported pain, anxiety, and tension after cardiac surgery.
The secondary objective was to evaluate the feasibility of integrating massage therapy into acute and postacute cardiovascular
surgical practices.
2. Methods
2.1. Inclusion and exclusion criteria
This study was approved by our institutional review board.
Eligible participants were scheduled to undergo coronary artery
bypass graft (CABG) surgery, valve repairs or replacements, or both
through a median sternotomy. Patients were approached preoperatively for participation in the study from November 3, 2006,
through February 14, 2008. We included only those who gave
consent and were medically able to participate in massage therapy
on postoperative days 2 and 4. Patients who had undergone
previous cardiac surgery, patients with chronic pain syndromes,
and patients with a history of psychosis were excluded from the
study. In addition, patients with prolonged bleeding or intubation
greater than 24 h also were excluded.
71
2.2. Randomization
Patients were randomly assigned to 1 of 2 treatment arms:
massage therapy or standard care with quiet relaxation (control).
To assure balanced allocation throughout the course of the study,
we used a randomized block design with 55 blocks of 4 and 55
blocks of 2; these 110 blocks also were permuted into a random
order to ensure that patients were distributed evenly among
treatment arms (the difference in patient numbers for each arm
was always 2). Randomizing with mixed blocks and using cards in
sealed envelopes masked the administrators who enrolled patients.
To account for potentially nonrandom withdrawal from the study,
the randomization scheme was determined in advance for 300
patients, and enrollment continued until at least 50 patients in each
study arm had completed day 4 of treatment. The large number of
randomizations was determined in advance because we anticipated a high proportion of patients remaining intubated on day 2 or
withdrawing from the study because of high pain levels before the
rst intervention.
2.3. Intervention
2.3.1. Massage therapy
Integrative massage was provided on postoperative day 2 (the
day after surgery) and day 4. The massage was given by a Certied
72
73
Table 1
Baseline patient characteristics (N 113).
Characteristic
Massage (n 62)
P-value
65 (12)
42 (68)
66 (14)
36 (71)
.33
.74
.38
17 (27)
31 (50)
14 (23)
10 (20)
24 (47)
17 (33)
74
Table 2
Changes in pain, anxiety, tension, and relaxation after each intervention.
Outcome
measure
Pain
Day 2
Day 3c
Day 4
Anxiety
Day 2
Day 3c
Day 4
Tension
Day 2
Day 3c
Day 4
Relaxation
Day 2
Day 3c
Day 4
Table 4
Changes in vital signs, hours of sleep, and length of hospitalization.
Massagea
Standard carea
Estimated difference
P-valueb
between treatment groups
1.5 (2.0)
0.7 (2.7)
1.5 (1.7)
0.8 (1.8)
0.3 (2.8)
0.4 (1.4)
0.5
0.6
1.1
.10
.11
<.001
1.4 (2.4)
0.7 (2.4)
1.7 (2.2)
0.6 (2.1)
0.6 (2.9)
0.2 (1.8)
0.5
0.2
1.2
.09
.62
<.001
2.4 (2.0)
0.9 (2.3)
2.2 (2.2)
1.0 (3.0)
0.1 (3.2)
0.3 (2.0)
1.0
0.3
1.6
.01
.52
<.001
2.1 (3.2)
1.2 (3.1)
1.8 (2.2)
1.2 (3.5)
0.8 (3.8)
0.4 (2.1)
0.5
0.0
1.3
.27
>.99
<.001
Measures are visual analog scale values, where 0 none, 10 most. For pain,
anxiety, and tension, negative changes indicated improvement; for relaxation,
positive changes indicated improvement. Data are shown as mean (SD).
b
Linear regression models were used to calculate the difference in outcomes after
adjusting for pretreatment values, age, and sex. Day-4 models also adjusted for
medications administered on day 3.
c
Results were calculated by subtracting day-2 posttreatment scores from day 3
scores.
Characteristic
Diastolic blood
pressure, mm Hga
Day 2
Day 4
Systolic blood
pressure, mm Hga
Day 2
Day 4
Heart rate,
beats/mina
Day 2
Day 4
Respiratory rate,
breaths/mina
Day 2
Day 4
Amount of sleep, hb
Day 2 vs 3
Day 3 vs 4
Length of
hospitalization, dc
a
b
c
54 (3477)
24 (1656)
8 (115)
47 (3274)
19 (742)
5 (020)
.38
.03
.39
Massage,
mean SD
Standard
care,
mean SD
Estimated
difference between
treatment groups
P-value
0.8 7.8
1.8 9.5
0.2 10.3
0.6 8.3
0.6
0.4
.70
.80
0.7 7.8
2.3 10.9
1.7 8.7
2.3 12.7
2.2
0.3
.16
.87
0.5 6.0
0.6 6.6
1.3 9.3
0.6 7.1
1.1
0.3
.42
.81
0.9 5.6
0.0 5.1
0.6 4.1
0.5 4.6
1.7
1.2
.03
.05
0.8 5.9
0.1 4.7
7.4 2.1
1.1 5.6
0.2 3.1
7.9 2.6
0.2
0.1
0.6
.81
.90
.18
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