Rheumatoid arthritis and massage therapy: A case study
Bethany Foster, Magloire Lobetti
Introduction
Rheumatoid arthritis is chronic autoimmune inflammatory disorder that com-
monly affects bilateral joints of the body, when the immune system mistakenly
attacks its own tissues (Mayo Clinic Staff, 2014). Approximately 1 out of 100
Canadians has rheumatoid arthritis (RA), which is equivalent to about 300,000
Canadians (The Arthritis Society, 2015). Early RA most commonly affects the
smaller joints first, such as the joints in your fingers and toes. Individuals suffer-
ing from RA may experience symptoms such as tender, warm, swollen joints,
morning stiffness that last for hours and rheumatoid nodules (Mayo Clinic Staff,
2014). There is no cure for rheumatoid arthritis, however medication can reduce
the pain and inflammation associated with this disorder. Will massage therapy
affect pain and the ability to perform daily tasks in a woman with rheumatoid
arthritis over a 5 week period ?
Methods
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Participant Information
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The participant in this study was a 55-year-old female office desk worker who
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was diagnosed with rheumatoid arthritis 14 years ago.Due to the progression
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of the participant’s condition, nodules were prominent on her interphalangeal
a data collection, however slight changes occurred between weeks 2-4 [Figure 1].
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joints. She experienced tightness, decreased range of motion and increased
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pain in her hands bilaterally, however the left hand was most affected. She used-
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modalities such as hot showers and the use of a sauna to decrease the pain and
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increase range of motion in her hands. The participant also took nonsteroidal
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anti-inflammatory drugs and analgesics such as methotrexate and ibuprofen to
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manage the pain and discomfort.
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Intervention
T h i
The intervention used in this study was massage therapy. The study was con-
ducted over a 5 week period with 60 minute treatments given once a week.
Bilateral treatments were performed on the upper limbs; shoulders, arms and
hands. The techniques used during the treatments included superficial reflex,
neuromuscular, and connective tissue techniques. Active andpassive ranges
of motion techniques and low grade joint mobilizations (grade 1 & grade 2)
were used at the end of treatments to promote joint health andrange of motion.
“The quantity of movement is as important as the quantity ofrange that is avail-
able” (Andrade, 2008, p.131). The application of the paraffin wax bath of the
hand was also incorporated into treatment in week 2-5 prior to the beginning
of treatment.
Data Collection
Two tools were used to collect data throughout this case study. A visual analog
scale (VAS) was used to measure the outcome of pain intensity before and after
Humber College Institue of Technology and Advanced Learning
treatment and the AIMS 2 Questionnaire was also completed upon arrival of surements before and after the treatments. Furthermore, this data also reflects
n
the participant at the clinic every week before treatment. on the probability value of the t-test (P=0.002), which indicates a statistically
o
significant change. The AIMS 2 questionnaire was administered adequately to
i iu s
Data Analysis
provide feedback on any changes in the patient’s physical ability to complete a
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.
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The data was analyzed using descriptive statistics. Pre and post intervention variety of tasks without pain. As a result, there was a 0% change, which means
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pain intensity measurements were measured weekly. Descriptive statistics were there was no improvement or decline that may have been triggered by the mas-
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used to calculate the mean and standard deviation. Percent change was calcu- sage therapy intervention. RA is associated with flare-ups and pain syndromes
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and this percent change indicates that we were able to maintain and manage
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lated to measure the participant’s ability to perform daily tasks.
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those symptoms without aggravating the condition. In the diagram displayed
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s
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Results
P o
in figure 1, the scores are the following: 81, 69, 79, 78 and 81.This probabili-
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o f ty means there was an effect on various functional activities performed by the
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The results of the study with the usage of the visual analog scale provided
i o
reliable data by measuring the effects of massage therapy on pain before and
n participant during those weeks. This data is significant because the application
r s of paraffin wax baths started in week 2, which potentially means there is a cor-
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after treatment. A lower score indicated an improvement in the perception of
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relation with the modality because of the increase in functional abilities report-
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pain. The results of the visual analog scale showed an average pre-treatment
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ed by the participant in the AIMS 2 questionnaire from week 2-3. Paraffin wax
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measurement mean of 4.3 and standard deviation of 0.6. The post-treatment
T
bath has been used in various studies including RA in the hands and resulted in
a
measurement indicated a mean of 2.7 and standard deviation of 0.9. There
positive outcomes. According to Ayling et al. (1999), “the modality also relieves
t h
was a statistically significant change between the baseline and intervention for
pain and stiffness immediately after its application with no documented detri-
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pain intensity (P = 0.002). The arthritis impact measurement scale (AIMS 2)
mental effects on the disease process, even though paraffin wax temporarily
questionnaire indicated a 0% change between the first and final week of the
raises joint temperature” (p.190). For future research, there should be a higher
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number of participants in order to evaluate the effects on individuals with RA. A
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randomized control trial is necessary to investigate further involvement of the
massage therapy intervention.
Reference
Andrade, C. K., & Clifford, P. (2008). Outcome-based massage: From evidence
to practice (2nd ed.). Baltimore, MD: Lippincott, Williams & Wilkins.
Ayling, J., & Marks, R. (1998). Efficacy of paraffin wax baths for rheuma-
toid arthritic hands. Physiotherapy Journal, 86(4), 190-201. doi:10.1016/
S0031-9406(05)60963-7
Mayo Clinic Staff. (2014). Rheumatoid arthritis. Retrieved
from http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/ba-
sicsdefinition/con-20014868
The Arthritis Society. (2015). Rheumatoid arthritis. Retrieved from http://
www.arthritis.ca/page.aspx?pid=982
Discussion Acknowledgements
We'd like to thank Amanda Baskwill and the Humber College research faculty
In this case study, the student massage therapists were able to observe the
for their support by allowing us to conduct this study. We also thank our instruc-
effects of massage therapy before and after the intervention with a visual ana-
tor, Andrew Clapperton, for guiding us throughout the process. Finally special
log scale (VAS). The average mean before treatment for weeks 1-5 was 4.3
thanks the participant for her honesty and willingness to participation and make
cm and 2.7 cm for the average mean after treatment. This data shows the pos-
this study possible.
itive outcomes of massage therapy since there was a decline in the VAS mea-