Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study Clinical Rehabilitation XXXXXXXXXX –1136 © The Author(s) 2013 Reprints and permissions:...

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Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study
Clinical Rehabilitation
XXXXXXXXXX –1136
© The Author(s) 2013
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CLINICAL
REHABILITATION
491586 CRE XXXXXXXXXX/0269215513491586Clinical RehabilitationNegahban et al.
2013
Musculoskeletal Rehabilitation Research Center, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran
Massage therapy and exercise
therapy in patients with
multiple sclerosis: a randomized
controlled pilot study
Hossein Negahban, Solmaz Rezaie and
Shahin Goharpey
Abstract
Objective: The primary aim was to investigate the comparative effects of massage therapy and exercise
therapy on patients with multiple sclerosis. The secondary aim was to investigate whether combination of
oth massage and exercise has an additive effect.
Design: Randomized controlled pilot trial with repeated measurements and blinded assessments.
Setting: Local Multiple Sclerosis Society.
Subjects: A total of 48 patients with multiple sclerosis were randomly assigned to four equal subgroups
labelled as massage therapy, exercise therapy, combined massage–exercise therapy and control group.
Interventions: The treatment group received 15 sessions of supervised intervention for five weeks.
The massage therapy group received a standard Swedish massage. The exercise therapy group was given
a combined set of strength, stretch, endurance and balance exercises. Patients in the massage–exercise
therapy received a combined set of massage and exercise treatments. Patients in the control group were
asked to continue their standard medical care.
Main measures: Pain, fatigue, spasticity, balance, gait and quality of life were assessed before and after
intervention.
Results: Massage therapy resulted in significantly larger improvement in pain reduction (mean change
2.75 points, P = 0.001), dynamic balance (mean change, 3.69 seconds, P = XXXXXXXXXXand walking speed (mean
change, 7.84 seconds, P = XXXXXXXXXXthan exercise therapy. Patients involved in the combined massage–
exercise therapy showed significantly larger improvement in pain reduction than those in the exercise
therapy (mean change, 1.67 points, P = 0.001).
Conclusions: Massage therapy could be more effective than exercise therapy. Moreover, the combination
of massage and exercise therapy may be a little more effective than exercise therapy alone.
Keywords
Massage therapy, exercise therapy, multiple sclerosis, outcome
Received: 6 December 2012; accepted: 6 May 2013
Article
Co
esponding author:
Hossein Negahban, Musculoskeletal Rehabilitation Research
Center, Ahvaz Jundishapur University of Medical Sciences,
Ahvaz, Iran.
Email: XXXXXXXXXX
http:
crossmark.crossref.org/dialog/?doi=10.1177%2F XXXXXXXXXX&domain=pdf&date_stamp= XXXXXXXXXX
Negahban et al. 1127
Introduction
Multiple sclerosis is one of the most common debil-
itating diseases, affecting millions worldwide.1
Patients with multiple sclerosis frequently experi-
ence symptoms and problems such as pain,1 fatigue,2
spasticity,3 muscle weakness,4,5 balance/coordina-
tion problems,6 walking impairment7 and poor qual-
ity of life.4
While exercise therapy is considered an impor-
tant non-pharmacologic therapy, it constitutes a
controversial issue for the rehabilitation of patients
with multiple sclerosis over many years8 because
more than 40% of all multiple sclerosis patients
experience some degree of symptom aggravation
during exercise therapy. Nevertheless, the cu
ent
consensus is that a well-organized exercise ther-
apy could be a safe and efficient way to diminish
symptoms and enhance the performance of multi-
ple sclerosis patients with mild to moderate dis-
ability.8,9 More specifically, scientific studies have
shown that exercise therapy in the form of strength
training,5,10 endurance training,4 and combined
strength/endurance training11,12 might have benefi-
cial effects with no harmful effects on a number of
outcomes such as fatigue, muscle strength, walk-
ing speed, stair climbing, dynamic balance and
quality of life.8
Although some multiple sclerosis patients who
have used massage therapy during their therapeutic
intervention have reported positive outcomes,13–15
little scientific evidence supports the notion that
massage therapy might be definitely beneficial to
patients with multiple sclerosis. To the researcher’s
knowledge, only two studies have investigated the
effects of massage therapy in improving the psy-
cho-emotional outcomes associated with multiple
sclerosis.3,16 Patients in these studies experienced
increased self-efficacy, better body image, improved
self-esteem and enhanced social functioning by the
end of the whole-body massage therapy period. No
study has yet investigated the effects of massage
therapy on various components of impairment and
functional limitations in patients with multiple
sclerosis.
The primary goal of this randomized controlled
pilot study was to investigate the comparative
effects of massage therapy and exercise therapy on
pain, fatigue, spasticity, balance, gait and quality of
life in patients with multiple sclerosis. The second-
ary aim was to investigate whether a combination of
oth massage and exercise in the massage–exercise
therapy group has an additive effect. The focus of
oth the exercise therapy and massage therapy was
on the lower extremities because of the more pro-
nounced involvement of the lower limbs as com-
pared to the upper limbs in this specific patient
population.17
Materials and methods
Patients
All patients signed an informed consent form before
commencing the study. Also, ethical approval for
the study was granted by the local ethics committee
(ETH-494).
Recruitment was performed by telephone con-
tact after extracting the information provided in the
medical records of the patients in the local Multiple
Sclerosis Society. Patients were included in the
study if they had clinically or laboratory confirmed
elapsing–remitting or secondary progressive mul-
tiple sclerosis,3,5 an Expanded Disability Status
Scale18 between 2 and 6, ability to stand unassisted
for at least 60 seconds (using aids if required), and
ability to walk 10 m safely even with an assistive
device. Exclusion criteria encompassed a severe
elapse one month before the study; involvement in
any physical therapy programme before beginning
the study; unstable cardiovascular condition; diabe-
tes; or lower limb arthritis that might interfere with
the patient’s participation in the prescribed inter-
vention.4,9,10,12 Also, patients with any musculoskel-
etal or neurological conditions except multiple
sclerosis were excluded.
The method of randomization was a balanced
andomization process in which the patients were
matched based on age and sex and randomly
assigned to four subgroups in equal sample propor-
tions using a table of random numbers. The groups
consisted of the massage therapy (group 1), exercise
therapy (group 2), massage–exercise therapy (group
3) and control group (group 4).
1128 Clinical Rehabilitation 27(12)
Study interventions
This study was a prospective, single-centre, ran-
domized controlled pilot trial with a repeated mea-
sures design and blinded assessments.
The patients assigned to the massage therapy,
exercise therapy and massage–exercise therapy
groups received three 30-minute sessions of super-
vised intervention per week for five consecutive
weeks in addition to their medical care. Therefore,
each patient received 15 therapeutic sessions with
two pre–post evaluative sessions as described in the
following sections. No patient was dropped from
the study due to intolerance or the adverse effects of
intervention.
The massage therapy group. This group received
a standard Swedish massage by a trained massage
therapist. This type of massage was performed
ased on the routines and guidelines provided in
the studies of Patterson et al.19 and Perlman et al.20
For the purpose of this study, the following tech-
niques were applied to the bilateral quadriceps
femoris, hip adductors, proneal and calf muscles:
petrissage (alternative grasping and lifting of the
target muscle between the thumb and fingers),
effleurage (gliding the hands over the skin of tar-
get muscle), and friction (an accurately delivered
penetrating pressure applied through the finger-
tips).20 Patients were asked to lie in a supine posi-
tion on a treatment table and a 7-minute massage
was applied on the lower portions of the quadri-
ceps femoris and hip adductors. In addition, a
4-minute massage was performed on proneal mus-
cles. Then the patients were told to lie in a prone
position and a 4-minute massage was applied on
the calf muscles.19 The total time related to the
massage therapy of the bilateral muscles of the
lower limbs lasted about 30 minutes.
The exercise therapy group. The exercise therapy
group was given a combined set of strength, stretch,
endurance and balance training exercises including
straight leg raising, forward lunge, hip adductor and
calf muscles stretching, walking on a treadmill,
cycling and balance board training (see Appendix
online for details).
The massage–exercise therapy group. To determine
whether the effects of independent massage therapy
and exercise therapy were different from those of
combined therapy, another group (designated as the
massage–exercise therapy group) was added to the
design of this study. Patients were encouraged to
perform active exercises of the exercise therapy (15
minutes) in addition to the passive massage of the
massage therapy (15 minutes) such that the total
time did not exceed 30 minutes for each session.
The order of exercise therapy vs. massage therapy
in the first therapy session was randomized for each
patient included in this group and this order
emained unchanged in the next sessions.
Control group. Patients in the control group were
asked to continue their standard medical care during
the study period. Also, they were asked to avoid
participation in any exercise programme or change
in their normal activities during the next five weeks.
The investigators of this study were responsible for
providing an appropriate intervention immediately
after the completion of the study.
Outcome measurements
Outcome measurements including pain, fatigue,
spasticity, balance, gait and the quality of life were
assessed (in a random order) during the pre-inter-
vention and immediately after the completion of the
intervention period by the same physiotherapist
who was blinded to the group assignments of the
patients.
Pain. Pain was assessed using a visual analogue
scale. Patients were asked to determine their pain
level on a 0–10 points scale in which 0 indicates no
pain and 10 indicates severe pain.
Fatigue. Fatigue during activities was assessed
using the Fatigue Severity Scale. The questionnaire
consists of nine items with response choices vary-
ing between 1 and 7 in which 1 indicates a strong
disagreement and 7 indicates a strong agreement.
The total score of Fatigue Severity Scale ranges
from 7 to 63, with higher scores indicating a higher
level of fatigue during activities. The Persian
Negahban et al. 1129
version of the Fatigue Severity Scale has been vali-
dated for use in Iran.21
Spasticity. Spasticity in ankle plantarflexors was
measured via the Modified Ashworth Scale. The
Modified Ashworth Scale is a tool for the determin-
ing the severity of muscle tone on a scale
Answered Same DayApr 12, 2022

Solution

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Critical Review Form – Quantitative Studies
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    CITATION
    Provide the full citation for this article in APA format:
      Negahban, H., Rezaie, S., & Goharpey, S. (2013). Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study. Clinical rehabilitation, 27(12), 1126-1136.
    STUDY PURPOSE
Was the purpose
stated clearly?
FORMCHECKBOX
Yes
FORMCHECKBOX
No
    Outline the purpose of the study. How does the study apply to your research question?
      Assuming we answer the research question accurately, it will assist us in figuring out what we need to answer. This won't just assist us with a
anging our study, yet it will also assist us with expecting any likely hurdles or problems. We will save time, energy, and exertion as a result of this. The study's fundamental objective was to think about the benefits of massage treatment and exercise therapy on multiple sclerosis patients. The secondary objective was to see assuming the use of both massage and exercise had an added substance sway.
    LITERATURE
Was relevant background literature reviewed?
FORMCHECKBOX
Yes
FORMCHECKBOX
No
    Describe the justification of the need for this study:
      Multiple sclerosis is a ho
endous condition that affects millions of individuals all through the world. Symptoms and concerns associated with multiple sclerosis incorporate discomfort, exhaustion, spasticity, muscular weakness, balance/coordination issues, strolling disability, and an inferior quality of life. While exercise treatment is an essential non-pharmacologic therapy, it has been a contentious theme in the restoration of patients with multiple sclerosis for a long time since over 40% of all patients with multiple sclerosis experience symptom worsening during exercise therapy. Nonetheless, this understanding is that an efficient exercise treatment may be a safe and successful strategy for a considerable length of time patients with low to direct impedance to decrease symptoms and further develop work. Scientific studies have demonstrated that exercise treatment as strength preparing, perseverance training4, and consolidated strength/aerobic exercise might have remedial effects with no unfortunate results on weariness, muscular strength, strolling speed, stair climbing, dynamic equili
ium, and personal satisfaction.
Albeit some patients with multiple sclerosis who used massage therapy as a feature of their restorative intercession revealed positive results, there is no scientific information to support the possibility that massage treatment is absolutely useful to individuals with multiple sclerosis. Just two studies have taken a gander at the effect of massage therapy on further developing the psycho-passionate outcomes connected with multiple sclerosis, as indicated by the researcher. Before the finish of the entire body massage therapy period, the patients in these trials had worked on...
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