title: Randomized clinical trial assessing whether additional massage treatments for chronic neck pain improve 12- and 26-week outcomes.
abstract: BACKGROUND
  This is the first study to systematically evaluate the value of a longer treatment period for massage. We provide a framework of how to conceptualize an optimal dose in this challenging setting of nonpharmacologic treatments.
  
  
  OBJECTIVE
  The aim was to determine the optimal dose of massage for neck pain.
  
  
  METHODS
  Two-phase randomized trial for persons with chronic nonspecific neck pain. Primary randomization to one of five groups receiving 4 weeks of massage (30 minutes 2x/or 3x/wk or 60 minutes 1x, 2x, or 3x/wk). Booster randomization of participants to receive an additional six massages, 60 minutes 1x/wk, or no additional massage.
  
  
  METHODS
  A total of 179 participants from Group Health and the general population of Seattle, WA, USA recruited between June 2010 and August 2011 were included.
  
  
  METHODS
  Primary outcomes self-reported neck-related dysfunction (Neck Disability Index) and pain (0-10 scale) were assessed at baseline, 12, and 26 weeks. Clinically meaningful improvement was defined as greater than or equal to 5-point decrease in dysfunction and greater than or equal to 30% decrease in pain from baseline.
  
  
  METHODS
  Clinically meaningful improvement for each primary outcome with both follow-up times was analyzed using adjusted modified Poisson generalized estimating equations (GEEs). Secondary analyses for the continuous outcomes used linear GEEs.
  
  
  RESULTS
  There were no observed differences by primary treatment group at 12 or 26 weeks. Those receiving booster dose had improvements in both dysfunction and pain at 12 weeks (dysfunction: relative risk [RR]=1.56 [1.08-2.25], p=.018; pain: RR=1.25 [0.98-1.61], p=.077), but those were nonsignificant at 26 weeks (dysfunction: RR=1.22 [0.85-1.74]; pain: RR=1.09 [0.82-1.43]). Subgroup analysis by primary and booster treatments found the booster dose only effective among those initially randomized to one of the 60-minute massage groups.
  
  
  CONCLUSIONS
  "Booster" doses for those initially receiving 60 minutes of massage should be incorporated into future trials of massage for chronic neck pain.
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA; Department of Biostatistics, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-600, Box 357232, Seattle, WA 98195, USA. Electronic address: cook.aj@ghc.org.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Cook
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Wellman
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cherkin
authors.affiliation: Department of Psychiatry, University of Vermont College of Medicine, 1 South Prospect Street, MS 446AR6, Burlington, VT 05401, USA.
authors.forename: Janet R
authors.initials: JR
authors.lastname: Kahn
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA; Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA 98195, USA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Sherman
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008405:Massage; D008875:Middle Aged; D019547:Neck Pain / Q000628:therapy*
keywords: Chronic neck pain; Clinical trial methods; Complementary medicine; Dosing; Massage; Randomized clinical trial