Real-World Massage Therapy Produces Meaningful Effectiveness Signal for Primary Care Patients with Chronic Low Back Pain: Results of a Repeated Measures Cohort Study.
OBJECTIVE
While efficacy of massage and other nonpharmacological treatments for chronic low back pain is established, stakeholders have called for pragmatic studies of effectiveness in "real-world" primary health care. The Kentucky Pain Research and Outcomes Study evaluated massage impact on pain, disability, and health-related quality of life for primary care patients with chronic low back pain. We report effectiveness and feasibility results, and make comparisons with established minimal clinically important differences.


METHODS
Primary care providers referred eligible patients for 10 massage sessions with community practicing licensed massage therapists. Oswestry Disability Index and SF-36v2 measures obtained at baseline and postintervention at 12 and 24 weeks were analyzed with mixed linear models and Tukey's tests. Additional analyses examined clinically significant improvement and predictive patient characteristics.


RESULTS
Of 104 enrolled patients, 85 and 76 completed 12 and 24 weeks of data collection, respectively. Group means improved at 12 weeks for all outcomes and at 24 weeks for SF-36v2's Physical Component Summary and Bodily Pain Domain. Of those with clinically improved disability at 12 weeks, 75% were still clinically improved at 24 weeks ( P  < 0.01). For SF-36v2 Physical and Mental Component Summaries, 55.4% and 43.4%, respectively, showed clinically meaningful improvement at 12 weeks, 46.1% and 30.3% at 24 weeks. For Bodily Pain Domain, 49.4% were clinically improved at 12 weeks, 40% at 24 weeks. Adults older than age 49 years had better pain and disability outcomes than younger adults.


CONCLUSIONS
Results provide a meaningful signal of massage effect for primary care patients with chronic low back pain and call for further research in practice settings using pragmatic designs with control groups.
Departments of Family and Community Medicine.
William G
WG
Elder
Clinical Sciences, University of Kentucky, Lexington, Kentucky.
Niki
N
Munk
Departments of Family and Community Medicine.
Margaret M
MM
Love
Department of Health Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.
Geza G
GG
Bruckner
Departments of Family and Community Medicine.
Kathryn E
KE
Stewart
Departments of Family and Community Medicine.
Kevin
K
Pearce
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008405:Massage / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D016896:Treatment Outcome
Complementary Therapies; Health-Related Outcomes; Massage Therapy; Practice-Based Research; Pragmatic Research; Primary Care; Rural Population