title: A randomised controlled trial on evaluation of the clinical efficacy of massage therapy in a multisensory environment for residents with severe and profound intellectual disabilities: a pilot study.
abstract: Recent literature has suggested that relaxation activities can reduce the challenging behaviours of people with intellectual disabilities, particularly in severe and profound grades, due to the counteractive effect of muscle relaxation on emotional frustration or psychological distress. Despite having inconclusive evidence, multisensory environment (MSE) and massage therapy (MT) are the commonly used approaches to relaxation among these people. However, these two approaches have not yet practised or tested in combination for reducing these people's challenging behaviours.
  
  
  
  A preliminary clinical efficacy trial was conducted to evaluate the effects of MT, MSE and their combined use for residents with intellectual disabilities in a long-term care facility on reducing their challenging behaviours. Eligible residents were recruited and randomly assigned to one of the four study groups (n = 11-12 per group), that is, MT in MSE, MSE alone, MT alone or usual care, for a 10-week intervention after a 1-month washout period. Outcome measures, including the Behaviour Problem Inventory, pulse and respiration rates, Behaviour Checklist and Alertness Observation Checklist, were assessed at recruitment and immediately following the interventions.
  
  
  
  A total of 42 participants (17 men and 25 women) completed the study. There were no significant differences in frequency and severity of challenging behaviours and most of the outcome measures between the four groups at post-test. Nevertheless, there were statistical significant differences on the active and inactive state (Alertness Observation Checklist) between the three treatment and control groups. Many participants in the three treatment groups changed from an active to inactive state (i.e. reduced activity levels) throughout the interventions, especially the MT in MSE. Such inactivity might suggest the participants' brief exhaustion followed by a period of alertness during the treatment activities. But their attention span and social contact to the immediate environment could still be maintained.
  
  
  
  Participants of MT in multisensory environment acquired more inactive state than the other study groups. This inactive state indicates a state of 'passive alertness', which is more likely in a relaxing manner.
authors.affiliation: Siu Lam Hospital, Hospital Authority of Hong Kong, Hong Kong.
authors.forename: J S L
authors.initials: JSL
authors.lastname: Chan
authors.affiliation: School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: W T
authors.initials: WT
authors.lastname: Chien
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D008405:Massage / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D000066553:Problem Behavior; D012720:Severity of Illness Index
keywords: alertness; challenging behaviours; massage therapy; multisensory environment; relaxation; severe and profound intellectual disability