Hospital-Based Massage Therapy At Boston Medical Center
Hospital-BasedMassage Therapyat Boston Medical CenterwithPaula Gardiner,MD, MPHPart 1 of the webinar series,“Hospital-Based Massage Therapy:Successes, Challenges, and Sound Advice”with Tracy WaltonHospital-Based Massage Therapy: Successes,Challenges, and Sound AdviceTracy WaltonMS, LMTResearcherWriterEducatorOncology massage specialist1
Hospital-Based Massage Therapy: Successes,Challenges, and Sound AdviceSpeakers will: Answer questions and provide guidance in hospital-basedmassage therapy Share hard data that have helped move massage therapytoward the standard of care Tell inspiring patient stories from in-hospital massage services Describe strategies for communicating and collaborating withmedical staffFeatured HospitalsBeaumont Health SystemsRoyal Oak, MIDartmouth-HitchcockMedical CenterLebanon, NHCalifornia PacificMedical CenterSan Francisco, CABoston Medical CenterBoston, MAMD AndersonCancer CenterHouston, TX2
Karen ArmstrongBeaumont Health SystemsRoyal Oak, MIBriane PinksonDartmouth-HitchcockMedical CenterLebanon, NHCarolyn TagueCalifornia PacificMedical CenterSan Francisco, CASat Siri SumlerMD AndersonCancer CenterHouston, TXPaula GardinerBoston Medical CenterBoston, MARoadmap for Webinar Featured Presenter/Program: Dr. PaulaGardiner, Boston Medical Center– Dr. Gardiner’s background– BMC and Integrative Medicine– Massage Therapy Program– Vision of the Future Questions from Participants (If time) General Hospital-BasedMassage Therapy Resources3
In this WebinarBoston Medical CenterBoston, MAPaula Gardiner, MD, MPHPaula Gardiner, MD, MPH Physician in family medicine, BMC, since 2008Trained at Tufts University School of MedicineTufts University Residency ProgramResearch Fellowship at Harvard MedicalSchool (Children’s Hospital, Osher Institute)4
Boston Medical CenterBoston Medical CenterBoston, Massachusetts496 bed academic medical centerTeaching hospital for BU School of MedicineCommunity-based careLargest provider of trauma/ER servicesin New EnglandLargest “safety-net” hospital in New EnglandBostonMedicalCenterServes 1/3 of Boston residentsMore than half of patients at annual incomebelow 200% of Federal Poverty Level( 44,200/family of 4)5
BMC PatientsLess than 1/4 have employer-basedhealth insurance70% of patients from social and ethnicminority populations30% do not speak English as primary language110 languages spokenHealth careforpeople who are homeless6
From www.bmc.orgIntegrative Medicine at BMCSafe, effective integrative therapies shouldbe available to everyone without regard toability to pay7
Integrative Medicine ServicesCommunity GardenFood PantryNutrition Education8
Integrative Medicine at BMCVisionBuild a center of excellence, a nationalmodel for how integrative medicine canpositively impact the health of the urbanunderservedClinical ilpsurtooerunupoealli vcrlidgacoseraleeseasinmcraltpiroarbi taernhiheCchheayprtivulmts9
What Does it Take to do Massagein a Hospital? SpaceMoneyJob descriptionsLegalLanguageChampions (more later on that)History of Massage at BMC10
History of Massage at BMCPhysical Space11
How are MTs Credentialed? State LicenseCertificate of Malpractice InsuranceImmunizationsAnnual TB testHIPAA TrainingHospital OrientationInternship Training for Professional MTsOncology MassageWorking in a medical settingHIPAA, hospital practicesAppropriate application of massageCross-cultural considerationsCharting skills12
Internship Training for Professional MTsInfant Massage at BMC13
Where is Massage Offered Now? Radiation Oncology Hematology/Oncology(Chemotherapy Infusion bays) Postpartum (Infant Massage) Palliative care Ambulatory care Staff table massage Staff on-site massageWhy Massage Evolved at BMC(How do we keep these wonderful MTs?) Grads of internship program or equivalentWanted to keep them aroundWanted them to be paidThink outside the box how to payHired––––Palliative care (grant funded)ACC (fee for service, sliding scale)Staff table massage (fee for service, 50/session))Staff chair massage (free, paid by philanthropic funds) Included in research projects14
Research/Data Collection on MassageOncology Massage Training Program in an Inner City Cancer CenterP. Gardiner, L. Mullen, T. Walton, R. Saper, J. RosenDept. of Family Medicine, Dept. of Surgery, Boston University Medical School, Boston, MABackground Few massage training programs provide hospital-basedmassage to underserved patients Few oncology massage training programs exist Little is known about the feasibility of providing massageto underserved patientsAimsOur primary aim is to create a sustainable oncologymassage training program to provide free massage tounderserved patients at a busy inner city hospital inBoston, Massachusetts, USAMaterials and MethodsAfter obtaining IRB approval, we developed oncologymassage admission materials, patient documentationtools, and an oncology massage curriculum. Weestablished safe hospital practice guidelines for ourmassage trainees in working with patients. We collecteddemographic information on our trainees andadministered pre and post knowledge, behavior, andconfidence questionnaires to each massage trainee.We used descriptive statistics to report on the previousnumber of years of experience with massage, age, race,occupation, and type of pre-requisite training in oncologymassage. We used T tests to compare the pre and postknowledge, behavior and confidence questionnaires foreach massage traineeResults We had over 60 massage therapists inquire about thetraining. Of those who inquired, 19 massage therapistswere selected to participate in four training internshipcourses. We provided over 400 free massages to cancer patients. Seventy percent (70%) of massage clients were breastcancer patients. Evaluations from patients and providers demonstratethat our oncology patients are benefiting from themassage services and curb chemotherapy side effects.Table 1. Demographics and Experience of MassageTherapist Participants (N 19)Frequency(percent)Previous massage experienceLess than 1 year4 (21)1-2 years11 (58)5-6 years3 (16)18 years1 (5)Age20-301 (5)30-406 (32)40-507 (37)50-603 (16) 602 (11)RaceNon-Hispanic White16 (85)Hispanic1 (5)Asian1 (5)Other1 (5)OccupationMassage therapist (MT)18 (95)MT and grants manager1 (5)Pre-requisite training oncologymassageCancer hospice and HIV training1 (5)3 (16)CME course at a massage schoolCME course and Walton Oncology4 (21)Massage trainingWalton Oncology Massage training8 (42)onlyNo formal training2 (11)Not specified1 (5)Limitations Small sample sizeTable 2. Difference Summary Scores for Behavior, Knowledge,and Confidence (N 19)StandardMeanDeviationP-ValueBehavior ScoreDifference-3.373.320.003Knowledge ScoreDifference-1.54.150.12Confidence ScoreDifference-5.43.120.001 Massage therapists were already interested in and hadprevious educational training in oncology massage. Thismay explain why we did not see a change in knowledgescore Survey questions were not previously validatedTable 3. Pre- and Post-Test Behavior Questions (N 19)MeanStandard P-ValueDifference DeviationCan warn patientsabout side effectsCan provide correctinformation onscientific evidenceCan easily recordinformation in 0.003ConclusionsTable 4. Pre-and Post-Test Confidence Questions (N 19)MeanStandard P-ValueDifference DeviationConfident in tailoringmassage protocolConfident in providingmassage to cancerpatientsConfident talking withcolleagues about cancermassageConfident working withPIC lines and IVs-1.261.37 0.001-1.271.05 0.001-1.371.46 0.001-1.521.26 0.001 It is feasible to have an oncology massage trainingprogram at a busy inner city hospital Training in a oncology clinical setting increased bothconfidence and clinical skills working with cancer patients Clinical skills such as patient documentation and providingmassage to patients with IVs increased in trainees. Massage therapists are interested in working withunderserved patientsFuture Directions To collect additional survey data on further graduates Provide continuing education credits Research mechanisms and benefits of massage for ourcancer patients Contact information: Paula.Gardiner@BMC.org15
Research on Massagein the Hospital Setting Effects of Massage Therapyon Preoperative Anxiety andPostoperative Pain in CancerPatients Undergoing PortImplantation Principal Investigator Dr.Jennifer RosenPortfor IVchemoadministration32Source: eter.jpg16
Where does Support Come From? NursesPhysiciansAdministrative StaffMassage TherapistsPatientsNursing SupportEarliest adopters of massageprogramNurses feel less burnt outLMTs bring holistic, patientcentered perspective17
Building Physician Support In-house data about patients’experience of massage Published research about benefits Prior positive experiences ofintegrative medicineAdministrative Support Human ResourcesHospital orientationRoom schedulingAppointment schedulingProgram coordination18
Building Capacity throughInterdisciplinary EducationProgram SustainabilityHow do we make CAM necessary, not just nice?Needs AssessmentAdministration, Providers, Researchers, PatientsAlign Program to Needs (Example Staff MassageProgram)Role of ChampionsAdvocate for SynergyResearchFunding is Key (creative options)19
Benefits of CAM InternshipPartnerships with SchoolsPatients get services at low or no costHospital can provide CAM services for freePartner schools get training opportunitiesTraining CAM professionals in certain aspectsof medical field Familiarizing medical staff with CAM BMC Massage Therapy Internship ProgramContact information:BMC Family Medicine 617 414 6267familymedicine@bmc.orgSaskia Cote, DirectorSaskiacote@gmail.comCindy GillanInstructor20
What worked? Sliding scale for fee for serviceEducational partnerships!Cultivating champions in all departmentsCollecting data—in-house researchGrant-writing skillsDo Differently? Would have partnered earlier with a massageschool to implement massage therapy trainingprogram. Would have charged tuition for the programearlier, not offered for free Would have provided low cost massage tostaff earlier21
The Future?Massage Therapy, CAM,Health Care, Health Care Reform Two things in health care reform– Accountable care organization– Patient-centered medical “home” Role of massage therapy?Resources in Hospital-BasedMassage Therapy Associations/Organizations Publications Research22
Resources in Hospital-Based Massage Therapy ACCAHC—Academic Consortium forComplementary and Alternative Health Care– Clinical Care Working Group (CWG)– Hospital-Based Massage Therapy (HBMT)Subgroup– Contact MK Brennan, MS, RN, LMBT, with info onyour program to share brennanmk@aol.com– ACCAHC Info, Conferences at www.accahc.orgResources in Hospital-Based Massage Therapy Society for Oncology Massage– Sets standards for oncologymassage education– Lists hospitals providingoncology massagewww.s4om.org23
Resources in Hospital-Based Massage Therapy Massage Therapy Foundation– Funds research– Funds community service– Education– Research literacy (online and face to face iontrainingsolutions.comAMTA Career Success Series “Working in a Health Care Environment”A guide from the AMTAFree downloadAvailable s/amta health care guide.pdfwww.amtamassage.org24
Hospital-Based Massage NetworkAssociation of hospitals/individuals sharing information aboutprogramsDirected by Laura KochExtensive resourcesData collectedSample HBMT proposals in Exploring Hospital-Based MassageAvailable at Natural Touch s in Hospital-Based Massage TherapyBooksMacDonald, G.Massage for the HospitalPatient and Medically FrailClient25
Resources in Hospital-Based Massage TherapyBooksMacDonald, G. Medicine Hands:Massage Therapy for People withCancerWible, J. Drug Handbookfor Massage TherapistsWalton, T. Medical Conditions andMassage TherapyTips for Using Researchto Promote HBMTwww.pubmed.gov (published research)www.clinicaltrials.gov (research in progress)When searching at these sites:Avoid “massage therapy” “hospital-based”Instead, search by condition or treatmentMassage therapy cancerMassage therapy strokeMassage therapy migraineMassage therapy back pain26
Research(some favorites)Mitchinson AR, Hyungjin MK, Rosenberg JM, Geisser M, Kirsch M, Cikrit D,Hinshaw DB. Acute postoperative pain management using massage as anadjuvant therapy: a randomized trial. Arch Surg 2007;142(12):1158-1167Grealish L, Lomasney A, Whiteman B. Foot massage. A nursing intervention to modifythe distressing symptoms of pain and nausea in patients hospitalized with cancer.Cancer Nurs. 2000 Jun;23(3):237-43.Post-White J, Kinney ME, Wavik K, Gau JB, Wilcox C, Lerner I. Therapeutic massage andhealing touch improve symptoms in cancer. Integrative Cancer Therapies2003;2(4):332-44.Jane SW, Chen SL, Wilkie DJ, Lin YC, Foreman SW, Beaton RD, Fan JY, Lu MY, Want YY,Lin YH, Liao MN. Effects of massage on pain, mood status, relaxation, and sleep inTaiwanese patients with metastatic bone pain: a randomized clinical trial. Pain152(2011) 2432-2442.Cassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at amajor cancer center. Journal of Pain and Symptom Management Sep 2004;28(3):244-9.Mitchinson et al. (2007)Sample size: 605 veterans undergoing majorsurgeryProcedure: up to five 20-min back massagesControls: Individual attention, routine careFindings. Compared to controls, massageassociated with: Pain Short-term anxiety27
Grealish L et al. (2000)Sample size: 87 inpatientsProcedure: 10-min foot massageControl: Quiet timeFindings. Compared to control, massageassociated with: Pain Nausea Relaxa onPost-White et al., 2003Sample size: 164 outpatients in chemotherapyControl/Comparisons: Standard care, Healing Touch,Caring presenceFindings. Compared to control, massage associatedwith: Anxiety Pain Analgesic use Mood RelaxationNo change in nausea (!)28
Cassileth and Vickers, 2004Sample size: 1290 in- and outpatientsControl: NoneProcedure: 20-60 min. massageFindings. Compared to pre-massage values,post-massage values suggested:Pain 40%Nausea 21.2%Fa gue 40.7%Anxiety 52.2%Depression 30.6%Jane et al, 2011Sample size: 84 inpatientsControl: attentionProcedure: 45 min. massage (3 sessions)Findings. Compared to control, massageassociated with:Pain Mood status improvedMuscle relaxa on 29
Research ReferencesCassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at a major cancer center. Journalof Pain and Symptom Management Sep 2004;28(3):244-9.Corbin L. Safety and efficacy of massage therapy for patients with cancer. Cancer Control Jul 2005;12(3):158-164.Ernst E. Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinicaltrials. Support Care Cancer. 2009 Jan 13.Grealish L, Lomasney A, Whiteman B. Foot massage. A nursing intervention to modify the distressing symptomsof pain and nausea in patients hospitalized with cancer. Cancer Nurs. 2000 Jun;23(3):237-43.Jane SW, Chen SL, Wilkie DJ, Lin YC, Foreman SW, Beaton RD, Fan JY, Lu MY, Want YY, Lin YH, Liao MN. Effects ofmassage on pain, mood status, relaxation, and sleep in Taiwanese patients with metastatic bone pain: arandomized clinical trial. Pain 152(2011) 2432-2442.Jane SW, Wilkie DJ, Gallucci BB, Beaton RD. Systematic review of massage intervention for adult patients withcancer: a methodological perspective. Cancer Nurs. 2008 Nov-Dec;31(6):E24-35. Review.Kutner J, et al. Methodological challenges in conducting a multi-site randomized clinical trial of massage therapyin hospice. Journal of Palliative Medicine 2010: 13:6;739:744. Click here for an abstract.Kutner J, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer.Annals of Internal Medicine: September 16, 2008; 149:6;369-380.Lu W, Ott MJ, Kennedy S, Mathay MB, Doherty-Gilman AM, Dean-Clower E, Hayes CM, Rosenthal DS. IntegrativeTumor Board: a case report and discussion from Dana-Farber Cancer Institute. Integr Cancer Ther. 2009Sep;8(3):235-41.Research References, continuedMenard MB. Making Sense of Research (2nd ed). Toronto: Curties-Overzet Publications, 2010.Moyer, C, et al. Does massage therapy reduce cortisol? A comprehensive quantitative review. Journal ofBodywork & Movement Therapies (2011)15:3-14.Moyer C, et al. A meta-analysis of massage therapy research. American Psychological Association, Inc.2004;130(1):1,3-18.Myers C, Walton T, Small B. The value of massage therapy in cancer care. Hematology/Oncology Clinics of NorthAmerica 2008;22:649-660.Phipps S, Barrera M, Vannatta K, Xiong X et al. Complementary therapies for children undergoing stem celltransplantation: report of a multisite trial. Cancer 2010 Jul 12. (Epub ahead of print)Phipps S, Dunavant M, Gray E, Rai SN. Massage therapy in children undergoing hematopoietic stem celltransplantation: results of a pilot trial. Journal of Cancer Integrative Medicine 2005;3(2):62-70.Phipps, S. Reduction of distress associated with paediatric bone marrow transplant: complementary healthpromotion interventions. Pediatric Rehabilitation 2002;5(4):223-34.Post-White J, Kinney ME, Wavik K, Gau JB, Wilcox C, Lerner I. Therapeutic massage and healing touch improvesymptoms in cancer. Integrative Cancer Therapies 2003;2(4):332-44.Walton T. "Massage Research in Massage Practice," in Medical Conditions and Massage Therapy: A Decision TreeApproach. Philadelphia: Lippincott Williams & Wilkins, 2011.30
THANK YOU!Questions?Karen ArmstrongBeaumont Health SystemsRoyal Oak, MIBriane PinksonDartmouth-HitchcockMedical CenterLebanon, NHCarolyn TagueCalifornia PacificMedical CenterSan Francisco, CASat Siri SumlerMD AndersonCancer CenterHouston, TXPaula GardinerBoston Medical CenterBoston, MA31
ContestHow to enter: Write a review of a “Hospital-Based Massage” webinar on Dr.Benjamin’s Facebook Wall at Facebook.com/BenjaminInstitute. You’re eligible for one entry per webinarWhat you can win: A free copy of Massage for the Hospital Patientand Medically Frail Client by Gayle MacDonald A complete set of the “Hospital-Based Massage Therapy”webinar series to give to a friend or colleagueWe b i n a r s Av a i l a b l e O n D e m a n dOther Webinars with Tracy Walton Massage in Cancer Care More About Cancer & Massage Cardiovascular Conditions & MassageAll Webinars Available at www.BenBenjamin.com32
We b i n a rs Ava i l a b l e O n D e m a n dDr. Ben BenjaminUnraveling the Mystery Series: Low Back Pain Cervical Pain Shoulder Pain Knee Pain Ankle Pain Hip & Thigh PainTom Myers Whitney Lowe Orthopedic Approaches to UpperBody DisordersOrthopedic Approaches toLumbo-Pelvic PainCarole Osborne Pregnancy Massage 101Anatomy Trains:Clinical Applications ofMyofascial MeridiansBeyond Good PostureAnd Many More Tracy Walton Massage in Cancer CareMore About Cancer & MassageCardiovascularConditions & MassageAll Webinars Available at www.BenBenjamin.comJOINThe Benjamin InstituteE-Mailing List&Receive a FREE Ebookon the Low Back33
Pre-requisite training oncology massage Cancer hospice and HIV training CME course at a massage school CME course and Walton Oncology Massage training Walton Oncology Massage training only No formal training Not specified 1 (5) 3 (16) 4 (21) 8 (42) 2 (11) 1 (5) Table 1. Demographics and Experience of Massage Therapist Participants (N 19) Mean .
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AA. "Massage Therapy Practice Act" refers to Sections 61-12C-1 NMSA 1978 et seq. (as amended through 2019). BB. "Massage therapy school" means a facility providing an educational program in massage therapy. CC. "MBLE. x " means the massage and bodywork licensing examination, as offered by the federation of state massage therapy .
The term “massage therapy” encompasses many techniques, and the type varies by a patient’s needs and physical conditions. 1 Common types include Swedish massage, deep tissue massage, sports massage, and chair massage. 2,3 In general, massage therapists treat patients by using touch to manipulate the muscles and other soft tissues of the body.
8. Therapeutic massage Page 144 a. Massage therapy Page 144 b. Massage therapy Page 144 c. Medical conditions it can help Page 145 d. Physical benefits of massage Page 146 e. Massage therapy and well-being – mental benefits Page 146 VIII. Advocacy P
Professional Ethics, Massage Therapy Law and a Clinical Internship. Texas Massage Academy offers the most innovative, comprehensive massage program available. Our programs include the following core subjects: Massage Technique – 200 Hours Massage Technique I – 150 Hours .
Massage your scar. This massage is only if you have had surgery. Do not massage until three weeks after surgery. Do not massage until all staples and clips have been removed. Your scar may feel very sensitive, tight or itchy. Scar massage will help reduce these feelings. This massage helps soften the scar and allows better blood flow to the area.
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