These measures are including, but not limited to, responsiveness of staff, pain management, discharge instructions, communication of nurses and doctors, and medication education, as well as their overall experience and recommendation of the hospital.

Numerous initiatives have been put in place at hospitals across the nation in order to help positively impact the HCAHPS scores, not only because continued improvements in patient care are essential but because these scores can affect Medicare and Medicaid reimbursement as hospitals of like size and setting are compared to others across the country.

A Case Study

In this month’s research review, we look at a feasibility study, Inpatient Massage Iherapy Versus Music Iherapy Versus Usual Care: A Mixed-Methods Feasibility Randomized Controlled Trial by Roseen et al conducted between July and December 2014. The authors analyzed responses to HCAHPS surveys for qualitative and quantitative data that indicated any impact created by the interventions of massage therapy and music therapy as compared to standard patient care.

Subjects were recruited at a large urban hospital that serves a diverse community. Exclusion criteria were extensive and mostly related to conditions that would not be conducive to receiving massage therapy, such as blood clotting disorders, respiratory or contact precautions, and anything resulting in an altered mental state. The electronic medical records of newly admitted inpatients were reviewed by the study staff. Eligibility was confirmed by the hospital staff. Patients consented for participation and randomized to the massage therapy arm, the music therapy arm, or the control arm (standard care) of the study.

The patients assigned to the study groups were offered 10 to 40 minute sessions, one to three times per day over the course of their hospital stay, with a licensed massage or board- certified music therapist. The massage therapy protocol included Swedish and acupressure techniques, such as light-stroking effl eurage, petrissage, and gentle compression. The sessions focused on patient hands, feet, arms, neck, shoulders, back, scalp, and head.

For music therapy, a two-step approach was implemented. The first step was the creation of a CD that included a personalized playlist of 12 songs based on the patient’s preferred music genres and artists. A second pre-recorded CD titled Manage Your Stress and Pain through Music was provided to the patient as well, along with a portable CD player with headphones. Patients were encouraged to listen to both CDs as often as they wanted during their hospital stay. The second phase included music-facilitated relaxation/meditation, songwriting, singing, and other passive and active music therapy techniques. In the end, 54 massage and 96 music therapy sessions were administered during the study.

The Results

According to the qualitative survey results, 13 massage therapy and 17 music therapy participants indicated that the interventions improved their hospital stay, noting improved sleep quality, relaxation, and distraction from hospital distress. Massage therapy was often linked to physical relaxation, while music therapy tended to yield a more healing environment patient response. In regards to quantitative data results, there was no appreciable difference between groups for pain management, recommendation of hospital, and overall hospital experience.

As the authors note, “Patient experience is complex and influenced by many aspects of care and environment. Given the complexity of patient experience, a single intervention like massage or music therapy may not be sufficient to elicit changes in HCAHPS score metrics.”

The challenges of providing massage and music therapy include elements of patient care, such as diagnostic studies to be done as well as therapist staffing schedules. Additionally, many patients have short hospital stays that limit ongoing daily interventions.

Finally, patient preference was not able to be considered in a research study setting. The study authors recommend “additional larger studies with expanded outcome measurement, e.g., evaluating pain and medication use immediately before and after intervention are needed to further assess the therapeutic effects of massage and music therapy in the inpatient setting.” In the end, the authors found that both massage and music therapies are feasible to provide in a hospital setting to patients. The full impact on HCAHPS scores is yet to be fully determined.

For more information on the Massage Therapy Foundation, please visit www.massagetherapyfoundation.org.