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Massage Today
September, 2011, Vol. 11, Issue 09

Massage for Symptoms of Multiple Sclerosis

A brief review of an article published in the Multiple Sclerosis Journal

By Massage Therapy Foundation Contributor

This month's Massage Therapy Foundation article review addresses a common issue, constipation, or difficulty having a bowel movement, among people with multiple sclerosis (MS).

Constipation affects many people; however, this is commonly a chronic issue for people with multiple sclerosis. Constipation can involve discomfort, distress and can negatively affect the quality of life for people with MS. However, research suggests the use of abdominal (stomach) massage can improve bowel movements. McClurg and colleagues conducted a study to determine the feasibility of using abdominal massage to alleviate constipation in people with MS.

Of 41 volunteers, 30 patients with MS and constipation were recruited and met the requirements to be included in the study. Several outcome measures were used, including several self-report questionnaires, including the Constipation Scoring System (CSS), the Neurogenic Bowel Dysfunction Score (NBDS), and a bowel diary. Participants were randomly assigned to a massage group or a control group (no massage). Both groups received bowel management advice. In addition to advice, the massage group participants, or their caregivers, were taught abdominal massage techniques. Four primary techniques were provided – stroking, effleurage, kneading and vibration. Participants and their caregivers were provided with instruction, practice and opportunities to ask questions regarding the techniques. Each participant in the massage group was advised to perform on themselves or receive from their caretakers abdominal massage daily for the 4-week intervention period. An instructional DVD was provided to participants in the massage group. Outcomes were measured at baseline (Week 0), post treatment (Week 4), and at Week 8; and were administered by telephone by a third party data collector who was blinded to participants' group assignment (massage versus control).

Findings indicated participants in the massage and control groups reported a decrease in CSS score (Week 0 to Week 4), suggesting improved bowel function; however, the massage group improved significantly more than the control group. The massage group also reported improvement on the NBDS, but the control group reported worse scores (Week 0 to Week 8); these data indicated the massage group reports were significantly improved over those participants in the control group. The bowel diary also provided telling evidence, such that the frequency of bowel movements increased (improved) for both groups, but participants in the massage group reported significantly more bowel movements than those in the control group (Week 0 to Week 4). Further, participant reports suggest time spent defecating reduced for both groups from Week 0 to Week 4, in the massage group it was reduced from 10 minutes at baseline to 6 minutes per day; and in the control group from 12 minutes to 10 minutes, per day.

The authors reported several limitations in this study, namely the small sample size and the potential lack of sensitivity of the NBDS to detect changes in the study population. As with many similar studies, a convenient sampling strategy was used, in that patients self-selected to participate in the study and thus may have different characteristics than those individuals who do not self-select to participate in research. As with most massage research, it was not possible to blind the participants or clinicians. The duration of the intervention was short compared to other published research; authors suggest the effects may have continued to increase if the intervention had been for a longer duration. Furthermore, some participants felt applying self-massage was tiring, and they were unable to apply the same pressure as the therapist. It is noted that the inability to provide adequate pressure for a sustained period could reduce massage treatment effects.

What is the take home message of this publication? McClurg and colleagues' findings support the feasibility of a randomized control trial (RCT) of abdominal massage to manage symptoms of constipation in people with MS. These study findings provide support for using abdominal massage with clients and patients who report symptoms related to constipation. Notably, study participants reported finding the bowel diary useful; bowel diaries may be a useful tool for monitoring and managing constipation in tandem with other modalities such as massage. Furthermore, as massage becomes recognized as a viable treatment for diverse populations, the use of instructional DVDs continues to gain popularity. Instructional DVDs that provide informal caregivers with massage techniques opens up new opportunities to receive the benefits of massage for people who may not otherwise have the financial resources to access massage.

In closing, McClurg and colleagues provided data in an area where empirical data is needed and demonstrated the feasibility of using abdominal massage "as part of an integrated bowel management program." As more conclusive research findings are published, we will gain more insight into the effects of massage on constipation symptoms in patients with MS and other patient populations who struggle with bowel management.

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