Massage therapy is a safe and effective way to reduce pain and improve function in adults with osteoarthritis of the knee, researchers at the Yale Prevention Research Center and at the University of Medicine and Dentistry of New Jersey (UMDNJ) report in the first clinical trial to assess the effectiveness of this treatment.
The 16-week study conducted to identify the potential benefits of Swedish massage on osteoarthritis patients with pain, stiffness and limited range of motion was published in the December 11 Archives of Internal Medicine. Osteoarthritis is a chronic condition that affects 21 million Americans and causes more physical limitation than lung disease, heart disease and diabetes mellitus, according to the Centers for Disease Control and Prevention (CDC).
The 68 study participants, who were at least age 35 with x-rays confirming their diagnosis of osteoarthritis of the knee, were randomly assigned either to an intervention group that received massage therapy immediately, or to a wait-list control group that received massage after an initial eight-week delay. Both groups were encouraged to continue previously prescribed medications and treatments.
Participants in the massage intervention group received a standard one-hour Swedish massage twice a week for four weeks, followed by Swedish massage once a week for the next four weeks at the Siegler Center for Integrative Medicine at the Saint Barnabus Ambulatory Care Center in Livingston, New Jersey. After the first eight weeks of massage therapy, participants had improved flexibility, less pain and improved range of motion.
The primary study outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index pain and functional scores, as well as changes in the Visual Analog Scale assessment of pain. Measures of pain, stiffness, and functional ability were all significantly improved by the intervention as compared to the control group.
Those who only continued with their usual care without massage showed no changes in symptoms. During weeks nine through 16, they received the massage intervention and experienced benefits similar to those receiving the initial massage therapy. When reassessed eight weeks after completion of the massage intervention, the benefits of massage persisted and remained significant, although the magnitude of effect was somewhat reduced.
"Massage is free of any known side effects and according to our results, clearly shows therapeutic promise," said senior investigator of the study David L. Katz, M.D., associate adjunct professor in the Department of Epidemiology & Public Health at Yale School of Medicine and director of Yale's Prevention Research Center. "So-called 'alternative' treatments like massage are most important when conventional treatments are far from ideal. Currently available non-steroidal anti-inflammatory drugs are often not well-tolerated by older adults with osteoarthritis. Cox-II inhibitors like Vioxx were developed as substitutes for traditional anti-inflammatory drugs, but pose highly-publicized toxicity problems of their own."
Katz conducted the study with Adam Perlman, M.D., executive director of the Institute for Complementary and Alternative Medicine at the UMDNJ-School of Health Related Professions. The research was the result of a CDC grant to Katz at the Prevention Research Center at Yale. Perlman, who directed the study at UMDNJ, said the significant improvement in symptoms after eight weeks of massage persisted even after the study was completed.
"Our results suggest that massage therapy can be used in conjunction with conventional treatment for osteoarthritis," said Perlman. "Ultimately, massage may be shown to lessen a patient's reliance on medications and decrease health care costs."
Perlman and Katz say that further study of the cost-effectiveness and the lasting impact of the intervention is warranted. They have begun collaborating on a follow-up study.
"Our hope is to show that this treatment is not only safe and effective, but cost-effective," said Perlman. "That could serve to change practice standards so that massage is a more common option for the many patients with osteoarthritis of the knee."
In addition to Katz and Perlman, other authors on the study included Alyse Sabina, Anna-leila Williams and Valentine Yanchou Njike, M.D., all of the Yale Prevention Research Center.
Citation: Archives of Internal Medicine, Vol. 166, No. 22 (December 11, 2006)
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