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March 6, 2010

Outcome Measures For Massage

I got a discussion started in my clinic the other day about documenting the outcome measures for massage therapy. This is important in physical therapy because if you decide to use a treatment on a patient, there must be a way to show an objective benefit to the type of treatment that you use.

While the analog scale for pain (where you ask the patient/client to rate their pain on a scale of one to ten) has been proven a valid and reliable measure in the literature, it is still considered a subjective measure. An objective outcome is one that can be measured, for example an increase in the angle of a joint. Soft tissue mobilization is easy to measure when we look at a neck, for example. You can ask your patient to look up and down, rotate side to side, and side-bend. All of these movements are measurable.

But how do you measure an objective benefit for someone who has chronic pain? Again, these improvements in function will rely on patient reports of improvement in their pain index, how long their pain was improved, and what they were able to do after the treatment that they were not able to do before. From experience, most patients had improvement in pain and function for only two to three days.

It was not uncommon in my massage practice to help someone with their low back pain on a Friday and have them come back the following week in worse shape than before. It turns out that massage made them feel so good that they went out over the weekend and "over did it" because they finally could move and do what they wanted. Their follow-up appointment would be devoted to getting them out of the trouble they created for themselves.

And it is the same for physical therapy. The above scenario makes it difficult to measure a cumulative improvement in a patient from massage therapy. However, combined with exercise, massage can make the patient comfortable long enough to do the exercises that will strengthen the supporting muscles around the joint. As the patient get stronger, their pain will likely subside and they should be weaned away from massage as an intervention. But, because massage treatment is often pleasant, many patients will lie in order to prevent being weaned away from it as they improve. As a result, insurance companies become reluctant to reimburse for these services and continue to relegate massage therapy to the periphery of the health care spectrum.

Posted by linda at March 6, 2010 8:19 AM

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