Massage/Aromatherapy Massage

Massage/Aromatherapy Massage

PEP Topic 
Caregiver Strain and Burden
Description 

Massage therapy involves the manipulation of the soft-tissue with various hand movements (e.g., rubbing, kneading, pressing, rolling, slapping, tapping). Massage therapy can elicit a relaxation response as measured by decreases in heart rate, blood pressure, and respiration. Often, massage is complemented with aromatherapy (i.e., essential oils combined with a carrier cream or oil to manipulate the soft tissues). Aromatherapy has been used together with massage in some studies. An aromatherapy massage is massage therapy delivered by a therapist while aromatherapy oils are administered by inhalation. Massage with or without aromatherapy has been studied in patients with cancer for management of anxiety, caregiver strain and burden, constipation, chemotherapy-induced nausea and vomiting, depression, lymphedema, pain, sleep-wake disturbances, and fatigue.

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Effectiveness Not Established

Research Evidence Summaries

Cronfalk, B.S., Ternestedt, B., & Strang, P. (2010). Soft tissue massage: Early intervention for relatives whose family members died in palliative cancer care. Journal of Clinical Nursing, 19, 1040–1048.

doi:10.1111/j.1365-2702.2009.02985.x
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Study Purpose:

To explore how bereaved relatives experienced early intervention with soft tissue massage during the first four months since the death of a family member who received palliative cancer care

Intervention Characteristics/Basic Study Process:

Study data resulted from two interactions with Swedish-speaking relatives of deceased patients with cancer who had received care in a large palliative care unit. Demographic and baseline data were collected in an initial 60-minute visit to the relative. Hand or foot soft tissue massage, which is defined as a gentle but firm movement of the skin that activates touch receptors, was done in slow strokes, light pressure, and circling movement using lightly scented vegetable oil.

One week after an eight-week intervention involving either protocol-driven or relative election of either hand or foot soft tissue massage, the first author audiotaped hour-long interviews with the 18 study participants. Open-ended interviews focused on the experience of receiving the massages via a dialectical validation approach to ensure understanding of relatives’ experience. The authors supported trustworthiness and qualitative credibility factors during interviews and data analysis processes based on interview transcriptions and close attention text. An additional follow-up telephone call six to eight months after the interview was intended to encourage participants to reflect on their current life situation in relation to the grieving process.

Sample Characteristics:

  • The sample (N = 18) was comprised of 14 females (78%) and 4 males (22%) who were bereaved relatives of deceased patients with cancer.
  • The age range of participants was 34–78 years (mean age = 56.2 years).
  • Diagnoses of the deceased patients were not noted.
  • The relationship to the patient was widow (9), widower (4), daughter (3), and sister (2).
  • The type of massage chosen was foot (9), hand (8), and hand and foot (1).
  • The working status of participants was sick leave (7), retired (6), and working full- or part-time (5).
  • Three relatives had previous experience with deep body massage.
  • The study authors provided no other information, such as educational status, about the sample. This status may help to interpret the rich textual findings presented by the authors.
  • Of the sample, 14 expressed interest in participating the first few weeks of their relative’s death, although the authors planned to contact relatives within three to six weeks of the relative’s death.
  • Seven relatives chose not to participate due to living too far away or a lack of interest in study participation.
  • Most chose to receive massages in their home, and most massages occurred in a silent environment.

Setting:

  • Single site
  • Home or palliative care center
  • Stockholm, Sweden

Study Design:

A prospective, descriptive, qualitative design was used.

Measurement Instruments/Methods:

  • Private interviews were audiotaped in which bereaved relatives narrated freely about their experience of receiving soft tissue massage over eight weeks.
  • Follow-up telephone conversations were initiated six to eight months postinterview “to see how the relative was doing.”

Results:

A qualitative content analysis allowed various levels of interpretation and abstraction to support one predominant theme: Bereaved relatives felt “feelings of consolation and help in learning to restructure everyday life.” The theme derived from four categories: (a) a helping hand at the right time, (b) something to rely on, (c) moments of rest, and (d) moments of retaining energy. Overall, soft tissue massage supported relatives’ need for comfort, as well as hope during a difficult transition time for relatives who sought a balance of grieving and moving on with their lives after the death of a loved one. No analysis of the follow-up telephone conversations appeared in the article.

Conclusions:

Early interventions for relatives who grieve the loss of a family member’s death, including sequential soft tissue hand or foot massage, may facilitate relatives’ feelings of belonging, human connection to healthcare staff who cared for their family member before death, sense of self, and energy to structure life after a family member’s death. Too often, delayed interventions cause unnecessary worry and suffering of bereaving relatives. The offering of soft tissue massage to those relatives at a desired time may constitute a cost-effective way to support bereaved relatives early in their grieving process.

Limitations:

  • The sample was small, with less than 30 participants.
  • Although the sample size appears adequate for qualitative studies, further replication of the study across cultures and healthcare units would expand application of the findings to multiple relatives who experience the death of a family member. For example, in some cultures, there may be limited acceptance of personal touching by a person that is not family.
  • Recruitment for this qualitative study occurred in one specialized palliative care unit, thus limiting generalizability of the study findings. The study also occurred in Sweden, and this may influence access and acceptance of soft tissue massage as a culturally-sensitive intervention in the United States. Scope of practice issues in the United States and other countries may influence nurses’ use of massage therapy with population groups, as well as nurses’ continued contact with families following a family member’s death. In this study, it appeared that at least one of the study authors served as a massage therapist, a behavior that may “cross the line” in the United States of inappropriately meshing two distinct healthcare provider roles.
  • The authors did not address “member checking,” a common process in qualitative research in which data findings gain support from a person experiencing the topic under study. The input of a grieving caregiver once the study data resulted would have addressed validation of the findings and expanded interpretation of those.

Nursing Implications:

Early support, including that inherent in the delivery of soft tissue massage, to grieving relatives of a family member who died from cancer or other chronic illnesses, offers a cost-effective intervention that may improve the health of those relatives. This intervention needs further testing to determine its efficacy but does highlight the importance of grieving relatives reconnecting with the healthcare professional, physical touch, and getting needed support. Further research with diverse populations in other global communities may extend understanding and acceptance of this potentially future intervention to add quality-of-life care to relatives and other family members. Testing of a soft tissue massage intervention could support evidence for the effectiveness of this intervention and nurses’ referral of caregivers to this intervention for improved quality of life.

Pinar, R., & Afsar, F. (2015). Back massage to decrease state anxiety, cortisol level, blood pressure, heart rate and increase sleep quality in family caregivers of patients with cancer: A randomised controlled trial. Asian Pacific Journal of Cancer Prevention, 16, 8127–8133. 

doi: 10.7314/APJCP.2015.16.18.8127
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Study Purpose:

To study the effectiveness of back massage on anxiety, stress markers, and sleep quality in the caregivers of patients with cancer

Intervention Characteristics/Basic Study Process:

Caregivers were randomized to treatment and control groups. Caregivers in the treatment group rested for 10 minutes in a silent room then were given a 15-minute back massage each evening. The control group rested quietly in a separate silence room. Study measures were obtained at baseline and on day 7. Blood samples were obtained on day 7 for cortisol levels.

Sample Characteristics:

  • N = 44
  • MEAN AGE = 42.31 years (range = 24–60 years)
  • MALES: 36.4%, FEMALES: 63.6%
  • KEY DISEASE CHARACTERISTICS: Not stated
  • OTHER KEY SAMPLE CHARACTERISTICS: Caregivers had secondary school education or less. About 50% were spouses, and the rest were parents of the patient. 

Setting:

  • SITE: Single site  
  • SETTING TYPE: Inpatient  
  • LOCATION: Turkey

Study Design:

Randomized, controlled trial

Measurement Instruments/Methods:

  • State-Trait Anxiety Inventory (STAI)
  • Cortisol levels
  • Blood pressure and heart rate
  • Pittsburgh Sleep Quality Index (PSQI)

Results:

Overall, 100% of the intervention group had moderate levels of anxiety at baseline, and those in the control group had low to high anxiety. Anxiety declined in the intervention group (p = 0.000) and remained essentially stable in the control group. Cortisol levels declined in the intervention group (p = 0.01) and were within reference levels. At baseline, 77.3% of caregivers in both groups had PSQI scores of 5 or greater, indicating poor sleep quality. Sleep quality scores declined in the intervention group (p = 0.000) and increased in the control group (p = 0.003) among those with initial scores greater than 5.

Conclusions:

Daily back massages for caregivers reduced anxiety and improved sleep quality.

Limitations:

  • Small sample (< 100)
  • Baseline sample/group differences of import
  • Risk of bias (no blinding)
  • Risk of bias (no appropriate attentional control condition)
  • Other limitations/explanation: Cortisol levels were within reference levels, so it was not clear how meaningful these changes were. Many patients in the control group had low baseline anxiety levels, and there could have been floor effects in this measure. Measurements were taken immediately after the massage was given, so the duration of effect was not clear.

Nursing Implications:

Back massage is a simple technique that nurses can use to help reduce anxiety and stress for the caregivers of patients with cancer. This is a complementary nursing action that can be used to support caregivers.

Rexilius, S.J., Mundt, C., Erickson Megel, M., & Agrawal, S. (2002). Therapeutic effects of massage therapy and healing touch on caregivers of patients undergoing autologous hematopoietic stem cell transplant. Oncology Nursing Forum, 29, E35–E44.

doi: 10.1188/02.ONF.E35-E44
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Intervention Characteristics/Basic Study Process:

In the control group, one of the researchers visited caregivers for about 10 minutes twice a week for three weeks and asked, “How are you doing?”

In the massage therapy and Healing Touch groups, caregivers were provided with six 30-minute sessions. A certified massage therapist administered massage therapy, and a certified therapist provided Healing Touch treatments.

Sample Characteristics:

  • The sample (N = 36) was comprised of family caregivers of patients undergoing hematopoietic stem cell transplantation.
  • Caregivers did not have an acute health problem.

Setting:

Outpatient oncology clinic

Study Design:

  • The study was a well-designed quasi-experimental trial without randomization (control group [n = 13], massage therapy group [n = 13], Healing Touch group [n = 10]).
  • The sample size was determined by power analysis.

Measurement Instruments/Methods:

  • Subjective Burden Scale
  • Beck Anxiety Inventory
  • Center for Epidemiologic Studies–Depression
  • Multidimensional Fatigue Inventory–20

Results:

  • No significant difference was found in burden.
  • Anxiety scores declined significantly for the massage therapy group only.
  • Although depression scores declined for both treatment groups, only the massage therapy group achieved significance on post-hoc analysis.
  • Significant differences in general fatigue, reduced motivation fatigue, and emotional fatigue were found between the control and massage therapy groups, but no differences were found in physical fatigue and activity.

Limitations:

  • The study had a small sample and no randomization.
  • Special training was needed for the intervention.

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