Title by Presenter Name

Questions?

Establishing an Integrative Care Center

Dr. Brent BauerDr. Adam Perlman

Thursday, October 4th

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From CAM to Integrative Medicine at Mayo Clinic

Research Informing Practice and Improving CareBrent A. Bauer MD

Director, Complementary and Integrative Medicine Program

Mayo ClinicDepartment of Medicine

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Decreased

Massage Therapy – Mayo ClinicPilot Trial

58 cardiac surgery patients

Cutshall, Comp. Therap.Clin. Practice, 2009

Pain Anxiety Tension

Massage therapy

quiet relaxationvs

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Massage Therapy after CV Surgery10

8

6

4

2

0

Before After

VAS

Anxiety Level

Control group (n=28)10

8

6

4

2

0

Before After

Massage group (n=30)

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Massage Therapy after CV Surgery10

8

6

4

2

0

Before After

VAS

Pain level

Control group (n=28)10

8

6

4

2

0

Before After

Massage group (n=30)

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Massage Therapy – Mayo ClinicRandomized – Controlled Trial 113 cardiac surgery patients MT therapy days 2,4 vs. quiet relaxation Decreased pain P<0.001 Decreased anxiety P<0.001 Decreased tension P<0.001 Increased relaxation P<0.001

Bauer, Comp. Therap. Clin. Practice, 2010

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Massage Therapy at Mayo ClinicOther Studies MT for colo-rectal surgery patients

2009 MT prior to cardiac interventions

2009 MT for thoracic surgery patients

2011 MT for breast cancer surgery pts

2012 MT for cardiologists and nurses

2010 MT for cardiac ultrasonographers

2011 MT for in-patient nurses 2012

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Massage Therapy at Mayo ClinicThe Impact Massage therapy now routine at MC

Domino effect Small investment > “snowball” returns

48 hospitals in US 7 international hospitals

Australia, Austria, China, Ireland, Switzerland, Turkey

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Massage Therapy at Mayo ClinicThe Vision

Massage therapy routinely available to all

Continue to use the Mayo experience to transform

health care in the U.S. and around the world

Hospitalized patients at Mayo Clinic

Family members Staff

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Questionsbauer.brent@mayo.edu

Bibliography Effect of massage therapy for postsurgical mastectomy

recipients. Drackley NL, Degnim AC, Jakub JW, Cutshall SM, Thomley BS, Brodt JK, Vanderlei LK, Case JK, Bungum LD, Cha SS, Bauer BA, Boughey JC. Clin J Oncol Nurs. 2012 Apr;16(2):121-4. PMID:22459520

Feasibility and effectiveness of massage therapy for symptom relief in cardiac catheter laboratory staff: a pilot study. Keller SR, Engen DJ, Bauer BA, Holmes DR Jr, Rihal CS, Lennon RJ, Loehrer LL, Wahner-Roedler DL. Complement Ther Clin Pract. 2012 Feb;18(1):4-9. Epub 2011 Sep 23. PMID:22196566

Effect of massage on pain management for thoracic surgery patients. Dion L, Rodgers N, Cutshall SM, Cordes ME, Bauer B, Cassivi SD, Cha S. Int J Ther Massage Bodywork. 2011;4(2):2-6. Epub 2011 Jun 29. PMID:21847428

Massage therapy after cardiac surgery. Wang AT, Sundt TM 3rd, Cutshall SM, Bauer BA. Semin Thorac Cardiovasc Surg. 2010 Autumn;22(3):225-9. Review. PMID:21167456

The effect of chair massage on muscular discomfort in cardiac sonographers: a pilot study. Engen DJ, Wahner-Roedler DL, Nadolny AM, Persinger CM, Oh JK, Spittell PC, Loehrer LL, Cha SS, Bauer BA. BMC Complement Altern Med. 2010 Sep 16;10:50. PMID:20846441 3031090-11

Bibliography Effect of massage therapy on pain, anxiety, and tension in

cardiac surgical patients: a pilot study. Cutshall SM, Wentworth LJ, Engen D, Sundt TM, Kelly RF, Bauer BA. Complement Ther Clin Pract. 2010 May;16(2):92-5. Epub 2009 Nov 14. PMID:20347840

Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study. Bauer BA, Cutshall SM, Wentworth LJ, Engen D, Messner PK, Wood CM, Brekke KM, Kelly RF, Sundt TM 3rd. Complement Ther Clin Pract. 2010 May;16(2):70-5. Epub 2009 Jul 14. PMID:20347836

Massage therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures. Wentworth LJ, Briese LJ, Timimi FK, Sanvick CL, Bartel DC, Cutshall SM, Tilbury RT, Lennon R, Bauer BA. Prog Cardiovasc Nurs. 2009 Dec;24(4):155-61. PMID:20002340

Value of massage therapy for patients in a breast clinic. Pruthi S, Degnim AC, Bauer BA, DePompolo RW, Nayar V. Clin J Oncol Nurs. 2009 Aug;13(4):422-5. PMID:19648098

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Title by Presenter Name

Questions?

American Massage Therapy Association

October 4, 2012

Adam Perlman, MD, MPHExecutive Director

Duke Integrative Medicine

At the Beginning

New Jersey• Siegler Center for

Integrative Medicine• Services Offered• Who do you hire• Research

Pilot Study (2006)• Randomized controlled trial; n=68

– Massage vs. wait list• Intervention: Whole body, Swedish massage for 8 weeks

– Standard techniques of petrissage, effleurage, and tapotement– 60 min twice weekly x 4 weeks– 60 min once weekly x 4 weeks

• Outcomes: function (WOMAC), pain (VAS), ROM, 50-ft walk• Results: well tolerated, decreased pain, and improved function• Effects persisted for weeks after cessation of massage

1. Archives of Internal Med. 2006;166:2533-2538

UMDNJ• Serving the underserved• Institute for Therapeutic

Massage• Research

Dose-finding study (2009-2011)• 2-Year study to define the ‘optimal practical’ dose of

massage for OA of the knee• Designed to inform a future, more definitive trial• Randomized, wait list-controlled, clinical trial• 5-arm trial

– 4 different ‘doses’ of standardized, whole body Swedish – wait list control

• Supported by NCCAM grant R01 AT004623• Trial Registration: clinicaltrials.gov NCT00970008

Dose-finding study - Design• Four distinct ‘doses’

– 1. 30 min/week x 8 weeks (240 min total)– 2. 30 min biweekly x 4 weeks, 30 min weekly x 4 weeks (360

min total)– 3. 60 min/week x 8 weeks (480 min total)– 4. 60 min biweekly x 4 weeks, 60 min weekly x 4 weeks (720

min total)– 5. Usual Care (no massage)

• Included: – Adults with radiographically confirmed OA of the knee– Self-reported pain between 4-9 on VAS

• Excluded: – RA, fibromyalgia, intraarticular injections, knee replacement

• Assessed: baseline, 8-, 16-, and 24-weeks• Outcomes: WOMAC, VAS, ROM, 50-ft walk

Manualization• Goal: to produce a study protocol that was tailored to subjects with

OA of the knee, while respectful of the individualized nature of massage therapy

• How to standardize an inherently individualized intervention?– CAM/nonphamacological research dilemma

• 2-month process– Massage therapists from pilot study– Investigative team– Massage scientists

• Constraints– Standard techniques– Reproducibility– Flexible for individual subject variability

Manualized protocols

Results•Recruitment completed two months ahead of schedule

– Free massages…– And more free massages!

•125 enrolled– 119 completed 8-week assessments– 115 completed entire trial– Intervention delivered: 11/2009 – 10/2010

Conclusions• Winner: 60-min once weekly• ‘Optimal-practical’= best bang for the buck

– producing the greatest ratio of desired effect compared to costs – costs = time, labor, and convenience

• Reinforced results of pilot study• Dose used for current study -

Duke• Shifting the model

o Access• Forging relationship

o DCI• Research

Current Study • Phase 2b Efficacy Trial

– Using 60-min once weekly dose– Massage vs. light touch vs. wait list– 52-week follow-up– N=219 at three sites: Duke, UMDNJ, Yale– Cost-effectiveness– Biomarkers

• ‘Unanticipated Benefits’– Modeled on studies by Cherkin et al. (Seattle)– Qualitative study– Participants of dose-finding study– ‘What else?’

The good, the bad, and the ugly.