Rajiv Gandhi University of Health Sciences, Karnataka s21

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore.

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL

“AN EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF MASSAGE THERAPY AMONG THE DEPRESSIVE CLIENTS ADMITTED IN SELECTED PSYCHIATRIC REHABILITATION CENTRES IN BANGALORE CITY.”

SUBMITTED BY,

Mrs ABANTIKA BAIDYA,

1ST YEAR M.Sc. NURSING,

ROYAL COLLEGE OF NURSING,

7TH MAIN, 1ST BLOCK, UTTARAHALLI,

BANGALORE -61.

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

PROFORMA SYNOSPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / Name of the Candidate and Address / Mrs ABANTIKA BAIDYA,
1ST YEAR M.Sc. NURSING,
ROYAL COLLEGE OF NURSING,
7TH MAIN ROAD, 1ST BLOCK, UTTARAHALLI,
BANGALORE- 560 061.
2. / Name of the Institution / Royal College of Nursing, Bangalore.
3. / Course of study / 1st Year MSc. Nursing, Psychiatric Nursing.
4. / Date of admission to course / 01-06-2010.
5. / Title of the Topic:
“An Experimental Study to Assess The Effectiveness of Massage Therapy Among The Depressive Clients Admitted in Selected Psychiatric Rehabilitation Centres in Bangalore City”.
6. / Brief resume of the intended work:
6.1 Need for the study
6.2 Review of literature
6.3 Objectives of the study
6.4 Operational definitions
6.5 Hypothesis of the study
6.6 Assumptions
6.7 Delimitations of the study
6.8 Pilot study
6.9 Variables / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7. / Materials and methods: 7.1 Source of data- Data will be collected from clients with depression in selected psychiatric rehabilitation centres in Bangalore.
7.2 Methods of data collection- Beck Depression Inventory Scale.
7.3 Does the study require any interventions or investigation to the patients or other human being or animals? Yes.
7.4 Has ethical clearance been obtained from your institution?
Yes, ethical committee’s report is here with enclosed.
8. / List of References / Enclosed

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION

“Movement is a Medicine for Creating Change in a Person’s Physical, Emotional & Mental Status.”

-Carol Welch

Touch conveys a sense of caring, an important component in the healing relationship. It is the core ingredient of massage and combines science and art. If touch is applied as massage, it is a "hands-on" treatment in which a therapist manipulates muscles and other soft tissues of the body to improve health and well-being.1

Massage has been practiced as a healing therapy for centuries in nearly every culture around the world.2 It stimulates the body to release endorphins which are natural pain-killing and mood-lifting hormones. It helps relieve muscle tension, reduce stress, and evoke feelings of calmness. Although massage affects the body as a whole, it particularly influences the activity of the musculoskeletal, circulatory, lymphatic, and nervous systems.3

Therapy or treatment is the attempted remediation of a health problem, usually following a diagnosis. Massage therapy is “a profession in which the practitioner applies manual techniques, and may apply adjunctive therapies, with the intention of positively affecting the health and well-being of the client”. Massage therapy refers to the application of various techniques to the muscular structure and soft tissues of the body that include applying fixed or movable pressure, holding, vibration, rocking, friction, kneading and compression using primarily the hands, although massage therapists do use other areas of the body, such as the forearms, elbows or feet. In fact, massage therapy positively influences the overall health and well-being of the client.

Despite the growing popularity of massage therapy, there is inconsistent empirical support for its effectiveness on depression.4 Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. The concepts of depression may differ according to the individual’s state of contexts and interpretations. Depression can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people to come out from depression. Symptoms of depression can be observed as: Low self-esteem is common with depression. So are sudden bursts of anger and lack of pleasure from activities that normally make you happy, including sex.5

To reduce depression, massage therapy is just one of many tools that fall in to the alternative medicine category. The amount of relief provided by massage therapy is different for every individual. Even if massage only helps to relax for a short period of time, it can also be applied for the treatment of depression.6

6.1 NEED FOR STUDY

“Concern should drive us in to action, not into a depression.”
- Karen Horney

Depression is a worldwide significant public health concern and has been ranked as one of the illnesses having the greatest burden for individuals, families, and society. Depression accounts for $14.4 billion annually of health care spending, lost productivity, and premature death.7 As well, depression is related to increased morbidity and mortality from medical conditions and decreased quality of life among many other negative consequences.8

Depression is one of the most common mental disorders affecting 340 million people in the world today.9 The World Health Organisation (WHO) has predicted that by 2020, depression will be the second biggest health problem world-wide and leading cause of disability and death world-wide for all ages, both sexes.10

The prevalence of psychiatric disorders is reported to differ between countries and within countries, across various ethnicities. Most studies on depression are from the developed world and there are few studies from developing countries. The prevalence of depression in a population based study conducted in approx 1 in 18 or 5.30% or 14.4 million people in USA, 7.9-8.6% of adults will have major depression during their lifetime in Canada, 1 in 5 older people living in the community and 2 in 5 living in care homes in Britain, urban Pakistan was 45.9%,11 while in rural Bangladesh, it was reported to be 29%12 and in a peri-urban clinic based study in Uganda, it was reported to be 6.1%.13

Earlier Indian studies have reported prevalence rates of depression that vary from 21–83% in primary care practices. The study on depression shows that among urban south Indians, the prevalence rate was 15.1%. Age, female gender and lower socio-economic status are some of the factors associated with depression in this population.6

In a recent study of both Indian and Western patients with depression it was found that 62% out of the Indian patients suffered from guilt as compared with 84% of the Western patients14. Studies conducted in the 1960s and 1970s reported a low prevalence (varying between 5.3% and 26.7%) of guilt feelings in Indian patients with depression. Carstairs & Kapur (1976), in their survey of a rural community in Karnataka, India, found that the rate of depression was 30.0 per 100015; reported that the rate of depression in a village in West Bengal rose from 37.7 per 1000 to 53.3 per 1000 after an interval of 10 years16. Another study conducted in Bangalore looked at the prevalence of depression in the college-age population (mean age 18.2 years). This population showed a 20.7% prevalence of depression (BDI ≥ 16), which is remarkably similar to the prevalence observed in Chinese-American individuals17. Perhaps most significant to this study was the finding that 25% of men in the Bangalore study were depressed, but only 18% of women were depressed.18

A study was conducted at University of Miami Medical School, Florida, USA, to assess the effectiveness of massage for children and adolescent suffering from stress-related disorders. A 30-minute back massage was given daily for a 5-day period to 52 children and adolescent who were hospitalized as suffering from depression and adjustment disorders. Subjective assessments were made by the children and adolescent themselves and by the nurses based upon perceived anxiety levels, sleep patterns and the willingness of the child and adolescent to be co-operative. Objective analyses were also made by analyzing stress hormone levels in the both the urine and saliva. The results were then compared to a control group who were shown relaxing videotapes for 30 minutes instead of massage therapy. The results of the study revealed that the children receiving a 30 minute massage were less depressed or anxious and had lower saliva cortisol levels after the massage. The study was concluded that massage therapy offers real benefits for adolescence suffering from depression and adjustment disorders.19

The researcher had an experience regarding the importance of massage therapy from researcher’s school mate who failed in the entrance examination. The classmate had undergone severe depression and was on treatment under a psychiatric specialist. Although the girl had taken a number of anti-depressant drugs but it was observed that those drugs started showing the side effects rather than improvement. Later a neighbour who was indigenous in medicine had suggested for massage therapy to treat the condition and they tried it. There was a notificable change in the condition within one month and the girl started to mingle with the family members. This made the researcher to conduct a study regarding the effectiveness of massage therapy among depressive patients to avoid the complications of anti-depressant drugs and to avoid such incidence later.

6.2 REVIEW OF LITERATURE

“A Literature review is a written summary of the state of existing knowledge on a research problem. The task of reviewing research literature involved the identification, selection, critical analysis and written description of existing information on a topic”.

A study was conducted in Mental Health Foundation at Greenwich Park, London to reduce the intensity of anxiety and depressive symptoms and assist in stress management. Only two randomised controlled trials of the mental health benefits of massage have been carried out. Among that the first grouped depressed children and adolescents either received massage over five days or viewed relaxing videotapes and in the second grouped depressed adolescent were randomly assigned to massage therapy or relaxation therapy over a five-week period. The result showed that in the first group those participants who received massage improved more on depressed mood and anxiety and in second group those who received massage showed a reduction in depression. There is some evidence that massage is beneficial in reducing anxiety, depression and stress.20

A meta-analysis of randomized controlled trials (RCTs) of massage therapy in depressed people was conducted using published studies from PubMed, EMBASE, PsycINFO, and CINAHL electronic database from inception until July 2008. 17 studies were included which contains 786 persons from 246 retrieved references except infants or pregnant women. Two reviewers assessed quality indicators by Jadad scale. Seventeen RCTs were of moderate quality, with a mean quality score of 6.4 (SD = 0.85). The pooled standardized mean difference in fixed- and random-effects models were 0.76 (95% CI, 0.61-0.91) and 0.73 (95% CI, 0.52-0.93), respectively. Both indicated significant effectiveness in the treatment group compared with the control group. Results showed positive effect of massage therapy on depressed people. So the study was concluded that massage therapy is significantly associated with alleviated depressive symptoms.21

A non-equivalent control group pretest-posttest quasi-experimental study was conducted in a nursing home, Korea to examine the effectiveness of foot reflexion massage on sleep disturbance, depression disorder, and the physiological index of the elderly. The study included 50 elderly people, resided in two different nursing homes in the same region. An experimental group and a control group were organized with 25 subjects respectively, and foot reflexion massage was provided for 12 sessions, 30 minutes per session. The method of data analysis included chi2-test, t-test, paired t-test, and ANCOVA, using the SPSS program package. The result showed that the experimental group improved sleep quality more than the control group and the experimental group had less depression disorder than the control group. The study concludes that foot reflexion massage is necessary to give as a successful nursing intervention to elderly who undergo a change in sleep, and suffer from a depression disorder due to deterioration in sleep.22

A study was conducted in USA by meta-analysis that used random assignment to test the effectiveness of massage therapy (MT). Mean effect sizes were calculated from 37 studies for 9 dependent variables. Single applications of MT reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level. Study shows that reductions of trait anxiety and depression were MT's largest effects, with a course of treatment providing benefits similar in magnitude to those of psychotherapy. The limitations of a medical model of MT are discussed, and it is proposed that new MT theories and research use a psychotherapy perspective.23

A study was conducted in Germany on the efficacy of Slow Stroke Massage in depression. The study investigated the antidepressant effects of an one hour lasting, relaxing, very sensitive soft treatment (Slow Stroke Massage) in a double controlled study comparing massage with a control condition and also comparing effects in depressed patients vs. healthy subjects. The treatment was repeated 5 times within intervals of 2-3 days on 32 acutely depressed patients. The pre-post-differences in various dimensions were significantly greater during massage than during the control condition. So the Study reported that slow Stroke Massage can be used effectively and safely as a complimentary therapeutic strategy in depressed patients.24

A study was conducted at a comprehensive community mental health centre in Southern Maine in USA to identify the effectiveness of the integration of massage and energy-based therapies with psychotherapy. The sample consisted of 20 women and 5 men, with mean age of 42 years and a mean history of 7.4 years of mental health treatment. No controlled pilot study was conducted by using interview data before and self-report instruments after completing a complimentary therapy like massage, acupuncture, reiki, and healing touch accompanying ongoing psychotherapy. The mean number of sessions was five. The result of the study was measured by an investigator-generated instrument with Likert-scale. The result reported that there was high levels of satisfaction with the service and significant levels of perceived (self rated) change on each outcome measure. The study conclude that the integration of complementary therapies into community mental health practice may hold promise of enhancing mental health outcomes and improving quality of life for long-term users of mental health services.25