Effect of Massage Therapy on Aggression in a Psychiatric Inpatient Unit
Condition: Psychiatric &or Mood Disorder
MeSH terms: Mood Disorders; Aggression
Study type: Interventional

Summary: 
      The purpose of this study is to investigate whether relaxation massage therapy is effective
      in reducing the levels of arousal and aggression on a young adult inpatient unit. It is
      hypothesised that relaxation massage therapy will lead to a lower incidence of violence and
      aggression on the ward via a reduction in the level of arousal and anxiety among inpatients.
    

Detailed description: 
      Patient aggression and agitation on psychiatric inpatient wards poses a significant problem
      for both staff and patients, and impairs the therapeutic environment of the ward. Relaxation
      massage therapy has previously been shown to reduce the level of arousal, stress, anxiety and
      aggression in adolescents/young adults with various psychiatric disorders including anxiety,
      depression, conduct disorder and bulimia. This project investigates whether relaxation
      massage therapy is an effective intervention treatment for the management of arousal and
      aggression on a young adult inpatient ward.

      Two treatment conditions will be assessed at different times on the ward; a) standard
      (control) treatment as per usual and b) relaxation massage therapy intervention treatment in
      addition to the standard treatment. Each treatment condition will be implemented for a
      six-week period. Depending on admission rate, we estimate there will be approximately 50
      participants in each treatment group. The massage therapy intervention treatment will consist
      of daily 20-minute, fully clothed, seated relaxation massage sessions, offered to all
      consenting patients during their period of hospitalization. We aim to determine whether
      relaxation massage therapy significantly reduces: i) the level of arousal, stress, anxiety,
      hostility and aggression in psychiatric inpatients; ii) the frequency and/or severity of
      aggressive incidents on the ward; iii) the need for sedating medication; iv) the need for
      patient seclusion and/or restraint; v) the mean duration of hospitalization and vi) the
      amount of sick leave taken by staff and the associated costs of running the ward. This will
      be assessed by pre- and post-massage therapy measures of heart rate and salivary cortisol
      levels; and staff and patient ratings of anxiety, hostility and aggression. The nature,
      frequency and severity of aggressive incidents on the ward, as well as the use of coercive
      measures during each treatment condition, will be assessed using the "Staff Observation
      Aggression Scale-Revised" (SOAS-R). Staff and patient perception of the atmosphere of the
      ward during each treatment condition will also be assessed using the "Ward Atmosphere Scale".

      It is hypothesized that relaxation massage therapy will lead to a lower incidence of violence
      and aggression on the ward via a reduction in the level of arousal, stress and/or anxiety
      among inpatients. It is further hypothesized that this will reduce the level of risk for both
      staff and patients and improve the therapeutic atmosphere of the ward. We also hypothesise
      that a reduction in aggressive incidents on the ward will be associated with a shorter mean
      duration of hospitalisation.
    

Intervention name(s): Massage therapy
Intervention type(s): Procedure
Intervention description(s): A qualified massage therapist will administer a 20-minute standard massage procedure with the client sitting fully clothed in a special massage chair. The massage therapy session will consist of ; 1) long, broad stroking with light-moderate pressure to the back, compression to the back (parallel to spine) from the shoulders to base of spine, trapezius squeeze, finger pressure on the shoulder; 2) arms dropped to the side with arms kneaded from shoulder to lower arm and pressing down on upper and lower arms; 3) entire hands massaged and pulling of fingers, light kneading to area of cervical vertebrae, pressing down on trapezius with finger pressure and squeezing continuing down the arms.
Allocation: Non-Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Aggression; Massage; Stress; Psychiatric inpatient