Paul Manley Clinic London Massage Research
Field, T., Schanberg, S., Kuhn, C., Field, T., Fierro, K., Henteleff, T., Mueller, C., Yando, R., Shaw, S. & Burman, I. (1998). Bulimic adolescents benefit from massage therapy. Adolescence, 33, 555-563.
METHODS: Twenty-four female adolescent bulimic inpatients were randomly assigned to a massage therapy or a standard treatment (control) group.
RESULTS: The massaged patients showed immediate reductions in anxiety and depression (both self-report and behavior observation). In addition, by the last day of the therapy, they had lower depression scores, lower cortisol (stress) levels, higher dopamine levels, and they showed improvement on several other psychological and behavioral measures.
Field, T., Peck, M., Krugman, S., Tuchel, T., Schanberg, S., Kuhn, C., & Burman, I. (1998). Burn injuries benefit from massage therapy. Journal of Burn Care and Rehabilitation, 19, 241-244.
METHODS: Twenty-eight adult patients with burns were randomly assigned before debridement to either a massage therapy group or a standard treatment control group.
RESULTS: State anxiety and cortisol levels decreased, and behavior ratings of state, activity, vocalizations, and anxiety improved after the massage therapy sessions on the first and last days of treatment. Longer-term effects were also significantly greater for the massage therapy group including decreases in depression and anger, and decreased pain on the McGill Pain Questionnaire, Present Pain Intensity Scale, and Visual Analogue Scale. Although the underlying mechanisms are not known, these data suggest that debridement sessions were less painful after the massage therapy sessions due to a reduction in anxiety, and that the clinical course was probably enhanced as a result of a reduction in pain, anger, and depression.
Field, T., Peck, M., Hernandez-Reif, M., Krugman, S., Burman, I., & Ozment-Schenck, L. (2000). Postburn itching, pain, and psychological symptoms are reduced with massage therapy. Journal of Burn Care & Rehabilitation, 21, 189-193.
METHODS: Twenty patients with burn injuries were randomly assigned to a massage therapy or a standard treatment control group during the remodeling phase of wound healing. The massage therapy group received a 30-minute massage with cocoa butter to a closed, moderate-sized scar tissue area twice a week for 5 weeks.
RESULTS: The massage therapy group reported reduced itching, pain, and anxiety and improved mood immediately after the first and last therapy sessions, and their ratings on these measures improved from the first day to the last day of the study.
Hernandez-Reif, M., Field, T., Largie, S., Hart, S., Redzepi, M., Nierenberg, B., & Peck, M. (2001). Childrens’ distress during burn treatment is reduced by massage therapy. Journal of Burn Care and Rehabilitation, 22, 191-195.
METHODS: Before dressing changes, 24 young children (mean age = 2.5 years) hospitalized for severe burns received standard dressing care or massage therapy in addition to standard dressing care. The massage therapy was conducted to body parts that were not burned.
RESULTS: During the dressing change, the children who received massage therapy showed minimal distress behaviors and no increase in movement other than torso movement. In contrast, the children who did not receive massage therapy responded to the dressing change procedure with increased facial grimacing, torso movement, crying, leg movement and reaching out. Nurses also reported greater ease in completing the dressing change procedure for the children in the massage therapy group. These findings suggest that massage therapy attenuates young children's distress responses to aversive medical procedures and facilitates dressing changes.
Hernandez-Reif, M., Field, T., Diego, M., & Fraser, M (2007). Lower Back Pain And Sleep Disturbances Are Reduced Following Massage Therapy. Journal of Bodyworks and Movement Therapies, 11, 141-145.
METHODS: Twenty- four adults with lower back pain were randomly assigned to a massage therapy or a progressive muscle relaxation group. Sessions were 30 minutes long twice a week for five weeks. On the first and last day of the 5-week study, participants completed questionnaires, provided a urine sample and were assessed for range of motion.
RESULTS: By the end of the study, the massage therapy group, as compared to the relaxation group, reported experiencing less pain, depression and anxiety, and improved sleep. They also showed improvement trunk flexion, and their serotonin and dopamine levels were higher.
Parlak Gürol, A., Polat, S. & Akçay, M.N. (2010). Itching, pain, and anxiety levels are reduced with massage therapy in burned adolescents. Journal of Burn Care and Research, 31, 429-432.
METHODS: Adolescents were massaged after admission to a burn unit.
RESULTS: After 5 weeks, massage therapy reduced pain, itching and state anxiety.
Hodgson, N.A., & Lafferty, D. (2012). Reflexology versus Swedish Massage to Reduce Physiologic Stress and Pain and Improve Mood in Nursing Home Residents with Cancer: A Pilot Trial. Evidence-Based Complementary and Alternative Medicine, 2012, 5 pages.
METHODS: Patients diagnosed with solid tumor and following completion of cancer treatments received 20 minutes of Swedish Massage Therapy to the lower extremities, versus 20 minute Reflexology.
RESULTS: Both Reflexology and Swedish Massage resulted in significant declines in salivary cortisol and pain and improvements in mood.
Grealish, L., Lomasney, A., & Whiteman, B. (2000). Foot massage. A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer. Cancer Nursing, 23, 237-243.
METHODS: This article describes the findings of an empirical study on the use of foot massage as a nursing intervention in patients hospitalized with cancer.
RESULTS: In a sample of 87 subjects, a 10-minute foot massage (5 minutes per foot) was found to reduce perceptions of pain, nausea, and relaxation when measured with a visual analog scale.
Stephenson, N.L., Weinrich, S.P., & Tavakoli, A.S. (2000). The effects of foot reflexology on anxiety and pain in patients with breast and lung cancer. Oncology Nursing Forum, 27, 67-72.
METHODS: To test the effects of foot reflexology on anxiety and pain in patients with breast and lung cancer.
RESULTS: Following the foot reflexology intervention, patients with breast and lung cancer experienced a significant decrease in anxiety. One of three pain measures showed that patients with breast cancer experienced a significant decrease in pain.
Wilkie, D.J., Kampbell, J., Cutshall, S., Halabisky, H., Harmon, H., Johnson, L.P., Weinacht, L., & Rake-Marona, M. (2000). Effects of massage on pain intensity, analgesics and quality of life in patients with cancer pain: A pilot study of a randomized clinical trial conducted within hospice care delivery. Hospice Journal, 15, 31-53.
METHODS: This randomized controlled clinical trial examined the effects of massage on perceived pain intensity, prescribed morphine, hospital admissions, and quality of life. Massage interventions consisted of 4, twice-weekly massages. Baseline and outcome measurements were obtained before the 1st and after the 4th massages.
RESULTS: Pain intensity, pulse rate, and respiratory rate were significantly reduced immediately after the massages. At study entry, the massage group reported higher pain intensity which decreased by 42% compared to a 25% reduction in the control group.
Rexilius, S.J., Mundt, C., Erickson Megel, M., & Agrawal, S. (2002). Therapeutic effects of massage therapy and handling touch on caregivers of patients undergoing autologous hematopoietic stem cell transplant. Oncology Nursing Forum, 29, 35-44.
METHODS: This study examined the effects of massage therapy and Healing Touch on anxiety, depression, subjective caregiver burden, and fatigue experienced by caregivers of patients undergoing autologous hematopoietic stem cell transplant.
RESULTS: Results showed significant declines in anxiety scores, depression, general fatigue, reduced motivation fatigue, and emotional fatigue for individuals in the massage therapy group only.
Smith, M.C., Kemp, J., Hemphill, L., & Vojir, C.P. (2002). Outcomes of therapeutic massage for hospitalized cancer patients. Journal of Nursing Scholarship, 34, 257-262.
METHODS: To examine the effects of therapeutic massage on perception of pain, subjective sleep quality, symptom distress, and anxiety in patients hospitalized for treatment of cancer, twenty participants received therapeutic massage and 21 received the control therapy, nurse interaction.
RESULTS: Mean scores for pain, sleep quality, symptom distress, and anxiety improved from baseline for the subjects who received therapeutic massage; only anxiety improved from baseline for participants in the comparison group. Sleep improved only slightly for the participants receiving massage, but it deteriorated significantly for those in the control group.
Forchuk, C., Baruth, P., Prendergast, M., Holliday, R., Bareham, R., Brimner, S., Schulz, V., Chan, Y.C., Yammine, N. (2004). Postoperative arm massage: A support for women with lymph node dissection. Cancer Nursing, 27, 25-33.
METHODS: To evaluate the usefulness of arm massage from a significant other following lymph node dissection surgery, subjects' significant others in the intervention group were first taught, then performed arm massage as a postoperative support measure.
RESULTS: Participants reported a reduction in pain in the immediate postoperative period and better shoulder function. Arm massage decreased pain and discomfort related to surgery, and promoted a sense of closeness and support between subjects and their significant other.
Shin, Y.H., Kim, T.I., Shin, M.S., & Juon, H.S. (2004). Effect of acupressure on nausea and vomiting during chemotherapy cycle for Korean postoperative stomach cancer patients. Cancer Nursing, 27, 267-274.
METHODS: Despite the development of effective antiemetic drugs, nausea and vomiting remain the main side effects associated with cancer chemotherapy. The purpose of this study was to examine the effect of acupressure on emesis control in postoperative gastric cancer patients undergoing chemotherapy. Forty postoperative gastric cancer patients receiving the first cycle of chemotherapy were divided into control and intervention groups. Both groups received regular antiemesis medication; however, the intervention group received acupressure training and was instructed to perform the finger acupressure maneuver for 5 minutes on the point located at 3-finger widths up from the first palmar crease, at least 3 times a day before chemotherapy and mealtimes or based on their needs. Both groups received equally frequent nursing visits and consultations, and reported nausea and vomiting.
RESULTS: Significant differences were noted between intervention and control groups in the severity of nausea and vomiting, the duration of nausea, and frequency of vomiting. This study suggests that acupressure appears to be an effective adjunct maneuver in the course of emesis control.
Soden, K., Vincent, K., Craske, S., Lucas, C., & Ashley, S. (2004). A randomized controlled trial of aromatherapy massage in a hospice setting. Palliate Medicine, 18, 87-92.
METHODS: Research suggests that patients with cancer,particularly in the palliative care setting, are increasingly using aromatherapy and massage. There is good evidence that these therapies may be helpful for anxiety reduction for short periods, but few studies have looked at the longer term effects. This study was designed to compare the effects of four-week courses of aromatherapy massage and massage alone on physical and psychological symptoms in patients with advanced cancer. Forty-two patients were randomly assigned to receive weekly massages with lavender essential oil (aromatherapy group), an inert carrier oil only (massage group) or no intervention.
RESULTS: We were unable to demonstrate any significant long-term benefits of aromatherapy or massage in terms of improving pain control, anxiety or quality of life. Sleep scores improved significantly in both the massage and the combined massage (aromatherapy and massage) groups. There were also statistically significant reductions in depression scores in the massage group.
Billhult, A., Lindholm, C., Gunnarsson, R., Stener-Victorin, E. (2009). The effect of massage on immune function and stress in women with breast cancer--a randomized controlled trial. Autonomic Neuroscience, 150, 111-115.
METHODS: Women, with breast cancer were assigned to a massage or an attention control group.
RESULTS: Massage decreased the deterioration of NK cell activity occurring during radiation therapy and lowered heart rate and systolic blood pressure.
Listing, M., Reisshauer, A., Krohn, M., Voigt, B., Tjahono, G., Becker, J., Klapp, B.F., & Rauchfuss. M. (2009). Massage therapy reduces physical discomfort and improves mood disturbances in women with breast cancer. Psycononcology, 18, 1290-1299.
METHODS: Women with breast cancer were randomized into a massage or a control group. For 5 weeks, bi-weekly 30-min massages were given in the back, head, and neck.
RESULTS: A greater decrease in physical discomfort and group fatigue was noted in the massage group as well as mood disturbance. The effect of massage on mood disturbances was greater when treated continuously by the same therapist.
Post-White, J., Fitzgerald, M., Savik, K., Hooke, M.C., Hannahan, A.B., Sencer, S.F.(2009). Massage therapy for children with cancer. Journal of Pediatric Oncology Nursing, 26, 16-28.
METHODS: Children with cancer received 4 weekly massages alternated with 4 weekly quiet-time control sessions. RESULTS: Massage was more effective than quiet time at reducing heart rate and anxiety in children as well as parent anxiety.
Boone, T. & Cooper, R. (1995). The effect of massage on oxygen consumption at rest. American Journal of Chinese Medicine, 23, 37-41.
METHODS: This study determined the effect of massage on oxygen consumption at rest. Ten healthy, adult males volunteered to serve as subjects. During the Control Session, each subject was placed in the supine position on a massage table to remain motionless for 30 minutes. During the Treatment Session, each subject received a 30-minute sports massage of the lower extremities. Oxygen consumption was measured.
RESULTS: The subjects' oxygen consumption did not change with the massage. Also, there were no significant differences in heart rate, stroke volume, cardiac output, and arteriovenous oxygen difference during the massage. These findings indicate that massaging the lower extremities results in neither an increase nor a decrease in the subjects' expenditure of energy at rest.
Lewis, P., Nichols, E., Mackey, G., Fadol, A., Sloane, L., Villagomez, E., & Liehr, P. (1997). The effect of turning and backrub on mixed venous oxygen saturation in critically ill patients. American Journal of Critical Care, 6, 132-140.
METHODS: A repeated-measures design was used to examine the effect of a change in body position (right or left lateral) and timing of backrub (immediate or delayed) on mixed venous oxygen saturation in 57 surgical ICU patients. Mixed venous oxygen saturation was recorded at 1-minute intervals for 5 minutes in each of three periods: baseline, after turning, and after backrub. Subjects were randomly assigned to body position and timing of backrub. Subjects in the immediate-backrub group were turned and given a 1-minute backrub. Mixed venous oxygen saturation was measured at 1-minute intervals for 5 minutes at two points: after the backrub and then with the patient lying on his side. For subjects in the delayed-backrub group, saturation was measured at 1-minute intervals for 5 minutes at two different points: after the subject was turned to his side and after the backrub.
RESULTS: Both position and timing of backrub had significant effects on mixed venous oxygen saturation across conditions over time. Subjects positioned on their left side had a significantly greater decrease in saturation when the backrub was started. At the end of the backrub, saturation was significantly lower in subjects lying on their left side than in subjects lying on their right side. The pattern of change differed according to the timing of the backrub, and return to baseline levels of saturation after intervention differed according to body position. Two consecutive interventions (change in body position and backrub) caused a greater decrease in mixed venous oxygen saturation than the two interventions separated by a 5-minute equilibration period. Turning to the left side decreased oxygen saturation more than turning to the ride side did. Oxygen saturation returned to clinically acceptable ranges within 5 minutes of the intervention.
Boone, T., Tanner, M., & Radosevich, A. (2001). Effects of a 10-minute back rub on cardiovascular responses in healthy subjects. American Journal of Chinese Medicine. 29, 47-52
METHODS: This study determined the cardiovascular responses to a 10-minute back rub. Twelve healthy, college-age males and females volunteered to participate as subjects. The subjects were assessed for 10 minutes on a massage table lying on one side. During the treatment period, a back rub was administered. Oxygen consumption and cardiac output were measured.
RESULTS: The central and peripheral components of oxygen consumption were changed and cardiac output decreased. These results indicate that the back rub was effective in inducing relaxation.
Delaney, J.P., Leong, K.S., Watkins, A., & Brodie, D. (2002). The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects. Journal of Advanced Nursing, 37, 364-371.
METHODS: This study investigated the effects of myofascial trigger-point massage therapy to the head, neck and shoulder areas on cardiac autonomic tone. A 5-minute cardiac interbeat interval recording, systolic and diastolic blood pressure and subjective self-evaluations of muscle tension and emotional state were taken before and after intervention.
RESULTS: Following myofascial trigger-point massage therapy there was a significant decrease in heart rate, systolic blood pressure and diastolic blood pressure. Analysis of heart rate variability revealed a significant increase in parasympathetic activity following myofascial trigger-point massage therapy. Additionally both muscle tension and emotional state showed significant improvement.
McNamara, M.E., Burnham, D.C., Smith, C., & Carroll, D.L. (2003). The effects of back massage before diagnostic cardiac catheterization. Alternative Therapies in Health Medicine, 9, 50-57.
METHODS: The purpose of this study was to measure the effects of a 20-minute back massage on the physiological and psychological human responses of patients admitted for a diagnostic cardiac catheterization.
RESULTS: There was a significant reduction in systolic blood pressure in the treatment group. In addition, main effects were noted for time for diastolic blood pressure, respiration, total Profile of Mood States score and pain perception in both groups.
Wentworth, L.J., Briese, L.J., Timimi, F.K., Sanvick, C.L., Bartel, D.C., Cutshall, S.M., Tilbury, R.T., Lennon, R., & Bauer, B.A. (2009). Massage therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures. Progress in Cardiovascular Nursing, 24, 155-161.
METHODS: Patients awaiting invasive cardiovascular procedures received 20 minutes massage at least 30 minutes before the procedure.
RESULTS: Pain, anxiety, and tension scores were lower for the massage group than the control group receiving standard care.
Braun, L.A., Stanguts, C., Casanelia, L., Spitzer, O., Paul, E., Vardaxis, N.J., & Rosenfeldt, F. (2012). Massage therapy for cardiac surgery patients-a randomized trial. The Journal of Thoracic and Cardiovascular Surgery, 144, 1453-1459.
METHODS: Elective cardiac surgery patients were randomized to receive massage or rest time at 2 points after surgery.
RESULTS: Massage Therapy produced a significantly greater reduction in pain, anxiety, and muscular tension and increases in relaxation.
Madenci, E., Altindag, O., Koca, I., Yilmaz, M., & Gur, A. (2012). Reliability and efficacy of the new massage technique on the treatment in the patients with carpal tunnel syndrome. Rheumatology International, 32, 3171-3179.
METHODS: CTS patients were divided into two equal groups. In the first group, splint and “Madenci” hand massage technique were applied, and in the second group only splint was applied.
RESULTS: The posttreatment PGA, MDPGA and grip strength scores were significantly improved in Group I compared to Group II.
Field, T., Diego, M., Cullen, C., Hartshorn, K., Gruskin, A., Hernandez-Reif, M., & Sunshine, W. (2004). Carpal tunnel syndrome symptoms are lessened following massage therapy. Journal of Bodywork and Movement Therapies, 8, 9-14.
METHODS: The objective of this study was to determine the effectiveness of massage therapy for relieving the symptoms of Carpal Tunnel Syndrome (CTS). Sixteen adults with CTS symptoms were randomized to a 4-week massage therapy or control group. Participants in the massage therapy group were taught a self-massage routine that was done daily at home. They were also massaged once a week by a therapist. The participants’ diagnosis was based on a nerve conduction velocity test, the Phalen test, and the Tinel sign test performed by a physician. The participants were also given the State Trait Anxiety Inventory (STAI), the Profile of Mood States (POMS), a visual analog scale for pain and a test of grip strength.
RESULTS: Participants in the massage therapy group improved on median peak latency and grip strength. They also experienced lower levels of perceived pain, anxiety, and depressed mood.
Hernandez-Reif, M., Field, T., Largie, S., Diego, M., Manigat, N., Seonanes, J., Bornstein, J. & Waldman, R. (2005). Cerebral Palsy symptoms in children decreased following massage therapy. Journal of Early Child Development and Care, 175, 445-456.
METHODS: Twenty young children (M age = 32 months) with Cerebral Palsy (CP) recruited from early intervention programs received 30-minutes of massage or reading twice weekly for 12 weeks.
RESULTS: The children receiving massage therapy showed fewer physical symptoms including reduced spasticity, less rigid muscle tone overall and in the arms and improved fine and gross motor functioning. In addition, the massage group had improved cognition, social and dressing scores on the Developmental Profile and they showed more positive facial expressions and less limb activity during face-to-face play interactions.
Field, T, Sunshine, W., Hernandez-Reif, M., Quintino, O., Schanberg, S., Kuhn, C., & Burman, I. (1997). Chronic fatigue syndrome: Massage therapy effects on depression and somatic symptoms in chronic fatigue syndrome. Journal of Chronic Fatigue Syndrome, 3, 43-51.
METHODS: Twenty chronic fatigue syndrome subjects were randomly assigned to a massage therapy or a SHAM TENS (transcutaneous electrical stimulation) control group.
RESULTS: Immediately following the massage therapy versus SHAM TENS on the first and last days of the study the massage therapy group had lower depression and anxiety scores and lower cortisol levels. Longer-term effects (last day versus first day) suggested that the massage therapy versus the SHAM TENS group had lower depression, emotional distress and somatic symptom scores, more hours of sleep and lower epinephrine and cortisol levels.
Wheeden, A., Scafidi, F.A., Field, T., Ironson, G., Valdeon, C. & Bandstra, E. (1993). Massage effects on cocaine-exposed preterm neonates. Journal of Developmental and Behavioral Pediatrics, 14, 318-322.
METHODS: Thirty cocaine-exposed preterm neonates (mean gestational age 30 weeks, mean birth weight = 1212 g, mean intensive care unit duration = 18 days) were randomly assigned to a massage therapy or a control group as soon as they were considered medically stable. Group assignment was based on a random stratification of gestational age, birth weight, intensive care unit duration, and entry weight into the study. The treatment group (N=15) received massages for three 15-minute periods over 3 consecutive hours for a 10-day period.
RESULTS: Findings suggested that the massaged infants (1) averaged 28% greater weight gain per day (33 vs 26 g) although the groups did not differ on intake (calories or volume), (2) showed significantly fewer postnatal complications and stress behaviors than the control infants, and (3) demonstrated more mature motor behaviors on the Brazelton examination at the end of the 10-day study period.
Cigales, M., Field, T., Lundy, B., Cuadra, A., Hart, S. (1997). Massage enhances recovery from habituation in normal infants. Infant Behavior and Development, 20, 29-34.
METHODS: Four-month-old infants were given either 8 minutes of massage, play, or no stimulation prior to an audiovisual habituation task.
RESULTS: Infants who received massage showed response recovery from habituation during test trials, whereas those in the other two conditions did not.
Hart, S., Field, T., Hernandez-Reif, M., & Lundy, B. (1998). Preschoolers’cognitive performance improves following massage. Early Child Development & Care, 143, 59-64.
METHODS: Preschoolers (M age = 4 years, 4 months) were given WPPSI subtests, including Block Design, Animal Pegs and Mazes, before and after receiving a 15-minute massage or spending 15-minutes reading stories with an experimenter.
RESULTS: Performance on the Block Design improved following massage and accuracy was greater on the Animal Pegs in the massage group.
Bishop, E., McKinnon, E., Weir, E., & Brown, D.W. (2003). Reflexology in the management of encopresis and chronic constipation. Paediatric Nursing., 15, 20-21.
METHODS: This study investigated the efficacy of treating patients with encopresis and chronic constipation with reflexology. An observational study was carried out of 50 children between three and 14 years of age who had a diagnosis of encopresis/chronic constipation. The children received six sessions of 30-minutes of reflexology to their feet. With the help of their parents they completed questionnaires on bowel movements and soiling patterns before, during and after the treatment. A further questionnaire was completed by parents pre and post treatment on their attitude towards reflexology. Forty-eight of the children completed the sessions.
RESULTS: The number of bowel movements increased and the incidence of soiling decreased.
Lämås, K., Lindholm, L., Stenlund, H., Engström, B., & Jacobsson, C. (2009). Effects of abdominal massage in management of constipation: A randomized controlled trial. International Journal of Nursing Students, 46, 759-79.
METHODS: People with constipation were randomized to an abdominal massage group in addition to an earlier prescribed laxative or control group receiving only laxatives.
RESULTS: Abdominal massage significantly decreased severity of gastrointestinal symptoms, constipation syndrome and abdominal pain syndrome. The massage group also had increased bowel movements.
Hernandez-Reif, M., Field, T., Krasnegor, J., Martinez, E., Schwartzman, M. & Mavunda, K. (1999). Children with cystic fibrosis benefit from massage therapy. Journal of Pediatric Psychology, 24, 175-181.
METHODS: Parents massaged their children with cystic fibrosis to reduce anxiety and their children’s anxiety and to improve the children's mood and peak air flow readings. Twenty children (5-12 years old) with cystic fibrosis and their parents were randomly assigned to a massage therapy or a reading control group. Parents in the treatment group were instructed and asked to conduct a 20-minute child massage every night at bedtime for one month. Parents in the reading control group were instructed to read for 20 minutes a night with their child for one month. On days 1 and 30, the parents and children answered questions relating to present anxiety levels and the children answered questions relating to mood, and their peak air flow was measured.
RESULTS: Following the first and last massage session, the children and parents reported reduced anxiety. Mood and peak air flow readings also improved for the children in the massage therapy group.