This article examines the key factors that contributed
to the successful integration of a massage therapy clinic into a rehabilitation
hospital setting.
by Anna Kania
Over the last decade, there has been a consistent
increase in the utilization of complementary and
alternative medicine (CAM) and therapies by the North
American public for various health-related reasons. As
such, a great degree of interest has been stimulated
among policy makers, researchers and conventional
biomedical practitioners about the various aspects of
CAM, and how integration and/or collaboration of CAM
therapies and biomedicine can occur.
The establishment of a massage clinic in a hospital
setting, and the presence of massage therapy as a member
of a multidisciplinary team, supports the potential for
integration of CAM therapy into a conventional
health-care setting. This article aims to examine and
highlight the key factors that contributed to the
successful integration of a massage therapy clinic into
a rehabilitation hospital setting.
The Setting
St. John’s Rehabilitation Hospital is a medium-sized
teaching hospital in Ontario, Canada, that provides a
specialized, multidisciplinary, patient-centered
approach for inpatients and outpatients recovering from
various injuries and surgeries, such as burns,
amputations, complex neurological and orthopedic
conditions, and organ transplants. It is also a leader
in burn rehabilitation as the only site in Canada with a
burn rehabilitation program.
 Recognizing new trends and developments in
health-care services, the management team of St. John’s
appreciated that patients also have become consumers of
health-care services, and that patient satisfaction is
an important measure when analyzing the success of a
program. As a result, in 1999, the management team
responded to patients’ requests for the presence of, and
on-site access to, CAM therapies by establishing four
clinics: chiropractic, massage therapy, chiropody and
acupuncture.
These four CAM therapies were selected based on a
systemic approach, which outlined key criteria that need
to be satisfied for approval to practice at St. John’s
Rehab Hospital. Three of the four were associated with
recognized teaching facilities. Initially, massage
therapy specifically was introduced for an outpatient
who reported that massage therapy was one of the key
therapeutic interventions that provided him with pain
relief. As treatment of various outpatients demonstrated
the benefits and therapeutic outcomes of the massage
intervention, the massage clinic at St. John’s
solidified its presence. It has grown ever since its
establishment in 1999.
The massage clinic is formally integrated into the
Back on Track program, which is an outpatient
rehabilitation program providing
specialized, multidisciplinary therapy to amputees, burn
survivors and individuals who have sustained complex
traumas at work or in motor vehicle accidents. Massage
therapy has become established as one of the key
disciplines in the multidisciplinary team approach
offered through this program. Although the majority of
the clients treated at the clinic are outpatients
enrolled in the Back on Track program, the clinic is a
multifunctional center and massage therapy is available
to all inpatients and outpatients of the hospital, staff
and community clients. Due to the broad range of
patients and clients treated by St. John’s massage
therapists, the types of therapy provided ranged from
relaxation to specialized work for various conditions
where symptoms—such as swelling, phantom pain, burn scar
tissue, myofascial pain syndromes, psycho-somatic
syndromes, and general soft tissue
restrictions—presented.
The establishment of a massage clinic in a hospital
setting, and the integration of massage therapy into a
multidisciplinary team environment as a key member,
supports the potential for integration of CAM therapies
into a hospital setting. It is important to emphasize
that the success of the massage clinic at St. John’s
Rehab Hospital occurred due to a variety of unique
factors, opportunities, vision, support of the hospital
staff (clinical and managerial) and perseverance of a
number of individuals—most notably the massage
therapists.
Keys To Success
Once the approval is granted by senior management for
the presence of a clinical discipline in a hospital, the
real work begins. Establishing a viable massage practice
and becoming a member of a multidisciplinary team
requires commitment, vision and engagement in various
activities.
A wide range of factors needs to be considered,
analyzed and managed on an ongoing basis. From the
business of running a clinic (which involves marketing,
revenue, growth projections) to clinical and treatment
issues, a number of fundamental ingredients became
evident: education (of staff, patients and clients),
clinical skills, defining the role of massage
therapists, hospital involvement, professional
activities and business skills.
Education
Massage therapy educational initiatives were of high
importance, especially in the early stages of massage
practice, as many clinicians and physicians expressed
uncertainty about the integration of massage therapy.
(Most related it to a spa service and were unfamiliar
with massage practice in a hospital setting.)
Staff at St. John’s Rehab Hospital was introduced to
the regulation and licensing of massage therapy, as well
as the education of massage therapists. The specific
role of massage therapy in a multidisciplinary context
also was described. They participated in educational
initiatives like workshops, in-service days, open
houses, awareness week activities, newsletters,
brochures and one-on-one conversations in which massage
therapists were able to speak to patient-related
questions. The therapists also discussed the benefits of
massage, as well as conditions for which it is
contraindicated.
A key tool utilized for educational purposes is
published research about the therapeutic benefits of
massage therapy. Articles about massage therapy related
to specific conditions or symptoms can be included with
patient treatment plans, to third-party payers or to
clinicians to support the massage intervention.
Education and knowledge are a very powerful tools. As
massage therapy research continues to grow and evolve,
this needs to be highlighted and shared with the various
disciplines massage therapists interact
with. Various educational initiatives continue on a
monthly basis to keep staff, patients and the community
abreast of current information regarding massage
therapy.
Excellent Clinical Skills
Excellent clinical skills— including assessment,
professional expression of a clinical impression, clear
identification of short- and long-term goals, the
ability to develop an appropriate treatment plan, and
determining the particular modalities appropriate to
specific tissues or conditions—are crucial for
establishing the clinical competency of the therapist.
Furthermore, consistent reference to research literature
to support clinical applications and use of validated
outcome measures are key aspects of outcome-based
practice. Developing practices that incorporate standard
outcome measures and research evidence are highly
important. They enable clinicians and physicians to
identify the therapeutic outcomes and benefits of the
therapeutic/massage intervention. In addition, there are
specific protocols, procedures and medical language
utilized by clinicians and physicians in the hospital
setting that massage therapists need to adopt in order
to be an inclusive clinical member.
Defining The Role Of Massage Therapy In A
Multidisciplinary Team
The multidisciplinary health-care model is commonly
used in hospital settings. The goal is to ensure that
all of the patient’s needs—from physical to
psychological—are addressed. A hospital team generally
consists of physicians, nurses, a physical therapist and
an occupational therapist (although there are variations
depending on the specific needs of the patient and the
organization). Other health-care disciplines, such as
social work, psychology, speech pathology and nutrition,
are brought on board as indicated. The entire spectrum
of one’s needs appear to be considered with these
various health-care disciplines involved.
All aspects of the patient’s care need to be
considered in order to avoid duplication of services.
Organizers need to examine which specific disciplines
are responsible for which aspect of patient care. So
what is the massage therapist’s role?
The approach taken at St. John’s was to have a clear
understanding of the scope of practice and the specific
role of each discipline. Then the case needed to be made
for how massage therapy would contribute to the present
system. Finally, all were encouraged to remain flexible
and adaptable to situations so that new ways of
enhancing patient care could be suggested.
For example, a holistic approach to patient care was
emphasized in certain cases, or general treatments were
recommended in order to facilitate the healing process
by decreasing stress, anxiety, pain intensity or
improving sleep. As the specialized palpation and manual
skills of massage therapists began to be recognized by
various clinical disciplines, massage therapy began to
develop
a unique presence in the multidisciplinary team.
Massage therapists comprised the group that was
“specialized” in manual release of soft tissue
restrictions, manual drainage techniques (for swelling
reduction) and scar massage. It also became recognized
as an important pain management approach. Although not
an exhaustive list, it is an example of how the role of
massage therapy can be defined within a hospital
context.
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