Effectiveness of Shiatsu on Pain Among Elderly with Arthritis Staying in Old Age Homes: A Randomized Clinical Trail

Introduction

Arthritis is an inflammatory disease that involves joints often manifested by joint pain, stiffness, swelling. It is one of the most common causes of disability among adults. Global estimates reveal that more than 100 million people are affected by arthritis. The number of people with arthritis is projected to increase.1

Global estimates reveal that more than 100 million people are affected by arthritis. More than 22% of American adults (over 52.5 million people) have arthritis. By 2030, the number of people with arthritis (adults 18 years and older) is expected to rise to 67 million. Two in three people who are obese may develop symptomatic knee osteoarthritis in their lifetime. It was estimated that 294,000 children (1 in 250 children in the U.S.) between infancy and 17 years of age were affected by arthritis or other rheumatic condition (juvenile idiopathic arthritis). According to a report, OA is the most common prevalent form of arthritis in India, affecting over 15 million adults each year.2,3

The prevalence of arthritis is high in India, ranging from 22% to 39% in different parts of the country. Approximately 45% of women over the age of 65 have arthritis. Arthritis affects about 50% of people at age 65 and older and this prevalence increases to 85% in the age group 75 and older. The prevalence of arthritis increases after the age 40 in men and women. More than half of people over 65 years of age have X ray evidence of the disease in at least one joint. Before the age 50, men are more often affected than women. However, the incidence of arthritis after age 50 is higher in women than men.4,5

It is important to initiate treatment to reduce further complications and prevent disabilities. Shiatsu is an effective massage therapy that can be applied to painful joints to reduce the pain of arthritis.

Materials and methods

The present study was conducted by using a randomized clinical trial. The study was carried out in Samprapti foundation and Balaji old age home. Data were collected from 1st November 2019 to 30th November 2019. Simple random sampling technique, lottery method were used to select the sample in each group. Sixty subjects were selected and they were allocated into the experimental and control groups by using the cover slip method. Section A included demographic variables and section B included numerical pain rating scale to measure the level of pain among elderly with arthritis. Score 0 was considered as no pain, 1-3 was mild pain, 4-6 was moderate pain and 7-10 were considered severe pain.

The content validity of structured questionnaires were established by submitting to five experts. The reliability of the tool was established through an inter-rater method. The reliability of numerical pain rating scale for assessing the level of pain among elderly with arthritis was 0.8 and the developed tools were found to be statistically reliable. A pilot study was conducted among 10 subjects.

The findings of the pilot study revealed the feasibility of the tool and practicability of the study. The ethical aspects of the research were maintained by getting formal permission from the medical authorities and consent from each subject. The shiatsu massage therapy was given to only the experimental group after measuring the pretest level of pain in the experimental and control group. The massage therapy was conducted twice in a day for 10 consecutive days started from 20th November 2019 to 30th November 2019. No intervention was given to subjects in the control group. After 10 days of massage therapy, a post test was conducted for both experimental and control groups.

Randomization Process

Table 1 shows the distribution of elderly according to pre-test and post-test levels of pain in the experimental group. Majority 20 (66.7%) had moderate level of pain, 6 (20%) had mild level of pain, 4 (13.3%) had severe level of pain in pre-test, while in post-test, majority 16 (53.3%) had moderate level of pain, 14 (46.7%) had mild level of pain.

Table 2 shows the distribution of elderly according to pre-test and post-test level of pain in the control group. A majority 19 (63.3%) had moderate level of pain, 8 (26.7%) had mild level of pain, 3 (10%) had severe level of pain in pre-test, while in post-test, majority 21 (70%) had moderate level of pain, 4 (13.3%) had severe level of pain, 5 (16.7%) had mild level of pain.

Table 3 shows the outcome of Wilcoxon test and Mann Whitney U test, carried out to assess the significance of Shiatsu massage therapy within the group and between the groups.

Comparison of level of pain within the experimental group - In the pre-test, mean score was 4.73 ± 1.33; in the post-test, mean score was 3.70 ± 1.34. Reduction in the level pain noted was 1.03. The wilcoxon Z value 2.678 shows that there was a highly significant difference at p <0.05.

Comparison of level of pain within the control group - In the pre-test, mean score was 4.30±1.21; in the posttest, mean score was 4.66± 0.90. Slight increase in pain noted was 0.36. The wilcoxon Z value 1.167 shows that there was no significant difference with p >0.05.

Comparison of level of pain between experimental group and control group - In the  pre-test, mean score was 4.73 ± 1.33 in the experimental group, 4.30 ± 1.21 in the control group;  mean difference was 0.43. The Mann Whitney U test Z  value 2.066  shows that there was  no significant difference at p >0.05. It shows during pretest, pain levels in both the groups were more similar.

Comparison of level of pain between experimental group and control group - In the post-test, mean score was 3.70 ± 1.34 in the experimental group, 4.66± 0.90 in the control group; mean difference was 0.96. The Mann Whitney U test Z  value 4.382 shows that there was  a significant difference with p <0.001.

Discussion

The present study was conducted to assess the effectiveness of shiatsu among elderly with arthritis staying in selected old age homes, Bangalore. On comparison of level of pain within the experimental group, the pre-test mean score was 4.73 ± 1.33, post-test mean score was 3.70 ± 1.34, reduction in the level of pain noted was 1.03. The wilcoxon Z value was 2.678 which shows that there was a highly significant difference at p <0.05.

On comparison of level of pain within the control group, the pre-test mean score was 4.30±1.21, post-test mean score was 4.66± 0.90 which indicated slightly increased pain 0.36. The wilcoxon Z value 1.167 shows that there was no significant difference at p >0.05.

On comparison of level of pain between the experimental group and control group, the  pre-test mean score was 4.73 ± 1.33 in the  experimental group,  was 4.30 ± 1.21 in the control group, with mean difference of 0.43. The Mann Whitney U test Z value was 2.066. It shows that there was no significant difference at p >0.05 indicating that during pre-test, pain levels in both the groups were more similar.

On comparison of level of pain between the experimental group and control group, the post-test mean score was 3.70 ± 1.34 in the experimental group, 4.66 ± 0.90 in the control group, with a mean difference of 0.96. The Mann Whitney U test Z value was 4.382,  indicating that there was a significant difference with p <0.001.

Conclusion

The present study concluded that the shiatsu massage therapy was effective in reducing the arthritis pain among elderly. It can be used as a self-management technique to reduce pain and improve the Quality of Life of elderly with arthritis. 

Conflict of interest

Author have no conflict of interest.