Care ally-assisted massage for Veterans with chronic neck pain: TOMCATT results

N Munk; J K Daggy; J E Slaven; E Evans; T Foote; B V Laws; M S Matthias; M J Bair

doi:10.1016/j.cct.2024.107561

Care ally-assisted massage for Veterans with chronic neck pain: TOMCATT results

Contemp Clin Trials. 2024 May 3:142:107561. doi: 10.1016/j.cct.2024.107561. Online ahead of print.

Authors

N Munk¹, J K Daggy², J E Slaven², E Evans³, T Foote³, B V Laws³, M S Matthias⁴, M J Bair⁴

Affiliations

¹ Indiana University School of Health and Human Sciences, Department of Health Sciences, Indianapolis, Indiana, USA; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Massage & Myotherapy Australia Fellow and Visiting Faculty of Health, University of Technology Sydney, Sydney, Australia. Electronic address: nmunk@iu.edu.
² Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, IN, United States.
³ Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana, USA.
⁴ Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana, USA; Indiana University School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA.

PMID: 38704120
DOI: 10.1016/j.cct.2024.107561

Abstract

Purpose: Chronic neck pain (CNP) is prevalent and challenging to treat. Despite evidence of massage's effectiveness for CNP, multiple accessibility barriers exist. The Trial Outcomes for Massage: Care Ally-Assisted vs. Therapist Treated (TOMCATT) study examined a care ally-assisted massage (CA-M) approach compared to a waitlist control prior to a study design modification (WL-C₀).

Methods: CA-M consisted of in-person training for veteran/care-ally dyads to learn a standardized 30-minue massage routine, instructional DVD, and printed treatment manual. Participants were to complete three care ally-assisted massage sessions weekly for 12-weeks. Outcomes collected at baseline, 1-, 3-, and 6-months included validated measures of neck pain severity and associated disability. Linear mixed-model approaches were used for analysis with 3-months as the primary outcome timepoint.

Results: Participants (N = 203) were 56.7 ± 14 years old, 75% White, 15% female, and 75% married/partnered. Among 102 CA-M participants, 45% did not attend the in-person training and subsequently withdrew from the study and were more likely to be younger (p = .016) and employed (p = .004). Compared to WL-C₀, CA-M participants had statistically significant reductions in pain-related disability at 3-months (-3.4, 95%CI = [-5.8, -1.0]; p = .006) and 6-months (-4.6, 95%CI = [-7.0, -2.1]; p < .001) and pain severity at 3-months (-1.3, 95%CI = [-1.9, -0.8]; p < .001) and 6-months (-1.0, 95%CI = [-1.6, -0.4]; p = .007), respectively.

Conclusion: In this analysis, CA-M led to greater reductions in CNP with disability and pain severity compared to WL-C₀, despite treatment engagement and retention challenges. Future work is needed to determine how to better engage Veterans and their care-allies to attend CA-M training.

Keywords: Chronic neck pain; Dyad; Integrative medicine; Partner massage; Veterans; Whole health.