1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 1: Principles of Outcome- Based Massage Outcome-Based Massage: Putting Evidence into Practice

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Objectives At the end of this presentation you will have the information needed to: Describe the goals and components of Outcome-Based Massage Describe the relationship between Outcome-Based Massage clinical decision-making, evidence-based practice, and the therapeutic relationship Identify the components of the structure, process, and outcomes of clinical care. Describe and distinguish among outcomes for medical massage, wellness massage, and whole systems massage Identify when it is appropriate to establish different types of outcomes for clients

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome-Based Massage Outcome-Based Massage (OBM) is a systematic treatment approach in which therapists provide massage interventions with the goal of achieving specified outcomes that are tailored to address each client’s unique needs, presenting issues and preferences

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Outcome-Based Massage Outcome-Based Massage has three key components: Outcome-Based Massage clinical decision-making, evidence-based practice, and the therapeutic relationship

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Outcome-Based Massage

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome-Based Massage Guided by the concept of Intelligent Touch Based on models of functioning, disability and health and wellness models Classifies massage techniques on the basis of the tissue layer they treat Uses a systematic clinical decision-making process Uses massage techniques to achieve specific treatment outcomes Selects massage techniques based on evidence Modifies interventions to address the client’s needs

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcomes for Massage Outcomes: the results of a single intervention or multiple interventions in plan of care Three steps to determine the appropriate treatment outcomes for a client. 1. Understand the potential therapeutic effects of massage and the evidence 2. Identify which of the client’s body structures and functions she can appropriately treat with massage techniques. 3. Determine whether she is treating the client’s impairments or providing a wellness intervention.

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Effects of Massage Techniques

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Structures and Functions Body structures: the various anatomical structures and systems of the body Body functions: the physiological functions of those anatomical systems Impairment: any loss or abnormality of the client’s body structures or functions that occur as a result of the pathophysiology of a medical condition Massage techniques are more appropriate for some body structures and functions than others.

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Structures and Functions for Massage: Musculoskeletal Musculoskeletal Adhesions/scarring Impaired connective tissue integrity Impaired joint integrity Impaired joint mobility Impaired muscle integrity Abnormal muscle-resting tension and muscle spasm Postural malalignment Swelling: Edema, joint effusion,

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Structures and Functions for Massage : Multisystem, Neurological, Energetic Multisystem Impaired sensation secondary to entrapment neuropathy or nerve root compression Pain Neurological Abnormal neuromuscular tone: Spasticity, rigidity, clonus Energetic Less than optimal biomagnetic field pattern Reduced energy flow

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Structures and Functions for Massage : Cardiovascular, Pulmonary, CNS Cardiovascular Decreased arterial supply Decreased venous return Increased blood pressure Swelling: lymphoedema Pulmonary Impaired airway clearance Dyspnea Decreased rib cage mobility (other than bony abnormality) Central Nervous System Reduced mental focus Failure to thrive in high-risk infants Lethargy

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Structures and Functions for Massage: Psychoneuroimmunological, GI Psychoneuroimmunological Stress Depression Altered body image Immune suppression Altered patterns of sleep Gastrointestinal Gastrointestinal immobility secondary to sedentary status

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Interventions for Wellness Versus the Treatment of Impairments The primary distinction is whether or not the focus of treatment is on an impairment in the client’s body structure or function. Wellness interventions: not concerned with addressing the client’s impairments. The treatment of impairments: aim is to reduce the impairments associated with medical conditions.

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Massage for Impairments: Health Health: a dynamic process that encompasses multiple domains, including the individual’s physical, emotional, social, and intellectual dimensions. In addition, some definitions of health address the individual’s ability to fulfill her social roles and respond to environmental stressors

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Massage for Impairments: The International Classification of Functioning, Disability and Health

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Massage for Impairments: The International Classification of Functioning, Disability and Health The model represents the individual at three levels: body structures and functions, activity, and participation. Body structures: Body functions Activity: the individual’s execution of a task or action in an ideal situation Participation: the individual’s involvement in a life situation, or his ability to execute a task within his environment Individual’s medical condition and personal and environmental factors affect all three levels of functioning concurrently.

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Massage for Impairments: Outcomes Which outcomes are relevant for the client’s needs and the intent of the intervention? A list of impairments in body structures and functions and outcomes that revolve around the treatment of impairments, recovery, and the prevention of secondary impairments

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Massage for Impairments: Outcomes Impairments Body Structures and Functions Amenable to Treatment with Massage and Related Outcomes

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

21. Massage for Wellness: Wellness Wellness: encompassing both a balance of “mind, body and spirit” and an individuals’ self-perception of their well-being, which is distinct from their state of “health.” A person can have a high level of wellness, even though he has a medical condition that leaves him with sub-optimal health For example, people who are living with chronic illnesses, disabilities or, medical conditions associated with age are still capable of experiencing high levels of wellness.

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Massage for Wellness: Wellness Interactions Model ©2007 LWW

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Massage for Wellness: Wellness Interactions Model Spirit: that part of a person’s non-physical being that embodies her drive to transcend the physical world Body and brain structures and functions: those body structures and functions that are free of impairments -- grade zero Activity capacity: as in ICF Ability to participate in society: as in ICF

24. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Massage for Wellness: Wellness Interactions Model Wellness behaviors: –personal factors that play a central role in wellness, –e.g. self-nurturance, healthy lifestyles, readiness for change, and perceived health. Environmental factors: – facilitators and barriers to wellness that the individual encounters in her social setting. –e.g. social attitudes, available wellness services, education, and the individual’s financial status

25. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Massage for Wellness: Outcomes Absence of impairments that stem from a medical condition A list of relevant body structures and functions and associated outcomes for wellness. Outcomes are directed at optimizing the client’s body structures and functions.

26. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Massage for Wellness: Outcomes Domains, Definitions, and Sample Outcomes for Wellness and Whole Systems

27. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

28. References The references for the material in this PowerPoint presentation are found in Chapter 1: Principles of Outcome-Based Massage