The efficacy of traditional Thai massage in decreasing spasticity in elderly stroke patients

Figures & data

Table 1 Demographic and baseline characteristics

Demographic and baseline characteristics	TTM group (n=24)	PT group (n=26)	P-value#
Sex: male	22 (91.7%)	15 (57.7%)	0.006*
Age (in years)	60.0±6.9	65.8±8.1	0.010*
Education: primary school	7 (29.2%)	5 (19.2%)	0.411
Underlying
Diabetes mellitus type 2	9 (37.5%)	11 (42.3%)	0.729
Hypertension	23 (95.8%)	23 (88.5%)	0.611
Dyslipidemia	19 (79.2%)	19 (73.1%)	0.614
Cardiac disease	2 (8.3%)	4 (15.4%)	0.669
Onset: first attack	18 (75.0%)	18 (69.2%)	0.650
Pathology: infarction	12 (50.0%)	15 (57.7%)	0.585
Surgery: yes	4 (16.7%)	8 (30.8%)	0.243
Muscles with maximum grading†			0.296
1+	13 (54.1%)	19 (73.1%)
2	10 (41.7%)	5 (19.2%)
3	1 (4.2%)	2 (7.7%)
Barthel Index (0–20)	16.4±4.3	10.9±6.6	0.001*
HADS: anxiety score (0–21)	4.8±3.9	4.1±3.1	0.529
HADS: depression score (0–21)	5.1±4.3	3.9±3.5	0.284
Pictorial Quality of Life score (0–72)	41.1±15.6	42.8±13.7	0.691

Notes:

# Unpaired t-test for continuous data, chi-square test, and Fisher’s exact test for categorical data.

† Muscles with maximum grading, evaluated using the modified Ashworth Scale.

* Statistically significant at P<0.05.

Abbreviations: HADS, Hospital Anxiety and Depression Scale; PT, physical therapy; TTM, traditional Thai massage.

Figure 1 Flow diagram of the study.

Abbreviations: MAS, modified Ashworth Scale; PT, physical therapy; TTM, traditional Thai massage.

Table 2 Number and percentage of subjects whose spasticity decreased by at least one grade between baseline and after treatment among the two groups, using per protocol analysis

Baseline	After treatment
	TTM group (n=24)			PT group (n=21)
	Grade ≤1	Grade 1+	Grade 2	Grade ≤1	Grade 1+	Grade 2
Grade 1+	9 (37.5%)	4 (16.7%)	0	9 (42.8%)	6 (28.6%)	0
Grade 2	5 (20.8%)	2 (8.3%)	3 (12.5%)	1 (4.8%)	1 (4.8%)	2 (9.5%)
Grade 3	0	1 (4.2%)	0	0	0	2 (9.5%)

Notes: Improvement is defined as the spasticity of muscles with maximum grading, decreased by at least one grade. P=0.286 after adjusting for age and sex using multiple logistic regression analysis.

Abbreviations: PT, physical therapy; TTM, traditional Thai massage.

Table 3 Number and percentage of subjects whose spasticity decreased by at least one grade between baseline and after treatment among the two groups, using intention-to-treat analysis with the last observation carried forward method

Baseline	After treatment
	TTM group (n=24)			PT group (n=26)
	Grade ≤1	Grade 1+	Grade 2	Grade ≤1	Grade 1+	Grade 2
Grade 1+	9 (37.5%)	4 (16.7%)	0	9 (34.6%)	10 (38.5%)	0
Grade 2	5 (20.8%)	2 (8.3%)	3 (12.5%)	1 (3.8%)	1 (3.8%)	3 (11.6%)
Grade 3	0	1 (4.2%)	0	0	0	2 (7.7%)

Notes: Improvement is defined as the spasticity of muscles with maximum grading, decreased by at least one grade. P=0.058 after adjusting for age and sex using multiple logistic regression analysis.

Abbreviations: PT, physical therapy; TTM, traditional Thai massage.

Figure 2 Functional ability evaluated using the Barthel Index at Week 0 and Week 6.

Note: *Statistically significant at P<0.05.

Abbreviation: PT, physical therapy.

Figure 3 Anxiety scores at Week 0 and Week 6.

Abbreviations: HADS, Hospital Anxiety and Depression Scale; PT, physical therapy.

Figure 4 Depression scores at Week 0 and Week 6.

Abbreviations: HADS, Hospital Anxiety and Depression Scale; PT, physical therapy.

Figure 5 Quality of life scores at Week 0 and Week 6.

Note: *Statistically significant at P<0.05.
Abbreviations: PT, physical therapy; QoL, quality of life.

Table 4 Patients’ assessment of outcomes

Patients’ assessment	TTM group (n=24)	PT group (n=21)	P-value#
Feelings of spasticity
Decreased	19 (79.2%)	11 (52.4%)	0.057
Indifferent	5 (20.8%)	10 (47.6%)
Use of limbs (functions)
Improved	9 (37.5%)	8 (38.1%)	0.967
Indifferent	15 (62.5%)	13 (61.9%)
Satisfaction
Satisfied	18 (75.0%)	19 (90.5%)	0.427
Indifferent	4 (16.7%)	2 (9.5%)
Dissatisfied	2 (8.3%)	0

Note:

# Chi-square test, Fisher’s exact test.

Abbreviations: PT, physical therapy; TTM, traditional Thai massage.

Table 5 Number of adverse events that occurred during the study by group

Adverse events	TTM group (n=24)	PT group (n=21)	P-value#
Number of adverse events	10 (41.7%)	8 (38.1%)	0.807
Muscle stiffness	8 (33.3%)	5 (23.8%)	0.482
Muscle pain	7 (29.2%)	5 (23.8%)	0.685
Muscle soreness	4 (16.7%)	1 (4.8%)	0.352
Ecchymoses	1 (4.2%)	1 (4.8%)	1.000
Joint swelling	1 (4.2%)	0	1.000

Note:

# Chi-square test, Fisher’s exact test.

Abbreviations: PT, physical therapy; TTM, traditional Thai massage.

Table S1 Step, area, and duration of traditional Thai massage protocol

Step	Areas	Duration
1	BML-leg (beginning from lower leg to upper leg then return to lower leg) and MaSP-ankle (press at anterior of ankle joint)	6 minutes
2	BML-back (along erector spinae muscle from L5 to C7)	9 minutes
3	BML and MaSP-lateral side of leg (beginning from gluteal area to lateral side of upper and lower leg)	5 minutes
4	BML and MaSP-medial side of leg (beginning from medial side of upper leg to lower leg)	5 minutes
5	BML-abdomen (around abdomen)	10 minutes
6	BML and MaSP-medial side of arm (beginning from middle of medial side of upper arm to anterior of wrist)	5 minutes
7	BML and MaSP-lateral side of arm (beginning from middle of lateral side of upper arm to middle of lower arm)	5 minutes
8	BML-shoulder (upper part of back at posterior shoulder)	5 minutes
9	BML-neck (posterior of neck)	5 minutes
10	MaSP-shoulder (lateral side of lower neck and posterior of shoulder)	5 minutes

Notes: In steps 1, 5, 6, and 7, the subject was lying supine. In steps 2–4, the subject was lying on their non-affected side. In steps 8–10, the subject was in a sitting position.

Abbreviations: BML, basic massage lines; MaSP, major signal points.