To complement “Medical Massage: Your Role on the Integrative Health Care Team” in the June 2016 print edition of MASSAGE Magazine.
Is massage therapy health care?
Massage therapists are regulated by nearly every U.S. state, with many therapists governed by departments of health or medicine. But the true test of whether to consider massage a health care profession or a service industry is public perception.
According to several national surveys, including one from the National Institutes of Health, the majority of people who have received massage therapy in the past five years have done so for health-related reasons—to address back and neck pain, headaches or stress, for example.
In an American Massage Therapy Association fact sheet, 91 percent of adult Americans surveyed said they believe massage can be effective for reducing pain, while 96 percent of respondents said they believe massage should be part of health care.
Increasingly, medical massage is included in health care settings and on health care teams. Integrative health care is an international movement: Medical providers around the globe are including complementary care on interdisciplinary teams, motivated by the most pervasive health problem today, pain.
A Nation in Pain
President Obama, the Institute of Medicine, the American Medical Association, the U.S. military, the Centers for Disease Control & Prevention and other entities have all called for better pain management alongside a reduction in pain medication.
There are an estimated 15 million people globally who suffer from opioid dependence and 69,000 people die from opioid overdoses each year, according to the World Health Organization. In the U.S. alone, non-steroidal anti-inflammatory drugs (NSAIDs) send 80,000 people to the emergency room annually, according to Never Only Opioids: The Imperative for Early Integration of Non-Pharmacological Approaches and Practitioners in the Treatment of Patients with Pain, a 2014 policy brief from PAINS Project.
Massage therapy offers a safe and evidence-informed alternative for pain management. That said, the majority of massage therapists do not follow simple standards of practice required of health care providers: health record keeping.
If the public insists that we become a member of their health care team and assist them in pain management, we need to document our care using standard, legal methods of communication.
Medical Massage Outcomes
The most important aspect of health record keeping for medical massage therapy is the ability to document measurable outcomes as a result of care. Our value is tied to effectiveness—if we can chart progress in the patient’s condition, primary care providers are more likely to refer their patients to us.
Simple 0-10 scales that measure pain, stress and activities of daily living are quite sufficient to substantiate a client’s condition and massage’s effect on his life. This information becomes more meaningful when graphed over time.
A quick glance at a graph illustrating a decrease in pain or an increase in function over the course of massage therapy sessions validates including a medical massage therapist on a pain-management team. It also justifies the expense for clients who pay for massage out-of-pocket.
Documenting patient satisfaction is the second-most-important function of health record keeping. In many cases, we rely on clients to ask for referrals or prescriptions for massage therapy. People who are dissatisfied with conventional medicine seek massage therapy on their own because it works and it feels good.
One arm of the Triple Aim, a strategy of health care reform, requires health care delivery systems to work to improve people’s experience of health care, and use the outcomes to measure success. This is very challenging in health care environments where treatment is often unpleasant and side effects are frequent.
Massage therapy can play a very important role in integrative health care, and is commonly used to boost patient satisfaction in hospitals and clinics.
Charting a massage therapy session can be fast and easy. Electronic health record systems prompt the necessary information to gather, and much of it can be done with the touch of a button. Basic health information required for wellness care includes:
- Client name
- Health history
- Current health information/changes in client’s presentation or condition
- Date of service and duration of session
- All treatments provided
- Location or body parts where treatment was applied
Records must be signed, dated and completed in 24 hours, or include the date completed if other than the date of service. Records must be retained for seven years, and kept secure and confidential.
Additional information is necessary when communicating with other members of a health care team or submitting bills for third-party reimbursement. In order to demonstrate meaningful outcomes, symptoms must be measured.
Chart the following information to enhance your success on health care teams and establish value with patients and physicians alike:
- 0-10 measures for pain, stress and activities of daily living
- Graph results over time
- Identify functional limitations
- Set goals based on activities of daily living
- Chart functional outcomes
- Provide self-care education and chart the client’s follow-through
Despite the challenges, being an active part of an integrative health care team is exciting. Patients readily acknowledge our contributions, and the medical staff sees the results of our work through patients’ improvement, as documented in our health records.
It is important to interact as a health care provider, record our findings on paper or electronically, and document the benefits of massage therapy.
Diana L. Thompson, L.M.P., has a private practice in Seattle, Washington, treating acute and chronic pain disorders. She created Hands Heal Electronic Health Record; authored Hands Heal: Communication, Documentation, and Insurance Billing for Manual Therapists; and has a new book titled Integrative Pain Management: Massage, Movement, and Mindfulness Based Approaches. Thompson wrote “Medical Massage: Your Role on the Integrative Health Care Team” for the June 2016 print edition of MASSAGE Magazine.