Therapeutic Touch ~ evidence for effectiveness?

[TruthSeeker]

I work in a large university-based hospital. I attended a meeting today where the topic was potential expansion of patient services. The question was basically "are our standards of care consistent with the latest evidence based medicine?"

It was fascinating.

The head of occupational therapy and the head of nursing made a joint proposal. They want to introduce complimentary/alternative medicine. Two general objections were immediately raised by the research and medical staff: 1) no evidence for effectiveness; 2) not covered under our health care system, so who pays?

Responses: 1) there are now RCTs showing the effectiveness of therapeutic touch (and the lack of RCTs doesn't mean that shark cartilege and homeopathy don't work) and 2) patients will pay for these services out of pocket thus generating revenue for the hospital.

As a research person, I immediately jumped up and asked for the ref on the RCT of therapeutic touch that found a clinically and statistically meaningful effect. I was told she couldn't remember the ref off hand.

Returning to my office, I emailed her a request for the citation. She read the email at 10:00 am.

No response as of yet.

I did a quick search but couldn't find it.

Does anyone know if this exists?

Thanks

 

[arcticpenguin]

What's an RCT?

If she comes up with something, you can counter with info from QuackWatch, including the famous study done by (then 12-year-old) Emily Rosa.

If they admit that revenue is the real issue, suggest that the hospital also institute prostitute services, since many patients would also pay for that.

 

[TruthSeeker]

What's an RCT?

If she comes up with something, you can counter with info from QuackWatch, including the famous study done by (then 12-year-old) Emily Rosa.

If they admit that revenue is the real issue, suggest that the hospital also institute prostitute services, since many patients would also pay for that.

I apologize for the jargon. I'm sleepy.

RCT = Randomized Controlled Trial
(preferably double blind)

We certainly did discuss the Emily Rosa study. But I'll have a look at quackwatch for more.

I don't think revenue is an issue. In Canada, hospitals aren't really pressured to be revenue-generating and patients are reluctant to pay for things not covered by insurance. I think they just used that argument in desperation when they saw the looks they were getting from the medical and research staff.

 

[Goshawk]

patients will pay for these services out of pocket thus generating revenue for the hospital.

As an alert consumer, I immediately jumped up and asked, "Who's responsible for this scam?"

Patients in a hospital naturally assume that everything goes on the Big Insurance Bill. Imagine the nasty surprises when patients start discovering that those nice massages they were offered, and accepted, are going to cost them instead of the insurance company.


Googling "therapeutic touch controlled study" turned up this abstract from the NIH.

Therapeutic touch and postoperative pain: a Rogerian research study.

 

[TruthSeeker]

Thanks. I found this too and have it on order.

From the abstract:

Using a single trial, single-blind, three-group design, 108 postoperative patients were randomly assigned to receive one of the following: therapeutic touch, a placebo control intervention which mimicked therapeutic touch, or the standard intervention of a narcotic analgesic. Using a visual analogue scale, pain was measured before and one hour following intervention. The hypothesis, that therapeutic touch would significantly decrease postoperative pain compared to the placebo control intervention, was not supported. Secondary analyses suggest that therapeutic touch may decrease patients' need for analgesic medication.

I emailed a colleague who studies pain. This is what she said about this study:

1) It is only single blind so we can not know that the therapist did not subtly communicate to the patient which treatment they received.

2) even if they did, however, there was no effect of TT on pain. Pain placebo responses are large so showing a significant effect over placebo requires a fairly large group difference.

3) I will have a look at the diff in analgesic. I bet you the amount of reduction will be so small as to not be clinically relevant. I've seen studies report statistically significant reductions in analgesic use that are on the order of only a few milligrams of drug, often substantially less than even a full dose. With over 30 subjects per group, a small difference may well be statistically but not significantly sig.


Once I receive the study, I'll update if there are any changes to my colleague's assessment.

 

[SteveGrenard]

As a medical researcher you should be familiar with MedLine/PubMed. If not, it is here:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi


If you enter "therapeutic touch" (without the quotes) into their search engine, you will get 23 pages of 454 references, most of which have linked abstracts. Here is Page 1 of 23




1: Lusby HR. Related Articles, Links
A response to "A critical evaluation of the theory and practice of therapeutic touch".
Nurs Philos. 2003 Apr;4(1):86. No abstract available.
PMID: 14498972 [PubMed - in process]
2: Salladay SA. Related Articles, Links
Should Christians use therapeutic touch?
Christ Bioeth. 2002 Apr;8(1):25-42. No abstract available.
PMID: 12956145 [PubMed - indexed for MEDLINE]
3: Richards K, Nagel C, Markie M, Elwell J, Barone C. Related Articles, Links
Use of complementary and alternative therapies to promote sleep in critically ill patients.
Crit Care Nurs Clin North Am. 2003 Sep;15(3):329-40.
PMID: 12943139 [PubMed - in process]
4: Whelan KM, Wishnia GS. Related Articles, Links
Reiki therapy: the benefits to a nurse/Reiki practitioner.
Holist Nurs Pract. 2003 Jul-Aug;17(4):209-17.
PMID: 12889549 [PubMed - indexed for MEDLINE]
5: Newshan G, Schuller-Civitella D. Related Articles, Links
Large clinical study shows value of therapeutic touch program.
Holist Nurs Pract. 2003 Jul-Aug;17(4):189-92.
PMID: 12889546 [PubMed - indexed for MEDLINE]
6: Miles P. Related Articles, Links
Pamela Miles. Reiki vibrational healing. Interview by Bonnie Horrigan.
Altern Ther Health Med. 2003 Jul-Aug;9(4):74-83. No abstract available.
PMID: 12868256 [PubMed - indexed for MEDLINE]
7: Reynolds M. Related Articles, Links
Reflecting on paediatric oncology nursing practice using Benner's Helping Role as a framework to examine aspects of caring.
Eur J Oncol Nurs. 2002 Mar;6(1):30-6.
PMID: 12849607 [PubMed]
8: Tall FD. Related Articles, Links
A close look at "A close look at therapeutic touch".
Nurs Outlook. 2003 May-Jun;51(3):126-9. Review. No abstract available.
PMID: 12830105 [PubMed - indexed for MEDLINE]
9: Crawford CC, Jonas WB, Nelson R, Wirkus M, Wirkus M. Related Articles, Links
Alterations in random event measures associated with a healing practice.
J Altern Complement Med. 2003 Jun;9(3):345-53.
PMID: 12816623 [PubMed - indexed for MEDLINE]
10: Lewis CR, de Vedia A, Reuer B, Schwan R, Tourin C. Related Articles, Links
Integrating complementary and alternative medicine (CAM) into standard hospice and palliative care.
Am J Hosp Palliat Care. 2003 May-Jun;20(3):221-8. Review.
PMID: 12785044 [PubMed - indexed for MEDLINE]
11: Chang SO. Related Articles, Links
The nature of touch therapy related to Ki: practitioners' perspective.
Nurs Health Sci. 2003 Jun;5(2):103-14.
PMID: 12709165 [PubMed - indexed for MEDLINE]
12: Dickstein R, Peterka RJ, Horak FB. Related Articles, Links
Effects of light fingertip touch on postural responses in subjects with diabetic neuropathy.
J Neurol Neurosurg Psychiatry. 2003 May;74(5):620-6.
PMID: 12700305 [PubMed - indexed for MEDLINE]
13: Wheeler S. Related Articles, Links
Henry IV of France touching for scrofula, by Pierre Firens.
J Hist Med Allied Sci. 2003 Jan;58(1):79-81. No abstract available.
PMID: 12680011 [PubMed - indexed for MEDLINE]
14: Rombalski JJ. Related Articles, Links
A personal journey in understanding physical touch as a nursing intervention.
J Holist Nurs. 2003 Mar;21(1):73-80.
PMID: 12666616 [PubMed - indexed for MEDLINE]
15: Schmehr R. Related Articles, Links
Enhancing the treatment of HIV/AIDS with Reiki training and treatment.
Altern Ther Health Med. 2003 Mar-Apr;9(2):120, 118. No abstract available.
PMID: 12652892 [PubMed - indexed for MEDLINE]
16: Miles P, True G. Related Articles, Links
Reiki--review of a biofield therapy history, theory, practice, and research.
Altern Ther Health Med. 2003 Mar-Apr;9(2):62-72. Review.
PMID: 12652885 [PubMed - indexed for MEDLINE]
17: Van Wijk R, Van Wijk EP. Related Articles, Links
The search for a biosensor as a witness of a human laying on of hands ritual.
Altern Ther Health Med. 2003 Mar-Apr;9(2):48-55.
PMID: 12652883 [PubMed - indexed for MEDLINE]
18: Miles P. Related Articles, Links
Preliminary report on the use of Reiki HIV-related pain and anxiety.
Altern Ther Health Med. 2003 Mar-Apr;9(2):36. No abstract available.
PMID: 12652881 [PubMed - indexed for MEDLINE]
19: Schiller R. Related Articles, Links
Reiki: a starting point for integrative medicine.
Altern Ther Health Med. 2003 Mar-Apr;9(2):20-1. No abstract available.
PMID: 12652880 [PubMed - indexed for MEDLINE]
20: Eliopoulos C. Related Articles, Links
Integrative care--Reiki.
Director. 2003 Winter;11(1):33-4. No abstract available.
PMID: 12630139 [PubMed - indexed for MEDLINE]

 

[athon]

I've noticed you do this a lot, Steve - you suggest a search engine, and cut and paste the results after you've inserted a phrase or term.

Suggesting Medline is one thing, and it occasionally has some interesting articles. But it is more of a links page to articles than a catelogue of research papers. Even looking at the clot you posted here, most of them are more journalistic reports than clinical trials.

I did a bit of search last year on TT, and found a heap of articles, but no reputable RCT's, and of the few 'trials' I found, nothing was repeated. In fact, the search introduced me to one of the real distinctions between pseudoscience and real science - articles on real science can lead you to not only several good clinical trials, but from there you can find repeats performed by institutions that have good reputations. Pseudoscience articles lead you nowhere, or often to some one off report that has never been reproduced.

Athon

 

[SteveGrenard]

"That's one thing this forum is good for - resources."Athon

Do I detect a bit of hypocrisy here?

The TruthSeeker says he is a researcher but could find no studies, pro or con save for Rosa which is the skeptic's darling of a study. I am sorry this blew that bubble away. Rosa has been refuted in many of the critiques and commentaries. A study done by a child, but really by her mother who with her colleagues, used Emily to make a point. It was an experiment where the investigator Emily, was the test subject and the sole test subject and started out as a school science project and ended up in the JAMA thanks to her mother and her friend's influence and assistance. as co-authors. Predictably TS could walk into the next meeting with Rosa in hand, and if his opponents are prepared, they will have the refutations and solidly trounce it. Don't you think it would be a good idea for TS to be prepared as well?

Re: referring to websites and pasting examples..........................................

Yes I do that a lot. So? On these pages you will find serious pro and con articles on TT. I pasted only page 1, there are 22 more. This was to give TS a flavor for what he would be looking at.

The Seeker should find his or her own way. I made no particular references. People asking for research help should be pointed. But doing their homework for them?

The items listed in MedLine are citations. Many have free links to abstracts. If the abstract interests you any medical library can order the full text if it is not available on-line which is also indicated.

From your chiding it would seem you are not familiar with PubMed's usefulness either or how it can or should be used.
Either that or you are trying to suppress its use by castigating any suggestion of its usefulness for Truth Seeker's quest.

Any institution, even in Canada, should research a modality thoroughly before offering it to its patients. This means a complete literature search, and an evaluation of that literature by many people both pro and con. If I were TruthSeeker I'd insist that every one of the 450 or so items listed in MedLine be acquired and distributed to a committee who should then read, consider, discuss and report back its decision either yea or nay. Discussing it at JREF won't cut it. Getting resources here will. Tell me athon you didn't write this:

"That's one thing this forum is good for - resources."

 

[TruthSeeker]

Re: "That's one thing this forum is good for - resources."Athon

Do I detect a bit of hypocrisy here?

The TruthSeeker says he


It's not so important, but I am a she.


s a researcher but could find no studies, pro or con save for Rosa


.This is not what I said. I did not go into the meeting prepared to discuss TT. It is far outside my area of specialty. I know the Rose study because it is famous. I was asking for double-blind RCTs which found effectiveness and clinical significance for TT. Not just a list of papers on TT. I was looking for supportive evidence. That my colleague has yet to send the reference she cited suggests it does not exist but we shall see if she produces the evidence.


which is the skeptic's darling of a study. I am sorry this blew that bubble away. Rosa has been refuted in many of the critiques and commentaries. A study done by a child, but really by her mother who with her colleagues, used Emily to make a point. It was an experiment where the investigator Emily, was the test subject and the sole test subject and started out as a school science project and ended up in the JAMA thanks to her mother and her friend's influence and assistance. as co-authors. Predictably TS could walk into the next meeting with Rosa in hand, and if his opponents are prepared, they will have the refutations and solidly trounce it. Don't you think it would be a good idea for TS to be prepared as well?

This is really not my job. However, the debate if there is to be one should be based on double-blind RCTs looking at clinically relevant populations (especially those we work with in our hospital). We are trying to make decisions about actual patients and we do not easily generalize across populations. As such, the Rosa study would be excluded.


The Seeker should find his or her own way. I made no particular references. People asking for research help should be pointed. But doing their homework for them?

I was not asking anyone to do my homework. I thought 1) it was an interesting story about an attempt to introduce CAM. 2) someone might know of a study off hand and spare me time reading through flawed papers. I apologize if that is outside the proper topic for this forum but I didn't think it was.

Any institution, even in Canada, should research a modality thoroughly before offering it to its patients. This means a complete literature search, and an evaluation of that literature by many people both pro and con. If I were TruthSeeker I'd insist that every one of the 450 or so items listed in MedLine be acquired and distributed to a committee who should then read, consider, discuss and report back its decision either yea or nay. Discussing it at JREF won't cut it. Getting resources here will. Tell me athon you didn't write this:

The hospital is under no obligation to waste time and resources conducting such an exercise. If the proponents of TT want it introduced into our standard of care, it is on them to prove its effectiveness. We have pretty clear standards regarding demonstrating the effectiveness of medical interventions. They tried to suggest such evidence existed. Nobody believed them when they were unable to provide a citation. The rest of my colleagues dismissed the idea and moved on. I was curious and thought to look. However, I repeat, the burden of proof is on them, not me or the hospital or the opponents of TT.

 

[SteveGrenard]

Okay then, if you are placing the onus on them, its fine. Then they should plow through the reams of literature on the subject. Perhaps somebody clued them into the resources on the subject by now. If you are not interested and not involved, excuse me. I seemed to think you were.

Since they came in unprepared to support their study and offered, as you stated, a non-existent study I was wondering how that non-existent study was chatacerized? Did they mention investigators name(s), a publication in which it appeared or did they just say some study was done, I don't know by who, where, when or what the results were or if it was published or not. Pretty sad argument on their part. There are 453 references in the resource I provided. Some of these are RCTs.

Emily Rosa's study must've been fun for little Emily but it just doesn't cut it on the disproof side for the reasons cited.
Many TT pracititoners do not even claim to be able to detect the energies from their subjects which is what Emily was testing. They claim the reverse -- that their energies are going out to the subject, not vice versa.



LOL...

 

[CFLarsen]

Emily Rosa's study must've been fun for little Emily but it just doesn't cut it on the disproof side for the reasons cited. Many TT pracititoners do not even claim to be able to detect the energies from their subjects which is what Emily was testing. They claim the reverse -- that their energies are going out to the subject, not vice versa.

Really? Please provide evidence of this. Are you saying that Emily Rosa's test is not suitable to test TT? What is, then?

LOL...

You can laugh all you want, Steve, but that doesn't change the fact that TT has not been proved to be a real phenomenon (outside placebo). You might also want to be a little more careful with posing as someone with scientific knowledge. As we have seen, you are utterly incompetent in these matters.

 

[Jeff Corey]

Many TT pracititoners do not even claim to be able to detect the energies from their subjects which is what Emily was testing. They claim the reverse -- that their energies are going out to the subject, not vice versa.

Many? I don't think so. Could you name some?

 

[TruthSeeker]

Okay then, if you are placing the onus on them, its fine. Then they should plow through the reams of literature on the subject. Perhaps somebody clued them into the resources on the subject by now. If you are not interested and not involved, excuse me. I seemed to think you were.

Since they came in unprepared to support their study and offered, as you stated, a non-existent study I was wondering how that non-existent study was chatacerized? Did they mention investigators name(s), a publication in which it appeared or did they just say some study was done, I don't know by who, where, when or what the results were or if it was published or not. Pretty sad argument on their part. There are 453 references in the resource I provided. Some of these are RCTs.

Emily Rosa's study must've been fun for little Emily but it just doesn't cut it on the disproof side for the reasons cited.
Many TT pracititoners do not even claim to be able to detect the energies from their subjects which is what Emily was testing. They claim the reverse -- that their energies are going out to the subject, not vice versa.



LOL...

I am interested intellectually but not in terms of setting hospital policy. I am not a clinician nor a hospital administrator.

They began by providing the insight that people really like TT and lots of hospitals provide it. When asked about effectiveness, they mentioned the RCT but could not remember the citation or the primary outcome. It was very sad on their part and I believe set back their agenda quite a bit. Our hospital is notoriously NOT "touchy-feely" and allied health professionals already feel marginalized (including psychology, physio etc. who do have valuable services to offer). Their presentation may add to the general stigma against allied health held by the surgeons and physicians. I hope this does not happen.

 

[Yahzi]

TruthSeeker
You rock!

Keep up the good fight. "All that is required for evil to triumph is for good men to do nothing."

 

[Larry Barrieau]

TT

I teach 7th grade Earth Science and we use the paranormal to apply the scientific method. This past week we watched "The Power of Belief" with John Stossel. The claim of TT was explained and a TT practitioner was waving her hands over a patient. I stopped the tape and asked for comments. Even my seventh graders could discern that it seemed to be a silly claim and that there would have to be powerful evidence to convince them. (And why would anyone conduct a single blind test?)

I had Emily come in and answer questions from my class when she was in the 8th grade. She's a nice girl and at the time she was close to the same age of my students. Her comfort level with her peers made the importance of real science sink in in a way that I could not convey as well.

 

[athon]

Re: "That's one thing this forum is good for - resources."Athon

From your chiding it would seem you are not familiar with PubMed's usefulness either or how it can or should be used.
Either that or you are trying to suppress its use by castigating any suggestion of its usefulness for Truth Seeker's quest.

Any institution, even in Canada, should research a modality thoroughly before offering it to its patients. This means a complete literature search, and an evaluation of that literature by many people both pro and con. If I were TruthSeeker I'd insist that every one of the 450 or so items listed in MedLine be acquired and distributed to a committee who should then read, consider, discuss and report back its decision either yea or nay. Discussing it at JREF won't cut it. Getting resources here will. Tell me athon you didn't write this:

"That's one thing this forum is good for - resources."

Yawn.

TS was after some useful clinical trials. Medline can lead you to some with intense searching, granted, but for the most part it would be like searching through a backlog of Newscientist magazines for the same purpose.

All I'm saying is that I've noticed that to appear like you know what you're talking about, you post a search engine site and the seach results. It's like me asking 'where's some trials exploring the hibernation of bears' and you post a Google search on bears. Yay!

This forum is a great place to seek out people who can put you onto good information. But when somebody asks for clinical trials, and you pretend authority through posting search engine results, I just have to giggle to myself.

Athon

 

[SteveGrenard]

All reputable clinical trials, pro or con, on this subject are apt to be indexed in Medline. If not, please tell us then where to find them since you know so much about data mining and clinical trials research .... How about the non-existent JREF database of failed challenege applicants? How about the informed comments of individual posters here such as yourself?

The problem is such posters have only one shtick to offer: there ain't none, don't bother, forget about it - never been proved. Same old refrain. People should read the studies, discuss them here, get opinions but all I seem to see around here is wholesale rejection of
concepts without any discussion of the merits or absence of merit from published studies. I am suggesting people think for themselves instead of following the leader ... which, I guess, is a popular game around here.

I guess this worries some people.

 

[TruthSeeker]

The problem is such posters have only one shtick to offer: there ain't none, don't bother, forget about it - never been proved. Same old refrain. People should read the studies, discuss them here, get opinions but all I seem to see around here is wholesale rejection of
concepts without any discussion of the merits or absence of merit from published studies. I am suggesting people think for themselves instead of following the leader ... which, I guess, is a popular game around here.

I guess this worries some people.

I did discuss the merits/flaws of the one abstract that was posted.

I am not following the leader. I am not a one schtick pony. You don't know a thing about me, my work or my scientific approach. I am interested in efficiency. If someone already knew the study, they might have saved me some time.

If this were about my own research, I would wade through all the junk because I love the junk

I would be happy to discuss the pros and cons of any study that you'd like.

If you can prove to me that TT provides better than placebo or standard of care outcomes (we rarely test treatments against placebos anymore), clinically relevant outcomes, assessed in a double-blinded fashion using rigourous methodological controls, I would be happy to change my mind about this treatment.

 

[athon]

Forget it, TS. This is the same loop that we always dance around, and that the advocates for unproven science seem to ignore.

I for one would also like to see a reputable, repeated clinical trial for TT. But we will get journalistic reports, allusion to trials, names and unsupported figures, and even the odd trial that when analysed is proven to be little more than a statistical report with some odd numbers. Outside of that, we play the same games.

If anybody finds anything, let me know.

Athon

 

[CFLarsen]

All reputable clinical trials, pro or con, on this subject are apt to be indexed in Medline. If not, please tell us then where to find them since you know so much about data mining and clinical trials research .... How about the non-existent JREF database of failed challenege applicants? How about the informed comments of individual posters here such as yourself?

Please find some "reputable clinical trials", which are "pro"TT. You are so good at using search engines, Steve, it should be a no-brainer.

The problem is such posters have only one shtick to offer: there ain't none, don't bother, forget about it - never been proved. Same old refrain. People should read the studies, discuss them here, get opinions but all I seem to see around here is wholesale rejection of concepts without any discussion of the merits or absence of merit from published studies. I am suggesting people think for themselves instead of following the leader ... which, I guess, is a popular game around here.

I guess this worries some people.

Nobody is following any leader. But people are apt to ask for evidence. If there is evidence, why can't we see it?

Oh, you forgot these:

• Please provide evidence that "They (TT healers) claim the reverse -- that their energies are going out to the subject, not vice versa."
• Are you saying that Emily Rosa's test is not suitable to test TT?
• What is, then?