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

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.