To the Editor:
I want to comment on the article by Marian Rowe, PhD, RN, and Danita Alfred, RN, MS, entitled, "The Effectiveness of Slow-Stroke Massage in Diffusing Agitated Behaviors in Individuals With Alzheimer's Disease" which appeared in the June 1999 issue of the Journal of Gerontological Nursing (Vol. 25, No. 6). The article was informative and interesting, although the lack of findings of a significant effect on the agitated behaviors observed were disappointing and counter-intuitive, and may be because of study limitations. What the article did not point out, which is worth mentioning, was the beneficial effects experienced by the individuals with Alzheimer's disease (AD) at the time of the massage therapy. This is extremely important, as those who work with individuals with AD can tell you. The person applying the massage can observe the individual's response, gauge whether or not there is a therapeutic effect, and adjust their actions accordingly.
The use of distraction with disruptive and agitated behaviors cannot be underscored enough. Some other suggested noninvasive therapeutic interventions include music and environmental (lighting) therapy, pet therapy, therapeutic recreation, and exercise (Tappen, 1997). While light touch therapy has been suggested to accompany music therapy (Tappen, 1997), it certainly is something to consider with deep massage therapy.
Whereas the documentation of long-term beneficial effects of deep therapeutic massage on agitated behaviors would have been the most desirable result, shortterm effects also are valuable and should not be overlooked. Deep therapeutic massage with individuals with AD certainly is worth continuing provided the individuals with AD respond to it positively.
Tappen, R.M. (1997). Interventions for Alzheimer's disease: A caregiver's complete reference. Baltimore: Health Professions Press.
Lettore B. Weinstein, RN, MA
Miami Beach, Fionda
We wish to thank Ms. Weinstein for her response to our article discussing the effectiveness of slowstroke massage on the diffusion of agitation in individuals with AD. While statistical significance is desirable, we cannot discount the logical analysis of study findings. We agree with Ms. Weinsteins assertion that a lack of significance is disappointing; however, we wanted to point out the obvious reduction in the mean agitation score observed during the treatment week (Vol. 25, No. 6, p. 26, Table 1).
Although, qualitative responses were not solicited from caregivers during this study, some did choose to provide subjective comments, which were overwhelmingly positive, although not descriptive in nature, regarding their patients' responses to the massage. Additionally, the calming effects associated with less disruptive sleep patterns are beneficial not only to individuals with AD but also to caregivers whose energies are restored by restful nights' sleep.
As nurses attempt to validate the efficacy of their interventions through scientific research, we must continue to provide both traditional and creative care that we intuitively and logically consider beneficial to patients. Caring for patients is both an art and a science. Many traditional, nonpharmacologic methods for providing care have been subjected to the rigors of scientific research. Some have been supported; some have been rejected; and still others, although not supported by the research process, are supported by the practice wisdom of countless nurses, who like Ms. Weinstein are willing to challenge statistical significance.
Marian Rowe, PhD, RN
Danita Alfred, MSNJiN