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[YanTing]

There is very scant description of the “placebo” / fake TT done.

“The placebo group received a simple touch non-TT mimic treatment resembling TT twice daily, between 11–12 a.m. and 3–4 p.m. Before placebo intervention, participants were approached in the same manner as the experimental group and intervention also lasted 5 min. Placebo intervention was performed by the same TT practitioners.”

“… touch non-Therapeutic Touch” ?  Were the participants touched?

What does “approached in the same manner“ mean?

The “placebo intervention” was performed by the TT practitioners?  Given that the TT practitioners believe their energy can affect people, plants, and animals, even at great distances, it would seem if they hovered near the participants while mentally going through “This will not work, this will not work, this will not work” in their minds, they should have recused themselves or not been selected at all.  Foxes, hen houses and all that.

My sense is (may be studies out there… I think one of my kids looked at the effects of touch on geriatric patients for her senior thesis) that a quiet presence of another person, establishing a  focused supportive connection (with or without physical contact), or focused personalized attention (in the case of some of the alternative practitioners, classical homeopaths et. al.) can have a positive and/or and calming effect.



Dementia and Geriatric Cognitive Disorders 2022;51:142-149

Senderovich H.(a, b, c), Gardner S.(d, e), Berall A. (d), Shultz R. (f), Grant B. (f), Santaguida V. (g)

a Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
b Division of Palliative Care, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
c University of Toronto, Toronto, ON, Canada
d Baycrest Kunin-Lunenfeld Centre for Applied Research and Evaluation (KL-CARE), Toronto, ON, Canada
e Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
f Baycrest SageCare, Toronto, ON, Canada
g University of Western Ontario, London, ON, Canada

Abstract

Introduction: This study aimed to investigate the use of therapeutic touch (TT) in the management of responsive behaviors in patients with dementia. Methods: A randomized, double-blinded control trial was used to compare response to TT in a population with responsive behaviors in dementia, in 3 phases, pretreatment, treatment, and posttreatment each lasting 5 days. The participants were divided into three groups: experimental, placebo, and control. The experimental group received regular TT, the placebo group received mimic TT, and the control group received regular routine care. Behavior was observed and recorded by trained research assistants every 20 min during the study time throughout each of the phases. Modified Agitated Behavior Rating Scale (ABRS) and Revised Memory and Behavior Check (RMBC) scores were used to assess the behavioral symptoms of dementia throughout the study. Results: All groups had decreasing RMBC scores during the pretreatment period, however; the experimental TT group was the only group whose RMBC scores continued to decrease during the treatment period. All groups had a similar pattern of rates of change in ABRS scores over the 15-day period, with no differential pattern of results related to experimental TT. Conclusion: Despite limited evidence, TT should be explored as an adjunctive therapy for reducing behavioral symptoms in individuals with dementia. Further research is needed to determine the effects of TT on responsive behaviors in dementia. There is a need for studies with larger sample sizes, equal distribution of participants between groups (in terms of dementia stages), and longer post study follow-ups.

Free full text:
https://www.karger.com/Article/FullText/523752

Excerpts:

"Therapeutic touch (TT) was developed by Dolores Krieger and Dora Kunz in the 1970s [7]. It is a modern utilization of ancient healing practices. TT is based on the idea of universal life energies and that a person’s energy field is balanced in health and imbalanced in disease. TT consists of three phases: centering, assessment, and treatment. In the centering phase, the healer achieves inner calmness and prepares to be of service to the patient. This phase can be achieved by quiet meditation or by taking deep breaths to relax the body. During the assessment phase, the practitioner places their hands a few inches away from the client’s body and accesses their energy field, achieving a sense of their field and any possible imbalances. During the treatment phase, the healer uses rhythmical and symmetrical movements of the hands to rebalance any disturbed flows of energy [8].

"Recently, TT has risen in popularity, being used to treat wounds, decrease pain in postoperative patients, relieve migraine headaches, reduce anxiety, relieve dyspnea, improve sleep quality, and increase function in patients with arthritis [3-6, 9, 10]. However, limited studies have been conducted on its effectiveness. Although some studies have shown preliminary evidence for the use of TT to reduce agitation in patients with dementia [11, 12], insufficient data exist, and further studies need to be conducted before definite conclusions can be drawn [8]. New knowledge on this subject would address present gaps in the literature, as well as possibly provide evidence-based rationale for the development and implementation of educational materials for this method. This study aimed to investigate the use of TT in the management of RBD."

"Participants were randomized into three groups: experimental, placebo, and control. The experimental group received regular TT, the placebo group received mimic TT, and the control group received regular routine care. When administering the mimic treatment, TT practitioners stimulated the movements of TT, however, made no attempt to achieve inner calmness nor interact with the participant’s energy field."

"During the treatment phase, the experimental group received regular TT twice daily, between 11–12 a.m. and 3–4 p.m. TT was performed by trained TT practitioners, and each intervention lasted about 5 min. The control group was not approached for TT intervention, instead receiving regular routine care at the same time intervals. The placebo group received a simple touch non-TT mimic treatment resembling TT twice daily, between 11–12 a.m. and 3–4 p.m. Before placebo intervention, participants were approached in the same manner as the experimental group and intervention also lasted 5 min. Placebo intervention was performed by the same TT practitioners.

"TT was administered in three phases: centering, assessment, and treatment. In the centering phase, the TT practitioner achieved inner calmness and prepared to be of service to the participant. This phase was achieved by taking deep breaths to relax the body. During the assessment phase, the TT practitioner placed their hands a few inches away from the participant’s body and accessed their energy field, achieving a sense of their field and any possible imbalances. During the treatment phase, the TT practitioner used rhythmical and symmetrical movements of the hands to rebalance any disturbed flows of energy."

"The modified Agitated Behavior Rating Scale (ABRS) was used throughout the study to measure frequency and intensity of the behavior symptoms of dementia. The scale includes five categories of behavior: manual manipulation, escape of restraints, searching/wandering, tapping/banging, and vocalization."

"The Revised Memory and Behavior Check (RMBC) was used throughout the study for assessing behavior symptoms of dementia, in addition to identifying mood changes and suspected depression. It is a 24-item checklist..."

"The baseline RMBC scores were significantly higher for experimental TT group (mean score 9.0, SD = 1.4, p < 0.0001, Table 1), who had a larger proportion of participants with severe dementia (77%)."

"Modeling results indicate that the control and mimic TT groups had a significant decline in RMBC scores in the pretreatment period (p < 0.0001 and p = 0.002, respectively, Table 2; Fig. 3). The experimental group also had a nonsignificant decline (p = 0.16) in RMBC scores. The control and mimic TT groups switched from decreasing scores in the pretreatment period to increasing scores in the treatment period (p < 0.0001 and p = 0.01). The experimental TT group continued to have decreasing scores over both these periods and the rates of change are not significantly different (p = 0.20). The experimental TT group switches from decreasing scores to increasing scores from the treatment period to the posttreatment period (p < 0.0001)."

[ABRS scores] “Modeling results indicate that the control, experimental, and mimic TT groups switched from decreasing scores in the pretreatment period to increasing scores in the treatment period (p = 0.03, p = 0.03, and p = 0.13, respectively, Table 3; Fig. 4). These group patterns were not significantly different (p = 0.82). Then all groups nonsignificantly switched from increasing scores in the treatment period to decreasing scores in the posttreatment period (p = 0.62, p = 0.26, and p = 0.30). These group patterns were not significantly different (p = 0.94).”

[Discussion]

“It is important to consider why only the experimental RMBC scores declined during the treatment period. While this may have been due to TT intervention, the RMBC scores for the experimental TT group were higher at baseline (likely due to a larger proportion of participants with severe dementia) and may have had more opportunity to decrease over time. However, similar studies have also found a decrease in responsive behaviors shortly after TT intervention [11] indicating this decrease may have been due to immediate effects of TT.

“For the experimental TT group, the RMBC scores began increasing in the posttreatment period. Other studies have also observed an increase in responsive behaviors in the 1–1.5 days postintervention [12, 15], suggesting there are minimal residual effects of TT after treatment. This suggests a need for ongoing supportive treatment to effectively reduce behavior using this nonpharmacological approach.”

“The generalizability of this study was limited by the small sample size of this cohort and short follow-up, as well as the characteristics of the participants, specifically that the vast majority of participants were female and Asian. The experimental group also had the largest proportion of participants with severe dementia and had the highest baseline RMBC and ABRS scores. Based on these differences in RMBC scores at baseline the reported outcomes of this study could be questioned.”

“While the results for this study were mixed, they suggest a need for further research into the effects of TT and its long-term impact. Other studies have shown preliminary evidence for the potential use of TT in reducing agitated behaviors in individuals with dementia. Specifically, TT may be beneficial for reducing common behaviors of agitation such as wandering, restlessness, and vocalizations.”


Comments:

The authors do not note that TT is inconsistent with scientific knowledge, or even that it is controversial.

As the authors note, the groups were not comparable. The experimental group had more severe dementia, and thus possibly was more susceptible to improvement due to placebo effects.

Looking at Fig. 3 and 4 (showing the two main outcome measures; higher numbers are worse behaviors), it looks the changes are small and almost random. By one measure (shown in Fig. 3) the treatment group showed improvement, while the other two groups got worse; but by the other measure (shown in Fig. 4), all three groups got worse during the treatment period!