Search JIM Advanced Search

Journal of Chinese Integrative Medicine ›› 2012, Vol. 10 ›› Issue (7): 743-750.doi: 10.3736/jcim20120704

Special Issue: Massages

• Original Clinical Research • Previous Articles     Next Articles

Rehabilitation of stroke patients using traditional Thai massage, herbal treatments and physical therapies

David Sibbritt1(), Pamela van der Riet2, Saowapa Dedkhard3, Kannapatch Srithong3   

  1. 1. School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle 2308, Australia
    2. School of Nursing and Midwifery, Faculty of Health, University of Newcastle, Newcastle 2308, Australia
    3. Department of International Affairs, Boromarajonani College of Nursing, Nakhon Lampang, Muang, Lampang 52000, Thailand
  • Received:2012-03-27 Accepted:2012-05-09 Online:2012-07-20 Published:2018-07-15
  • Contact: David Sibbritt

Objective: To determine quantitatively if a unique rehabilitation program using traditional Thai massage, herbal treatments and physical therapies could improve activities of daily living, mood and sleep patterns, and pain intensity of stroke patients over time.
Methods: This was a prospective cohort study, conducted over a three-month period. Patients were recruited from a 42-bed rehabilitation centre in Northern Thailand, which admits mainly stroke, head injury and spinal patients for rehabilitation.
Results: There were 62 patients enrolled in the study, with 55% being male. The average age of patients was 59 years and 63% were married. The average time since the initial stroke was 15 months. At baseline, the average Barthel Index score was 50.7, and the average emotion, pain and sleep scores were 2.6, 3.1, and 3.2, respectively. After adjusting for age, gender and time since initial stroke in the longitudinal model, the Barthel Index significantly improved by 6.1 points after one month (P<0.01) and by 14.2 points after three months (P<0.01); emotion significantly improved by 0.7 points after one month (P<0.01) and by 0.9 points after three months (P<0.01); pain significantly improved by 0.5 points after one month (P<0.01) and by 0.5 points after three months (P<0.01); sleep significantly improved by 0.5 points after one month (P<0.01) and by 0.6 points after three months (P<0.01).
Conclusion: This unique stroke rehabilitation program has produced significant improvements in activities of daily living, mood, pain and sleep patterns of stroke patients. These findings warrant the need for further research to compare patients undergoing this program of rehabilitation with patients undergoing more conventional rehabilitation programs.

Key words: stroke, rehabilitation nursing, medicine, Oriental traditional, massage, phytotherapy, physical therapy, cohort studies

Figure 1

Patient flow diagram"


Time point n Barthel Index Emotion Pain Sleep
Baseline 62 50.7±21.9 2.6±1.0 3.1±0.9 3.2±0.9
After one month 62 56.1±21.0** 3.3±1.0** 3.6±0.5** 3.7±0.6**
After three months 19 62.4±20.7** 3.7±0.6** 3.7±0.6** 3.8±0.6**
[1] Magnusson G, Ballegaard S, Karpatschof B, Nyboe J . Long-term effects of integrated rehabilitation in patients with stroke: a nonrandomized comparative feasibility study[J]. J Altern Complement Med, 2010,16(4):369-374
doi: 10.1089/acm.2009.0097
[2] Thailand Ministry of Public Health. Department for Development of Thai Traditional and Alternative Medicine Ministry of Public Health.[ 2009-11-11]. . Department for Development of Thai Traditional and Alternative Medicine Ministry of Public Health. [2009-11-11]. .
[3] World Health Organization. Health topics: Stroke, cerebrovascular accident. 2006.
[4] McArthur KS, Quinn TJ, Dawson J, Walters MR . Diagnosis and management of transient ischaemic attack and ischaemic stroke in the acute phase[J].BMJ,2011, 342: d1938
doi: 10.1136/bmj.d1938 pmid: 21454457
[5] Hart J . Poststroke recovery: emerging complementary therapies[J]. Altern Complement Ther, 2010,16(5):277-280
doi: 10.1089/act.2010.16506
[6] Furie KL, Ay H. Initial evaluation and management of transient ischemic attack and minor stroke. (2012-04-21)[ 2012-05-02]. Initial evaluation and management of transient ischemic attack and minor stroke. (2012-04-21) [2012-05-02]. .
[7] Luijendijk HJ, Stricker BH, Wieberdink RG, Koudstaal PJ, Hofman A, Breteler MM, Tiemeier H . Transient ischemic attack and incident depression[J]. Stroke, 2011,42(7):1857-1861
doi: 10.1161/STROKEAHA.110.604405 pmid: 21566240
[8] Wiles R, Demain S, Robison J, Kileff J, Ellis-Hill C , McPherson K.Exercise on prescription schemes for stroke patients post-discharge from physiotherapy[J]. Disabil Rehabil, 2008,30(26):1966-1975
doi: 10.1080/09638280701772997 pmid: 18608413
[9] Duncan P, Studenski S, Richards L, Gollub S, Lai SM, Reker D, Perera S, Yates J, Koch V, Rigler S, Johnson D . Randomized clinical trial of therapeutic exercise in subacute stroke[J]. Stroke, 2003,34(9):2173-2180
doi: 10.1161/01.STR.0000083699.95351.F2
[10] Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T ; American Heart Association/American Stroke Association Council on Stroke; Council on Cardiovascular Radiology and Intervention; American Academy of Neurology.Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline[J]. Circulation, 2006,113(10):e409-449
[11] Noh DK, Lim JY, Shin HI, Paik NJ . The effect of aquatic therapy on postural balance and muscle strength in stroke survivors — a randomized controlled pilot trial[J]. Clin Rehabil, 2008,22(10-11):966-976
doi: 10.1177/0269215508091434
[12] Mehrholz J, Kugler J , Pohl M.Water-based exercises for improving activities of daily living after stroke[J].Cochrane Database Syst Rev, 2011,(1):CD008186
doi: 10.1002/14651858.CD008186.pub2 pmid: 21249701
[13] Blackmer J , Jefromova L.The use of alternative therapies in the Saskatchewan stroke rehabilitation population[J].BMC Complement Altern Med, 2002, 2: 7
doi: 10.1186/1472-6882-2-7 pmid: 117436
[14] Li LT, Wang SH, Ge HY, Chen J, Yue SW, Yu M . The beneficial effects of the herbal medicine Free and Easy Wanderer Plus(FEWP) and fluoxetine on post-stroke depression[J]. J Altern Complement Med, 2008,14(7):841-846
doi: 10.1089/acm.2008.0010
[15] Jung WS, Choi DJ, Cho KH, Lee KS, Moon SK, Kim YS, Bae HS . Safety and efficacy assessment of chungpyesagan-tang for acute ischemic stroke[J]. Am J Chin Med, 2003,31(2):181-190
doi: 10.1142/S0192415X03000898 pmid: 12856857
[16] Shin BC, Lee MS . Effects of aromatherapy acupressure on hemiplegic shoulder pain and motor power in stroke patients: a pilot study[J]. J Altern Complement Med, 2007,13(2):247-251
doi: 10.1089/acm.2006.6189
[17] Kang HS, Sok SR, Kang JS . Effects of meridian acupressure for stroke patients in Korea[J]. J Clin Nurs, 2009,18(15):2145-2152
doi: 10.1111/j.1365-2702.2008.02522.x pmid: 19583646
[18] Johansson K, Lindgren I, Widner H, Wiklund I, Johansson BB . Can sensory stimulation improve the functional outcome in stroke patients? Neurology. 1993; 43(11):2189-2192.
doi: 10.1212/WNL.43.11.2189 pmid: 8232927
[19] Wong AM, Su TY, Tang FT, Cheng PT, Liaw MY . Clinical trial of electrical acupuncture on hemiplegic stroke patients[J]. Am J Phys Med Rehabil, 1999,78(2):117-122
doi: 10.1097/00002060-199903000-00006 pmid: 10088585
[20] Gosman-Hedstrom G, Claesson L, Klingenstierna U . Effects of acupuncture treatment on daily life activities and quality of life[J]. Stroke,1998,29:2100-2108
doi: 10.1161/01.STR.29.10.2100
[21] Mok E, Woo CP . The effects of slow-stroke back massage on anxiety and shoulder pain in elderly stroke patients[J]. Complement Ther Nurs Midwifery, 2004,10(4):209-216
doi: 10.1016/j.ctnm.2004.05.006 pmid: 15519938
[22] Fox M, Dickens A, Greaves C, Dixon M, James M . Marma therapy for stroke rehabilitation — a pilot study[J]. J Rehabil Med, 2006,38(4):268-271
doi: 10.1111/j.2042-7166.2005.tb00469.x pmid: 16801211
[23] Song MR, Song HM . The effects of foot reflexology on ADL and fatigue in stroke patients[J]. Korean J Rehabil Nurs, 2005,8(2):139-148
[24] Blunt E . Foot reflexology[J]. Holist Nurs Pract, 2006,20(5):257-259
doi: 10.1097/00004650-200609000-00009
[25] Laures J, Shisler R . Complementary and alternative medical approaches to treating adult neurogenic communication disorders: a review[J]. Disabil Rehabil, 2004,26(6):315-325
doi: 10.1080/0963828032000174106
[26] Chokevivat V, Chuthaputti A . The role of Thai traditional medicine in health promotion. The 6th Global Conference on Health Promotion. Bangkok. 2005.
[27] Buttagat V, Eungpinichpong W, Chatchawan U, Arayawichanon P . Therapeutic effects of traditional Thai massage on pain, muscle tension and anxiety in patients with scapulocostal syndrome: a randomized single-blinded pilot study[J]. J Bodyw Mov Ther, 2012,16(1):57-63
doi: 10.1016/j.jbmt.2011.04.005
[28] Jirayingmongkol P, Chantein S, Phengchomjan N, Bhanggananda N . The effect of foot massage with biofeedback: a pilot study to enhance health promotion[J]. Nurs Health Sci, 2002,4(3):A4
doi: 10.1046/j.1442-2018.2002.01140_9.x
[29] Wilkowski RA . Relax! The Thai way[J]. Int J Childbirth Educ, 2004,19(1):4-6
[30] Chia M,Chia M. Nuad Thai: Traditional Thai massage. Bangkok: Healing Tao Books. 2005. German.
[31] Piravej K, Tangtrongchitr P, Chandarasiri P, Paothong L, Sukprasong S . Effects of Thai traditional massage on autistic children’s behavior[J]. J Altern Complement Med, 2009,15(12):1355-1361
doi: 10.1089/acm.2009.0258 pmid: 20001837
[32] Thiagarajan K.The Thai herbal compress technique healing from Thailand[J].Massage, 2007, 133: 1
[33] van der Riet P, Dedkhard S, Srithong K . Complementary therapies in rehabilitation: nurses’ narratives. Part 1[J]. J Clin Nurs, 2012,21(5-6):657-667
doi: 10.1111/jcn.2012.21.issue-5-6
[34] van der Riet P, Dedkhard S, Srithong K . Complementary therapies in rehabilitation: stroke patients’ narratives. Part 2[J]. J Clin Nurs, 2012,21(5-6):668-676
doi: 10.1111/j.1365-2702.2011.03726.x pmid: 22098401
[35] Hsieh YW, Wang CH, Wu SC, Chen PC, Sheu CF, Hsieh CL . Establishing the minimal clinically important difference of the Barthel Index in stroke patients[J]. Neurorehabil Neural Repair, 2007,21(3):233-238
doi: 10.1177/1545968306294729 pmid: 17351082
[36] Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y . The visual analog scale for pain: clinical significance in postoperative patients[J]. Anesthesiology, 2001,95(6):1356-1361
doi: 10.1097/00000542-200112000-00013
[37] Rabe-Hesketh S, Skrondal A. Multilevel and longitudinal modeling using Stata[M]. College Station, Texas: Stata Press,2005,(): 317
[38] Kutner JS, Smith MC, Corbin L, Hemphill L, Benton K, Mellis BK, Beaty B, Felton S, Yamashita TE, Bryant LL, Fairclough DL . Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial[J]. Ann Intern Med, 2008,149(6):369-379
doi: 10.7326/0003-4819-149-6-200809160-00003
[39] Kelly AM . Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med. 1998; 5(11):1086-1090.
doi: 10.1111/acem.1998.5.issue-11
[40] Zisapel N, Nir T . Determination of the minimal clinically significant difference on a patient visual analog sleep quality scale[J]. J Sleep Res, 2003,12(4):291-298
doi: 10.1046/j.0962-1105.2003.00365.x
[1] Brody Slostad, Tejinder Khalsa, Kathleen Young, Hildalicia Guerra, Anjali Bhagra. A case-based approach to integrative medicine for cardiovascular disease prevention. Journal of Integrative Medicine, 2020, 18(2): 159-162.
[2] Ameena Yasmeen, Ghulamuddin Sofi, Kaleemullah Khan. Aamar-e-Advia (shelf-lives) of drugs in Unani system of medicine: A conceptual review. Journal of Integrative Medicine, 2020, 18(2): 114-124.
[3] Louisa Sylvia, Emerson West, Allyson M. Blackburn, Carina Gupta, Eric Bui, Tara Mahoney, Geraldine Duncan, Edward C. Wright, Simon Lejeune, Thomas J. Spencer. Acceptability of an adjunct equine-assisted activities and therapies program for veterans with posttraumatic stress disorder and/or traumatic brain injury. Journal of Integrative Medicine, 2020, 18(2): 169-173.
[4] Chang-quan Ling. Traditional Chinese medicine is a resource for drug discovery against 2019 novel coronavirus (SARS-CoV-2). Journal of Integrative Medicine, 2020, 18(2): 87-88.
[5] Sherman Gu, Arthur Yin Fan. Controversial conclusions from two randomized controlled trials for acupuncture's effects on polycystic ovary syndrome or in vitro fertilization support. Journal of Integrative Medicine, 2020, 18(2): 89-91.
[6] Xue-qing Yu, Shu-guang Yang, Yang Xie, Jian-sheng Li. Traditional Chinese medicine in the treatment of idiopathic pulmonary fibrosis based on syndrome differentiation: Study protocol of exploratory trial. Journal of Integrative Medicine, 2020, 18(2): 163-168.
[7] Mohadeseh Ostovar, Abolfazl Akbari, Mohammad Hossein Anbardar, Aida Iraji, Mohsen Salmanpour, Salar Hafez Ghoran, Mojtaba Heydari, Mesbah Shams. Effects of Citrullus colocynthis L. in a rat model of diabetic neuropathy. Journal of Integrative Medicine, 2020, 18(1): 59-67.
[8] Preecha Nootim, Nattiya Kapol, Waranee Bunchuailua, Panoopat Poompruek, Parankul Tungsukruthai . Current state of cancer patient care incorporating Thai traditional medicine in Thailand: A qualitative study. Journal of Integrative Medicine, 2020, 18(1): 41-45.
[9] Sajjad Sadeghi, Farzaneh Ghaffari, Ghazaleh Heydarirad, Mehdi Alizadeh. Galen’s place in Avicenna’s The Canon of Medicine : Respect, confirmation and criticism. Journal of Integrative Medicine, 2020, 18(1): 21-25.
[10] Maryam Naeimia, Narjes Gorjib, Zahra Memarianib, Reihaneh Moeinib, Mohammad Kamalinejadc, Fatemeh Kolangid. Gastroprotective herbs for headache management in Persian medicine: A comprehensive review. Journal of Integrative Medicine, 2020, 18(1): 1-13.
[11] Md. Anzar Alam, Mohd Aleemuddin Quamri, Ghulamuddin Sofi, Barkati Md.Tarique. Understanding hypothyroidism in Unani medicine. Journal of Integrative Medicine, 2019, 17(6): 387-391.
[12] Naghmeh Yazdi, Alireza Salehi, Mina Vojoud, Mohammad Hossein Sharifi, Ayda Hoseinkhani. Use of complementary and alternative medicine in pregnant women: a cross-sectional survey in the south of Iran. Journal of Integrative Medicine, 2019, 17(6): 392-395.
[13] Wen Qiang Lee, Jeremy Teoh, Pei Zheng Kenneth Lee, Zhi Xiong Gerard Low, Xueling Sim, Foong Fong Mary Chong, Norbert Ludwig Wagner. Factors influencing communication of traditional Chinese medicine use between patients and doctors: a multisite cross-sectional study. Journal of Integrative Medicine, 2019, 17(6): 396-403.
[14] Zienab Mahmoudpour, Javad Shokri, Mohammad Kamalinejad, Neda Meftah, Soraya Khafri, Seyyed Ali Mozaffarpur, Hoda Shirafkan. The efficacy of a Persian herbal formulation on functional bloating: A double-blind randomized controlled trial. Journal of Integrative Medicine, 2019, 17(5): 344-350.
[15] Claire L. Hoban, Roger W. Byard, Ian F. Musgrave. Analysis of spontaneous adverse drug reactions to echinacea, valerian, black cohosh and ginkgo in Australia from 2000 to 2015. Journal of Integrative Medicine, 2019, 17(5): 338-343.
Full text



[1] Jin-zhou Tian, Jing Shi, Xin-qing Zhang, Qi Bi, Xin Ma, Zhi-liang Wang, Xiao-bin Li, Shu-li Shen, Lin Li, Zhen-yun Wu, Li-yan Fang, Xiao-dong Zhao, Ying-chun Miao, Peng-wen Wang, Ying Ren, Jun-xiang Yin, Yong-yan Wang, Beijing United Study Group on MCI of the Capital Foundation of Medical Developments. An explanation on "guiding principles of clinical research on mild cognitive impairment (protocol)". Journal of Chinese Integrative Medicine, 2008, 6(1): 15-21
[2] Jin-rong Fu. Establishment of multivariate diagnosis and treatment system of modern gynecology of traditional Chinese medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 22-24
[3] Jun Cai, Hua Wang, Sheng Zhou, Bin Wu, Hua-rong Song, Zheng-rong Xuan. Effect of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2008, 6(1): 37-40
[4] Dong Yang, Yong-ping Du, Qing Shen, Wei Chen, Yan Yu, Guang-lei Chen. Expression of alpha-smooth muscle actin in renal tubulointerstitium in patients with kidney collateral stasis. Journal of Chinese Integrative Medicine, 2008, 6(1): 41-44
[5] SUN Ming-yu, ZUO Jian, DUAN Ji-feng, HAN Jun, FAN Shi-ming, ZHANG Wei, ZHU Li-fang, YAO Ming-hui. Antitumor activities of kushen flavonoids in vivo and in vitro. Journal of Chinese Integrative Medicine, 2008, 6(1): 51-59
[6] Hai-feng Wei, Bai-liu Ya, Ling Zhao, Cui-fei Ye, Li Zhang, Lin Li. Evaluation of tongue manifestation of blood stasis syndrome and its relationship with blood rheological disorder in a rat model of transient brain ischemia. Journal of Chinese Integrative Medicine, 2008, 6(1): 73-76
[7] Guo-hong Yuan, Xiao-jing Pang, He-chao Ma. Synergic effects of Danggui Buxue Decoction in reducing toxicity of cytoxan in tumor-bearing mice. Journal of Chinese Integrative Medicine, 2008, 6(1): 83-88
[8] Li Zhou, Hong-xing Zhang, Ling-guang Liu, Wen-jun Wan. Effect of electro-acupuncture at Fenglong (GV 16) on nitric oxide and endothelin in rats with hyperlipidemia. Journal of Chinese Integrative Medicine, 2008, 6(1): 89-92
[9] Jin-zhou Tian, Jing Shi, Xin-qing Zhang, Qi Bi, Xin Ma, Zhi-liang Wang, Xiao-bin Li, Shu-li Shen, Lin Li, Zhen-yun Wu, Li-yan Fang, Xiao-dong Zhao, Ying-chun Miao, Peng-wen Wang, Ying Ren, Jun-xiang Yin, Yong-yan Wang, Beijing United Study Group on MCI of the Capital Foundation of Medical Developments. Guiding principles of clinical research on mild cognitive impairment (protocol). Journal of Chinese Integrative Medicine, 2008, 6(1): 9-14
[10] Daniel Weber, Janelle M Wheat, Geoffrey M Currie. Inflammation and cancer: Tumor initiation, progression and metastasis,and Chinese botanical medicines. Journal of Chinese Integrative Medicine, 2010, 8(11): 1006-1013