treated by the therapist applying firm, gentle pressure to certain points to restore balance (Booth, 1993; Maxwell, 1997; Stevenson, 1995). Shiatsu massage, therefore, combines a knowledge of massage, which people have used for centuries to heal their aches and pains, with energy pathways that are interconnected and provides a holistic tableau for addressing mind, body, and spirit (Luth & Henry, 2000). Although Smith (1991) argued that most of Western medicine clinical practice has simply been taken for granted and does not rest on scientific findings, practices formerly seen as alternative or comple58 JOURNAL OF HOLISTIC NURSING / March 2001 Downloaded from jhn.sagepub.com at PENNSYLVANIA STATE UNIV on March 4, 2016 mentary are now being used more and more frequently in traditional patient care (Dossey, 1999; “The Mainstreaming of Alternative Medicine,” 2000). Although there are many different types of massage (Jahnke, 1985; Owens & Ehrenreich, 1991), there is little research to demonstrate the scientific effectiveness of specific types of massage, including shiatsu. This study will add scientific findings to the body of knowledge about massage, specifically that of shiatsu massage. The nurse has a responsibility to educate and support patients seeking answers to chronic health problems that traditional medicine may not be able to relieve. To provide the education consumers need to make informed choices, nurses must have reliable research studies on which to base treatment recommendations and referrals. Lower back pain is a problem encountered by a great many adults (Deyo et al., 1991). Anxiety often accompanies pain, has been accused of being the cause of lower back pain (Lampe et al., 1998), and may be a factor for an individual anticipating his or her first massage. The purpose of this study was to explore the effects of shiatsu on the pain and anxiety associated with lower back pain. METHOD Design A quasi-experimental pretest-posttest single-group design was used to answer the following six research questions: 1. Does lower back pain of adults differ significantly before and after each of four shiatsu treatments? 2. Does lower back pain of adults differ significantly at the completion of a shiatsu treatment and 2 days following the treatment? 3. Does anxiety of adults complaining of lower back pain differ significantly before and after each of four shiatsu treatments? 4. Does the pain or anxiety experienced by adults complaining of lower back pain differ as a function of gender, age, the gender of the shiatsu therapist, medications taken prior to the study, type of hobbies, type of employment, years of low back pain, or history with shiatsu massage? 5. Does shiatsu massage significantly decrease the major inconveniences experienced by adults with lower back pain? 6. Would adults who experienced four shiatsu treatments for lower back pain recommend this treatment approach to their friends or relatives with a similar condition? Brady et al. / SHIATSU AND LOWER BACK PAIN 59 Downloaded from jhn.sagepub.com at PENNSYLVANIA STATE UNIV on March 4, 2016 Sample Inclusion criteria for participants in the study were older than the age of 18, have no open sores or lesions on their back, have no diagnosis of bone cancer, complaining of lower back pain, and agree to undergo four shiatsu treatments in a 4- to 8-week period. Potential subjects were informed that the benefits of their participation in this study included receiving four shiatsu treatments at a reduced rate as well as experiencing the therapeutic effects of shiatsu as an adjunct to their routine plan of medical care. There were 66 participants in the study, 39 (59%) women and 27 (41%) men. Participants’ ages ranged from 18 to 68, with an average age of 39.58. Thirteen of the participants (19.6%) indicated they had had a shiatsu massage treatment previously; 53 (81.4%) of these participants, therefore, had their first shiatsu treatment at the beginning of this study. All participants in this study were Caucasian. Men indicated an average of 7.7 years of lower back pain, and the women indicated an average of 9.6 years. Of the participants, 23 (34.8%) were under the care of a health professional for their lower back pain, 9 seeing medical doctors and 14 seeing chiropractors. Seventeen of these 23 first visited the health care professional about their lower back pain within the previous 7 months. Only 28 (42%) indicated they had ever had any diagnostic tests regarding their lower back pain, and 12 of them were diagnosed within the last 2 years. Seven participants were diagnosed 2 to 4 years ago, and the remaining 9 were diagnosed between 5 and 20 years ago. The four most frequent responses to questions about illness or conditions experienced at the beginning of the study were neck pain (n = 38, 57.5%), upper back pain (n = 31, 46.9%), headaches (n = 28, 42.4%), and joint pain (n = 26, 39.3%). Instruments Pain was measured as the respondent’s self-report using the Visual Analogue Scale (VAS) (Huskisson, 1974). The VAS is widely recognized as a valid and reliable tool for measuring an individual’s perception of his or her own pain (Huskisson, 1974; Pope et al., 1994). The VAS possesses both concurrent validity and discriminant validity (Gift, 1989), and the reliability of the VAS has been demonstrated as r = .71 using a test-retest method (Reville,