jhn.sagepub.com at PENNSYLVANIA STATE UNIV on March 4, 2016 The fifth research question asked if shiatsu massage decreased the major inconveniences of lower back pain each subject identified at the beginning of the study and then rated at the conclusion of the study. Using the demographic questionnaire, participants were given an opportunity to identify five major inconveniences they were experiencing at the beginning of the study. At the conclusion of the study, on the exit questionnaire, participants were asked to indicate for each inconvenience they had identified if it was now bothering them not at all (1), less(2), the same(3), more(4), or much more(5). Table 2 illustrates that the subjects believed their inconveniences were affecting them less after four shiatsu treatments. To address the last research questions, participants were asked if they would recommend shiatsu treatments to a friend or relative suffering from lower back pain. One subject did not answer this question. The other 65 indicated they would recommend shiatsu, and a majority put an exclamation point after the question, underlined it, or otherwise indicated not only agreement but apparent emphatic agreement. Participants were asked to share their thoughts about shiatsu, the therapists, or the research study at the conclusion of the exit questionnaire. Forty (60.6%) of the subjects responded to this question, and positive responses were written by 39 of the 40 (97.5%). Comments included how relaxed they felt after the treatments (n = 15), the decrease in lower back pain since starting the treatments (n = 12), the fact that they had been sleeping better since beginning shiatsu treatments (n = 5), and the desire to continue with shiatsu (n = 5). Both shiatsu therapists were praised highly throughout these comments, and 9 of the 40 thanked the specific therapist for helping so much. The 40 respondents also included three negative comments. Two of the 40 66 JOURNAL OF HOLISTIC NURSING / March 2001 TABLE 2 Mean Responses to “How Are Inconveniences Affecting You Now?” M n Five inconveniences 1.94 36 Four inconveniences 2.01 55 Three inconveniences 2.09 62 Two inconveniences 2.15 65 One inconvenience 1.96 66 Downloaded from jhn.sagepub.com at PENNSYLVANIA STATE UNIV on March 4, 2016 mentioned the rebound pain the day after treatment, and the one person who provided only negative comments found the sporadic nature of applying pressure interfered with relaxation but wished the treatments were longer. DISCUSSION Participants in this study reported a very positive experience with shiatsu as an intervention for their lower back pain. Their report of pain decreased significantly after each treatment and throughout the study period, although the reported pain after each treatment was significantly lower than it was reported to be 2 days later. State anxiety, which is commonly associated with pain (Spielberger, 1983) and may be a factor for individuals experiencing massage for the first time, decreased after each treatment, whereas trait anxiety, which is purported to be a stable construct (Spielberger, 1983), did not vary across the four treatments. Pain and state anxiety decreased throughout the study regardless of the subject’s gender, age, hobbies, employment, years of lower back pain, history with shiatsu, or the fact that some took pain medications prior to the study and some did not. There was no difference in perceived pain or state anxiety related to any of these demographic variables. When asked to identify up to five of the inconveniences experienced as a result of their lower back pain, all 66 participants responded with at least one. The most common complaints were the pain itself, sleep disturbances, problems with lifting and/or bending, trouble sitting, increased irritability, and being unable to play with their children as they would like. When asked at the conclusion of the study to identify how these inconveniences were bothering them now, participants’ rankings gathered around a 2.0, which corresponds to less on the 5-point scale. All of the participants indicated they would recommend shiatsu massage to a friend or relative who was experiencing lower back pain, and 39 of the 40 who responded to the open-ended question about the therapy and study were positive and grateful for this experience. It was interesting to note throughout this study that referrals for participants came from chiropractors, a pain clinic, and an arthritis clinic. A request for a future study on burn clients came to the therapists from the physicians in the local burn clinic. Brady et al. / SHIATSU AND LOWER BACK PAIN 67 Downloaded from jhn.sagepub.com at PENNSYLVANIA STATE UNIV on March 4, 2016 The significant decreases in perceived pain and anxiety scores found in this study are consistent with the findings from the study on cancer patients reported by Ferrell-Torry and Glick (1993). FerrellTorry and Glick’s study was limited to 9 male participants who experienced massage in a variety of environments. These authors suggested future studies include women, larger samples, a controlled environment for all participants, and longitudinal measures. In a critique of the methodology of research studies evaluating massage, Cawley (1997) noted that many studies had small samples and administered only one or two