oil in the prone and supine positions on a massage bed, with participants undressing and covering themselves with towels provided, and following the treatment re-dressing behind a screen. Both massages covered all areas of the body: feet, legs, hips, back, upper chest, arms, hands, neck and face. MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT 8 A SM routine is generally carried out for 45 minutes to one hour. The minimum time for a TM is usually one and a half hours for the ‘classic routine’ (Salguero & Roylance 2011). In this crossover trial, both Thai and SM were performed for 45 minutes. Although the whole body was covered in this time, there may be increased benefit by performing the TM for one and a half hours. TM is a flexible therapy and is tailored to the client – a relaxing massage will incorporate slower, gentler movements whereas an energising massage would include deep stretching, faster speed and stronger pressure. The massage may be a general TM or therapeutic (concentrating on a particular issue). In this crossover trial the TM performed was of the general and energising type. SM can be tailored to the client’s requirements, by varying the pressure, speed and movement type of the strokes used. In this study firm pressure and medium speed of strokes were used during SM; movements included effleurage (including reinforced i.e. hand on top of hand or hand on top of fingers), alternate thumb massage, petrissage (including using flat of knuckles), friction and tapotement Materials and equipment The Activation-Deactivation Adjective Check List (AD-ACL) (Thayer, 1989) was used to measure arousal. The AD-ACL is a 20-item multidimensional psychometric test of various arousal states, with 4 subscales – Energy (items: Active, Energetic, Vigorous, Lively, Full of pep), Tiredness (items: Sleepy, Tired, Drowsy, Wide-awake, Wakeful), Tension (items: Jittery, Intense, Fearful, Clutched up, Tense) and Calmness (items: Placid, Calm, At rest, Still, Quiet). Items use a 4-point Likert response format with response options Definitely yes, Slightly, Cannot decide and Definitely no. A desirable arousal state is indicated by high MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT 9 levels of energy and calmness and low levels of tiredness and tension. An active arousal state is indicated by high levels of energy and tension and low levels of tiredness and calmness. For this study the total score was calculated and reported so that higher scores represented the more desirable states: higher total scores of desirable arousal occurred where participants reported high levels of Energy and Calmness, but low levels of Tiredness and Tension; higher total scores of active arousal occurred where participants reported high levels of Energy and Tension, but low levels of Tiredness and Calmness. Specific for this study, two visual analogue scales measured tiredness and pain over the previous three days, which participants marked on one 100 mm-long line (converted into a score between 0 [no] and 10 [extreme]). Participants were asked to rate their generalised, overall experience of pain, without reference to a specific location, body area or type of pain. Previous research has reported test-retest reliability for the AD-ACL subscales to be 0.89 for energy, 0.89 for tiredness, 0.93 for tension and 0.79 for calmness (Thayer, 1989). Moreover, factorial validity of the four primary scale components (energy, wakefulness, tension and calmness) and the two secondary scale components (energetic and tense arousal) has demonstrated (Koš čec et al., 2001). Participants reported their primary and secondary presenting symptoms and their previous experience of CAM and/or massage therapies on the Baseline Data Sheet. An interview guide was created to conduct semi-structured interviews at MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT 10 the three time points: base-line before randomisation, cross-over and final, to explore participants’ social constructions and experiences of TM and SM: A social construct: a concept or perception of a phenomenon based on collective views developed and maintained within a society or societal group as opposed to existing inherently or naturally (Oxford Dictionary). Participants were also asked to write a brief, free-text record in the study diary of how they had been feeling over the preceding 24 hours and to describe what and how many of any prescribed medicines, or alternative remedies they took during the study. Methodology triangulation was used in this mixed-method trial in order to reduce bias, provide validity and verification, give enhanced insight into the subject, and to ensure comprehensiveness of data. This included interviews, diaries and validated quantitative data collection via psychological scales (Thrumond 2001). Participants were randomized after all baseline data had been collected and before treatment commenced. Only the clinician (masseuse) was aware of which participant was allocated to which arm and what the codes of the randomisation sequence represented. In studies with interventions of this type it is impossible for the clinician delivering the intervention (massages) to be blind. The collection of interview data and conducting the data analysis were all undertaken blind. Data Analysis AD-ACL subscales were analysed for internal-consistency reliability with Cronbach’s