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well as empowering patients to self-manage their pain. This report describes treatment of a FM patient with MRMT® that focuses on improving pain management through increased physical activity. Methods The patient who participated in this study was a 63-year-old female diagnosed with FM as defined by the American College of Rheumatology [15]; she had a concurrent diagnosis of Type 2 diabetes that had been identified in 2002. This patient presented to the clinic in 2011 complaining of chronic pain that had not improved despite prior treatments that included traditional massage therapy, physical therapy, and chiropractic sessions. While she had also previously tried pharmacologic treatment for FM, she had discontinued this approach due to adverse effects. Starting in October 2013, the patient was treated approximately every two weeks by a specialist in MRMT®. The study continued for approximately 6 months. This study was performed at an MRMT Clinic. Permission to collect and publish data for this study was obtained from the patient. Assessment-Based treatment approach: MRMT® MRMT® uses a multilayered assessment approach for each patient that has been designed to take into consideration a patient’s different perceptions of pain and function, as well as differences in how they react to their pain. Both patient and therapist ratings of pain and function are recorded during this process, as described further below. This comprehensive assessment helps the therapist customize the treatment plan with handson passive pain management techniques based on J. H. Kellogg’s seven massage procedures [16]. The technique or combination of techniques used varies not only from patient to patient, but also may vary for a single patient Figure 1: Overview of the MRMT® Assessment Process. Each step of the “OHIPAS” patient-centered approach is carried out as part of every treatment session so that patients are continuously assessed, and manual therapies can be adjusted appropriately to match the patient’s needs. DOI: 10.23937/2469-5793/1510086 ISSN: 2469-5793 Bowyer et al. J Fam Med Dis Prev 2018, 4:086 • Page 3 of 6 • level using a scale of 0-10 modified from the Wong-Baker Faces Pain Rating Scale [17]; she also rated her perceived level of function using a scale of 0-100%, divided into 10% increments. These ratings were tracked over time. Therapist ratings of pain and function: Therapist ratings of the patient’s pain and function were collected during each treatment visit through the MRMT® assessment process and were also tracked over time. Clinical and quality of life measures: At both baseline and at the end of the study, we recorded the patient’s BMI, HbA1C levels, medication usage, and perceptions about her FM symptoms. A postural analysis and active range of motion tests were performed before and after each treatment as part of the assessment. Analysis We conducted a pre-post evaluation of the results therapist, and the average of the total score is converted into percent function using an empirically derived calculation. The additional elements of the OHIPAS assessment are collected through conversations with the patient, and during the manual therapy treatment. The six components of the MRMT® assessment are combined to produce a single therapist-assessed rating of the patient’s pain and function that includes both the physical and psychological aspects of pain as described by the patient. This therapist-based rating scale was tested for its reliability across six trained therapists with multiple patients. We determined that ratings were not significantly different between therapists (p > 0.1), leading us to implement this composite therapist-based rating for all patients. Study measures Patient ratings of pain and function: Before each MRMT® treatment, the patient rated her maximum pain Words to describe pain. The therapist observes the patient’s behavior and asks the patient to describe their pain using words in the top two rows during the assessment. Points in the right column are assigned to give a maximum score of 10. DOI: 10.23937/2469-5793/1510086 ISSN: 2469-5793 Bowyer et al. J Fam Med Dis Prev 2018, 4:086 • Page 4 of 6 • movement and clenching of her jaw
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