Practice Guideline on Malay Massage
Transcription
Practice Guideline on Malay Massage
TRADITIONAL AND COMPLEMENTARY MEDICINE PRACTICE GUIDELINE ON MALAY MASSAGE Revised Edition, November 2009 2 First Edition, October 2007 Second Edition, November 2009 All rights reserved. No part of this book may be reproduced, stored, or transmitted in any form or by any means, electronic or otherwise, including photocopying, recording, internet or any storage and retrieval system without prior written permission from the publisher. Published by: Traditional and Comple mentary Medicine Division Ministry of Health Malaysia ISNB 983 – 44754 – 4-4 Cover design by : Mohd Affendy Baharudin Traditional and Complementary Medicine Division Ministry of Health Malaysia 2 Acknowledgements .............................................................................................................................i 1. Introductions ..............................................................................................................................1 2. Objectives...................................................................................................................................2 3. Massage .....................................................................................................................................2 3.1 Malay Massage ....................................................................................................................2 3.2 Petua and Pantang Larang ...................................................................................................3 4. Procedures and Techniques .........................................................................................................4 5. Indications ..................................................................................................................................5 6. Contraindications and side effects ................................................................................................6 7. 8. 6.1 Contraindications.................................................................................................................6 6.2 Side effects of Massage Therapy ...........................................................................................6 Standard Of Practice....................................................................................................................7 7.1 Cleanliness ..........................................................................................................................7 7.2 Confidentiality .....................................................................................................................7 7.3 Respect ...............................................................................................................................7 7.4 Maintain professional distance ............................................................................................7 7.5 Personal Grooming ..............................................................................................................7 Terminology................................................................................................................................8 9. APPENDICES ...................................................................................................................................9 Appendix 1 : Types of Malay Massage.........................................................................................10 Appendix 2 : An Overview of Work Process for Malay traditional Masseur. .................................11 Appendix 3: Clerking Form .........................................................................................................12 Appendix 3: Clerking Form .....................................................................................................15 Appendix 3: Clerking Form .........................................................................................................15 Appendix 4: Screening Form.......................................................................................................18 Appendix 5: Consent Form.........................................................................................................20 Appendix 6 : Guide in Treatment Plan of Malay Massage for Chronic Pain and Post Stroke Management ............................................................................................................................21 Diagram 1 : Massage Techniques /Strokes ..................................................................................22 Diagram 2: Hand Washing Techniques ........................................................................................24 10. REFERENCES..........................................................................................................................25 11. Committee Members.............................................................................................................27 2 Acknowledgements Special thanks to every individual and organizations that have in one way or another contributed comments and advices during the preparation of the Traditional and Complementary Medicine Practice Guidelines on Malay Massage. i 1. Introductions Traditional medicine is the knowledge, skills and practice of holisti c health care, recognized and accepted for its role in the maintenance of health and the treatment of diseases. It is based on indigenous theories, beliefs and experiences that are handed down from generation to generation1 . Although modern medicine is widely spread, traditional medicine still exists and widely used in many countries. Interest in traditional medicine has increased over the last decade. People are now more prepared to look for alternative approaches to maintain their health. World Health Organization’s (WHO) traditional medicine programme was developed in conjunction with the adoption of the health for all strategy and the primary health care approach. The Regional Strategy for Traditional Medicine in Western Pacific Region was prepared to help guide national governments, WHO and other partners in the efforts to ensure the proper use of traditional medicine and its contribution for maintaining health and fighting diseases in the Region. One of the strategies indicates the need to promote public awareness and access to traditional medicine. It recommends that government and non government organization should motivate healers to cooperate and voluntarily share their healing knowledge and practices. Access to traditional medicine through informed choice should be facilitated and mutual understanding between practitioners of traditional and modern medicine should be promoted. In January 2006 ,the Malaysian Cabinet had approved the establishment of Traditional and Complementary Medicine ( T&CM) unit in three hospitals, Kepala Batas Hospital in Penang, Putrajaya Hospital in Federal Territory of Putrajaya and Sultan Ismail Hospital in Johore. The implementation of the pioneer project is towards integrating traditional and complementary medicine into the existing public healthcare delivery system.. To implement the services, the unit is provided with T&CM practice guidelines on the three modalities of treatment. 1 2. Objectives The objective are to promote the highest standards in the practice of the Malay Massage modalities of treatment and to ensure public safety. 3. Massage Massage has been categorized under the Manipulative and Body Base Method according to National Center for Complementary and Alternative Medicine, National Institute of Health, United State of America. Massage has shown to improve the circulation, relieving many common muscle aches and pains, boosting immunity and promoting an overall sense of well being 2. Massage may be used as primary therapeutic intervention or as an adjunct to other therapeutic techniques3 . The mode of action 4,5 are by : (1) mobilization of inter-tissue fluids, (2) reduction or modification of edema, (3) increase of local blood flow, (4) decrease of muscle soreness and stiffness, (5) moderation of pain, (6) facilitation of relaxation, and (7) prevention or elimination of adhesions . 3.1 Malay Massage The Malay massage is a mixture of kneading, stroking and pressing with hands (Diagram 1: Massage Techniques / Strokes). The massage strokes are done depending on the masseur’s judgment of one’s body need, and selected natural plants or herbal oils are applied during the massage 6,7. It also sometimes accompanied with special pray incantations and take home advise in form of post massage work out/ exercises 8,9. Malay massage is divided into two types of massage based on their purpose; wellness and therapeutic massage. For the purpose of wellness, the massage helps in reducing anxiety, improving sleeps, in boosting immunity of the body10 and in reducing stress. 2 Massage that fall into this categories includes relaxation massage (urutan merehatkan badan), rejuvenating massage ( urutan penyegaran badan) and Improve blood circulation massage (urutan melancarkan peredaran darah). Therapeutic massage on the other hand helps to improve the condition of a particular illness and in reducing severity of pain. Common illness that benefit from such massage includes sprains and low back pain. Therapeutic massages are specified into massage of nerve ailments, joints ailments, sprains, muscle ailments and others. (Appendix I: Types of Malay Massage) 3.2 Petua and Pantang Larang a. Take a light meal before massage treatment. Before Malay massage procedure: every patient is advised to have light meals / breakfast as a fasting patient may be at risk of fainting episodes or hypoglycaemia. Too heavy a meal may also lead to ineffective massage. b. Shower / Bath If patient needed to take a bath, please do so after 1 hour completed Malay massage procedure. c. Rest Rest at least for 1 hour after completed massage. d. Rehydrates Patient are encourage to drink lots of warm plain water to rehydrate themselves after massage. This is to prevent muscle soreness that occur post massage. 3 4. Procedures and Techniques Massage treatment takes a variety of forms and may last between 15 to 90 minutes. (15-45 minutes for chronic pain and 60-90 minutes for post stroke cases) Treatment starts with a case history, assessment on the client’s condition and the indications for massage 11 (Please refer appendix 2: Work Process for Malay traditional Masseur). During clerking for the case history and doing the assessment for suitability for massage, the practitioner/masseur are required to document all findings in the clerking form .(Appendix 3: Borang Penilaian Urutan Melayu).Additional information can be obtain in the screening form if so required (Appendix 4 : Screening Form). During the assessment, if the client is not suitable for the treatment, advice to seek appropriate medical treatment should be given.(please refer Section 6 : Contraindications for Massage) Before starting any procedures or treatment, practitioner are required to explain the procedures to the patient prior signing the consent form( Appendix 5 : Consent Form For Malay Massage). All procedures are also required to be documented in patient’s record. Malay massage treatment session ends with counseling and advises regarding dietary intakes and exercise technique for patient to continue at home. The number and frequency of follow up visit for Malay massage treatment are catered according to individual bases (Appendix 6: Guide in Treatment Plan of Malay Massage for Chronic Pain and Post Stroke Management). However, any adverse event or side effect that occurs must be reported and documented in appropriate form for further action. In the unit, to preserve the authenticity of Malay massage technique, all Malay massage are done on a raised floor that made of wood known as pangkin (figure 1).The patient is dressed appropriately to respect their privacy. Part of Malay massage techniques are shown in Diagram 1: Massage Techniques/Strokes. All type of massage oil being used must be registered with the Ministry of Health, Malaysia. Any oils that contain methlysalicylate are prohibited. 4 Figure 1 : Pangkin 5. Indications Massage is administrated as an complementary to other therapy, medical or rehabilitation therapy and in some cases it is only carried out with the approval of a medical practitioner. Application of massage can be categories to different types of conditions11. a) For generalized constitutional disorder, massage helps to enhances the elimination of toxin and waste products. This achieve by systemic effect where massage enhance the circulation systems particularly the venous return and of the lymph. It also has indirect effect to the autonomic nervous system which in turn improves the production of glandular secretions and organ functions. Massage also has a localized effect where promote muscle relaxation for the patient ; example Stroke patient8 , edema. b) Acts on reflex zones , whether these areas arise from either direct referred pain relating to the organ or indirect tissue changes example tension headaches c) Helps to alleviate some of the symptoms associate with the disease ; example Low back pai n12 , Chronic pain13 ,Anxiety and Depression. 5 6. Contraindications and side effects Massage is contraindicated when it could cause worsening of a particular condition, unwanted tissue destruction, or spread of disease 14. A very small numbers of serious injuries have been reported, and most occurred because caution were not followed or massage was given by a person who was not properly trained. 6.1 Contraindications Acute Infections Acute Inflamations Trauma Bacterial and fungal infections Athlete’s foot Cellulitis Ringworm Impetigo Abscesse Fever Toxaemia (septicaemia) Viral infections Measles Areas affected by herpes zoster (shingles) Gout Infective arthritis Ulcerative colitis Appendicitis Open wounds Bone fracture Bony avulsion Vascular Disease Others Aneurysm Varicose veins Venous thrombosis Portal hypertension Impaired blood supply to a tissue Weakness in the wall of the blood vessels as in haemophilia, Acute strains, Suspicious lumps or growth Osteoporosis 6.2 Side effects of Massage Therapy15 Massage therapies are not totally devoid of side effects. Below are some of side effects that might occur post massage procedures. The incidence of adverse events is unknown, but probably low16. a. Temporary pain or discomfort b. Bruising c. Swelling d. Allergic reactions of massage oils 6 7. Standard Of Practice All Malay massage therapists must adhere to following standard of practice when conducting massage. 7.1 Cleanliness A therapist must always maintain his / her cleanliness and also the surrounding environment. It involves good technique of hand washing prior to massage treatment. (See Diagram 2: Hand Washing Procedure) 7.2 Confidentiality Every part of patient’s body must be treated as confidential information. Therefore therapist cannot divulge the identity of patient nor any deformities of the patient to any third party. 7.3 Respect A therapist must respect the patient’s body and maintain its privacy. When conducting a massage treatment, any parts of the patient’s body that are not involved during the procedure, must be covered to protect privacy and to respect patient’s dignity. 7.4 Maintain professional distance A therapist should not unload their own personal problems to the patient. 7.5 Personal Grooming - A therapist must wear clean and suitable clothes for massage. - A therapist must give undivided attention during massage - A therapist will not wear any jewelry during massage session that hinder massage procedure 7.6 7.7 A therapist should not used sharp pointed object as a tool for massage. Only the same gender massage therapist will conduct the session onto the same gender client. If otherwise, a chaperone is required throughout the session. 7 8. Terminology Malay terminology Translation Simpul Biawak, Tarik mengkarung Muscle spa sm, Ular ular Muscle cramp Anak anjing tegang Angin Sakit Angin Bengkak Inflamation Pecah angin Urat lari Urat terseliuh Sprain Semut semut Cucuk cucuk Kebas Numbne ss Tebal kulit 8 9. APPENDICES 9 Appendix 1 : Types of Malay Massage References: Traditional Malay Massage; Syed Mahdi Syed Fouzi Barakbah. Paper Presentation. First Asia Pacific Traditional and Complementary Medicine Conference, Malaysia 2008 Appendix 2 : An Overview of Work Process for Malay traditional Masseur. 11 Appendix 3: Clerking Form UNIT PERUBATAN TRADISIONAL DAN KOMPLEMENTARI HOSPITAL _______________ Pesakit Angin Ahmar KAD RAWATAN URUT MELAYU MAKLUMAT PESAKIT Nama : No. KP : Umur : Alamat : No. Pendaftaran : Jantina : Poskod : Negeri : No. Tel : Bangsa : RUJUKAN DARI / KEPADA Tanpa Rujukan PENILAIAN TANDA VITAL SEBELUM RAWATAN Tekanan Darah : mmHg Berat : kg Tinggi : Kadar Denyutan Nadi : persaat Suhu Badan : 0 Dextrose : Skala Kesakitan 0 (Tandakan bulat pada yang berkenaan) Tidak Sakit 1 2 Mengganggu Tugas Har ian 3 4 5 C 6 Tidak Selesa 7 8 Cm mmol/L 9 Sakit Teruk Sakit 10 Sakit Tidak Tertahan SEJARAH PESAKIT FAKTOR RISIKO SEJARAH ANGIN AHMAR Tarikh Serangan Tandakan ( ⁄ ) mana yang berkenaan Sendiri Keluarga Sejarah Pengubatan Serangan angin ahmar Serangan pertama Darah Tinggi Serangan kedua Kencing Manis Serangan seterusnya Serangan Jantung Ciri-ciri / Lokasi Serangan Masalah Jantung Sila nyatakan : Kanan Kiri Kolestrol Tinggi Infact Haemorrhage Merokok Tiada Pendarahan Pendarahan Bekas Perokok RAWATAN LAIN Tandakan ( ⁄ ) mana yang berkenaan Rawatan Diterima Ya Tidak Rehabilitasi Sila nyatakan di mana : Rawatan Tradisional Lain Ubat-ubatan Moden Ubat-ubatan Herba 12 Sila nyatakan jenis rawatan/ubatan PENILAIAN PESAKIT Jenis kelumpuha n : Seluruh badan Separuh badan Kiri Kanan Lokasi ( site ): Huraian : Isikan nama bahagian yang mengalami kelumpuhan . Samada bahagian Kiri atau Kanan. Anggota yang sakit e.g Kaki, Bahu dll Ciri-ciri kelumpuhan (Character) Huraian: Isikan ciri yang dialami;e.g tidak boleh mengerak anggota bahagian,kejang, keras Ketidak upa yaan (Disability) yang lain: Huraian: Isikan samada pesakit mengalami simptom yang lain e.g tidak boleh bertutur , tidak boleh menelan air atau/dan makanan dll Faktor yang menjadikan keadaan lebih buruk (Aggrevating Factor) : Faktor yang menambahbaikan keadaan (Relieving Factor) : Kemajuan (Progression) : Isikan perbandingan keadaan pesakit dari tempoh kelumpuhan hingga hari ini. CATATAN 13 PENILAIAN RAWATAN Ulasan : PLAN RAWATAN Ulasan Nama Pengamal Tanda tangan : Tarikh: 14 UNIT PERUBATAN TRADISIONAL DAN KOMPLEMENTARI HOSPITAL _______________ Pesakit Kesakitan Kronik KAD RAWATAN URUT MELAYU MAKLUMAT PESAKIT Nama : No. KP : Umur : Alamat : No. Pendaftaran : Jantina : Poskod : Negeri : No. Tel : Bangsa : RUJUKAN DARI / KEPADA Tanpa Rujukan PENILAIAN TANDA VITAL SEBELUM RAWATAN Tekanan Darah : mmHg Kadar Denyutan Nadi : Skala Kesakitan 0 (Tandakan bulat pada yang berkenaan) persaat 1 Tidak Sakit 2 Mengganggu Tugas Har ian 3 Berat : kg Tinggi : Suhu Badan : 0 Dextrose : 4 5 C 6 Tidak Selesa 7 8 Cm mmol/L 9 Sakit Tidak Tertahan Sakit Teruk Sakit 10 SEJARAH PESAKIT FAKTOR RISIKO SEJARAH TRAUMA Tandakan ( ⁄ ) mana yang berkenaan Sendiri Keluarga Sejarah Pengubatan Serangan angin ahmar Darah Tinggi Kencing Manis Serangan Jantung Masalah Jantung Sila nyatakan : Kolestrol Tinggi Merokok Bekas Perokok RAWATAN LAIN Tandakan ( ⁄ ) mana yang berkenaan Rawatan Diterima Ya Tidak Rehabilitasi Sila nyatakan di mana : Rawatan Tradisional Lain Ubat-ubatan Moden Ubat-ubatan Herba Appendix 3: Clerking Form 15 Sila nyatakan jenis rawatan/ubatan PENILAIAN PESAKIT Lokasi ( site ): Huraian : Isikan nama bahagian yang sakit. Samada bahagian Kiri atau Ka nan. Anggota yang sakit e.g Kaki, Bahu dll Ciri-ciri kesakitan (character) Huraian: Isikan ciri kesakitan yang dialami;e.g cucuk,tarik,dll Menjalar ( Radiate) Huraian: Isikan pergerakkan kesakitan yang dialami. Sebagai contoh bermula kesakitan bermula di kaki kiri dan ianya dapat dirasakan/menjalar hingga ke paha kiri Masa bermula Onset Huraian: Isikan masa mulanya kesakitan itu bermula e.g 3 bulan yang lepas , 6 bulan yang lepas Perkembangan Progression Huraian: Isikan perbandingan keadaan kesakitan pesakit dari tempoh ia bermula hingga hari ini.e.g kesakitan bertambah teruk dari boleh berjalan dulu tetapi sekarang menggunakan bantuan untuk berjalan. Huraian: Disini menjelaskan tempoh masa kesakitan apabila pesakit diserang kesakitannya.e.g 10 minit, 20 minit dll Tempoh Duration Faktor yang menyebabkan keadaan kesakitan lebih teruk (Aggrevating Factor) : Faktor yang mengurangkan kesakitan (Relieving Factor) : Simptom yang berkaitan Associated symptoms 16 PENILAIAN RAWATAN ULASAN PLAN RAWATAN Nama Pengamal : Tanda tangan Tarikh: 17 Appendix 4: Screening Form KEMENTERIAN KESIHATAN MALAYSIA UNIT PERUBATAN TRADISIONAL DAN KOMPLEMENTARI HOSPITAL ………………… BORANG SARINGAN ( SCREENING FORM) No. K/Pengenalan R/N: Nama : Alamat : Tarikh lahir: Jantina Umur: Tarikh: Masa Diagnosa Pesakit (Patient’s Diagnosis): Aduan Pesakit (Chief Complaints): Sejarah Perubatan yang lalu (Past medical history): - Darah Tinggi (Hypertension): - Kencing Manis (Diabetes Mellitus): - Penyakit Jantung (Ischaemic Heart Disease): -Sawan (Epilepsy): - Lelah ( Asthma): - Barah ( Cancer): - Lain-lain: ………… Sejarah pembedahan yang lalu (Past surgical history): …………………………………………………. ……………………………………………….. ………………………………………………… …………………………………………………. Sejarah Pengambilan Ubat-ubatan (Medication History): . Keputusan Ujian jika ada (investigations results if available): Coagulation Profile: RBS: X Rays: Lain-lain : Alahan (Allergy) 18 19 Appendix 5: Consent Form UNIT PERUBATAN TRADISIONAL DAN KOMPLEMENTARI HOSPITAL ………………….. BORANG KEIZINAN URUTAN MELAYU Sila baca maklumat ini dengan teliti. Rujuk kepada pengamal anda jika terdapat perkara yang tidak anda pahami. Apakah Urutan Melayu? Urutan Melayu adalah satu kaedah urutan yang unik kerana sentuhannya yang lembut,mantap dan tertumpu kepada penggunaan jari. Urutan Melayu terbahagi kepada dua kategori, iaitu Urutan Kesihatan Badan (kesegaran) dan Urutan Perubatan (terapeutik) Apakah urutan kesegar an? Urutan kesegaran adalah bertujuan pencegahan penyakit . Apakah urutan terapeutik? Urutan terapeutik merupakan urutan untuk membantu meningkatkan proses penyembuhan dan mengurangkan kesakitan yang dihadapi. Perkhidmatan Urutan Melayu di unit Perubatan Tradisional dan Komplementari yang sediakan adalah :1. 2. 3. 4. Urutan kesegaran dalam Penjagaan Ibu selepas Bersalin Urutan terapeutik untuk kesakitan kronik Urutan terapeutik untuk Angin Ahmar Urutan terapeutik untuk Rawatan Perbidanan Adakah terdapat maklumat-maklumat lain yang perlu dimaklumkan kepada pengamal? Selain daripada maklumat perubatan yang biasa, adalah amat penting bagi anda memberitahu pengamal sekiranya anda mengalami masalah masalah berikut: ( Sila tanda (√ )yang berkaitan) Ya Tidak Penyakit darah beku di anggota kaki deep venous thro mbosis Kepatahan Tulang Mengalami masalah pendarahan Mengambil ubat pencairan darah” anticoagulants’ atau sebarang ubatubatan. Penyakit Osteoporosis Masaalah kulit Alahan kepada minyak PERAKUAN KEIZINAN Saya faham bahawa saya boleh bertanya sebarang soalan berkenaan rawatan saya sebelum menandatangani borang ini. Saya juga bebas untuk menarik balik keizinan yang saya berikan bagi memberhentikan penyertaan saya ke atas prosedur-prosedur ini pada bila-b ila masa. Prosedur prosedur telah dijelaskan kepada saya dan saya faham atas penjelasan yang diberi. Den gan ini, saya secara sukarelanya bersetuju untuk men jalan i prosedur-prosedur di atas. Saya juga memahami bahawa satu rekod perkh id matan kesihatan saya akan disimpan. Rekod ini adalah sulit dan t idak akan didedahkan kepada sesiapa melain kan sekira ianya diarahkan oleh wakil saya, atau diri saya sendiri atau sebarang cara lain yang dibenarkan atau atas arahan mahkamah. Tandatangan: ............................................................................ Tandatangan Saks i :......................................... Nama Penuh: ............................................................................ Nama Saksi : ..................................................... No. Kad Pengenalan: ................................................................. No Kad Pengenalan : ........................................ Tandatangan Pengamal: ....................................................................................................... Tarikh: ................................................................................................................................. 20 Appendix 6 : Guide in Treatment Plan of Malay Massage for Chronic Pain and Post Stroke Management17 Chronic Pain Number of session Breakdown of sessions Post Stroke 3 sessions 7 sessions 3 session in a week First week : 3 session s Can either be : Second week : 2 sessions 3 days in a row Third week : 2 sessions Or Alternate days Assessment Done at the third sessions Done at the seventh session 5 sessions 10 sessions for effectiveness Maximum session given in the unit for cases 21 Diagram 1 : Massage Techniques /Strokes 22 23 Diagram 2: Hand Washing Techniques Hand Washing Techniques 1 2 Palm to palm. Right palm over left hand and vise versa. 3 4 Palm to palm fingers interlaced. Back of finger to opposing palms with fingers interlocked. 6 5 Rotational rubbing of right thumb REFERENCES clasped in left palm and vice versa. Rotational rubbing, with clasped fingers of right hand in left palm and vice versa. 24 10. REFERENCES 1. Western Pacific Region (WPRO), The Regional Strategy for Traditional Medicine in Western Pacific Region, Manila 2002. 2. Lena Posner, Guide to the benefit of massage (cited 2009 Nov 23).Available from http://www.redmoonmassagetherapycom/assest/docs/guide_01.pdf 3. Andrew Vickers, Catherine Zollman, Clinical review : ABC of Complementary Medicine : Massage Therapist , BMJ : 319:1254-1257 ( 6 November) 4. Lynn Freeman ,Chapter 13 : Massage Therapy, Mosby’s Complementary & Alternative Medicine, A Research-Based Approach, second edition; pg : 389 -413. 5. J Michael Wieting, DO, Med. Massage, Traction, and Manipulation. E medicine Article. July 2005. 6. Syed Mahdi Syed Fouzi Barakbah, Traditional Malay Massage ( Presentation) First Asia Pacific Traditional and Complementary Medicine Conference, Malaysia,4 – 6 Nov 2008 7. Haniza MA,Fariza F,Norlaili A, Norsuria AG; A qualitative study on urut Melayu –traditional Malay massage (paper submitted for publication to the Journal of Complementary and Alternative Medicine). 8. Md Khusairi Hj Salleh, Suatu Kajian Mengenai Prinsip , Kaedah & Cara : Urut Tradisional Melayu , Darul Numan, Edisi Pertama, ms 40-69 9. Haliza Mohd Riji, Prinsip dan Amalan dalam perubatan melayu , Bab 5 : Prinsip and Amalan Rawatan : 137-183 10. Impact of a Massage Therapy Clinical Trial on Immune Status in Young Dominican Children Infected with HIV-1;The Journal of Alternative and Complementary Medicine , Jul 2006, Vol. 12, No. 6 : 511 -516 11. Mario – Paul Cassar ,Handbook of Clinical Massage: A Complete Guide for Students and Practitioners, second edition 2004;Churchill Livingstone; pg 93 -168 12. Sylvia Carlson, Massage for Stroke Patients : what is a stroke and what role can massage therapy play in recovery process.Suite 101.com.Oct 2006.(cited 2009 April 22).Available from http://massagetherapy.suite101.com/article.cfm/massage_for_stroke_patients 13. Cherkin DC, Sherman KJ Deyo RA , et al, A Review of the evidence for the effectiveness, safety and cost of acupuncture, massage therapy and spinal manipulation for back pain, Annals of Internal Medicine, 2003 , 138 (11) : 898 -907. 25 14. Jennie C.I. Tsao, Effectiveness of Massage Therapy for Chronic, Non – malignant Pain : A Review. Evidence – based Complementary and Alternative Medicine, Feb 2007. 15. Jerilyn A. Cambron,DC, Phd;jeniffer Dexheimer, LMT; Patricia Coe, CMT; Randy Swenson, MPHE,DC, University of Health Sciences , Side Effects of massage Therapy : a Pilot Study. 16. Ernst E, The Safety of Massage Therapy. Rheumatology (oxford)2003;42(9):1101-6 17. Traditional and Complementary Medicine Division, Ministry of Health Malaysia, Consensus Meeting on Improvement Strategy in Traditional and Complementary Medicine (T&CM) Services in Integrated Hospital with T&CM Practitioners, March 2009. 26 11. Committee Members Review and Improvement Strategies of Traditional and Complementary Medicine Practice Guideline Workshop For Malay Massage , 2008.(Working group) Pauziah Monil Dr Zalilah Abdullah Traditional Malay Medicine Practitioner Traditional and Complementary Medicine Division Traditional and Complementary Medicine Unit Ministry of Health Malaysia Putrajaya Hospital Md Bakri Hassan Physiotherapy Department Kepala Batas Hospital Yaacob Mohd Daud Traditional Malay Medicine Practitioner Traditional and Complementary Medicine Unit Putrajaya Hospital Mustaffa Sultan Physiotherapy Department Sultan Ismail Hospital Kamarul Hj Abd. Rahman Traditional Malay Medicine Practitioner Traditional and Complementary Medicine Unit Kepala Batas Hospital Che Salasiah bt Abd Majid Qualified Nurse Traditional and Complementary Medicine Unit Kepala Batas Hospital Haslina Hashim Traditional Malay Medicine Practitioner Traditional and Complementary Medicine Unit Kepala Batas Hospital Robaieyah Ramlie Traditional Malay Medicine Practitioner Traditional and Complementary Medicine Unit Kepala Batas Hospital Editorial Members For Traditional and Complementary Medicine Practice Guideline. Dr Ramli Abd Ghani Director Traditional and Complementary Medicine Division Ministry of Health Malaysia Dr Shamsaini Shamsuddin Senior Principal Assistant Director Traditional and Complementary Medicine Division Ministry of Health Malaysia Jaafar Lassa Senior Principal Assistant Director Traditional and Complementary Medicine Division Ministry of Health Malaysia Dr Fariza Dato’ Fadzil Principal Assistant Director Traditional and Complementary Medicine Division Ministry of Health Malaysia 27 28