Академический Документы
Профессиональный Документы
Культура Документы
available at www.sciencedirect.com
a
33A Holt Street, North Ryde, Sydney, NSW 2113, Australia
b
Hong Kong, PR China
Available online 4 March 2008
KEYWORDS Summary
Massage; Objectives: To assess the efcacy of an aromatic essential oil (1% Zingiber ofcinale and 0.5%
Knee pain; Citrus sinesis) massage among the elderly with moderate-to-severe knee pain.
Essential oil; Method: Fifty-nine older persons were enrolled in a double-blind, placebo-controlled experi-
Experimental mental study group from the Community Centre for Senior Citizens, Hong Kong. The intervention
was six massage sessions with ginger and orange oil over a 3-week period. The placebo control
group received the same massage intervention with olive oil only and the control group received
no massage. Assessment was done at baseline, post 1-week and post 4 weeks after treatment.
Changes from baseline to the end of treatment were assessed on knee pain intensity, stiffness
level and physical functioning (by Western Ontario and McMaster Universities Osteoarthritis
index) and quality of life (by SF-36).
Results: There were signicant mean changes between the three time-points within the inter-
vention group on three of the outcome measures: knee pain intensity (p = 0.02); stiffness level
(p = 0.03); and enhancing physical function (p = 0.04) but these were not apparent with the
between-groups comparison (p = 0.48, 0.14 and 0.45 respectively) 4 weeks after the massage.
The improvement of physical function and pain were superior in the intervention group com-
pared with both the placebo and the control group at post 1-week time (both p = 0.03) but not
sustained at post 4 weeks (p = 0.45 and 0.29). The changes in quality of life were not statistically
signicant for all three groups.
Conclusion: The aroma-massage therapy seems to have potential as an alternative method for
short-term knee pain relief.
2008 Elsevier Ltd. All rights reserved.
Introduction
0965-2299/$ see front matter 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ctim.2007.12.003
132 Y.B. Yip, A.C.Y. Tam
Figure 1 Participants and study ow. Note: a = 1, began physiotherapy; b = 1, walking difculty & 1, reported massage causing
more pain; c = 1, reported massage was ineffective; d = 1, admitted to hospital.
affected joint in the lower limb among Hong Kong Chinese. antipyretic and analgesic effects.8 Ginger has been used as
Recently, a local survey reported that among people aged an anti-inammatory and anti-rheumatic for musculoskele-
50 and over, 13% of women and 7% of men were diagnosed tal disorders in Ayurvedic and Chinese medicine for more
with osteoarthritis of the knee and that 24% of women and than 2500 years.6,9,11 Three clinical trials reported the short-
17% of men had persistent knee pain.2 OA is often associated term benecial effects of Ginger extract taken orally in knee
with pain, functional impairment,1,3 and reducing quality of pain reduction.6,8,12 However, oral ginger extract has a pun-
life.4,5 gent taste, and can causes mild gastrointestinal (GI) adverse
Present-day therapy for OA of the knee is directed at events like nausea, dyspepsia and eructation.6,11 Aromatic
symptoms, since there is no established disease-modifying ginger essential oil used with massage therapy, can be a safe
therapy.6 Many older people have turned to alternative ther- alternative, avoiding these GI adverse events.
apies such as herbal6 and massage treatment7 for relief. Massage therapy has long history and has been shown to
Ginger is one of the most popular herbal remedies and have positive effects on musculoskeletal pain1315 or chronic
has a long tradition of medicinal use. Ginger (Zingiber pain16 and is most popularly used with pain syndromes.
ofcinales) belongs to the family of Zingiberaceae. It con- Field et al.17 proposed that massage leads to increased
tains a number of different pungent and active ingredients serotonin (by urinary 5HIAA levels) and dopamine (by urine
of sesquiterpene hydrocardons predominantly zingiberene,8 assays) and closes the gate to the pain stimulus. As well,
gingerols, pinene, cineole, capsaicin, beta-carotene, caf- massage can increase endorphin levels and enhance local
feic acid, and curcumin.9,10 Gingerols can convert into blood ow which could increase the clearance of local pain
6-paradol, 6-gingerol and 6-shogaol. These compounds have mediators.18 Massage therapy has been shown to be an effec-
Effectiveness of massage with aromatic ginger and orange essential oil 133
tive treatment in some areas of musculoskeletal problems massage with ginger essential oil (1% ginger and 0.5% orange
like low back pain,15 neck pain,13 or chronic pain.16 How- oil in olive oil as the base lubricant) and conventional
ever, Ernst18 performed a systematic review evaluating the treatment. 0.5% orange essential oil (Citrus Aurantium) was
effectiveness of massage therapy for pain relief and found added to give a more acceptable odor since some partici-
that there was no fully convincing evidence that massage- pants would nd the pungent odor of ginger oil disturbing.
controlled musculoskeletal pain. Osborn et al.19 suggested The orange essential oil was about 90% limonene.23 Both
that an essential oil might prolong the effects of massage. essential oils were from Absolute Aromas Ltd. Olive oil
Two clinical trials have reported benecial effects from was selected as the base because it was relatively less
aroma-massage in relieving physical symptoms among can- costly, and safe for dry and delicate skins compared to
cer patients in a palliative care setting.20,21 other carrier oils. The placebo control group received the
Unfortunately, there is limited evidence either for or massage with olive oil only as well as conventional treat-
against the efcacy of aroma-massage with ginger essential ment, while the control group received no massage but
oil for arthritic pain. The aim of this study was to assess the conventional treatment during study. However, an equiva-
efcacy of massage with aromatic Ginger essential oil (Zin- lent massage session was given to the control group after
giber ofcinales) in relieving knee pain and stiffness, and study as a service. The same supply of oils and dilutions
enhancing physical functionality and quality of life among were used throughout the study. Efeurage and petrissage
older persons. The participants satisfaction as well as any were applied over the back and the front of both legs of the
adverse events from this add-on treatment was noted. participants. Various muscles on the thigh and leg were mas-
saged: Quadriceps femoris, Gracillis, Biceps femoris on the
Methods thigh and Fibularis Longus, Gastrocnemius, Tibialis anterior
on the leg. Tendons in the lower limbs were massaged as
well: the tendon of Quadriceps femoris, Patellar ligament,
Study design and participants
tendon of Gastrocnemius and Calcaneal tendon.24 The mas-
sage treatment was given by a nurse with training in leg
This was a double-blind, placebo-controlled group exper- aroma-massage. Her skill was assessed and evaluated by
imental study design. The research was carried out on a an experienced masseur. Safety was evaluated on the basis
voluntary basis among members of the Community Cen- of physical examination and the subjects self-reporting of
tre for Senior Citizens, Hong Kong. The participants were study events.
recruited via notices on bulletin boards.
A power calculation was rst performed for the over-
all test of efcacy. According to the table of Portney and Data collection procedures
Watkins,22 a sample size for each group of N = 18 can detect a
medium effect size (f = 0.5) with a power of 90% at = 0.05. Questionnaires and health assessments were performed by
Therefore, the expected total number of participants was year four nursing students using face-to-face interviews.
54. In this study, the data collector and all participants were
The inclusion criteria were those (1) having knee joint blinded to the group allocation. Besides, the nurse who gave
pain that scored 4cm or above on a 10cm visual analog scale the massage therapy was not involved in the data collec-
over the past week; (2) aged 60 years or above; (3) who were tion of outcome measurements except the general feedback
able to understand the explanation of the study, complete toward the massage process. Data were collected at three
the interview and comprehend the instructions. The partic- time points (1) before the intervention (baseline assess-
ipants were excluded if they (1) had knee joint surgery in ment), (2) 1 week after the completion of treatment (post
the past 3 months; (2) were undergoing physiotherapy for 1-week assessment) and (3) 4 weeks after the completion of
the knee joint pain; (3) had an allergic reaction towards treatment (post 4-week assessment).
natural essential oils; (4) had cancer and/or blood clotting
diseases such as hemophilia; (5) were undergoing steroid Outcome measures
injection treatment; (6) had a large wound over knee joint
area; or (7) had acute inammatory signs over the knee joint Demographic information including age, gender, educa-
area. tion occupation and medical history and knee pain related
Participants who were eligible and willing to participate information (e.g. knee pain nature, duration of knee pain
in the study were requested to sign a consent form before and treatment for the current knee pain condition) were
undergoing treatment. Participants were allocated to one of recorded.
three groups by them randomly drawing an envelope. There The primary outcome was the knee joint pain intensity.
were three letters on the envelopes, i.e. letters AC. The It was measured by the Western Ontario and McMaster Uni-
participants were allocated on the basis of the letter on the versities Osteoarthritis Index (WOMAC).25 A standard 10-cm
envelope into either an intervention group (IG), a placebo horizontal Visual Analogue Scale (VAS) was used. Participants
control group (PG) or a control group (CG). were asked to place their ngers at the point on a line rep-
resenting their level of pain with the anchor points of 0 = no
Ginger massage treatment protocols pain and 10 = pain as bad as it could be. Information on
the duration of current knee joint pain episode was also
Participants in the intervention and placebo groups received obtained.
a session of 3035 min of aroma massage on both lower limbs The secondary outcomes were knee joint stiffness inten-
six times within 23 weeks. The intervention group received sity, physical functioning and quality of life. Both knee
134 Y.B. Yip, A.C.Y. Tam
Table 1 Demographic characteristics of intervention, placebo control and control groups at baseline
Gender
Male 3 (15.8) 5 (29.4) 3 (17.6)
Female 16 (84.2) 12 (70.6) 14 (82.4) 0.56
Occupation
Housewife 7 (36.8) 6 (35.3) 9 (52.9)
White collar 0 (0.0) 1 (5.9) 0 (0.0) 0.54
Services 1 (5.3) 1 (5.9) 1 (5.9)
Labour/worker 11 (57.9) 9 (52.9) 7 (41.2)
Highest education attainment
Primary or below 16 (84.2) 16 (94.1) 16 (94.1)
Junior secondary 1 (5.3) 1 (5.9) 0 (0.0) 0.59
Senior secondary or above 2 (10.5) 0 (0.0) 1 (5.9)
Treatment in the past month
On analgesics 8 (42.1) 4 (23.5) 6 (35.3) 0.50
On NSAIDs 7 (36.8) 5 (29.4) 8 (47.1) 0.57
Knee pain site
Unilateral knee 1 (6.30) 2 (6.20) 1 (5.90)
Bilateral knee 18 (94.70) 15 (93.80) 16 (94.1) 0.99
joint stiffness and physical functioning were assessed by 0.94 to 1, and the inter-rater reliability ranged from 0.97
WOMAC. It consisted of 24 questions, assessed on a 10- to 1.
cm visual analog scale, analyzed as 3 subscales with the
average score of 5 questions on pain, 2 questions on stiff-
ness, and 17 questions on physical function. Overall quality Data analysis
of life was measured by the Short Form 36 item general
health questionnaire (SF-36).26 It included eight multi-item Normality checking of the outcome data was examined
scales containing 210 items each plus a single item to by the KolmogorovSmirnov test, with p < 0.05 indicat-
assess health transition. The scales covered the dimen- ing that the data were not normally distributed and that
sions of physical functioning, physical role, bodily pain, non-parametric statistics should be performed. We then
social functioning, emotional role, vitality, mental health compared the baseline characteristics of participants from
and general health. The scores ranged from 0 (maximal the control, placebo control and intervention groups using
symptoms/maximal limitation/poor health) to 100 (no Kruskal Wallis test or Chi-square tests according to the
symptoms/no limitations/excellent health). At the end of type of variables. To determine whether groups of partici-
the sixth session, participants were asked about their accep- pants improved in outcome measures, we calculated a mean
tance of the intervention. Adverse events, i.e. the onset, change by the following formula: mean change = X2 X0
duration and intensity (mild, moderate, or severe) were and X1 X0 , where X2 was the mean score at post 4
noted. weeks, X1 was the mean score at post 1-week and X0
A panel of ve experts including one doctor, two physio- was the mean score at baseline. The Friedman test was
therapists and two nurses with at least 2 years experience used to compare the outcome measures over the base-
in the orthopaedic area were invited to verify the content line and the two follow-ups within the groups since most
validity of the outcome measures. The validity was cal- of outcome data were not normally distributed. The level
culated by a content validity index (CVI). The overall CVI of signicance was 0.05 (one-tailed) for all tests. All of
was 0.77, the 1-week testretest reliability ranged from the analyses were completed using the Statistical Pack-
Effectiveness of massage with aromatic ginger and orange essential oil 135
Table 2 Comparison on the mean change in the WOMAC subscales among intervention, placebo and control groups from post
1-week follow-up and post 4-week follow-up to baseline
Baseline Post 1-week Post 4-week Post 1-week Post 4-week Within group
(mean S.D.) (mean S.D.) (mean S.D.) to baseline to baseline p-valuea
(mean S.D.) (mean S.D.)
WOMAC
Painb (020, worse)
IG 5.74 2.40 4.26 2.26 3.95 1.93 1.47 2.27 1.79 2.49 0.02
PG 4.53 2.21 3.94 2.11 2.88 1.50 0.69 2.75 1.65 2.29 0.11
CG 6.35 2.37 5.24 2.33 5.64 2.55 1.12 2.06 0.71 3.22 0.06
Between-groups p-valuec 0.59 0.48
Stiffness (08, worse)
IG 2.74 2.31 1.21 1.23 1.58 1.46 1.53 2.29 1.16 2.27 0.03
PG 1.71 1.69 1.44 1.50 1.01 1.03 0.31 1.62 0.65 1.32 0.29
CG 2.29 1.40 1.59 1.62 2.59 2.24 0.71 1.69 0.29 2.05 0.04
Between-groups p-valuec 0.26 0.14
Function (068, worse)
IG 14.19 9.79 10.13 6.45 10.54 7.89 4.07 5.21 3.65 6.67 0.04
PG 11.07 6.49 10.13 5.23 10.61 5.97 1.08 3.81 0.47 5.80 0.35
CG 15.53 5.56 16.14 5.90 14.64 4.88 0.61 5.99 0.89 5.50 0.29
Between-groups p-valuec 0.03 0.45
CG, control group; IG, intervention group; PG, placebo control group; S.D., standard deviation; WOMAC, Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC) consists of 24 questions, assessed on 10-cm visual analog scale, analyzed in 3 subscales as
the average score for 5 questions on pain, 2 questions on stiffness, and 17 questions on function.
a p-Value is calculated by Friedman test for within group comparison.
b In baseline between-groups comparison on pain level by Kruskal Wallis test, p-value = 0.01.
c p-Value is calculated by Kruskal Wallis test for between-groups comparison.
age for Social Sciences, version 9.0 (SPSS Inc., Chicago, column). There were no signicant differences among
IL). control, placebo control and intervention groups for use
of oral analgesic, NSAIDs and other outcome measures
(p = 0.070.97).
Results
Effect on knee pain and stiffness relief
Participants socio-demographic and knee pain
related characteristics Reductions in the current knee pain ratings were similar
among the three groups either at post 1-week (p = 0.59)
Of the 59 participants enrolled in this study, 53 (89.8%) par- and post 4 weeks (p = 0.48) for between-groups compari-
ticipants completed both post 1-week and 4-week follow-ups son. However, the intervention group reported a reduction
(Fig. 1.). The majority of the 53 participants were women in knee pain rating (p = 0.02) at the 4-week follow-up period,
(79%) and the mean age was 73.59 years old (S.D. = 5.42 but neither the placebo control (p = 0.11) nor control groups
years). Their mean knee joint pain history was 9.71 years (p = 0.06) demonstrated this for within group repeated mea-
(S.D. = 7.05 years) (Table 1). sure analysis.
The majority of participants (n = 49%, 92.4%) reported Intervention group participants did show more stiffness
bilateral knee joint pain. About half (50.9%) had regular relief outcomes (p = 0.03) than the placebo group (p = 0.29)
medical follow-up on knee joint pain. Eighteen participants and control group (p = 0.04), as assessed by the WOMAC:
(34.0%) used oral analgesics, while 20 participants (37.7%) Stiffness for within group repeated measures analysis. How-
used oral non-steroid anti-inammatory drugs (NSAIDs). ever, there were no signicant differences in mean change
There were no signicant differences between the partici- in stiffness intensity for between-group comparison at the
pants (n = 53) and those who dropped out (n = 6) with respect post 1-week follow-up (p = 0.26) or post 4-week follow-up
to the socio-demographic characteristics (p = 0.810.95) (p = 0.14).
and outcome measures (p = 0.080.97), except the educa-
tional level (p = 0.02). The drop-outs were less educated
than the participant group. Among the participants, the Improvement in physical functioning
control group suffered greater pain (p = 0.01) and reported
poorer in fullling the physical role (p = 0.02) than placebo Intervention group participants did show more favourable
control and intervention groups (refer to Table 2, rst physical functioning outcomes than both the placebo con-
136 Y.B. Yip, A.C.Y. Tam
Table 3 Comparison on the mean change in the SF-36 Subscales among intervention, placebo and control groups from post
1-week follow-up and post 4-week follow-up to baseline
SF-36
Physical function (0100, better)
IG 57.96 19.57 7.54 13.40 2.33 14.23 0.15
PG 57.51 19.00 3.27 15.82 1.61 13.62 0.62
CG 52.94 17.59 3.53 10.72 6.47 19.35 0.42
Between-groups p-valueb 0.59 0.23
Physical rolec (0100, better)
IG 62.50 27.64 1.18 19.61 2.63 19.36 0.49
PG 65.44 29.07 10.16 23.92 3.31 24.62 0.89
CG 38.60 26.45 5.15 31.35 6.99 31.01 0.95
Between-groups p-valueb 0.26 0.84
Bodily pain (0100, better)
IG 38.21 20.85 9.45 23.73 8.47 16.58 0.16
PG 49.18 14.36 12.50 18.44 7.12 20.09 0.20
CG 37.8 11.84 4.18 17.16 2.29 17.32 0.52
Between-groups p-valueb 0.03 0.29
General health (0100, better)
IG 47.05 20.69 1.27 15.09 1.89 14.40 0.69
PG 51.12 17.80 3.69 17.49 5.18 15.38 0.52
CG 40.76 22.52 1.88 18.15 6.35 16.61 0.14
Between-groups p-valueb 0.75 0.12
Vitality (0100, better)
IG 50.10 22.56 9.82 20.05 4.93 19.50 0.10
PG 51.10 17.71 2.76 17.07 9.19 20.74 0.17
CG 47.43 19.52 4.78 22.91 5.88 16.90 0.17
Between-groups p-valueb 0.73 0.10
trol and the control groups, as assessed by the WOMAC for group participants did show more improvement in phys-
between-group comparison at the post 1-week follow-up ical function outcomes (p = 0.04) than the placebo group
(p = 0.04) but this was not sustained at the post 4-week (p = 0.35) and control group (p = 0.29), as assessed by the
follow-up. For within group comparison, the intervention WOMAC: Physical Function.
Effectiveness of massage with aromatic ginger and orange essential oil 137
of functional ability and observation assessment were 10. Schnaubelt K. Advanced aromatherapy: the science of essen-
found.29 tial oil therapy. Rochester: Vermont; 1998.
In conclusion, the results of our study show that six- 11. Srivastava KC, Mustafa T. Ginger (Zingiber ofcinale) in
sessions of aroma-massage therapy using ginger and orange rheumatism and musculoskeletal disorders. Med Hypotheses
essential oil was effective in relieving moderate-to-severe 1992;39(4):3428.
12. Bliddal H, Rosetzsky A, Schlichting P, Weidner MS, Ander-
knee joint pain, stiffness and daily function in the short-
sen LA, Ibfelt HH, Christensen K, Jensen ON, Barslev J. A
term but not for improving the quality of life. No adverse randomized, placebo-controlled, cross-over study of ginger
effects were reported. Therefore, aroma-massage therapy extracts and ibuprofen in osteoarthritis. Osteoarthrit Cartilage
seems to have some potential as an alternative method for 2000;8(1):912.
short-term knee pain relief. 13. Cen SY, Loy SF, Sletten EG, Mclaine A. The effect of traiditonal
Chinese therapeutic massage on individuals with neck pain.
Clin Acupuncture Orient Med 2003;4(2/3):8893.
Acknowledgements 14. Furlan AD, Brosseau L, Imamura M, Irvin E. Massage for
low back pain: a systematic review within the framework
We would like to acknowledge the partial support of the of the Cochrane Collaboration Back Review Group. Spine
SN Departmental Research Committee for this study. The 2002;27(17):1896910.
authors would also like to thank Ms. Chau Yu Moon, Ms. 15. Cherkin DC, Eisenberg D, Sherman KJ, Barlow W, Kaptchuk
Ng Yuk Wah and Ms. Tsui Hoi Ying for their contributions to TJ, Street J, et al. Randomized trial comparing tradition
the data collection and eldwork for this study. The authors Chinese medical acupuncture, therapeutic massage, and self-
care education for chronic low back pain. Arch Intern Med
also gratefully acknowledge Dr. Tony Chan for his thought-
2001;161(8):10818.
ful discussion especially on the analysis and Mr. Ian Dunn 16. Walach H, Guthlin C, Konig M. Efcacy of massage therapy in
for English proof-reading and suggestions on renement of chornic pain: a pragmatic randomized trial. J Altern Comple-
the manuscript. Additionally, the study would not have been ment Med 2003;9(6):83746.
possible without the co-operation of the arthritic partici- 17. Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. Cor-
pants. I conrm all patient/personal identiers have been tisol decreases and serotonin and dopamine increase following
removed or disguised so the patient/person(s) described are massage therapy. Int J Neurosci 2005;115(10):1397413.
not identiable and cannot be identied through the details 18. Ernst E. manual therapies for pain control: chiropractic and
of the story. massage. Clin J Pain 2004;20(1):812.
19. Osborn CE, Barlas P, Baxter GD, Barlow JH. Aromatherapy: a
survey of current practice in the management of rheumatic
References disease symptoms. Complement Therap Med 2001;9(2):627.
20. Soden K, Vincent K, Craske S, Lucas C, Ashley S. A randomized
1. Rapp SR, Rejeski WJ, Miller ME. Physical function among older controlled trial of aromatherapy massage in a hospice setting.
adults with knee pain: the role of pain coping skills. Arthrit Palliative Med 2004;18(2):8792.
Care Res 2000;13(5):2709. 21. Wilkinson S, Aldridge J, Salmon I, Cain E, Wilson B. An eval-
2. Lau EC, Cooper C, Lam D, Chan VNH, Tsang KK, Sham A. Factors uation of aromatherapy massage in palliative care. Palliative
associated with osteoarthritis of the hip and knee in Hong Kong Med 1999;13(5):40917.
Chinese: obesity, joint injury, and occupational activities. Am 22. Portney LG, Watkins MP. Foundations of clinical research:
J Epidemiol 2000;152(9):85562. applications to practice. Norwalk, Connecticut: Appleton &
3. Hochberg MC, Lawrence RC, Everett DF, Cornoni-Huntley J. Epi- Lange; 1993. p. 667.
demiologic associations of pain in osteoarthritis of the knee: 23. Tisserand R. Essential oil safety data manual. Brighton: Tis-
data from National Health and Nutrition Examination Survey serand Institute; 1989.
and the National Health and Nutrition Examination-I Epidemi- 24. Marieb EN. Human Anatomy & Physiology. San Francisco: Ben-
ologic Follow-up Survey. Semin Arthrit Rheu 1989;18(4 suppl jamin Cummings; 2001.
2):49. 25. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt
4. Bellamy N, Buchanan WW. A preliminary evaluation of the LW. Validation study of WOMAC: a health status instrument for
dimensionality and clinical importance of pain and disabil- measuring clinically important patient relevant outcomes to
ity in osteoarthritis of the knee and hip. Clin Rheumatol anti-rheumatic drug therapy in patients with osteoarthritis for
1986;5(2):23141. the hip or knee. J Rheumatol 1988;15(12):183340.
5. Rejeski WJ, Shumaker S. Knee osteoarthritis and health related 26. Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health
quality of life. Med Sci Sports Exercise 1994;26(12):14415. survey (SF-36). I. Conceptual framework and item selection.
6. Altman RD, Marcussen KC. Effects of a ginger extract on Med Care 1992;30(6):47383.
knee pain in patients with osteoarthritis. Arthrit Rheu 27. Angst F, Aeschlimann FAA, Steiner W, Stucki G. Responsive-
2001;44(11):25318. ness of the WOMAC osteoarthritis index as compared with the
7. Ramsey SD, Spencer AC, Topolski TD, Belza B, Patrick D. Use SF-36 in patients with osteoarthritis of the legs undergoing
of alternative therapies by older adults with osteoarthritis. a comprehensive rehabilitation intervention. Ann Rheum Dis
Arthrit Rheu 2001;45(3):2227. 2001;60:83440.
8. Thomson M, Al-Qattan KK, Al-Sawan SM, Alnaqeeb MA, Khan I, 28. United Kingdom Central Council for Nursing Midwifery and
Ali M. The use of ginger (Zingiber ofcinale Rosc.) as a potential Health Visiting. Standards for the administration of medicines.
anti-inammatory and antithrombotic agent. Prostag Leukotr London: UKCC; 1992.
Essent Fatty Acids 2002;67(6):4758. 29. Miu DKY, Chan TY, Chan MH. Pain and disability in a group of
9. Geiger JL. The essential oil of ginger, Zingiber ofcinale, and Chinese elderly out-patients in Hong Kong. Hong Kong Med J
anaesthesia. Int J Aromather 2005;15:714. 2003;10(3):1605.