Complementary Therapies in Medicine 32 (2017) 109–114

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Complementary Therapies in Medicine

journal homepage: www.elsevier.com/locate/ctim

Effects of massage therapy on anxiety, depression, hyperventilation and T

quality of life in HIV infected patients: A randomized controlled trial
⁎
Reychler Gregorya,b,c, , Gilles Catyb, Arcq Audec, Lebrun Lauriec, Belkhir Leïlad, Yombi Jean-Cyrd,
Marot Jean-Christophee
a
Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Bruxelles, Belgium
b
Service de Médecine Physique et Réadaptation, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
c
Service de Pneumologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
d
AIDS Reference Centre, Service de Médecine Interne, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
e
Service d’infectiologie, Clinique Saint-Pierre, Ottignies, Belgium

A R T I C L E I N F O A B S T R A C T

Keywords: Introduction: HIV infection is often preceded or accompanied by psychiatric comorbidities. These disorders
Massage improve with complementary therapies. The aim of this study was to measure the effect of massage therapy on
Anxiety anxiety, depression, hyperventilation and quality of life in HIV infected patients.
Depression Method: Adult HIV-infected patients were randomized (n = 29) in massage therapy group (one hour a week
HIV
during four weeks) and control group. Anxiety and depression (HADS-A and HADS-D), hyperventilation
(Nijmegen questionnaire) and quality of life (WHOQOL-HIV) were evaluated at inclusion and after 4 weeks.
Results: At inclusion, 51% and 17% of the patients had a positive HADS-A and HADS-D score respectively. Two
facets from WHOQOL-HIV (“Home environment” and “Death and dying” (p = 0.04)) were different between
groups. After the four week massage therapy, a significant improvement was observed only for Nijmegen
questionnaire (p = 0.01) and HADS-A (p = 0.04) contrarily to WHOQOL-HIV and HADS-D. Domains of the
WHOQOL-HIV did not improve following the massage therapy. Only “Pain and discomfort” facet improved after
massage therapy (p = 0.04).
Conclusion: This study highlights the positive impact of a four week massage therapy on anxiety and
hyperventilation in HIV infected patients. However, neither benefit of this program was observed on depression
and quality of life.

1. Introduction
Around 35 million individuals are infected with human immuno-
deficiency virus (HIV) worldwide.1 The use of combination of antire-
troviral therapy (cART) has dramatically reduced disease progression
and death among patients with HIV infection. However, there is still
neither definitive cure nor effective vaccine.
HIV infection is often preceded or accompanied by psychiatric
disorders. Indeed, higher prevalence of depression and anxiety dis-
orders was reported among patients infected with HIV than in the
general population.2–5 If hyperventilation was associated to these
emotional distress,6 it has never been investigated in HIV infected
patients.
Psychiatric disorders and others commorbidities have been related
to reduced quality of life and increased morbidity and mortality in the
context of aging HIV population.7–11 Thus, health related quality of life
is a critical element in treatment and care programs of HIV infected
patients.7,12 Moreover, managing these HIV-related disorders are im-
portant because anxiety symptoms and depression among HIV-infected
individuals were associated with nonadherence to cART.13,14
A recent study focused on self-care strategies used by patients to
manage these comorbidities. They included, among other things,
alternative/complementary therapies.3 One of the most popular alter-
native/complementary therapies is massage therapy that can reset the
threshold levels of the baroreceptors of arterial vessels which trigger
rise in blood pressure and heart rate.15
Different publications suggested an improvement in quality of life,16
depression.17 and anxiety18 after massage therapy in people living with
HIV/AIDS even if stronger evidences are needed to support its use19
Surprisingly, the effect of massage on hyperventilation has never been

⁎
Corresponding author at: Service de Pneumologie, Cliniques universitaires St-Luc (UCL), Avenue Hippocrate 10, 1200 Brussels, Belgium.
E-mail addresses: Gregory.reychler@uclouvain.be (R. Gregory), gilles.caty@uclouvain.be (G. Caty), aude.arcq@student.uclouvain.be (A. Aude),
laurie.lebrun@student.uclouvain.be (L. Laurie), leila.belkhir@uclouvain.be (B. Leïla), jean.yombi@uclouvain.be (Y. Jean-Cyr), Jean-Christophe.MAROT@cspo.be (M. Jean-Christophe).

http://dx.doi.org/10.1016/j.ctim.2017.05.002
Received 22 December 2016; Accepted 8 May 2017
Available online 11 May 2017
0965-2299/ © 2017 Elsevier Ltd. All rights reserved.
R. Gregory et al.
evaluated.
The aim of this study was to compare in a randomized controlled
study the effect of a 4 week massage therapy on anxiety, depression,
hyperventilation and quality of life in HIV infected patients.
2. Material and method
2.1. Ethics statement
The study was approved by the regional Ethics Committee in
Université catholique de Louvain in Brussels (B403201524761) and
registered on ClinicalTrial (NCT02535429). All of the patients provided
written informed consent in accordance with the Declaration of
Helsinki and with current guidelines for Clinical Good Practice.
2.2. Subjects
HIV-infected patients regularly attending the outpatient infectious
disease clinic (Cliniques universitaires Saint-Luc and Clinique Saint-
Pierre) were recruited on a voluntary basis and without financial
compensation for this study. Consecutive patients fulfilling the inclu-
sion criteria were selected by the physician after approval of the
patients to enrol in the study. The study was realized between June
and December 2015.
The following inclusion criteria were used: 18 years or older,
infected with HIV for at least 6 months,20 followed in our Institution
and a native French speaker (patients born in a francophone family
speaking French at home and living in the francophone part of
Belgium). The exclusion criteria were: unstable (defined by any clinical
modification of health outcomes) in the three last months and for the
duration of the study, neurological or musculoskeletal disorders.
2.3. Measures
The sociodemographic and HIV-related information’s were collected
at inclusion.
2.3.1. Anxiety and depression (HADS)
Anxiety and depression were assessed by the validated French
version of Hospital Anxiety and Depression Scale (HADS) which is
divided in two parts with 7 items for each one: HADS-A (for anxiety)
and HADS-D (for depression), respectively.21 All items are rated from 0
(“never”) to 3 (“very often”). The highest scores indicate a greater
frequency of symptoms. The total score of the scale is a measurement of
general mental distress. For the HADS-A or HADS-D, the cut-off points
were higher than 8 for a borderline anxiety or depression and higher
than 11 for anxiety or depression, respectively.
2.3.2. Hyperventilation
Hyperventilation was evaluated by Nijmegen questionnaire (NQ).22
The NQ is the most commonly used screening tool for dysfunctional
breathing and specifically for hyperventilation. It includes 16 items
related to anxiety symptoms. Frequency incidence of all the items is
rated with a five-point ordinal scale (from 1 “never” to 5 “very
frequently”). Total score is calculated by adding scores of each item.
Cut-off score of 23 have been fixed for this study to identify hyperven-
tilation.
2.3.3. Quality of life (WHOQOL-HIV)
Quality of life was measured by the validated French version of the
specific WHOQOL-HIV questionnaire.23 General health status is eval-
uated by asking the subjects to rate his or her health on a Likert scale
ranging from 1 (very poor) to 5 (very good). WHOQOL-HIV includes
120 items. The structure of the WHOQOL-HIV questionnaire includes a
profile with scores across six domains (physical, psychological, level of
dependence, social relationships, environment and spirituality) and 29
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Complementary Therapies in Medicine 32 (2017) 109–114
facets, with 5 of these facets relating to HIV/AIDS (symptoms of person
living with HIV/AIDS (PLWHA), social inclusion, forgiveness and
blame, concerns about the future, death and dying). Non-specific
questions concerning the subject’s overall quality of life and health
status are also included. All of the items are rated on a five-point scale
(from “not at all” to “extremely” for the intensity and capacity domains;
from “never” to “always” for frequency; from “very dissatisfied” to
“very satisfied” or from “very good” to “very poor” for evaluation). For
negatively framed items, the scores are reversed so that the higher the
score, the better the quality of life. A score is calculated from the facet
and domain. Each item of a facet and facet of a domain contribute
equally to the facet and domain scores, respectively.
2.4. Design
At inclusion, all the patients received a package including three
questionnaires (WHOQOL-HIV, HADS, Nijmegen). They were asked to
fill out these questionnaires (Initial evaluation). They received a second
similar package and were asked to fill out these questionnaires after
four weeks (Final evaluation). The initial evaluation was compared to
the final evaluation. A trained researcher was present to provide
assistance in completing the questionnaires if necessary. The patients
were randomized in intervention and control groups by a computer
generated random number list (www.randomizer.org) with an alloca-
tion ratio of 1:1.
During the four weeks, each patient of the intervention group
received the massage therapy (one massage session a week) by the same
trained physiotherapist who was not a member of the infectious disease
clinic. It consisted in a back massage with the techniques of Swedish
massage for 30 min with baby oil. The massage was performed in a
quiet area from a primary care center. The assessor (GR) was blinded.
2.5. Statistical analysis
The sample size needed for detecting the minimal change (0.5x SD)
on HADS-A based on preliminary data with a power of 0.80 was
determined (n = 13). Statistical analyses were performed using SPSS
Statistics 23.0 (IBM Company, SPSS Inc., Chicago, IL, USA). Descriptive
data were expressed by mean ± SD or by median with interquartile
range depending on the normality of the distribution. Normality of the
distributions was verified by Kolmogorov-Smirnov test. Results were
compared by paired Student t-test after checking the normality of the
distribution. Homogeneity of variances was checked by Levene’s test.
Significance level was set at 0.05.
3. Results
Among the 45 recruited patients, 29 were enrolled and randomized
in the two groups (Fig. 1). The patients who were not included did not
want to participate or cannot participate for transportation problems.
Fifteen and fourteen patients were included in MT and control groups
respectively. One patient did not complete the sessions of massage
therapy for familial reason.
The socio-demographic data of the included patients are summar-
ized in Table 1. The age range of the patients was 25–73 years old. The
proportion of patients whose CD4+ cell counts were less than 500 cells
per microliter or having an undetectable viral load (< 40 copies/mL)
was 17%. All the patients were undergoing HAART.
The results of the different questionnaires at inclusion and the
comparison between the questionnaires at inclusion and after the study
are presented in Table 2 and Table 3, respectively. In our study, 51% of
the patients had a higher HADS-A score than the cut-off score for this
questionnaire and 20% of the patients presented a HADS-A score higher
than 11 which corresponds to an anxiety state. Only one patient had
depression (HADS-D > 11) and 17% of patients were borderline
(HADS-D between 8 and 11). Two facets from WHOQOL-HIV (“Home
R. Gregory et al. Complementary Therapies in Medicine 32 (2017) 109–114

Enrollment
Assessed for eligibility (n=45)

Excluded (n=16)

Š Not meeting inclusion criteria (n=0)

Š Declined to participate (n=16)

Randomized (n=29)

Allocation
Allocated to Massage therapy (n=15) Allocated to Control group (n=14)

Š Received allocated intervention (n=14) Š Received allocated intervention (n=14)

Š Did not receive allocated intervention (n=1) Š Did not receive allocated intervention (n=0)

Analysis
Analysed (n=14) Analysed (n=14)
Š Excluded from analysis (n=0) Š Excluded from analysis (n=0)

Fig. 1. Consort flow chart of the study.

Table 1 environment” (p = 0.02) and “Death and dying” (p = 0.04)) were

Socio-demographic data of the randomized patients. different between groups at inclusion.
A significant difference was observed for Nijmegen questionnaire
MT Group Control Group
(n = 15) (n = 14)
(p = 0.01) and HADS-A (p = 0.04) only after the four week massage
therapy. No evident benefit on the different domains of the WHOQOL-
Sex HIV appeared following the massage therapy. We observed a significant
M/F 9/6 12/2 improvement for “Pain and discomfort” facet after massage therapy
Age (years) (p = 0.04).
45.5 ± 10.9 47.1 ± 16.6

Education 4. Discussion
None 0 (0) 0 (0)
Primary school 2 (13.3) 4 (28.6)
Secondary school 3 (20.0) 5 (35.7)
This study highlights the positive impact of a four week massage
Second level 8 (53.3) 3 (21.4) therapy on anxiety and hyperventilation in HIV infected patients.
Third level 2 (13.3) 2 (14.3) However, neither benefit of this program was observed on depression
Marital status and quality of life.
Single 5 (33.3) 5 (35.7) At inclusion, both groups had similar characteristics. There was
Married 4 (26.7) 3 (21.4) more man than women. The results of the Nijmegen questionnaire
Co-habiting 1 (6.7) 5 (35.7)
cannot be compared to other HIV population because it has never been
Separed 2 (13.3) 0 (0)
Divorced 2 (13.3) 1 (7.1)
investigated in this population. However, the mean score is lower in
Widowed 1 (6.7) 0 (0) both groups than the recognized cuff-score to determine hyperventila-
Health status
tion.24
Very poor 0 (0) 1 (7.1) The level of anxiety in our HIV infected patients was higher than in
Poor 4 (26.7) 1 (7.1) the general population. Indeed, HADS-A mean scores in the general
Neither good, nor poor 1 (6.7) 5 (35.7) population are usually lower than 6.425–27 and depends on country and
Good 7 (46.7) 6 (42.8)
gender.28 However, HADS-A score was in the range of previous studies
Very good 3 (20.0) 1 (7.1)
on HIV infected patients.29–31 The proportion of patients with a higher
HIV status
score than the cut-off score is nearly twice greater than in an
Asymptomatic 7 (46.7) 12 (85.7)
Symptomatic 1 (6.7) 0 (0)
epidemiological study (33.3% of patients).2
AIDS 7 (46.7) 2 (14.3) The mean HADS-D score in our study is similar to the general
population.27 and the proportion of patients with depression is lower
Data are expressed by number of patients and relative frequency between parentheses or than in a large epidemiological study on HIV2 It can be surprising
mean and SD (for age). because depression was previously related to HIV.4,5,32,33 However, the
MT: massage therapy.
HADS-D score varies widely in studies in HIV infected patients and it

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Table 2 Table 2 (continued)

Scores for the questionnaires at inclusion in both groups.
Control Group MT Group p value
Control Group MT Group p value (n = 14) (n = 15)
(n = 14) (n = 15)
[3.36; 4.16] [3.48; 4.20]
NQ 13.93 ± 12.42 16.87 ± 12.70 0.54 Fear of the future 3.86 ± 0.61 3.89 ± 0.74 0.89
[6.76; 21.1] [9.83; 23.9] [3.50; 4.21] [3.48; 4.31]
HADS-A 7.64 ± 5.11 8.53 ± 2.78 0.57 Death and dying 3.07 ± 0.79 3.64 ± 0.62 0.04
[4.7; 10.6] [7; 10.1] [2.61; 3.53] [3.3; 3.98]
HADS-D 5.29 ± 3.27 4.2 ± 3.28 0.38 Overall 14.33 ± 1.95 15.31 ± 2.28 0.22
[3.4; 7.17] [2.38; 6.01] QoL & general [13.20; 15.45] [14.05; 16.58]
WHOQOL-HIV Domain 1 _ 14.99 ± 2.40 14.35 ± 2.53 0.49 health perception
Physical [13.60; 16.37] [12.94; 15.75]
Pain and 3.77 ± 0.80 3.67 ± 0.77 0.72 Data are expressed by mean ± SD and confidence interval between brackets.
discomfort [3.31; 4.23] [3.24; 4.09] MT: massage therapy – NQ: Nijmegen questionnaire – HADS-A: Hospital Anxiety and
Energy and 3.61 ± 0.68 3.44 ± 0.84 0.55 Depression Scale-Anxiety part – HADS-D: Hospital Anxiety and Depression Scale-
fatigue [3.22; 4.00] [2.97; 3.91] Depression part.
Sleep and rest 3.71 ± 0.80 3.43 ± 1.04 0.41
[3.25; 4.18] [2.85; 4.00]
Symptoms of 3.88 ± 0.60 3.75 ± 0.77 0.78 was lower than the cut-off score in various studies similarly to our
PLWHAs [3.54; 4.23] [3.39; 4.24] results.30,31,34,35 Even if a lot of these studies were performed in Africa,
Domain 2 _ 15.30 ± 1.56 16.05 ± 1.36 0.18 they can be compared with our results due to the absence of ethnic
Psychological [14.40; 16.20] [15.29; 16.80] influence demonstrated on depression.36
Positive feelings 3.92 ± 0.53 4.13 ± 0.43 0.24
[3.61; 3.93] [3.89; 4.37]
The proportion of patients with a score suggesting an hyperventila-
Cognitions 3.75 ± 0.35 4.02 ± 0.44 0.07 tion (Nijmegen questionnaire score > 23) was higher in our study than
[3.54; 3.95] [3.78; 4.26] the estimated rate in the general population.37 It can be related to the
Self-esteem 3.67 ± 0.53 3.67 ± 0.61 0.98 level of anxiety of these patients. No comparison is possible because it is
[3.37; 3.98] [3.33; 4.00]
the first study to investigate this outcome in HIV population.
Body image and 3.83 ± 0.91 4.23 ± 0.42 0.15
appearance [3.30; 4.35] [3.99; 4.46] Quality of life was evaluated with a specific questionnaire to HIV
Negative feelings 3.96 ± 0.50 3.96 ± 0.35 0.99 population. It appeared good in our patients sample and similar to what
[3.67; 4.25] [3.63; 4.28] it was previously reported in these patients.23,38,39 The examination of
Domain 3 _ Level of 14.38 ± 2.29 14.53 ± 2.84 0.88 the relationship between HIV infection and the quality of life has been
independence [13.06; 15.70] [12.95; 16.1]
Mobility 3.99 ± 0.79 4.03 ± 0.72 0.89
increasingly studied over the last 10 years. As previously mentioned,
[3.53; 4.44] [3.63; 4.43] the quality of life is related to antiretroviral treatment11 but also to
Activities of daily 2.57 ± 0.63 2.83 ± 0.99 0.40 CD4+ cell counts,40,41 the onset of symptoms,41,42 depression and
living [2.2; 2.93] [2.28; 3.38] stress.43,44
Dependence on 3.77 ± 0.94 3.72 ± 1.13 0.89
Anxiety and hyperventilation scores improved significantly after the
medication or [3.23; 4.31] [3.09; 4.35]
treatment four sessions of massage therapy contrarily to depression and quality of
Work capacity 4.26 ± 0.85 4.11 ± 0.89 0.64 life. This modification was not observed in the control group. Although
[3.77; 4.75] [3.61; 4.6] there is no minimal clinical important difference (MCID) determined for
Domain 4 _ Social 14.61 ± 1.51 14.81 ± 1.79 0.75 HADS-A in HIV infected patients, based on the MCID related to COPD
relationships [13.75; 15.48] [13.82; 15.80]
Personal 3.93 ± 0.61 3.96 ± 0.61 0.89
patients (MCID = 1.32)45 we can hypothesize that the statistically
relationships [3.58; 4.28] [3.62; 4.30] significant improvement is also clinically relevant (−1.5). A similar
Social support 3.3 ± 0.80 2.83 ± 0.82 0.13 benefit of massage therapy on anxiety has been also previously
[2.84; 3.76] [2.37; 3.28] demonstrated in other diseases.46–48 However, it has never been studied
Sexual activity 3.57 ± 0.55 3.81 ± 0.58 0.26
in adult HIV infected patients. Only two studies on HIV children and
[3.25; 3.89] [3.49; 4.14]
Social inclusion 3.81 ± 0.49 4.21 ± 0.54 0.47 adolescent showed a benefit on anxiety following massage therapy.18,49
[3.53; 4.10] [3.92; 4.51] To our knowledge, the benefit following massage therapy has never
Domain 5 _ 15.52 ± 1.67 15.76 ± 1.46 0.68 been demonstrated on hyperventilation before this study. However, it is
Environment [14.55; 16.48] [14.95; 16.57] not surprising due to the well-known relationship between hyperventi-
Physical safety 4.00 ± 0.53 3.71 ± 0.44 0.12
lation and anxiety.6 and the benefit we observed after massage therapy
and security [3.69; 4.31] [3.46; 3.95]
Home 3.60 ± 0.73 4.17 ± 0.53 0.02 on this last disorder. The improvement was similar than in another
environment [3.18; 4.02] [3.88; 4.47] study evaluating the effect of acupuncture on hyperventilation.50
Financial 3.36 ± 0.80 3.56 ± 0.99 0.55 No benefit of massage therapy was observed on depression contra-
resources [2.90; 3.82] [3.01; 4.11]
rily to the results of previous studies on HIV-uninfected.51 and infected
Health and social 4.24 ± 0.35 4.39 ± 0.42 0.30
care [4.03; 4.44] [4.16; 4.62] patients17 It is certainly explained by the low HADS-D scores of the
New information 3.76 ± 0.64 3.68 ± 0.53 0.72 patients at inclusion in our study and the short duration of the program.
or skills [3.39; 4.13] [3.39; 3.97] Indeed, all the patients were depressed in these studies. Moreover, a
Recreation and 3.70 ± 0.81 3.83 ± 0.73 0.66 recent systematic review noted that massage therapy was beneficial on
leisure [3.23; 4.17] [3.42; 4.23]
depression in fibromyalgia only if the duration was longer than 5
Physical 4.33 ± 0.43 3.93 ± 0.77 0.10
environments [4.08; 4.57] [3.51; 4.36] weeks.48
Transport 3.96 ± 0.56 4.12 ± 0.46 0.41 Quality of life was not modified by the four week massage therapy.
[3.64; 4.28] [3.87; 4.38] This is in accordance with a recent systematic review highlighting a
Domain 6 _ 14.01 ± 2.10 14.48 ± 2.07 0.55
lack of evidence regarding the effect of different nonpharmacologic
Spirituality [12.80; 15.23] [13.33; 15.63]
Spirituality, 3.33 ± 1.11 3.11 ± 1.33 0.63
interventions on quality of life and a disparity in the results of the
Religion, Personal [2.69; 3.97] [2.37; 3.85] different studies.52 No domain from the WHOQOL-HIV improved
beliefs statistically after the massage therapy but the facet “Pain and dis-
Forgiveness 3.76 ± 0.69 3.84 ± 0.65 0.74 comfort” improved significantly. That can be related to the effect of

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Table 3
Comparison of the scores for the different questionnaires before and after the study period in both groups.

Control Group MT Group

Before After p value Before After p value

NQ 13.9 ± 12.4 14.6 ± 11.7 0.59 16.9 ± 12.7 11.2 ± 8.9 0.01

HADS-A 7.6 ± 5.1 7.3 ± 3.3 0.67 8.5 ± 2. 8 7.0 ± 2.9 0.04

HADS-D 5.3 ± 3.3 4.9 ± 3.0 0.39 4.2 ± 3.3 2.9 ± 3.4 0.09

WHOQOL-HIV
Domain 1 _ Physical 14.75 ± 2.32 14.92 ± 2.00 0.79 14.16 ± 2.52 15.49 ± 2.72 0.09
Pain and discomfort 3.71 ± 0.79 3.86 ± 0.68 0.34 3.64 ± 0.79 4.00 ± 0.72 0.04
Energy and fatigue 3.54 ± 0.68 3.54 ± 0.73 1.00 3.36 ± 0.81 3.69 ± 0.99 0.11
Sleep and rest 3.63 ± 0.77 3.63 ± 0.63 1.00 3.40 ± 1.07 3.60 ± 0.96 0.44
Symptoms of PLWHAs 3.88 ± 0.62 3.89 ± 0.57 0.94 3.76 ± 0.77 4.20 ± 0.71 0.08

Domain 2 _ Psychological 15.17 ± 1.55 15.63 ± 1.65 0.14 15.92 ± 1.32 16.02 ± 2.02 0.79
Positive feelings 3.89 ± 0.54 3.97 ± 0.50 0.24 4.10 ± 0.43 4.10 ± 0.52 0.65
Cognitions 3.71 ± 0.34 3.96 ± 0.33 0.02 3.99 ± 0.44 4.11 ± 0.47 0.12
Self-esteem 3.65 ± 0.54 3.69 ± 0.63 0.63 3.61 ± 0.59 3.63 ± 0.75 0.92
Body image and appearance 3.78 ± 0.93 3.88 ± 0.82 0.38 4.17 ± 0.37 4.03 ± 0.76 0.48
Negative feelings 3.92 ± 0.51 3.98 ± 0.51 0.71 3.97 ± 0.62 4.13 ± 0.77 0.29

Domain 3 _ Level of independence 14.39 ± 2.38 14.08 ± 2.45 0.38 14.45 ± 2.93 14.49 ± 2.99 0.94
Mobility 3.98 ± 0.83 4.03 ± 0.77 0.77 4.00 ± 0.74 4.06 ± 0.79 0.74
Activities of daily living 2.53 ± 0.63 2.42 ± 0.89 0.62 2.83 ± 1.03 2.64 ± 0.93 0.12
Dependence on medication or treatment 3.78 ± 0.97 3.75 ± 0.94 0.82 3.64 ± 1.13 3.66 ± 1.21 0.94
Work capacity 4.31 ± 0.86 4.09 ± 0.86 0.08 4.13 ± 0.92 4.33 ± 0.88 0.32

Domain 4 _ Social relationships 14.57 ± 1.55 15.35 ± 1.95 0.04 14.90 ± 1.82 15.60 ± 1.76 0.09
Personal relationships 3.89 ± 0.62 3.98 ± 0.82 0.45 3.94 ± 0.63 4.13 ± 0.47 0.19
Social support 3.38 ± 0.82 3.54 ± 0.80 0.06 2.90 ± 0.80 3.07 ± 0.82 0.24
Sexual activity 3.58 ± 0.57 3.74 ± 0.66 0.28 3.84 ± 0.59 4.01 ± 0.61 0.09
Social inclusion 3.82 ± 0.52 4.09 ± 0.54 0.12 4.21 ± 0.56 4.39 ± 0.49 0.25

Domain 5 _ Environment 15.52 ± 1.74 15.58 ± 1.76 0.86 15.80 ± 1.51 16.13 ± 1.80 0.17
Physical safety and security 4.03 ± 0.54 3.88 ± 0.68 0.25 3.7 ± 0.46 3.99 ± 0.51 0.05
Home environment 3.57 ± 0.75 3.75 ± 0.71 0.40 4.13 ± 0.52 4.16 ± 0.58 0.79
Financial resources 3.32 ± 0.82 3.36 ± 0.69 0.75 3.66 ± 0.95 3.67 ± 0.51 0.87
Health and social care 4.26 ± 0.36 4.24 ± 0.39 0.89 4.42 ± 0.42 4.44 ± 0.38 0.71
New information or skills 3.74 ± 0.66 3.74 ± 0.62 1.00 3.69 ± 0.55 3.81 ± 0.58 0.14
Recreation and leisure 3.74 ± 0.83 3.88 ± 0.61 0.27 3.77 ± 0.73 3.84 ± 0.75 0.61
Physical environments 4.34 ± 0.44 4.31 ± 0.49 0.86 3.99 ± 0.77 4.10 ± 0.84 0.45
Transport 3.96 ± 0.58 3.91 ± 0.66 0.60 4.13 ± 0.48 4.14 ± 0.47 0.91

Domain 6 _ Spirituality 13.82 ± 2.04 14.35 ± 2.59 0.27 14.5 ± 2.14 15.11 ± 2.41 0.17
Spirituality, Religion, Personal beliefs 3.31 ± 1.15 3.28 ± 1.29 0.84 3.16 ± 1.37 3.40 ± 1.28 0.18
Forgiveness 3.68 ± 0.64 3.89 ± 0.74 0.16 3.86 ± 0.68 3.91 ± 0.69 0.78
Fear of the future 3.85 ± 0.64 3.91 ± 0.70 0.70 3.87 ± 0.77 4.09 ± 0.80 0.29
Death and dying 2.98 ± 0.75 3.28 ± 0.90 0.15 3.61 ± 0.63 3.71 ± 0.71 0.55

Overall QoL & general health perception 14.33 ± 2.03 15.25 ± 1.50 0.12 15.26 ± 2.36 15.44 ± 2.72 0.78

Data are expressed by mean ± SD.

MT: massage therapy – NQ: Nijmegen questionnaire – HADS-A: Hospital Anxiety and Depression Scale-Anxiety part – HADS-D: Hospital Anxiety and Depression Scale-Depression part.

massage on the reduction of cytokines53 and pain.47 However, we can
observe that two domains (“physical” and “social relationship”) im-
proved more than the minimal change corresponding to half a standard
deviation. This criterion can be discussed but it is based on a rigorous
psychological and empirical foundation.54 Despite this interpretation, it
seems difficult to affirm the benefit of massage therapy on quality of life
in HIV infected patients based on our results.
The limitation of this study is that the sample better reflects the
patients followed in a health care center rather than other patients.
Indeed, the characteristics of the sample are slightly different from the
global Belgian HIV population according to the last report from the
Belgian Scientific Institute of Public Health.55 The ratio between men
and women who took part in the study is 2.6 higher than in the Belgium
population of HIV infected patients (1.7). The mean age and percentage
of treated patients are slightly higher than the global population.
However, we hypothesize that these elements does not influence the
effect of massage therapy.
The choice of the massage therapy can be discussed. Different kind
of massage, durations and frequencies of sessions were proposed in the
literature. Even if the duration of massage therapy showed a relation-
ship with the benefit,48 some studies with shorter massage therapy
showed also improvements.47,56 This justified the choice of our
program.
In conclusion, a four week massage therapy showed an improve-
ment on anxiety and hyperventilation in HIV infected patients. Massage
could be proposed to anxious HIV infected patients. However, the
benefit of this program was not observed on depression and quality of
life. Further studies could clarify the best massage therapy to be
proposed to HIV infected patients.
Conflict of interest
None.
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