We take a look at two pilot studies looking into complementary therapy approaches to support clients with symptoms of long Covid
The Anosmia, Acupressure, Aromastick and Aromapot Project
By project leads, Dr Peter Mackereth, Paula Maycock and Ann Carter
Before COVID 19 emerged, anosmia (the inability to detect odours) was a relatively unknown term outside of medicine; however, olfactory disorders are not new health concerns. Nasal polyps, enlarged turbinates*, as well as degenerative disorders such as multiple sclerosis, Parkinson’s disease and Alzheimer’s can result in difficulties to detect odours. Patients who have had laryngectomies or tracheotomies may also experience hyposmia (decreased ability to detect odours) due to a reduced or absent nasal airflow. Head trauma and local disease, such as cancer (and some cancer treatments), can be linked with long-term disorders of taste and smell.
For several years, our project team has worked in cancer care with patients experiencing symptoms such as anosmia and xerostomia (dry mouth) – often referred to as ‘difficult to treat’ concerns. To help ease these distressing side-effects of treatment, with some success, we have used various therapies such as acupuncture/acupressure, massage, essential oils and reflexology, often in combination.
The challenge is that most of these symptoms require a series of treatment combinations and ongoing advice and self-care. What we do know is that these challenging symptoms can affect quality of life, in particular depressing a cancer patient’s mood and reducing their appetite (Bernhardson et al, 2009).
Long COVID patients can ill afford the detrimental effects of anosmia, which is often experienced alongside fatigue, breathlessness, muscle and joint pain and insomnia. As therapists, we know that interventions that combine touch techniques with aromatherapy can have benefits on wellbeing. From our review of the literature, we have found that even odour-evoked memories can alter mood and be useful for helping with psychological and physical health concerns (Carter et al, 2019). For someone who has altered ability to smell, even using regular recall of an aroma could be potentially of benefit.
Importantly, there are many factors that can increase and decrease nasal resistance. Both smoking and alcohol increase nasal resistance, as does infective rhinitis – all can compromise the ability to detect odours. Research studies have shown that marked sensation of increased airflow was demonstrated when substances such as camphor, eucalyptus, L-menthol, vanilla, or lignocaine were applied to the nasal mucosa (Chaaban & Corey, 2011).
In the last 12 months, our team has embarked on a pilot project with volunteers. The process seeks to evaluate the combination of twice daily aroma trainings, using three separate pots, each with a pad infused with a different single essential oil. Prior to the inhalations from each of the three aromapots, the volunteers are asked to carry out a tapping routine of specific acupressure points which link to olfaction and gustatory function. During the day, our participants supplement this routine with using an aromastick with the same combination of essential oils used in the three pots. Participants are advised to hold the aromastick 2 to 6cms away from the nostrils, then use a gentle breathing technique, which we call ‘3 Breaths to Calm’. This involves breathing in through the nose and then out through the mouth (Carter & Mackereth, 2019). Usually, this activity can be done before a coffee or tea break and before lunch, so approximately three times a day, linked to consumption of food and drink.
Using questionnaires, we are collecting data at the start of an individual’s personal project and after five weeks of adhering to the routine. Our initial pilot work with six participants revealed improvements in anosmia after three to four weeks of using the protocol. We are also intending to gather qualitative data via interviews with volunteers about the experience of living with anosmia and using our aromatherapy and acupuncture protocol. Our purpose in using the protocol is to stimulate the participants’ parasympathetic response to the triggers of selected aromas, combined with gentle acupressure, so promoting olfactory and gustatory function. Currently we have four students, all aromatherapists, from our recent online ‘Therapeutic Uses of Aromasticks and Aromapots’ course assisting with the project.
We hope to present our work in 2022, once the data has been collected from a larger sample.
*Turbinates are several thin bony elongated ridges forming the upper chambers of the nasal cavities – these increase the surface area allowing for rapid warming and humidification of inhaled air.
Dr Peter Mackereth was the clinical lead of the complementary therapy and wellbeing service at The Christie for more than 15 years. He is currently an honorary researcher and lecturer at The Christie and a volunteer therapist at St Ann’s Hospice. Paula Maycock is a senior complementary therapist at The Christie, Manchester. Ann Carter has worked as a complementary therapist and teacher since 1989 in hospices and the acute sector.
Bowen therapy study
By project lead, Jo Wortley
In February 2021, I joined forces with Dianne Bradshaw* to launch a quantitative observational study that would look at whether Bowen therapy might prove a helpful intervention in improving the symptoms and wellbeing of people affected by long COVID.
The initial aim was to recruit 60 to 70 qualified Bowen practitioners, who would provide a series of six weekly Bowen sessions to self-elected clients (participants) who had been experiencing symptoms of long COVID for six months or more and were eligible to take part in the study. Measure Yourself Medical Outcome Profile (MYMOP) questionnaires were to be completed by each participant, with all of the Bowen practitioners taking part receiving online training to help them understand the aims and objectives of the study and how to use the MYMOP questionnaires appropriately, in order for the data to be valid.
As with many complementary therapy interventions, in a ‘real world’ situation, Bowen sessions are adapted to meet the needs and presenting symptoms of the individual client, which may change from one session to the next. For this reason, the Bowen practitioners taking part were not required to follow a ‘standardized’ treatment, however they were asked to only use moves learned during their core Bowen training (modules 1 to 5).
At the time of writing (December 2021), I am pleased to report that 30 practitioners managed to complete a series of six treatments with at least one study participant, producing a total of 26 valid sets of data. While I am yet to fully collate and compare the data, the initial results look very promising, with the majority of participants seeing an improvement in one or both symptoms that they were seeking help with, as identified in their MYMOP questionnaires. When comparing data taken from Weeks 1 and Weeks 7 only:
- 14 out of 15 participants reported an improvement in their fatigue;
- 12 out of 14 participants reported an improvement in their mobility (walking, jogging or running);
- 20 out of 22 participants reported an improvement in their general wellbeing
While these results look very positive, we do need to understand what happens to people who have no intervention over a 7-week period, to establish whether this is ‘normal’ recovery.
It was also very pleasing to see that the vast majority (22 out of 24) also highly recommended Bowen, rating it between 8 and 10 out of 10.
While it’s involved a lot of time and effort, it’s exciting to be leading the way with this study and once it has been published, I will of course ensure that FHT members are made aware of the key outcomes. Although this study obviously focuses on Bowen therapy, it is important that as a community of professional therapists, we all share as much information and best practice as we can, to ensure the long-term safety of our clients and to also demonstrate the potential role that therapies may have in helping to support clients with long COVID, where appropriate.
* Dianne, an experienced Bowen and McTimoney practitioner who worked on both humans and animals, sadly passed away several months after the study was launched.
Jo Wortley is a Director and Senior Tutor at the College of Bowen Studies, which offers an FHT accredited practitioner qualification in the Bowen Technique, alongside a range of Bowen masterclasses. thebowentechnique.com