A survey of visually impaired Anma-Massage-Shiatsu practitioners in Japanese hospitals.

KONDO Hiroshi1), FUJII Ryosuke2)

1)Center for Integrative Medicine, Faculty of Health Science,
Tsukuba University of Technology
4-12-7 Kasuga, Tsukuba City, Ibaraki 305-8521, Japan
E-mail: kondo0207@k.tsukuba-tech.ac.jp, Tel. & FAX: +81-29-858-9599
2)Course of Acupuncture and Moxibustion, Department of Health, Faculty of Health Sciences,
Tsukuba University of Technology

Abstract: OBJECTIVE: To determine the number of visually impaired Anma-Massage-Shiatsu practitioners employed in hospitals, and obtain information to facilitate the ability of the visually impaired to develop occupational skills.
METHODS: We surveyed 3,497 hospitals in the regions of Kanto and Kansai. The survey was a questionnaire distributed by mail to hospitals registered with the Welfare and Medical Service Agency.
RESULTS: There were 226 Anma-Massage-Shiatsu practitioners employed at 141 hospitals (mean: 1.6), and 182 Anma-Massage-Shiatsu, acupuncture, and moxibustion practitioners at 101 hospitals (mean: 1.8). Among these practitioners, 101 were visually impaired persons working in 76 hospitals. There are 8,818 hospitals in Japan. It can be assumed that 780visually impaired Anma-Massage-Shiatsu practitioners are employed by Japanese hospitals.
CONCLUSIONS: This study was able to determine that hospitals can employ visually impaired Anma-Massage-Shiatsu practitioners and obtain useful data for improving access for the visually impaired in the workplace.
Keywords: Anma-Massage-Shiatsu practitioner, Japanese hospitals, Visual impairment

1. Introduction
 Anma and acupuncture has played an important role in Japanese herbal medicine since the Edo period in Japan.Anma and acupuncture has been developed as a profession for the visually impaired since the Edo period.
 As of 2009, there are 8,818 hospitals and 2,743 massage therapists working in hospitals in Japan, according tothe statistical survey of the Ministry of Health, Labour and Welfare [1]. However, there is still much to be elucidatedregarding the job descriptions of massage therapists, the ratio of sighted to visually impaired therapists, and theworking conditions of visually impaired massage-acupressure therapists.
 The aims of this study were to improve the understanding of the working conditions of hospital massage-acupressure therapists with visual impairment and to obtain source materials for the development of future workareas of visually impaired massage-acupressure therapists.

2. Methods
 The survey was conducted in 3,497 Kanto and Kansai hospitals registered with the Welfare and Medical Service Agency. The survey questionnaire was mailed by post; the survey period was February 15–26, 2010. The survey covered the following topics: summary descriptions of the institutions, implementation of massage therapy, employment status, special arrangements for visually impaired therapists, affiliated department, and evaluation of massage. The hospitals that responded (all hospitals) and the hospitals that employed visually impaired therapists (hospitals with visually impaired therapists) were compared.

3. Results
 In total, 859 hospitals responded (response rate: 24.7%).
3.1 Employment status of massage therapists and acupuncture-moxibustion-massage therapists
 There were 226 massage therapists employed by 141 hospitals (mean: 1.6 therapists per hospital) and 182 acupuncture-moxibustion-massage therapists employed by 101 hospitals (mean: 1.8 therapists per hospital) (Fig. 1). There were 107 visually impaired therapists employed by 76 hospitals.
3.2 Affiliated department
 Most massage therapists were affiliated with the rehabilitation department in all hospitals (79.1%) and hospitals with visually impaired therapists (80.3%).
3.3 Implementation of massage therapy
 The questionnaire included items that allowed multiple answers regarding treatments provided from among four categories: physical therapy, massage therapy, exercise therapy, and acupuncture therapy. Approximately 60% of all hospitals performed exercise therapy and physical therapy, but only 28.2% and 8.1% performed massage therapy and acupuncture therapy, respectively. For the hospitals with visually impaired therapists, 86.8% performed physical therapy, 85.5% exercise therapy, 77.6% massage therapy, and 10.5% acupuncture therapy.
3.4 Person in charge of physical therapy, massage therapy, or exercise therapy
3.4.1 Type of therapists providing physical therapy
 Among all hospitals, 32.7% of the therapists providing physical therapy were physical therapists, constituting the largest group among the different therapists. This percentage was almost equivalent to the sum of the percentages of massage therapists (18.7%) and acupuncture-moxibustion-massage therapists (14.2%). In the hospitals with visually impaired therapists, 37.8% of the therapists providing physical therapy were massage therapists, constituting the largest group, followed by physical therapists at 30.4%. The percentage of acupuncture-moxibustion-massage therapists was 3.7%.
3.4.2 Type of therapists providing massage therapy
 Among all hospitals, 45.9% of the therapists providing massage therapy were massage therapists, followed by acupuncture-moxibustion-massage therapists at 30.6% and physical therapists at 20.7%. In the hospitals with visually impaired therapists, 65.5% of the therapists providing massage therapy were massage therapists, followed by physical therapists at 12.5%, judo therapists at 8.0%, and acupuncture-moxibustion-massage therapists at 6.9%.
3.4.3 Type of therapists providing exercise therapy
 Among all hospitals, 39.8% of the therapists providing exercise therapy were physical therapists, followed by massage therapists at 13.3% and acupuncture-moxibustion-massage therapists at 10.3%. In the hospitals with visually impaired therapists, 44.6% of the therapists providing exercise therapy were physical therapists, followed by massage therapists at 27.3% and acupuncture-moxibustion-massage therapists at 1.7%.
3.4.4 Special arrangements for visually impaired therapists
 Of all hospitals, 50.0% had special arrangements for visually impaired therapists concerning medical record processing, and 44.2% of the hospitals had minimal or no special arrangements. Among the hospitals with visually impaired therapists, 57.9% had special arrangements and 35.5% had minimal or no special arrangements.
3.4.5 Evaluation of massage therapy
 The hospitals were asked to share their thoughts regarding medical service fees of “massage” at medical institutions. Among all hospitals, 51.6% responded that the fees [covered by the national health insurance] were low. Among the hospitals with visually impaired therapists, 72.4% responded that the fees [covered by the national health insurance] were low.

4. Discussion
4.1 Estimated number of visually impaired massage therapists employed by hospitals, and future trends
 At the time of the questionnaire survey (2009), there were a total of 8,818 hospitals in Japan. Thus, the number of hospitals employing visually impaired massage therapists was estimated at 780 (= 76/859 × 8,818). The number of visually impaired massage therapists employed by hospitals was estimated at 1,601 (= 107/76 × 1,137).
4.2 Implementation of massage therapy
 Our previous studies [2,3] showed that most massage therapists were affiliated with the rehabilitation or surgery/orthopedic surgery departments. We obtained similar results for visually impaired massage therapists. The percentage of hospitals that implemented massage therapy was 28.2%. In contrast, the percentage was very high (77.6%) in hospitals that employed visually impaired therapists. These results suggested that hospitals with visually impaired therapists often used massage therapy in rehabilitation. In addition, the results led to the speculation that massage therapy was often used in combination with physical therapy and exercise therapy, and that visually impaired massage therapists played an active role as people responsible for providing such treatment.
4.3 Evaluation of massage therapy
 Compared to all hospitals, a higher percentage of hospitals with visually impaired therapists described the medical service fees [covered by the national health insurance] as low. This result indicated that hospitals with visually impaired therapists highly value the usefulness of massage therapy and massage therapists.

4. Conclusion
 Based on the results of our survey, we estimated the number of visually impaired massage therapists in hospitals nationwide to be 1,601. Visually impaired massage therapists were mostly affiliated with the rehabilitation or surgery/orthopedic surgery departments. The results of our study suggested that hospitals with visually impaired therapists often used massage therapy in rehabilitation. In addition, the results led to the speculation that massage therapy was often used in combination with physical therapy and exercise therapy, and that visually impaired massage therapists played an active role as people responsible for providing such treatment.

References
[1] Statistics and Information Department, Minister’s Secretariat, Ministry of Health, Labour and Welfare. [The 2008 medical institutions (static and dynamic) survey and hospital reports (as of October 1, 2008).] 2009. (Japanese)
[2] Fujii R, Kurihara K, Kondo H, Tanaka H, Kuroiwa S. [Acupuncture-moxibustion-massage therapists in medical institutions (general clinic edition).] Journal of Education and Research of Massage and Acupuncture. 2010;32(1):21-52. (Japanese)
[3] Fujii R, Kurihara K, Kondo H, Tanaka H, Handa M, Kuroiwa S. [Acupuncture-moxibustion-massage therapists in medical institutions II (hospital edition).] Journal of Education and Research of Massage and Acupuncture. 2011;33(1):37-66. (Japanese)