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What are your thoughts, beefs, opinions on massage therapy becoming evidence based practice?
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I don't think it will ever become completely so...at least not in the US. The Canadian education standards in the provinces that regulate, on the whole, are so much higher than most schools here, and it seems there's a healthy emphasis on research. I think the more that becomes scientifically validated about the effects of massage, the more that empowers us to help people and to convince more physicians to view massage therapy as a valuable part of their treatment recommendations.

For me personally, massage is a necessity to help my back and shoulder pain so I can avoid taking drugs. For other folks, it's a treat, something they do to pamper themselves, and when that's the case, the only evidence they care about is that it makes them feel good.
Hi Bodhi,

Great question. As health care SLOWLY becomes more integrated and health insurance is focusing on preventative solutions, massage therapists will become a bigger part of self care. As this happens I believe there will be a push for more evidence based work which can only help us get better at what we do.
Interesting, but let's see what the Cochran Reviews said about massage: http://www.cochrane.org/reviews/

- Mechanical neck pain
Overall, the quality of the studies was poor and the number of participants in most trials was small. …Therefore, no firm conclusions could be drawn and the effectiveness of massage for improving neck pain and function remains unclear.

- Dementia
Insufficient evidence to draw conclusions about the possibility that massage and touch interventions are effective for dementia or associated problems

- Promoting growth and development of preterm and/or low birth-weight infants
Evidence that massage for preterm infants is of benefit for developmental outcomes is weak and does not warrant wider use of preterm infant massage.

-There has been quite a lot of research on massage for long-term back pain. But the studies don't give clear answers about whether it works. .. overall, the research isn't good enough to say whether massage can help long-term back pain or not.

- We don't know whether massage helps pain caused by a slipped disc. There isn't any research to tell us.

-There's no research to say how baby massage can help women who have postnatal depression.

-We can't say if baby massage works because there hasn't been enough research.

-Some people try massage therapy for carpal tunnel syndrome. But there hasn't been any good research to say whether or not it works.

And so on...
So we have to be careful on what we mean by evidence-based medicine here. Most evidence-based study is based on some strict criteria, while massage therapy is more of a personal and some of the benefits cannot simply be measured mechanically.
Evidence based practise (EBP) is the judicious use of the best available evidence along with clinical experience and patient preferences. These 3 pillars are the foundation of EBP. One of them can not be used in isolation and still be called EBP.
The research you quote below is from systematic reviews, that only look at randomized controlled trials (RCT).
As stated above the research pillar of EBP is "the best available" evidence not RCT's only. Thus other types of evidence must be considered if no RCT is available.

No available evidence is not evidence of no efficacy.

Terra Rosa said:
Interesting, but let's see what the Cochran Reviews said about massage: http://www.cochrane.org/reviews/

- Mechanical neck pain
Overall, the quality of the studies was poor and the number of participants in most trials was small. …Therefore, no firm conclusions could be drawn and the effectiveness of massage for improving neck pain and function remains unclear.

- Dementia
Insufficient evidence to draw conclusions about the possibility that massage and touch interventions are effective for dementia or associated problems

- Promoting growth and development of preterm and/or low birth-weight infants
Evidence that massage for preterm infants is of benefit for developmental outcomes is weak and does not warrant wider use of preterm infant massage.

-There has been quite a lot of research on massage for long-term back pain. But the studies don't give clear answers about whether it works. .. overall, the research isn't good enough to say whether massage can help long-term back pain or not.

- We don't know whether massage helps pain caused by a slipped disc. There isn't any research to tell us.

-There's no research to say how baby massage can help women who have postnatal depression.

-We can't say if baby massage works because there hasn't been enough research.

-Some people try massage therapy for carpal tunnel syndrome. But there hasn't been any good research to say whether or not it works.

And so on...
So we have to be careful on what we mean by evidence-based medicine here. Most evidence-based study is based on some strict criteria, while massage therapy is more of a personal and some of the benefits cannot simply be measured mechanically.
Attachments:
In my opinion Evidence Based Practice is critical for the advancement of our profession, especially for those who want to be a part of the American health care system. I understand that some therapists do not want to go there, and that's fine--I'm speaking about those who do. EBP makes the most sense for massage because, as you point out Bodhi, it is a three pronged approach, taking into account the patient/client preferences and clinical experiences as well as using best available evidence.

The first step is to get research literacy into the schools so that new graduates can evaluate research and use it appropriately. Then we need massage therapists to actually conduct research. At least in this country, most research having to do with massage is being conducted by other health care professionals--as the principal investigator. That too needs to change and requires massage therapists to have a higher level of education. The result of research is the evidence, and who better to conduct it than those who were trained in it?
My thoughts exactly Jan. I'm trying to do just that. I've been a LMT for 15 years and a part-time grad student at the U of A for the past 3. I'm preparing for my internship before graduating and would like to set up a colloboration with Cortiva, PCC, or the Providence Institutes, and the U for either student research case studies or a micro-longitudinal pilot study. You and I met more than 15 years ago at DIHA when I was just starting out; I don't expect you to remember as we talked only once and I actually graduated from SWIHA. I have a UA professor who is interested in helping with my project and I'm gathering information now to get this ball rolling. Do you have any contacts you could recommend left at Cortiva that I could talk to who might be interested?

Jan Schwartz said:
In my opinion Evidence Based Practice is critical for the advancement of our profession, especially for those who want to be a part of the American health care system. I understand that some therapists do not want to go there, and that's fine--I'm speaking about those who do. EBP makes the most sense for massage because, as you point out Bodhi, it is a three pronged approach, taking into account the patient/client preferences and clinical experiences as well as using best available evidence.

The first step is to get research literacy into the schools so that new graduates can evaluate research and use it appropriately. Then we need massage therapists to actually conduct research. At least in this country, most research having to do with massage is being conducted by other health care professionals--as the principal investigator. That too needs to change and requires massage therapists to have a higher level of education. The result of research is the evidence, and who better to conduct it than those who were trained in it?
I always am intrigued by research having an undergrad degree in biology but there is also the other side of it that I have seen with a friend who works in it for a big university and gets millions of dollars from drug companies. She tells me horror stories of people in her office throwing out results that they didn't like and scary things like that.

I also wonder how you can really track the changes from a massage accurately. If you teach one technique to 10 massage therapists and they do it on one person it will feel different from each person and on each person. How do you track anything then really?

It is just big guesses but people want to know more about what works and what doesn't before they try things like massage for different conditions. I need to know more about how research is done and how to interpret it all because otherwise it is meaningless.

Julie
I've had many of the same concerns Julie and think it's good to read any abstract or scientific article with a discerning eye. I've often thought you can find evidence to support any argument and it's all a sales pitch we should filter through. But you and I both love MT; right? And who better than us to lead research in this area keeping bias and confounding to a minimum using the best scientific skills available. I think one has to start with an educated quess and then control the conditions as much as possible to get to the valid information. Have you read any of Ravensara S.Travillian's articles in Massage & Bodywork Magazine? She has been a monthly contributer with the goal of teaching MT's how to think critically and interpret MT abstracts and text. M&B Mag has a digital version too if you're interested: Massageandbodywork.com

Julie Onofrio said:
I always am intrigued by research having an undergrad degree in biology but there is also the other side of it that I have seen with a friend who works in it for a big university and gets millions of dollars from drug companies. She tells me horror stories of people in her office throwing out results that they didn't like and scary things like that.

I also wonder how you can really track the changes from a massage accurately. If you teach one technique to 10 massage therapists and they do it on one person it will feel different from each person and on each person. How do you track anything then really?

It is just big guesses but people want to know more about what works and what doesn't before they try things like massage for different conditions. I need to know more about how research is done and how to interpret it all because otherwise it is meaningless.

Julie
Hmmmm, why is it, that unless it can be proven "scientifically", it must not be viable. Massage (to me) is such an individual experience. I would question the intent behind EBM, is it just monetary (to be more readily accepted by the insurance companies) or is it to find techniques/modalities that consistently provide clients with positive results. I would think that answer would then be used to skew the data to favor which ever outcome was wanted.
Totally agree Elena...We don't need scientifically proven evidence to prove data.. We cannot deny the advances made in science like stem -cell research...ex: growing a new finger.. but to prove a method as universal...is also a dilemma . The placebo effect,.where Japanese scientists asked for volunteers to expose themselves to poison Ivy..and resulted in an itching red burning rash were eventually told it was not poison Ivy.
You could replace that experiment with any practise..its the belief in what the client is exposing themself to that has the result they expect.
How do you measure what the mind believes? Isn't this a question with a simple answer?


Elena Barrioz said:
Hmmmm, why is it, that unless it can be proven "scientifically", it must not be viable. Massage (to me) is such an individual experience. I would question the intent behind EBM, is it just monetary (to be more readily accepted by the insurance companies) or is it to find techniques/modalities that consistently provide clients with positive results. I would think that answer would then be used to skew the data to favor which ever outcome was wanted.

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