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Questions on Affective Massage Therapy
Yep, that's with an "A"!
An editorial on "Affective Massage Therapy" in the IJTMB made me raise a few questions, not just about research, but also about what is going on in the everyday results I see in my practice.
First of all the articles addresses something which I have seen in other articles that have to do with a defect in the analysis of previous studies - a within group analysis done with a between groups design. Can someone explain this a little more? How prevalent is this defect in analysis in all of Field's research?
The article then goes on to talk about first and second order effects. This is something that I've wondered about a lot in my practice. Research has shown that MT lowers anxiety and depression - by lowering them alone, a myriad of health problems can possibly be alleviated. The article also I made me bring up my sleep question again, which might in turn lead to other results.
The identification of a subfield "Affective" Massage Therapy made me wonder if I needed to go and take a course in English grammar. Basically it is the "observable components of an individual's feelings, moods an emotions" and it addresses some areas in which research could be done. The anatomic sites would be an interesting study, just because I frequently hear "Why is it that a hand massage feels so good?" from clients. Other sites that came to mind would be feet, back and scalp (weird, I know - some clients just want to relax)
I've a question on the "Experience Effects". With the pediatric study which was an overview of 24 RCTs, it looks like for each study the same therapist was used for each application (probably to ensure standardisation in the protocol and application). Since there was such an increase in the levels of stress reduction as the recipients got more familiar with massage therapy, could that also have been attributed to the recipient being more comfortable with the therapist?
Also, as far as cortisol levels go, how do people view the Lawler/Cameron RCT that showed that cortisol levels were reduced with massage?
Also, on a different thread there was a reference made to studies on the client/therapist relationship.
Since this seems to be addressed quite a bit in the discussions on here, what's the latest from a research perspective (Robin brought it up on one of the threads, so I'll throw it up on here again).?
An editorial on "Affective Massage Therapy" in the IJTMB made me raise a few questions, not just about research, but also about what is going on in the everyday results I see in my practice.
First of all the articles addresses something which I have seen in other articles that have to do with a defect in the analysis of previous studies - a within group analysis done with a between groups design. Can someone explain this a little more? How prevalent is this defect in analysis in all of Field's research?
The article then goes on to talk about first and second order effects. This is something that I've wondered about a lot in my practice. Research has shown that MT lowers anxiety and depression - by lowering them alone, a myriad of health problems can possibly be alleviated. The article also I made me bring up my sleep question again, which might in turn lead to other results.
The identification of a subfield "Affective" Massage Therapy made me wonder if I needed to go and take a course in English grammar. Basically it is the "observable components of an individual's feelings, moods an emotions" and it addresses some areas in which research could be done. The anatomic sites would be an interesting study, just because I frequently hear "Why is it that a hand massage feels so good?" from clients. Other sites that came to mind would be feet, back and scalp (weird, I know - some clients just want to relax)
I've a question on the "Experience Effects". With the pediatric study which was an overview of 24 RCTs, it looks like for each study the same therapist was used for each application (probably to ensure standardisation in the protocol and application). Since there was such an increase in the levels of stress reduction as the recipients got more familiar with massage therapy, could that also have been attributed to the recipient being more comfortable with the therapist?
Also, as far as cortisol levels go, how do people view the Lawler/Cameron RCT that showed that cortisol levels were reduced with massage?
Also, on a different thread there was a reference made to studies on the client/therapist relationship.
Since this seems to be addressed quite a bit in the discussions on here, what's the latest from a research perspective (Robin brought it up on one of the threads, so I'll throw it up on here again).?
Views: 457
Replies to This Discussion
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Permalink Reply by Laura Allen on
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Sounds like a good question for Chris, Eric, and Bodhi to dissect on the other site :) BTW, I'll raise a wee drammie for your Christmas health!
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Permalink Reply by Vlad on
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Tullamore Dew Therapy has it's merits for sure, Laura. Think we might need to do some research on that sometime and employ the use of some lovely wee Irish crystal glasses.
Sure, why not ask it on this site? It's not as if there should be sides in learning about this stuff.
Some others might be interested in the answers.
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You're right, why indeed? There are a lot more people to contribute their perspectives here. I think most of them are on this one, too.
Vlad said:Tullamore Dew Therapy has it's merits for sure, Laura. Think we might need to do some research on that sometime and employ the use of some lovely wee Irish crystal glasses.
Sure, why not ask it on this site? It's not as if there should be sides in learning about this stuff.
Some others might be interested in the answers.
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Permalink Reply by Christopher A. Moyer on
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Hey "Vlad" -
Thanks for starting this thread. Let me see if I can address some of your questions.
An editorial on "Affective Massage Therapy" in the IJTMB made me raise a few questions, not just about research, but also about what is going on in the everyday results I see in my practice.
First of all the articles addresses something which I have seen in other articles that have to do with a defect in the analysis of previous studies - a within group analysis done with a between groups design. Can someone explain this a little more? How prevalent is this defect in analysis in all of Field's research?
In my scientific opinion, this 'defect' is present in many TRI studies, but to be fair it shows up in other clinical research as well. It isn't necessarily a defect all by itself, but it is a weakness when within-group effects are emphasized over and/or confused with between-groups effects.
A within-group effect is the technical way of saying that we took a person or sample of people and measured there they are before treatment (e.g., we ask them to complete a self-report instrument telling us how anxious they are). Then, we give them treatment (e.g., massage therapy). Finally, we measure those same people a second time to see how much they have changed since we last measured them.
This procedure strikes most people, and especially non-scientists, as perfectly logical. Any difference that we see (e.g., a decrease in anxiety) is evidence that the treatment worked, no? Well, maybe it is, and maybe it isn't. There are other possible explanations for a change if one is observed. Some of these include the mere passage of time - after all, people naturally heal or feel better even without treatment; the placebo effect - we know that people actually tend to do better if they merely expect they have received a working treatment, even if the treatment itself is not therapeutic (think sugar pills in medical research); and a statistical measurement effect known as regression to the mean which I'll rely on wikipedia to explain to whomever is interested. These, and some other things I have neglected to mention, are all alternate explanations for why a change might have occurred even if the treatment we have provided is useless. As such, within-group effects are suspect whether or not they are "statistically significant," which is itself only a mathematical concept (but a useful one when applied correctly).
For all the reasons just mention, it is generally preferable in treatment research to randomly assign research subjects to receive either the treatment being investigated, or a control treatment. Then, we compare where the treatment group is at the end of the study, vs. where the control group is at the end of the study. Because both groups have had the same amount of time pass, and (hopefully) both believe they have received treatment, and are both equally vulnerable to regression to the mean, any difference we observe between the two groups at the end of the study must be due to the treatment that only one of the two groups received.
To conduct a between-groups study, and then emphasize the within-group effects, is either a novice mistake or an attempt to make one's results look much better than they actually are. A considerable number of massage therapy research studies contain this flaw.
The article then goes on to talk about first and second order effects. This is something that I've wondered about a lot in my practice. Research has shown that MT lowers anxiety and depression - by lowering them alone, a myriad of health problems can possibly be alleviated. The article also I made me bring up my sleep question again, which might in turn lead to other results.
The identification of a subfield "Affective" Massage Therapy made me wonder if I needed to go and take a course in English grammar. Basically it is the "observable components of an individual's feelings, moods an emotions" and it addresses some areas in which research could be done. The anatomic sites would be an interesting study, just because I frequently hear "Why is it that a hand massage feels so good?" from clients. Other sites that came to mind would be feet, back and scalp (weird, I know - some clients just want to relax)
I've a question on the "Experience Effects". With the pediatric study which was an overview of 24 RCTs, it looks like for each study the same therapist was used for each application (probably to ensure standardisation in the protocol and application).
That may not have been the case for all 24 studies, though I believe it was the case for the four studies we used to examine an experience effect relating to state anxiety. The paper, when you get to it, should clarify this (I'd have to check myself to be sure).
Since there was such an increase in the levels of stress reduction as the recipients got more familiar with massage therapy, could that also have been attributed to the recipient being more comfortable with the therapist?
Certainly; that's a good thing to have considered.
Also, as far as cortisol levels go, how do people view the Lawler/Cameron RCT that showed that cortisol levels were reduced with massage?
It's hard to know exactly what you are asking. I was able to include this article in a review my students and I have recently completed on the MT/cortisol link, so I'm familiar enough with it to say that they do not provide sufficient data to permit calculation of a statistical effect size. This is frustrating because the study was well done otherwise. (Good clinical research studies should include sufficient detail to allow any later reader or reviewer to independently examine the statistics completely, but often this is not the case in massage therapy research.)
Also, on a different thread there was a reference made to studies on the client/therapist relationship.
Since this seems to be addressed quite a bit in the discussions on here, what's the latest from a research perspective (Robin brought it up on one of the threads, so I'll throw it up on here again).?
Well, I'm very interested in it. :) Do you have a more specific question?
-CM
P.S. Your name isn't really Vlad, is it?
P.P.S. Concerning the difficulty many people have regarding affect vs. effect - there is an excellent internet feature on this, and other grammar conundrums, here.
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Chris,
Thanks for the clarification on the between groups/within groups issue. So basically the way I look at it is that this is an area in which bias comes into play, right? In other words, you want to emphasize the effect, so you (either intentionally or it could even be non-intentionally) use within groups analysis because you want the effects to be more.
I suppose this highlights the fact that we need to be aware of this when we're looking at the details of any study. You call it a weakness. Seems more like a defect to me since I would have thought that the people running it OR doing a peer review would have caught it. Was the TRI research peer reviewed back then?
OK, the pediatric study - I'm tearing through it and I'll throw up more specific Q's on it later - one thing that jumped out at me though was where there was mention again of the statisical power and the lack of descriptive stats in MT studies. This to me is just amazing - why have a study without stats being published? To me it's just a bit crazy, but maybe that's because I kind of like numbers. Seems to me that a study isn't worth squat if it doesn't have solid stats? No?
As for the Lawler/Cameron RCT, I had read elsewhere that it was well run and just wanted to know what you thought of it. It's a pity their data wasn't good enough.
OK, as a sideline, I'm going to tell you a wee story that actually has to do with this article just to tell you what the outcome of just reading this article did to some massage therapist somewhere doing her work:
I was working on Sunday afternoon and I did 2 x1.5 hour massages on twin brothers. I see one of the brothers every week - he's some sort of counsellor and works with addicts and so finds massage a good way to unwind and let go every week (his job is pretty stressful and massage works well for him). I'd never met his twin brother and so I'd to do the initial interview, do the intake form etc. So it turns out that this new guy had lost his job a couple of months ago, he'd moved back down here, tried to get another job and ended up having anxiety attacks because of something that had happened which I needn't go into. His anxiety was so high he has to see a shrink and go on to medication. So I'm listening to him and the word "Anxiety" is blinking in my head. The next thing you know I find that my "talk" has changed quite a bit from what it normally would be. I find myself saying "Well, if there are 2 things that massage can help with, hands down, it's anxiety and depression. In fact, it you get a bunch of scientists to agree on one thing, it's that massage will definitely, without doubt, been PROVEN to help with anxiety through research". (I talked a wee bit about secondary effects too). The bloke really liked the massage. I know this is totally unscientific, but I think me emphasizing the research aspect of it helped him even more than if I hadn't said anything (or if I'd done my normal "talk")..
The point I'm trying to make is that I felt pretty good telling him what I knew for sure and he felt pretty good too. Now, even though I knew massage helped with depression and anxiety before I read the article, just the re-emphasis of it through reading the article changed my "talk" significantly (and the way I delivered it in the tone of my voice) - so it's also a good indication that I should just keep on reading.
As for the client/therapist relationship, I mentioned it because it was brought up (I think Robin mentioned in a humongously long thread that you had done research in it) and it sounded interesting. This is probably going to be a really stupid quesion, but I'm going to ask it anyway. Has there been any studies where there has been a comparison between massage protocol given with different therapists compared against protocol given by the same therapist? In the real world (at least in my practice anyway) I pretty much know that part of the reason the get a massage is because of that relationship. (My clients rock....well...except for this one dude...I'll not go into it).
I had looked at the same site (grammar girl) when I was reading the paper and had to keep the aardvark pic in my head as I was reading it. I still have to stop and think every now and then though.....
As for my name. Some call me Vlady boy, some call me The Valdster and yet others call me The Impaler (it's a long story that has to do with grey squirrels).
Does it really matter what my name is? I'm just an massage therapist, out doing my thing, trying to understand what's going on in massage research - think everyone else is probably doing the same.
Cheers.
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Thanks for the clarification on the between groups/within groups issue. So basically the way I look at it is that this is an area in which bias comes into play, right? In other words, you want to emphasize the effect, so you (either intentionally or it could even be non-intentionally) use within groups analysis because you want the effects to be more.
I suppose this highlights the fact that we need to be aware of this when we're looking at the details of any study. You call it a weakness. Seems more like a defect to me since I would have thought that the people running it OR doing a peer review would have caught it. Was the TRI research peer reviewed back then?
Many MT studies published by TRI but also by other researchers, too, have appeared in smaller journals with scientific standards that have not been very high. That may sound like just my opinion, and it is an opinion, but the fact that those journals were willing to publish articles lacking statistical details that better journals consider to be essential is, I think, evidence for my opinion.
Just because a study was reviewed, does not mean it was reviewed correctly, or well. Poor-quality reviews are a bigger problem at the smaller journals, logically. The top journals in a field will tend to be rigorously reviewed. There is only a small number of MT studies that have appeared in premier journals.
OK, the pediatric study - I'm tearing through it and I'll throw up more specific Q's on it later - one thing that jumped out at me though was where there was mention again of the statisical power and the lack of descriptive stats in MT studies. This to me is just amazing - why have a study without stats being published? To me it's just a bit crazy, but maybe that's because I kind of like numbers. Seems to me that a study isn't worth squat if it doesn't have solid stats? No?
I think my coauthor and I use some pretty strong language to say what you've just said toward the end of the article. :)
As for the Lawler/Cameron RCT, I had read elsewhere that it was well run and just wanted to know what you thought of it. It's a pity their data wasn't good enough.
Agreed. They themselves might have the statistical details that were not in the published paper itself.
OK, as a sideline, [snip]
That story is great! I love it. Thanks for telling me about it. Based on some of the data I've seen, I would venture to guess that the very anxious twin would get even better effects from subsequent massages. The first one, no matter how good, is going to be a "new" experience, and newness is not conducive to relaxation and the reduction of anxiety.
As for the client/therapist relationship, I mentioned it because it was brought up (I think Robin mentioned in a humongously long thread that you had done research in it) and it sounded interesting. This is probably going to be a really stupid quesion, but I'm going to ask it anyway. Has there been any studies where there has been a comparison between massage protocol given with different therapists compared against protocol given by the same therapist? In the real world (at least in my practice anyway) I pretty much know that part of the reason the get a massage is because of that relationship. (My clients rock....well...except for this one dude...I'll not go into it).
Your idea is not a bad idea for the basis of a study. I haven't seen a study like that, no.
Does it really matter what my name is?
Nope. But I found myself wondering if you are someone I have conversed with previously under another name. No need to answer - if you'd like to be anonymous, that is just fine by me.
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Permalink Reply by Emmanuel Bistas on
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I had to read the thread multiple times to understand it, I even had to look up "wee drammie" and "Tullamore Dew" :)
Curious about the "claim" about reduction of stress hormone... Are there textbooks or serious sources that make this (unsubstantiated) claim?
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Permalink Reply by Stephen Jeffrey on
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Hi Vlad
you said = The point I'm trying to make is that I felt pretty good telling him what I knew for sure and he felt pretty good too.
This represents a key point in your conversation with your client in that you have now struck an accord from which the session can rapidley move from talking to treating.
How/why you reached this point has nothing to do with the EBP more to do with your skills as a therapist =
So I'm listening to him and the word "Anxiety" is blinking in my head. The next thing you know I find that my "talk" has changed quite a bit from what it normally would be.
The reason you changed your talk was intuative .....you began to engage your higher self / and your intake experience in a way that enabled you to reach that vital point when talk stops and treatment begins. Unlike the many other professionals we are so very privalaged to have a treatment time span ( 90mins ) that does not choke/suffocate this intuative/empathetic artistry allowing us to reach/touch our accute/chronic clients e/affectively.
Have the confidence to place more trust in your experience as a MT and what happens to the tissues beneath your fingers rather than the written word.
EBP claims or the written word may prove false tommorrow?
The teachings and experiences from your clients are the truth to cherish.
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Hello!
Emmanuel and Stephen - thanks for your comments. I appreciate the fact that people are taking their time to read this thread (since my comments are long and require people to look at the docs and links).
Emmanuel -
Re: the claim about reduction of stress hormone, I can't actually remember where I heard or read the claim first. However, back when I was doing my basic training we were told that the Touch Research Institute was the main player in massage research in the US. So if you look at their home page you will see that reduces stress hormones is one of the bullets. If you take it further and do a search on their website for the word cortisol you will find further information which would indicate that cortisol is being reduced. Taking it further if you go to google scholar and plug in massage cortisol you will find further abstracts from individual studies (many of them will be TRI research).
I'm not sure how steeped into our schooling this claim is overall (I just know that I was told it in school), but one of the things that definitely is missing a our schooling is research literacy and critiquing the studies - knowing what the difference is between a systematic review or meta-analysis and other studies etc. How strongly do they indicate a cause and effect? Also, how well were the studies run? It's these types of questions that many of us can get confused mainly because it's completely new to us. At least, it's fairly new to me.
As far as the cortisol claim goes, I'm going with "it's up in the air" at the minute.
As far as Tullamore Dew Therapy goes - we definitely need more research in that and I want to get involved.
Stephen -
First off, I had started this thread and I only realized later that you had also generated another thread a couple of months ago on this very same article which addressed the cortisol question quite a bit - sorry I missed that and should have just continued on in your thread!
Your blog post on the initial interview should be read by everybody and I can tell that you have a lot of empathy for your clients. I like to think that I have empathy too. One of the reasons behind my transition into this career is because I went through a period of serious back problems that made me do some hard thinking about life - I think my empathy is rooted in that experience. It makes me a better therapist and my confidence as a therapist is pretty important to me. When I told the story of how just reading an article had an affect (or is it an effect? - ha!) on my practice I wanted to show that yes, my confidence was boosted by the certainty of research - not just by the research itself, but by me actually taking time out to research the research and just feeling good about it. Others may not want to do that and to be honest, what others do isn't really my concern. As for using my intuition and feeling what is going on beneath my hands? I do that too. I don't know how any massage therapist couldn't. It's a huge reason why I'm kept busy in my practice - I customize each session and I listen to what my hands are telling me. I just know that the combination of both is what is going to make me better at my job, feeling confident about what I'm doing and that will all translate into my clients feeling better. Some people might think that research/scientific perspective and intuition are mutually exclusive. Why is that? Why can't we pay attention to both? You talk about empowering the client in the initial interview in your blog, but is there not also a certain amount of empowerment for the therapist that comes from examining the scientific perspective - even if the information is dismissed?
Oh and if more research shows that levels of stress and depression is not lowered by massage then I'll keep on top of the findings and my talk will change again - I think there's more likelihood of me waking up one morning and finding myself looking like Kate Moss, but that's besides the point.
Happy Boxing Day, Stephen!
I'm going to throw up some more articles for discussion on this thread later (stuff to do now - like play with my Christmas presies). If anyone else wants to ask questions on research articles or methods or anything along those lines, please feel free to use this thread to do so.
Cheers.
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Curious about the "claim" about reduction of stress hormone... Are there textbooks or serious sources that make this (unsubstantiated) claim?
Yes, definitely. Any of the articles and books authored by the TRI folks report this. Subsequently, and articles or books that use those items as sources tend to include it, too.
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How/why you reached this point has nothing to do with the EBP more to do with your skills as a therapist
That's not true. The latter part is likely to be true - Vlad's skill in interpersonal communication was undoubtedly important in the example she provided. But to say that it has "nothing to do with the EBP" isn't true at all - if it were we could say any crazy thing to people, so long as we said it right.
Vlad can tell me if I'm wrong on this, but I suspect that she found it easier to communicate the information effectively because she had reasonable confidence in it, knew she'd be able to answer subsequent questions accurately and conscientiously (if there were any), and these things freed her to be more comfortable with the person, the information, and the treatment that was about to follow.
I can understand that you and I might place different values on the importance of EBP, but to discount it to zero seems preposterous.
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Vlad - good points in your last post.
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