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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).?
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Replies to This Discussion
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Permalink Reply by Robin Byler Thomas on
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Loved both sites Christopher and Vlad; thanks for the levity.
I do both of these types of research, though the majority of my interest (and training) is in quantitative research. I find a qual approach is most useful for generating hypotheses, and a quant approach is most useful for testing hypotheses. Put another way, a qual approach seems more useful for exploration, and a quant approach seems more useful for confirmation/rejection.
Here's an approach suggested for research in CAM that may also work best for MT using both qualitative and quantitative methods in equal measures:
1. Context, paradigms, philosophical understanding and utilization
2. Safety status
3. Comparative effectiveness
4. Component efficacy
5. Biological mechanisms
The author suggesting this strategy sums it up by saying it "will generate evidence relevant to clinical practice." Here is the article If anyone wants to read it: - Attachments:
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Permalink Reply by Christopher A. Moyer on
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Robin -
Argh! What is this .mht format you're fond of? :)
Related to a remark I made just a bit earlier - I'm also *very* skeptical of folks who think we need special or different approaches for researching "CAM" than we do for everything else. Why would this be the case? Most especially when "CAM" isn't even a well-defined category?
-C.A.M. (Life is funny, isn't it?)
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Here is a link to a pdf of the same article Robin posted:
http://www.lclmllc.com/documents/FonneboetalBMC2007.pdf
Posting the link is not an endorsement of the article. :)
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Ah, one more thing I'd like to say about quant. vs. qual vs. WSR...
I fear those of you who don't know me so well will typify me as being closed-minded and limited in my perspective, given my strong preference for quantitative approaches, and you're certainly entitled to your opinion (though, logically, I don't agree that favoring quant approaches is equivalent to being blinkered). So it may interest you to know that I am currently in the middle of co-editing a book about massage therapy research, and that the chapter outline my colleague and I created includes separate chapters on quantitative methods, qualitative methods, and mixed/WSR approaches to massage therapy research. Each of these chapters (and may others) will be authored by individuals with specific expertise.
The finished product is some time off, but we do have a publishing contract and are in the thick of the book's production as I write this.
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CAM - How perfect!
Sorry, it must be my software; I'll try and save it in PDF form next time.
You don't consider massage therapy CAM?
The 5 step strategy suggested is not unusual to science; it's all science; only more science. I don't believe we can ignore the synergistic effects of a MT session and to capture it appropriately we need to use more science.
BTW, I will include a couple articles written by a statatician who supports Whole System Research (WSR); as soon as I read them. I love stats and epi myself, and know the value of RCTs.
Oh yes, I can't wait for your book to come out!
Christopher A. Moyer said:Robin -
Argh! What is this .mht format you're fond of? :)
Related to a remark I made just a bit earlier - I'm also *very* skeptical of folks who think we need special or different approaches for researching "CAM" than we do for everything else. Why would this be the case? Most especially when "CAM" isn't even a well-defined category?
-C.A.M. (Life is funny, isn't it?)
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CAM - How perfect!
Sorry, it must be my software; I'll try and save it in PDF form next time.
Maybe other folks like and use that format, but it's a new one to me, and I don't seem to be able to use it. And, in any case, whenever possible I like to see an article in its original form. The pdfs tend to be duplicates of any print version.
You don't consider massage therapy CAM?
I do not consider CAM to be a well-defined term, or a very useful one. I could go on (and on), but that pretty well sums up my position.
The 5 step strategy suggested is not unusual to science; it's all science; only more science. I don't believe we can ignore the synergistic effects of a MT session and to capture it appropriately we need to use more science.
No argument there.
BTW, I will include a couple articles written by a statatician who supports Whole System Research (WSR); as soon as I read them. I love stats and epi myself, and know the value of RCTs.
Oh yes, I can't wait for your book to come out!
Ha, me either! More correctly, it will be "our" book, as my colleague and I will be equal co-editors. There are about 20 folks authoring chapters, so it will be their book, too. But it's going to be a little while...
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Permalink Reply by Vlad on
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Another article - excellent! I better put the kettle on.....
And a book in the making? Even more excellent! ("I like this ship. It's exciting!")
Emmanuel - TDT is Tullamore Dew Therapy. Sometimes I try to do some quantitative research on how many braincells I can kill with it.
As for the qualitative/quantitative view. Notice I used a "/" instead of a "vs"? I don't really think there should be a "vs".
In my view (though it's a "still learning" view) the Moyeristic input into research is important AND the Thomasonian - making sense of it all is something maybe we should all start paying attention to.
As far as WSR goes, the non-hierarchical nature of it is what is interesting to me. For the most part I viewed qualitative as a building block upon which the quantitative is done (another one of Menards articles shows the pyramid pretty well), and WSR is more or less questioning that hierarchy.
As for bias and confounds, if my understanding is right these are issues in all types of research. One of the challenges is in keeping high levels of objectivity and accountability for confounds and the methodology plays an important part in that. The RCT is the big kahuna since it involves such control over the confounds and bias (hopefully - if it's well run) and in doing so, it has to be reductionist by nature.
Marissa - this thread was intended to be a learning thread, so I'm glad you're reading it. I'm learning too!
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Permalink Reply by Emmanuel Bistas on
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("I like this ship. It's exciting!")
"We are gonna need a bigger boat" sounds more like it. I am joking of course.:)
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Another article - excellent! I better put the kettle on.....
Wait - you're a distiller?! ;)
Emmanuel - TDT is Tullamore Dew Therapy. Sometimes I try to do some quantitative research on how many braincells I can kill with it.
Yeah, nothing wrong with that, since we all have way more than we need. Did you know that, even without drinking, 35,000 of our brain cells die everyday and are not replaced? Isn't that amazing?
the Moyeristic
I thought this could be the first usage of this word on the net, so I checked. It isn't.
http://www.google.com/search?sourceid=gmail&rls=gm&q=Moyeri...
Still, it's exciting to have an adjective coined in my name. Curiously, it rhymes with "voyeuristic." I don't know if that's good or bad.
The RCT is the big kahuna since it involves such control over the confounds and bias (hopefully - if it's well run) and in doing so, it has to be reductionist by nature.
Indeed. A question for you Vlad - do you think we can ever really avoid reductionism as we are trying to understand the way something works?
Marissa - this thread was intended to be a learning thread, so I'm glad you're reading it. I'm learning too!
I think we all are. I am.
Marissa, your post was much too modest. :) I'm glad you made it though. It lets us know that maybe there are some folks who are just reading, in addition to the folks like myself who keep on posting (and posting, and posting...)
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Permalink Reply by Marissa on
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It is most likely that I am not alone. I think that there are a lot of us "body-workers" out here being pulled along in a little tug boat by the big bad barge. I'm going to semi-quote Laura Allen when I say that I feel like a kindergarten student in a room full of college professors. I "know" what my hands tell me and I "know" what my clients tell me. To sit back and take it apart and question all the variables is mind-boggling. We are often taught that "intuition" is key in this field. However, when you take the intuition variable out of the equation what are you left with? Training, yes. But what are the guiding principles behind the training? Keep it coming, Professors, we are all ears... or eyes, slowly glazing over, as the case may be. ;)
Christopher A. Moyer said:Marissa, your post was much too modest. :) I'm glad you made it though. It lets us know that maybe there are some folks who are just reading, in addition to the folks like myself who keep on posting (and posting, and posting...)
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You're certainly not a kindergarten student. But I am a college professor! :)
By the way, I do think intuition is important in massage therapy, along with focus/mindfulness/presence/being in the moment or whatever one prefers to call it. That is notoriously hard to assess, as evidenced by the fact that there isn't even an agreed upon term for what it is.
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