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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 Vlad on
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Too much eggnog, Baileys, wine and TDT brought on a brain fart when I wrote that last post:
It should have been
if more research shows that levels of anxiety and depression is not lowered by massage
instead of:
if more research shows that levels of stress and depression is not lowered by massage
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Permalink Reply by Robin Byler Thomas on
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Great thread Emmanuel, Stephen and Vlad. I think we are all saying the same thing: just because experimental research, such as an RCT, cannot address what we know and see happening with our clients, does not mean it's not happening, or, that it's not equally effective; it is and we know it. Part of the problem, in MT research, has been not having the right instrumentation to measure this phenomena. Perhaps that is why more emphasis was put on the in group differences reported in the article you mentioned Vlad.
If MT is considered a whole system approach to healing that utilizes many modalities, rather than a single application of one working method, we really cannot apply only a reductionist method to investigate its complexities without limiting its effectiveness. MT's use many approaches and consider numerous client levels in uniquely individualizing each treatment session; and adjust as necessary to clients changing needs. It is the combination of all these concerns and the client/therapist interaction that guides the healing process. We also consider what the patient brings to the table; their beliefs and attitudes, their medical history, their individual experiences, and their goals in considering a treatment plan. Oh, what can be achieved with a client who has a great attitude.
Now might be a good time to bring up the topic of qualitative research applied to MT, as an equal companion to quantitative research. Qualitative research gives rich, in-depth, descriptive detail that may well fill the gap experimental data leaves out. Intervention studies often result in statistically significant results that have no meaning in real life situations; they don't translate. This is where qualitative research comes in and gives meaning to non-statistical findings. Cortisol levels may not have had statistically significant results, however, study participants stress levels may have gone down, as described in key informant interviews or focus groups, better quality of life revealed, improvements to relationships at home and work, increases in awareness, productivity and overall well-being, and often a break in the pain cycle.
I've attached another great study addressing these issues that are not unique to the MT industry. Physical therapy, psychology, surgery, and the nursing field have also wrestled with these same issues; why does an intervention work, how does the participant experience it, and what meaning do they give to it? Qualitative research addresses the impact of the context and the process of the intervention and is needed to help round out quantitative research in massage therapy. An example the author gives is a study of the effects of qigong on school children in China. Although no significant differences were found between two groups in quality of life using a validated quality of life scale, data collected in qualitative interviews with teachers showed a calming and relaxing effect of qigong and less complaints from children in class as well (elements not included on the quality of life scale). Another example was of acupuncture in the prevention of recurrent cystitis. Not only was this medical issue addressed but changes to other health issues were noticed that centered around re-establishing harmony or balance; i.e. sleep, stress, digestion, stress levels, urinary habits, and reduced pain. This was realized from qualitative data gathered in rounding out the study. Sound like results seen often in MT sessions, no? My point is we need both quantitative and qualitative research in MT; inclusive research that considers all we do as practitioners. - Attachments:
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Permalink Reply by Emmanuel Bistas on
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Thank you for the info, I really appreciate it. I was able to find the claim in a massage textbook as well. I had always thought of it as something that people said (similar to 'drink water' and 'flushing of toxins') and not that it was result of research or that the research was contentious.
It is interesting to read the points about 'within-group' and 'between-groups' differences, and about the notion that the client/therapist relationship potentially influences the results of a treatment, or that telling the client how massage is proven to help with 'x' can influence the treatment. There are so many other factors that could influence a treatment, for example, a client's relationship with touch, transference issues, familiarity with massage, personal belief systems.
What parameters are usually taken into consideration in those randomly controlled trials? Is there a comprehensive list of variables that must be held constant in these studies? And are they the same for for condition-specific massage as they are for general wellness massage?
Christopher A. Moyer said: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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Hello!
Chris/Stephen:
"but I suspect that she found it easier to communicate the information effectively because she had reasonable confidence in it"
Yup - it was the extra confidence that I liked and it came through in how I interacted and communicated with the client.
Robin:
You rock - not only because you are involved in research but because you make me think about stuff and you attach great reading material! I read the first Verhoef article you posted on another thread (I've still to read the one you have posted on this one - I'll get to it, honest) and it's a really interesting read. A while back when I started looking at research I read Menards article on research methods and it made me wonder if there was a wee rift between quantitative and qualitative researchers at some stage. To me, it seems that it's all pretty dang important. As for an RCTs inadequacies, that may be true and I'm still in learning mode. However, I have to admit that I think there is an intrinsic quality to a well designed RCT that is just...well..."pure" is the best word I can use (that's really corny, I know, but I can't come up with a better word) and the confidence that it can deliver is so high when there is positive outcome that I don't think anyone should ever ignore it. Is there a type of hyper-rationalization and reductionism in quantitative research in regard to our work? I still haven't really reached any conclusion on that. However, I do think that all of us should be looking at what both qualitative and quantitative studies are showing, analyse, critique, learn, study, have good old think with a cup of tea in hand and come to our own conclusions.
For anyone interested:
Here are some lecture notes on bias and confounding - it hasn't got to do with massage research specifically (epidemiology just isn't our bag, is it?), but it gives an idea of the number of biases and confounds that can come into play generally within research (I also lke the way the notes describe confounds). I thought it was pretty interesting.
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Hi Vlad,
Is there a type of hyper-rationalization and reductionism in quantitative research in regard to our work?
It sure seems that way based on some of the comments made on this site and the EBP site, wouldn't you say? I too, have relished our RCT research completed in the past five years; I wrote a term paper on its major effects this past semester. We have waited so long for validation it's been great to have evidence in the old school traditional form; but not to the exclusion of energy work. I'm not ready to go there when there's a growing body of researchers making the argument that utilizing qualitative, or observational, design can be equally effective at investigating energy work as experimental or randomized trials; much like many MT's have presented throughout this site. We need both to describe our work.
BTW, I've appreciated every link you've provided Vlad; most of them I've read before, but this gave me a chance to review, save and file them for future use. I did just read the Lawler/Cameron RCT on MT intervention for migraines. I was kind of avoiding it because many docs don't think measuring cortisol levels means much; something about them being so subject to change?? The study was a good replication of an earlier Fields study, with a bigger sample size and more outcome measures of related stress factors and sustainability of effects for three weeks after the end of the study; not too many studies out there with any sustained effects (although Chris has one he completed). Nice graphs, tables, use of analysis, and description of methods.
Oh yea, and the Epi lecture; omg that's a long list of bias. I also learned this semester that confounders are sometimes referred to as control variables (hadn't heard that before).
Vlad said:Hello!
Chris/Stephen:
"but I suspect that she found it easier to communicate the information effectively because she had reasonable confidence in it"
Yup - it was the extra confidence that I liked and it came through in how I interacted and communicated with the client.
Robin:
You rock - not only because you are involved in research but because you make me think about stuff and you attach great reading material! I read the first Verhoef article you posted on another thread (I've still to read the one you have posted on this one - I'll get to it, honest) and it's a really interesting read. A while back when I started looking at research I read Menards article on research methods and it made me wonder if there was a wee rift between quantitative and qualitative researchers at some stage. To me, it seems that it's all pretty dang important. As for an RCTs inadequacies, that may be true and I'm still in learning mode. However, I have to admit that I think there is an intrinsic quality to a well designed RCT that is just...well..."pure" is the best word I can use (that's really corny, I know, but I can't come up with a better word) and the confidence that it can deliver is so high when there is positive outcome that I don't think anyone should ever ignore it. Is there a type of hyper-rationalization and reductionism in quantitative research in regard to our work? I still haven't really reached any conclusion on that. However, I do think that all of us should be looking at what both qualitative and quantitative studies are showing, analyse, critique, learn, study, have good old think with a cup of tea in hand and come to our own conclusions.
For anyone interested:
Here are some lecture notes on bias and confounding - it hasn't got to do with massage research specifically (epidemiology just isn't our bag, is it?), but it gives an idea of the number of biases and confounds that can come into play generally within research (I also lke the way the notes describe confounds). I thought it was pretty interesting.
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Robin -
Glad you're liking the links. If you're interested, this is actually the most useful site on the web and has been scientifically proven to reduce stress (make sure your sound is turned on).
It's brilliant.
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LOL
Vlad said:Robin -
Glad you're liking the links. If you're interested, this is actually the most useful site on the web and has been scientifically proven to reduce stress (make sure your sound is turned on).
It's brilliant.
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Permalink Reply by Christopher A. Moyer on
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Vlad said:Robin -
Glad you're liking the links. If you're interested, this is actually the most useful site on the web and has been scientifically proven to reduce stress (make sure your sound is turned on).
It's brilliant.
Ha.
I wonder how many folks who think of me as some kind of hyper-rational, super-serious scientist stereotype, will get a kick out of learning that I visit www.cuteoverload.com as a means of stress reduction.
This is our secret, O.K.?
-CM
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On the quantitative / qualitative issue:
I have a different take on it than some other folks. First off, I'd like to note that we shouldn't think of researchers as being qual or quant, though I admit individuals often do emphasize one approach. However, I believe the best scientists choose the most suitable approach for the topic they are currently researching, and so would find it unnecessarily limiting, and faulty, to be referred to as a "qualitative researcher" or a "quantitative researcher."
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.
It's probably a bias of mine, but I am very suspicious of researchers who indicate that they do qualitative research exclusively. I suspect in many cases (not all) that this means they avoided training in quantitative methods because they found them intimidating.
Changing topics slightly...
I don't agree that doing qualitative research, or whole systems research, gets one around the problems associated with reductionism. WSR is still reductionistic; it's just that one is reducing to a different level. My scientific opinion is that, if we want to understand something, we're stuck with reductionism. Attempts to do an end-run around it either sacrifice more than they gain, or turn out to be reductionism disguised by having a different name attached to it.
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I also learned this semester that confounders are sometimes referred to as control variables
They're confounders, or confounding variables, when they're uncontrolled (i.e., they are allowed to vary). They potentially confound the results, and obscure a clear understanding of the relationship between the independent variable(s) and dependent variable(s).
They're control variables when steps have been taken to control them (i.e., they are prevented from varying, or only allowed to vary in a systematic way). This ensures that they do not confound our understanding of the relationship between the independent variable(s) and the dependent variable(s).
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Vlad/Robin, very well said. From the articles that Robin posted on whole systems research and on qualitative research, along with Vlad's links on bias and confounding and introduction to research methods for massage therapists, it is obvious to me that the talk on evidence-based massage therapy should proceed with caution. It feels good to know there are people out there who suggest a more comprehensive approach to seeking "evidence".
It appears to me that we must look for evidence that is complete, that takes all facets of massage therapy into consideration -including the client and the therapist, that pays attention to quantitative and qualitative, that is based on unbiased research, and, I am sure, much more. The question is, how does one get others to see the light? Those who are focused solely on quantitative research may not even notice the articles that Robin and Vlad posted.
And Vlad, what is TDT? do I want to know? :)
Robin Byler Thomas said:Great thread Emmanuel, Stephen and Vlad. I think we are all saying the same thing: just because experimental research, such as an RCT, cannot address what we know and see happening with our clients, does not mean it's not happening, or, that it's not equally effective; it is and we know it. Part of the problem, in MT research, has been not having the right instrumentation to measure this phenomena. Perhaps that is why more emphasis was put on the in group differences reported in the article you mentioned Vlad.
If MT is considered a whole system approach to healing that utilizes many modalities, rather than a single application of one working method, we really cannot apply only a reductionist method to investigate its complexities without limiting its effectiveness. MT's use many approaches and consider numerous client levels in uniquely individualizing each treatment session; and adjust as necessary to clients changing needs. It is the combination of all these concerns and the client/therapist interaction that guides the healing process. We also consider what the patient brings to the table; their beliefs and attitudes, their medical history, their individual experiences, and their goals in considering a treatment plan. Oh, what can be achieved with a client who has a great attitude.
Now might be a good time to bring up the topic of qualitative research applied to MT, as an equal companion to quantitative research. Qualitative research gives rich, in-depth, descriptive detail that may well fill the gap experimental data leaves out. Intervention studies often result in statistically significant results that have no meaning in real life situations; they don't translate. This is where qualitative research comes in and gives meaning to non-statistical findings. Cortisol levels may not have had statistically significant results, however, study participants stress levels may have gone down, as described in key informant interviews or focus groups, better quality of life revealed, improvements to relationships at home and work, increases in awareness, productivity and overall well-being, and often a break in the pain cycle.
I've attached another great study addressing these issues that are not unique to the MT industry. Physical therapy, psychology, surgery, and the nursing field have also wrestled with these same issues; why does an intervention work, how does the participant experience it, and what meaning do they give to it? Qualitative research addresses the impact of the context and the process of the intervention and is needed to help round out quantitative research in massage therapy. An example the author gives is a study of the effects of qigong on school children in China. Although no significant differences were found between two groups in quality of life using a validated quality of life scale, data collected in qualitative interviews with teachers showed a calming and relaxing effect of qigong and less complaints from children in class as well (elements not included on the quality of life scale). Another example was of acupuncture in the prevention of recurrent cystitis. Not only was this medical issue addressed but changes to other health issues were noticed that centered around re-establishing harmony or balance; i.e. sleep, stress, digestion, stress levels, urinary habits, and reduced pain. This was realized from qualitative data gathered in rounding out the study. Sound like results seen often in MT sessions, no? My point is we need both quantitative and qualitative research in MT; inclusive research that considers all we do as practitioners.
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Permalink Reply by Marissa on
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I have to say that I find this all very fascinating. I'm completely out of my league here, but I am thoroughly enjoying reading all your posts. The peeling apart inch by inch to find something or maybe nothing depending on the layer is fabulous. Us mere mortals may not be able to contribute much, but I'm enjoying the read! Keep it up!
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