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Obstacles

What do you think is the major obstacle preventing massage therapy from becoming evidence based?

Replies to This Discussion

Permalink Reply by Ben on July 14, 2009 at 9:07pm

I think the greatest obstacle is time. There seems to be a lot of research being done right now with results being published more frequently than in the past. Massage therapy has moved into a "medical" realm over the last several years. Through technology, communication and education, the clinical modalities are based on physiological laws and sound anatomy and physiology. I think that we are on the cusp of seeing massage therapy divided and re-classified as "medical" and "non-medical." One of which will be based upon research and results that can be duplicated in same scenario situations.

However, there are a lot of massage therapists and many seem to go their own direction with their education. Not all modalities will be evidence based. So will it ever happen at all? If so, I think we are headed in that direction and it is a matter of time until the division occurs and "medical" massage lobbies to be in the same realm as chiropractic and or physical therapy as viewed by insurance companies and the mainstream.

Just my thoughts,

Ben

Permalink Reply by Cliff Korn on July 14, 2009 at 10:45pm

Oh my, this simple question has anything other than simple answers! The obstacles are myriad – to pick “the” major one would require a magic 8-ball, the eye of a newt, and several bucketfuls of lucky guesses. The difficulty of developing relevant double-blind studies with a “sham massage” component aside, there are too few therapists working similarly to study effectively. There is nothing “pure” about the practice of massage therapy. I know of no one who does only NMT, or MFR, or CST, etc. to serve their clients’ needs. All available tools are blended and used situationally to meet client expectations. The difficulty in correlating study results when therapists are more concerned with client results than study integrity is problematic. To leave a client in pain after only a single modality is used is anathema to most massage therapists. They will muddy study protocol to mix methodologies in client treatment until perceived results are obtained.

There is also no great hue and cry from the majority of the profession for evidence-based therapy. Many “know what they know and evidence be damned.” The “average” massage therapist does not support massage therapy research. This is evidenced by the small percentage of massage therapists who support the Massage Therapy Foundation, the only industry-based research organization serving the profession. The Foundation still looks at $1000 as a lot of money, when, in fact, all parallel sister profession foundations deal with much larger numbers. I recently wrote an article on why I thought massage therapists should earmark the revenue from their 1st massage each month to the Massage Therapy Foundation. I got a lot of perplexed or hostile looks after that article was published. If evidenced based care is to become a reality then ALL therapists will have to come to grips with the fact that the Massage Therapy Foundation is THE foundation of the profession. It’s what will enable our income 10, 20, and/or 50 years from now to be maintained.

In my opinion, for massage therapy to become evidence based we will have to 1st, as a profession, become learned in research techniques and usage. We will have to become, if involved in a study, ok with doing a partial job with a client for the sake of study integrity, and . . . . . .we will have to develop a desire to become stewards of the profession instead of just practitioners.

Permalink Reply by Whitney Lowe on July 15, 2009 at 11:56am

I think Cliff has some very valid points about the obstacles to EBP. In the U.S. the primary obstacle as I see it is that very few massage schools actually teach people to think about research from the time of their initial training. As a result, many, if not most, practitioners don't really understand how research shapes their profession or their own work. Consequently, they don't even know what EBP actually is. Until people realize the way in which research shapes their practice and the need to move toward EBP, we have a very long way to go. Unfortunately, it will take much longer for our field to begin thinking this way. As with so many things it has to change with education and we are a long way behind in that area.

Permalink Reply by Jan Schwartz on July 16, 2009 at 5:36pm

I think fear is an obstacle too. "I know what I know and I don't want to be told it's wrong", as Cliff said. The word research is scary to some and they think they will be left behind somehow and that it will change how they work. And maybe it will, or maybe it will just change how they communicate how massage works. I still remember when I started massage school the word on the street was that massage increased circulation systemically, AND it got rid of lactic acid. Anyone else remember that? I'll bet there are a lot of therapists still saying those very words and a lot of schools still teaching those concepts.

Two issues here I guess. One is overcoming the fear of research, and the other is adequately training teachers.

And Ben, maybe it is time for some serious tier licensing conversations--it's not like we have to invent anything, there are models out there.

Permalink Reply by Whitney Lowe on July 16, 2009 at 5:56pm

Since we seem to have identified education (or lack thereof) as one of the main obstacles to EBP, I am curious to hear what others think on this subject. As an educator I am constantly looking at ways to make certain topics more interesting or finding ways to get people to realize how important some subjects (like research) are. We obviously need to get more research content into the schools, but how do we go about getting practicing professionals (those already out of school) more interested in the principles of EBP? Education is still at the core of this issue and the natural answer is continuing education. I wonder, though, how many people would attend a continuing education class on research in massage? Any thoughts on this?

Permalink Reply by Jan Schwartz on July 16, 2009 at 6:04pm

There must be some stats on this somewhere. Hasn't the Foundation been doing some workshops? I'm sort of out of that loop, but we know who we can ask. I'll shoot Diana an email right now. Would be interesting to see the attendance.

Whitney Lowe said:

Since we seem to have identified education (or lack thereof) as one of the main obstacles to EBP, I am curious to hear what others think on this subject. As an educator I am constantly looking at ways to make certain topics more interesting or finding ways to get people to realize how important some subjects (like research) are. We obviously need to get more research content into the schools, but how do we go about getting practicing professionals (those already out of school) more interested in the principles of EBP? Education is still at the core of this issue and the natural answer is continuing education. I wonder, though, how many people would attend a continuing education class on research in massage? Any thoughts on this?

Permalink Reply by Whitney Lowe on July 16, 2009 at 6:08pm

Yes, the Foundation has been doing some workshops on this, but if you think about the math it is really a tiny drop in the bucket as far as addressing the needs. They are only doing a handful of workshops around the country (U.S.) and there are over 1400+ schools. It is a start, but I think a much broader educational initiative is needed.

Here's the link that shows their current schedule of programs
http://tiny.cc/BQvgi

Jan Schwartz said:

Hasn't the Foundation been doing some workshops? I'm sort of out of that loop, but we know who we can ask. I'll shoot Diana an email right now. Would be interesting to see the attendance.

Permalink Reply by Jan Schwartz on July 16, 2009 at 6:12pm

Agreed, a drop in the bucket, but I'm curious to know the attendance. Glad to see NHI and others jumping on it.

Whitney Lowe said:

Yes, the Foundation has been doing some workshops on this, but if you think about the math it is really a tiny drop in the bucket as far as addressing the needs. They are only doing a handful of workshops around the country (U.S.) and there are over 1400+ schools. It is a start, but I think a much broader educational initiative is needed.

Here's the link that shows their current schedule of programs
http://tiny.cc/BQvgi

Jan Schwartz said:
Hasn't the Foundation been doing some workshops? I'm sort of out of that loop, but we know who we can ask. I'll shoot Diana an email right now. Would be interesting to see the attendance.

Permalink Reply by Whitney Lowe on July 24, 2009 at 12:31pm

I just ran across this yesterday and realized another obstacle that we have to overcome on the road to EBP. That is... the lack of peer review and accountability within our profession. Because of the increasing emphasis on the importance of research, people (and I see this mainly in CE providers) are picking up on this and saying they are using the "latest research" in their presentations. For many of these people research is becoming a buzzword that is being used from a marketing perspective to make them look more academically supported. However, when it comes down to it, there is clearly not adequate research evidence being used in the way the marketing pitch makes it sound.

For example, I picked up the latest edition of a book from one of our profession's primary authority figures. On the back cover it says: "...revised and updated with the latest research..."

In the book there is a section talking about a common soft-tissue disorder, bursitis of the knee. The author states: "Anything I say on the causes of this injury is pure conjecture. I've never seen or heard of any research done on it." Yet, a quick Google Scholar search with the parameters "knee + bursitis" comes up with an estimated 18,500 results! Never heard of any research done on it? Where is the accountability and peer review within our profession? If these materials are held up as the leading literature in our field, it makes it very difficult for others to take us seriously and for us to really say we are using evidence-based concepts in our practice.

Permalink Reply by Jan Schwartz on July 24, 2009 at 1:13pm

There are a number of books (and CE workshops) out there right now that tout the latest research. Some have absolutely no citations. In the case of books it's hard to believe the publishers let them get away with it. In the case of workshops, since we don't teach research in our schools to any useful degree, I think people blindly accept what the provider says because they are generally "an approved provider". We are not discerning consumers. It's easier not to be when all we need are the hours to get re-licensed, re-certified, re-whatever...

Whitney Lowe said:

I just ran across this yesterday and realized another obstacle that we have to overcome on the road to EBP. That is... the lack of peer review and accountability within our profession. Because of the increasing emphasis on the importance of research, people (and I see this mainly in CE providers) are picking up on this and saying they are using the "latest research" in their presentations. For many of these people research is becoming a buzzword that is being used from a marketing perspective to make them look more academically supported. However, when it comes down to it, there is clearly not adequate research evidence being used in the way the marketing pitch makes it sound.

For example, I picked up the latest edition of a book from one of our profession's primary authority figures. On the back cover it says: "...revised and updated with the latest research..."

In the book there is a section talking about a common soft-tissue disorder, bursitis of the knee. The author states: "Anything I say on the causes of this injury is pure conjecture. I've never seen or heard of any research done on it." Yet, a quick Google Scholar search with the parameters "knee + bursitis" comes up with an estimated 18,500 results! Never heard of any research done on it? Where is the accountability and peer review within our profession? If these materials are held up as the leading literature in our field, it makes it very difficult for others to take us seriously and for us to really say we are using evidence-based concepts in our practice.

Permalink Reply by Carl W. Brown on July 28, 2009 at 10:38am

I think EBT has to be driving by public demand. Schools will teach to what the public wants. I find myself beating my head against the wall over the issue of California Health Freedom Act disclosures that outline what a person does, how it works and what educations they had to learn what they do. It allows people to make informed decisions about who they want yet there seems to be no interest either from the public or the profession.
I also think that people equate EBT with medical massage. I don’t believe it is in that if we limit ourselves to just the medical aspects of the work, we are not providing the best service. I think EBT give us a critical perspective to evaluate both the hard and soft sides to the work. I think that we need to blend science, intuitive, kinesthetic and interpersonal skills based on what produces the best results based on objective evidence.

Permalink Reply by Kim Goral on September 21, 2009 at 9:43pm

I just wrote an article for the AMTA MA chapter newsletter about why massage therapists should be more interested in research. I uploaded it as a blog post on here, so feel free to read (and critique!). I'm one of the few who is interested in getting involved in research- enough that I'm currently in a Master's program to learn how to design, implement, and analyze research. I wish more massage therapists would go this route, but I realize it is not feasible for everyone to stop their life for a couple of years, and possibly relocate (As I am doing). However, even if you are not directly involved in research there are still ways to look up research that has already been done and familiarize yourself with what is proven vs. what is theory and what your teacher told you in school. I have many more thoughts on the subject, all in my article.

It's on the rise..more and more people are talking about it. We're not there yet, but I think in another few years, more and more therapists will be thinking about research.