Research Matters
by Janet Kahn, Ph.D.

In this column, researcher and massage therapist Janet Kahn, Ph.D., visits the major issues, organizations and people involved in research into complementary health care, especially massage, and updates readers on policies related to such research. In this issue: the Massage Therapy Foundation’s first research conference.

The Massage Therapy Foundation’s "Highlighting Massage Therapy in CAM Research" conference in Albuquerque, New Mexico, this past September marked a huge step for both the foundation and the massage profession. Wherever you are as you read this, I encourage you to stand up and give a grateful round of applause to foundation President John Balletto and Director Gini Ohlson and all the other officers and staff, and board and committee members. (Or better yet—send a check, because they have done a great service for us all, and I hope I can make that more clear to you in this column.)

Hitting the target

This was a three-day conference on massage research that absolutely hit the target in terms of where our profession is, and what it needs right now, in relation to research. It was a wonderful mix of sessions presenting original research, networking opportunities, posters presenting research results and works in progress, provocative keynotes, and perhaps most importantly, workshops that provided the kind of research education and collaborative opportunities that we, as clinicians and educators, need right now. If you were interested in massage research—how to do it, how to teach it, how to read it and make sense of it—at this conference, you found plenty of offerings that met you where you were. That says a lot for the planning process.

What was not offered at the conference was also important. There were no sessions at this conference offering the technique-oriented continuing-education sessions that we expect at other kinds of educational gatherings. That kind of continuing education is vital to our development as professionals, of course, but it is not appropriate at a research conference. By focusing exclusively on research, the conference hosts ensured that the folks who attended were all there for the same purpose. This brought a great coherence and sense of community to the event, which fed us deeply during those three days. This was possible because there is now enough interest in massage research to schedule an entire conference for just that purpose. The 180 registrants—researchers, massage therapists and educators—can attest to that. There is also enough quality material to present on research results, methods and literacy to fill a three-day conference. The organizers recognized that we have matured to this level and created a conference that suited the profession well.

It is not just those inside the field who are recognizing the importance of massage research and the growing readiness of our field to engage meaningfully in this endeavor. This conference was funded in part by a grant from the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH). This is a real achievement for the foundation—and it took persistence. The foundation was turned down when it first submitted a proposal to NCCAM for funding of such a conference. As always with peer review at NIH, the foundation was given a written critique of how the review committee saw the strengths and weaknesses of the original proposal. Based on that critique, foundation staff revised and resubmitted the proposal, and received funding.

Focusing in

In addition to NCCAM funding, NIH was present in the person of Richard Nahin, a program officer at NCCAM, who gave one of the keynote addresses, explaining NCCAM’s goals in relation to massage research. He outlined goals that will help determine not just when massage works, but how it works. He also specifically said NCCAM is interested in both the therapeutic potential and the wellness benefits of massage. This is most welcome from the NIH which, like much of allopathic medicine, has been focused on pathology more than on human potential for wellness.

The other keynote speakers were, in chronological order, Trish Dryden, Edzard Ernst and Jim Oschman. Dryden—an experienced massage therapist, educator and researcher from Toronto, Ontario, Canada—offered wise and playful encouragement for engaging the research enterprise at a level appropriate to our individual interests. Using a local weather phenomenon known as the Albuquerque Box, she also cautioned us against flying around in the same space all the time. (If you want to know more, search online for "Albuquerque Box.") One of the most important aspects of Dryden’s talk was her elucidation of the concept of research “readiness.” This concept, derived from her own research of a range of complementary and alternative medicine (CAM) disciplines, highlights the hallmarks of a profession's likeliness to engage in research and foster a culture of inquiry.

Ernst, well-known for his many systematic reviews in the field of CAM research, has from that vantage point often had the role of noting the poor quality of much massage research. Happily, he was more encouraging this year. His talk focused on the concept of evidence-based research and its application to the field of therapeutic massage.

Oschman may be familiar to many of you from his book Energy Medicine: The Scientific Basis of Bioenergetic Therapies, and the series of articles on energy medicine that he authored in The Journal of Bodywork and Movement Therapies a few years back. His lectures are always provocative and wide-ranging. This keynote mixed scientific information on how the body heals, particularly focusing on connective tissue and electrical fields, with quotes from Oschman and others. One of my favorites was Richard Feynman's statement, “I can live with doubt and uncertainty and not knowing. I think it is much more interesting to live not knowing than to have answers that might be wrong." Oschman is always nudging us outside of whatever box we have built for our intellectual comfort.

While the job of key speakers is often to offer the big picture and to provoke us beyond our comfort zones, other presenters helped ground us in more narrowly focused educational tasks. These sessions were varied and offered much of what a field in its research infancy needs. In fact, it has occurred to me that if all the educational workshops were put together, we would have the outline of a reasonable research literacy text or curriculum.

The issue of research literature was covered coming and going. Both Cynthia Piltch and Dryden offered workshops on how to read a research article and critically evaluate the assumptions, strengths and weakness of the research being reported. You can decide whether that is the coming or the going part. Leon Chaitow, author of many books and editor of the Journal of Bodywork and Movement Therapies, offered two workshops (a long and a short version) on writing for academic and peer-review publication.

Key aspects of research design were introduced in workshops, with a real effort to cover many different kinds of investigation. Martha Menard offered an introduction to the design of qualitative research. Marlaine Smith gave an overview of the design issues and process in a study of massage for people with cancer, offering a real glimpse for the newcomer into the gritty aspects of actually getting a study done. I moderated a four-person panel on designing massage-research protocols which covered: general issues in protocol design; specific issues related to design of protocols for energetic modalities (in this case, polarity therapy); issues of sensitivity to particular populations (the cultural sensitivities involved in working with a Native American population and the emotional sensitivities of subjects recovering from sexual trauma); and the challenges of designing and training practitioners in highly structured physical protocols. Cynthia Price offered a workshop on developing and testing new measurements, and led the audience through her process of creating and evaluating a valid scale to assess subjects’ levels of body connection. There is not space to include every workshop offered, but I hope this gives you some sense of the range.

Anatomy of a conference

I want to say two more things about my experience of this conference. The first is that, as with any good conference, what you see is not all that you get. A conference is somewhat like a human body. There is the obvious form and all the basic anatomical structures, like workshops, panels, posters, keynotes, breakfast, lunch and dinner—you know, the bones, the organs, the muscles. And then there is what happens in and around the structure that gives it life. Much of this happens in the restaurants and the hallways and the elevators—wherever people can catch a moment to talk with one another. As one participant I have no idea, of course, how many connections were made, how many seeds planted that will bear fruit in the years to come.

I can tell you that I had the opportunity to have dinner with a dozen people who are engaged in research on massage for people with cancer. This was a rare opportunity. Another gathering took place of people interested in trying to get a massage-research publication going. Maybe they will and maybe they won’t—but undoubtedly the conversation about this will deepen, and our profession will come closer to that achievement by virtue of the opportunity to meet one another and to get excited about this possibility. Notice, that the opportunity was not only a result of the foundation holding the conference, or of NCCAM and the other sponsors supporting the conference. The opportunities were made by attending the conference. I only got to meet with other massage-and-cancer researchers because I showed up and they showed up. As the old saying goes, “You can’t win if you don’t play.”

An unexpected theme

The second parting comment is this: Let me whisper it in your ear, as the older man whispered “plastics” into the ear of Dustin Hoffman in “The Graduate.” Case studies. This is the next frontier for us. It emerged as an unexpected theme from the conference. More than one keynote speaker spoke of the importance of “case studies”. Trish Dryden and I offered a well-attended workshop on clinical case-reporting. And one of the highlights of the conference was the presentation of two awards to winners of the Massage Therapy Foundation’s student case report contest. Doug Hamm, a student at the Brian Utting School of Massage in Seattle, Washington, won for his case report titled “Impact of Massage Therapy in the Treatment of Linked Pathologies: Scoliosis, Costovertebral Dysfunction and Thoracic Outlet Syndrome,” which he presented formally on the final day of the conference. The other winner, Susie Young of the Southwest Academy of Healing Arts, was unable to attend, and her award was received in her absence by the school's director. Her case report was titled, “Testing the Effectiveness of Massage Therapy for Fibromyalgia Syndrome by Establishing a Variety of Evidence-Based Instruments.” Both of these case studies will be published in the Journal of Bodywork and Movement Therapies.

Why are case studies so important? Oh, let me count the ways. Case studies teach both clinical and research skills. They show us how these skills are so closely related. Case studies demand that we observe carefully, objectively and honestly. Clinical case reporting requires that we describe what we see, what we feel, what we do. It nudges us to explain ourselves.

We are a profession that values intuition. I share that value. At the same time, I believe that we often misuse the term, relying on it as a way to avoid having to articulate what we have noticed that nudged us to make this or that treatment decision. It is easy to say, “I just had a sense.” And yet, so often, that sense was actually preceded by an observation that went by so quickly we didn’t stop to articulate it. When we do stop to articulate things to one another, when we do take the time to tell each other of our cases that are surprisingly successful, or mysteriously frustrating, we will do ourselves and our colleagues a great favor. We will begin to create the case-study literature that will in and of itself deepen our understanding of our work, and that may in time determine the next quantitative studies to be undertaken.

This conference was a huge undertaking. Only the officers and staff of the foundation know what else was not done, because they spent more than the last year working to put on this spectacular event. Only they know whether putting on another such conference is a high priority in light of the overall mission of the foundation. I trust their judgment, of course. And at the same time, I would like to add my voice to the many who have asked for more.

MT Foundation Accepts Research Grant Proposals

The Massage Therapy Foundation has a deadline of March 1, 2006 for submission of research-grant proposals. In order to submit a proposal, applicants must follow the established guidelines and complete a grant application, which can both be found on the Foundation’s web site at www.massagetherapyfoundation.org.

The Massage Therapy Foundation research grants are awarded to individuals or teams conducting studies that promise to advance our understanding of specific therapeutic applications of massage, public perceptions of and attitudes toward massage therapy, and the role of massage therapy in health-care delivery. The research grant is available to investigators who have experience in the relevant field of research, and are presently associated with or have secured the cooperation of a university, independent research organization, or other institution qualified and willing to function as a sponsoring organization for the purpose of the project.

Research-grant recipients are selected annually by a panel of medical- research and massage-therapy professionals who evaluate each applicant in a number of areas, including: significance of the research issue or question; scientific and technical merit of the research design and proposal; capability of the proposed staff and sponsoring institution; and adequacy and appropriateness of the proposed budget. The awards range from $1,000 to $20,000 and must be used in the specific time period for which they are awarded. A summary of past research grants awarded can be viewed at www.massagetherapyfoundation.org.

The Massage Therapy Foundation advances the knowledge and practice of massage therapy by supporting scientific research, education, and community service. A 501(c)(3) public charitable organization founded in 1990, the Foundation receives and grants funds for massage therapy research, community service and education.

For more information, contact Alison Pittas at apittas@massagetherapyfoundation.org or (847) 905-1667.