Massage therapists often function as a bridge – our field is now commonly perceived as an intersection between conventional and alternative health.
A pioneering program trains researchers in complementary and integrative health (CIH). This program is a partnership between a university doing conventional biomedical research, the University of Washington in Seattle, and a University focused on CIH, the National University of Natural Medicine in Portland, Oregon.
The universities came together to create a multidisciplinary program they called BRIDG: “Building Research Across Interdisciplinary Gaps,” which was funded by the National Center for Complementary and Integrative Health (NCCIH). The program is described by Bradley, et al in the Journal of Alternative and Complementary Medicine.
Why should massage therapists care about this program, even though it wasn’t designed for practitioners? Massage therapists often function as a bridge – our field is now commonly perceived as an intersection between conventional and alternative health.
We can function as a bridge between medical doctors and patients when we communicate with doctors or when our services are part of a patient’s care plan. Our industry spans from luxury service to essential health service, and our knowledge and skills merge Eastern and Western practices.
Even as we work, our hands may bridge energy centers or an asymmetric pelvic girdle! So, as conventional medicine and CIH fields increase connection, it is important that massage therapists stay informed and relevant to the larger CIH context.
A Gap in Clinical Health Research
Why is the BRIDG program important for CIH in general? In all fields of health, there is a shortage of researchers who are also trained clinicians, or medical practitioners who deal directly with patients. Many barriers, including financial barriers, make it difficult for clinicians to participate in research.
However, clinicians are very important for medical research to translate to clinical practice. In order to address the lack of clinician-researchers, the National Institute of Health funds clinician-researcher awards to individuals and the institutions that train them. These funding grants had generally been in conventional rather than holistic fields of biology and medicine until recently.
Even though the public widely uses CIH, the CIH field in particular lacks clinician-researchers. According to a 2012 US National Health Interview Survey, 33.2% of adults and 11.6% of children have used CIH, which includes massage therapy. Still, many CIH practices are controversial due to lack of supporting scientific data. The lack of support for CIH clinician-researchers contributes to this lack of evidence.
Additionally, unlike the development of pharmaceuticals, CIH practices are usually developed and used by practitioners before they are studied via scientific method. This is the opposite of the typical clinical research approach and creates a barrier to rigorous systematic research that requires novel approaches to continue making progress.
To address these issues, in 2012 the National Center for Complementary and Integrative Health began to fund training programs for CIH clinician-researchers.
One of these grants required that a conventional medical research institution and an institution that trains CIH practitioners would partner. The BRIDG program between the University of Washington and National University of Natural Medicine was created and successfully funded through the NCCIH and was in operation for four years at the time of the publication of the article, “Design of a Multidisciplinary Training Program in Complementary and Integrative Health Clinical Research: Building Research Across Interdisciplinary Gaps.”1
The grant included clinicians who were doctors of naturopathy, acupuncture and Asian medicine, and chiropractic. Important to note, Asian medicine and chiropractic training includes manual and bodywork practices, meaning the research done by non-massage practitioners can feed into knowledge of massage therapy.
The BRIDG program focused on forming interdisciplinary connections and cross-training, with the goal of improving the quality of CIH research. Practitioners at the National University of Natural Medicine received research training and mentorship at the University of Washington. And, correspondingly, trainees with conventional biomedical backgrounds at the University of Washington received training and mentorship in CIH clinical practice and research. The authors assert that this program “required unprecedented innovation and collaboration” because of both cultural and geographic divides.
The structure of the training program included several elements: individualized educational training for each trainee, mentorship, research project development, and interdisciplinary experiences such as seminars and retreats.
Trainees were placed with mentors from the partner facility. Mentors included representatives from nursing, medicine, pharmacy, social work, and public health at the University of Washington, as well as representatives from the National University of Natural Medicine and Oregon Health and Science University.
Subject matter and research expertise in the mentor team included natural products, mind-body modalities, CIH health services, acupuncture, and traditional CIH disciplines. The training initiative also focused on translating research from the laboratory to practice, disseminating research so people know about it, and evaluating and improving the program.
A unique element of the program was non-clinician researchers had clinical clerkships in order to see CIH practices in a real-world settings. Although for legal reasons the clerkships were generally observational, in certain cases including mind-body practices, the researchers were able to participate in clinical practice.
How well is this program working out? The BRIDG program included evaluation metrics that were able to provide data on program outcomes, to assess the effectiveness of the partnership between the universities, and to provide judgments about the adequacy of the program at multiple levels.
So far, the program has accepted three naturopathic doctors and four doctors of acupuncture and Asian medicine. Additionally, the six conventional medicine trainees accepted included basic science PhD researchers, medical doctors, and PhDs in nursing and psychology.
Challenges faced in running the program included changes in availability of mentors with active grant funding, and the intensity of developing clinical research when trainees don’t have clinical backgrounds.
The most significant barrier presented was logistical issues related to CIH practitioners not fitting conventional medicine credentialing requirements. The delays and barriers presented by this challenge have implications for long-term sustainability.
“It is very difficult for a CIH provider to establish a departmental home in an academic medical center if a department does not already exist for one’s clinical discipline,” the authors note.
How BRIDG Impacts Massage Therapists
The BRIDG program was designed to bridge gaps between clinical and conventional research, and between research and practice. Collaborations can spur innovation and can reduce perceived barriers to understanding. As stated by Bradley, et al: “The advantage of sharing a common language cannot be overstated, as it may serve to reconcile perceived paradigm differences between CIH and conventional providers.”
CIH research affects the knowledge and practice of massage. Massage use and credibility have increased through decades of scientific research, which has allowed clients and other health practitioners to appreciate us as valuable health-and-wellness practitioners. Some of this research has been through multidisciplinary clinical trials, where massage therapy was one of several CIH practices demonstrated to be beneficial.
Additionally, other manual therapy and mind-body practices, including those from chiropractic and Asian medicine, overlap with the scope of massage therapy. Research findings in these fields have informed best practice and evidence-based practice techniques for massage.
Continued research and funding for research in massage is needed, and there are a few ways this research can happen. Some massage therapists, including the authors of this article, have created a career in research either as a clinician or by getting their doctorate. Many of these massage therapist-researchers perform research at universities, within the federal government, and at medical centers.
It is not necessary to have a PhD to participate in or lead a research study. You can continue a career as a massage therapist while also contributing to research.
One clinician-researcher award from the NCCIH supports massage therapists to obtain research experience (Funding Announcement PA-19-031). Additionally, the Massage Therapy Foundation (massagetherapyfoundation.org) offers yearly research and community service grants to massage therapists and provides training on how to write case studies and research reports.
1. Bradley, R, Booth-LaForce, C, Hanes, D, Scott, C, Sherman, KJ, Lin, YS, and Zwickey, H. Design of a Multidisciplinary Training Program in Complementary and Integrative Health Clinical Research: Building Research Across Interdisciplinary Gaps. The Journal of Alternative and Complementary Medicine.May 2019, pp. 509–516. DOI: 10.1089/acm.2018.0454
About the Authors:
Jacqueline Tibbett, PhD, LMT, received her doctorate from the Department of Physiology and Biophysics at the University of Miami Miller School of Medicine. Tibbet’s research interests are in biopsychosocial understanding of pain and motor dysfunction. She is currently an entrepreneur in manual therapy-related bodywork and education. MK Brennan, RN, LMBT (retired), recently retired from private practice in massage therapy and nursing. She has been a member of the Massage Therapy Foundation (MTF) Writing Group since 2011. She served as president of the Society for Oncology Massage Board and the American Massage Therapy Association, and is a member of the Clinical Working Group and Hospital Based Massage Therapy task force through the Academic Collaborative for Integrative Health.