evidence-based practice

In health professions, scientific research often guides treatment, but it’s not the only element of evidence-based practice

Some massage therapists overlook research as a guiding principle. This article breaks down all the reasons you shouldn’t do that.

Research, the creative and systematic work to increase knowledge, is a product of human curiosity and intelligence that has been applied to every aspect of life, from the humanities to science and from technology to the arts.

In the health professions, scientific research often guides treatment. It is one of the elements of evidence-based practice; but it’s not the only one. Evidence-based practice was first defined by David Sackett (1934–1985), MD,  in the 1990s; a more recent definition, in the textbook “Evidence-Based Medicine: How to Practice and Teach It” (Elsevier, 2011) has it as “integrating the best available research evidence with clinical expertise and the patient’s unique values and circumstances.”

This approach is also referred to as evidence-informed practice. This term is sometimes used to indicate that the decision-making process is more person-centered than science-centered, which is a more suitable viewpoint for some people. Still, expertise and research remain important factors.

Other times, evidence-informed practice is used when well-designed, peer-reviewed studies are sparse in an area, making it difficult to find research to support treatment. This may have been the case with massage therapy research in the past, but not today.

A search for “massage” in the International Journal of Therapeutic Massage & Bodywork (IJTMB) and PubMed, free databases of references and abstracts, provides nearly 16,000 results. Research (both evidence-based and evidence-informed), expertise and client values should be the basis of massage therapy treatment. However, for some, research may be the most overlooked part. This article will help explain many reasons research is important for massage therapy practitioners.

The Beginning of Massage Research

When I went to massage school in the 1980s, there was no mention of research. I learned a one-hour full body massage over 40 hours of instruction and that was it—certified! By today’s standards that was insufficient. When I started my physical therapy program in the early ’90s, evidenced-based practice was beginning to be incorporated into programs.

Students were introduced to research via coursework and assigned projects intended to strengthen understanding and use of research, but there were still implicit biases for traditions, beliefs and opinions. This was even more evident in practice. During my clinical affiliations I had little to no exposure to research in physical therapy and was encouraged to learn by observation and the teachings of my more experienced instructors. Fortunately, evidence-based practice increased profession-wide with the strong support of professional associations and organizations.

Today there are parallels within the massage therapy profession. Massage therapists are introduced to research in most entry-level training programs, with profession-wide support provided by organizations like the Massage Therapy Foundation (MTF) which funds research and publishes the International Journal of Therapeutic Massage & Bodywork (IJTMB) in a free, open-access format. The MTF also has free e-books, podcasts, infographics and other resource materials to support evidence-based practice at its website.

Barriers to Massage Research

Continuing education instructors are using researched-based evidence in their courses, while leaders are extolling the benefits of understanding and applying research as well as becoming actively involved in it. Even with all these resources to assist massage students and therapists in getting the most out of research and evidence-based practice skills, some barriers may still need addressing.

One barrier can be a misunderstanding about research: Research is sometimes thought of as investigation done by people in white coats—at universities or laboratories—who are experts with many years of experience and advanced degrees, and mainly interested in numbers and statistics. Others believe research is something beyond them, with reports full of difficult jargon.

It can be hard for some students, or even seasoned therapists, to identify with the role of researchers. These misunderstandings can create a sense that research is uninteresting or irrelevant to massage practitioners. Such misunderstandings can act as a barrier that stops people from becoming engaged in research.

In fact, over 50% of the articles published in IJTMB over the past two years include massage therapists as authors. These individuals have chosen to further the knowledge base of their profession by participating in research.

We’re All Doing Research

One productive approach is to distinguish that each of us is doing a kind of research all the time. We are always increasing our knowledge, either formally or informally. Each of us has a model or map of the world and is continually seeking new evidence with which to verify or alter that model.

Each massage therapy session with a client can be seen as a piece of research in which what is learned in conversation and touch is tested over time. Over dozens of clients and hundreds of sessions we build our own theories of what different types of clients like and what is effective for them. This is the foundation for expertise.

But, because no one individual has had the opportunity to objectively and systematically analyze every condition and circumstance for every type of client, there is a need for organized research. In the same way your individual experience builds expertise, research helps build professional, evidence-based best practices.

Studies and Case Reports

One way for students and practitioners to share these research insights with other therapists is through writing a case report or case series. Check out the Case Report Hub on the Massage Therapy Foundation’s website, which provides resources to comprehend and undertake writing case reports and case studies.

When taking your first taste of research it is advisable to start with small bites. News stories, magazine articles and other media have no shortage of stories that reference one study or another. But research news can be confusing. One of the first tenets to understand about scientific research is that issues are seldom permanently settled and that new research can either support or challenge previous studies as well as our personal beliefs.

An online search through IJTMB, PubMed, Google Scholar or other search engines should provide the primary sources of studies. To become familiar with reading research, begin with the abstract, the short summary of a research study. It’s generally freely available even when the full text of a study is behind a paywall. It is condensed, and therefore does not tell the full story; but it’s a good place to start.

The abstract usually puts a study in perspective, gives the rationale behind the study, provides an overview of who and what the study looked at, provides notes and results—and what these results mean for clinical practice. With this information you can generally tell if the study is relevant to your interests, and therefore fascinating enough to obtain the full text. Reading and digesting research papers take some practice; go slowly.

Don’t get weighted down with all the details at first, but instead focus on the big picture. Read the introduction, methods and discussion sections to gain a fairly good grasp of the interest points without spending much time on the statistical analysis.

Many research studies have an author who specializes in the statistical analysis of data and often writes the most technical portion of the report independently. It is the methods section that generally contains a description of the technique or treatment that is used in the investigation.

The description should be clear and understandable, as this allows for others to duplicate the study’s methods for verification of the results. At times, the treatment will be included in an appendix or referred to from another study that used the same protocol. In the latter case, the referenced study then needs to be sought out to review the treatment. Some studies include a section that reviews key points or clinical relevance. Be sure to read over these sections.

What If There’s No Research?

Sometimes there is no research on a question you would like answered. Then what do you do? When there is no evidence, how do you follow evidence-based practice? When there is no research to guide you it is fully acceptable, and advisable, to base treatment on professional experience and client input, with guidance from scientific plausibility. Even when there is research available, definitions of best practices are not always defined. In addition, there can be conflicting views as to what best practices are. At times, the strength of conflicting evidence can be weighted.

How many studies support one recommendation over another? Have systematic reviews or meta-analysis been performed? When the weight of the evidence seems to balance out, the practitioner can choose the treatment approach most consistent with their knowledge, training and philosophy of treatment.

Other factors that may reduce the helpfulness of research are the specific conditions and participants in a particular study. How similar are they to the individual you have as a client? If your client is significantly different from the study participants, then the likelihood of strong carryover of the effect is reduced. Still, the information may carry significance in how you think about client problems and reinforce the habit of evidence-based practice. Adapt an open mind that allows for new evidence to be considered as knowledge builds time and encourages flexibility to change treatment techniques as needed.

Reading research will help you stay informed, support good communication with other health providers, provide treatment options, assist problem-solving, and address client questions.

About the Author

Arthur Veilleux

Arthur Veilleux, PT, DPT, OCS, was certified as a massage therapist in 1987. He continued a private massage practice and teaching through physical therapy program graduation in 1993. He received a doctor of physical therapy degree in 2006 and served as an adjunct instructor at the Rutgers University Doctor of Physical Therapy program from 2012–2017.