Massage has been incorporated into many different environments, including integrative care teams, specialized clinics, outpatient and inpatient hospital environments, hospice care and acute care settings.
In recent decades, as the evidence base for massage and the acceptance of massage have grown, professional opportunities available to massage therapists have also broadened.
Massage on the Integrative Care Team
Now with integrative health care becoming more prevalent, massage is often part of these integrative care teams, with massage therapists working alongside medical, allied health care and other complementary practitioners. Hospital environments and integrative care settings are both areas that benefit from massage training that addresses specific competencies related to them.
These varying work environments mean that massage therapists are working with a wide range of patients, some with complex and serious health conditions and very specific health needs. These may necessitate adaptations to treatment or may involve contraindications.
They may require working around equipment, a deep understanding of specific diseases or knowledge of specific medical treatments. These varied environments also find massage therapists working with health care practitioners from a range of disciplines, which makes an understanding of each other’s work, abilities, specialties and scope of practice important.
Current massage therapy education varies from one school to another. The competencies provided by standard massage therapy training in the U.S. are more than sufficient for working in more general environments. However, the therapist presented with some of these specialized clinical opportunities may benefit from additional training that provides enhanced competencies to meet their very specific needs.
Some schools offer hospital-based massage therapy programs; however, among them there may be a lack of consistency regarding curriculum and competencies. While there have been ever-increasing trends toward integrative care and interdisciplinary research, training that addresses specific competencies for complementary health care practitioners working in integrative environments is not as common.
Within the medical community there have been efforts to define outcome-based competencies for health care1. Doing the same for massage in hospital or integrative care environments seems prudent.
Hospital-Based Massage Competencies
The Academic Collaborative for Integrative Health (ACIH) established the Hospital-Based Massage Therapy (HBMT) Task Force in 2012. Their goal was to assess current HBMT training and implementation and to develop a set of specific HBMT competencies. The ACIH Competencies for Optimal Practice in Integrated Environments were used as a basis for broad categories of competencies and feedback from representatives of hospitals that included HBMT programs was incorporated.
The HBMT Task Force identified that there was a wide range of practice standards and delivery of massage therapy in hospital settings. While some HBMT programs required specific education of their therapists, many did not and many felt that therapists required further specific training once hired to meet the needs of the particular programs2.
The competencies that representatives of HBMT programs felt were often lacking included some related to clinical practice and others that related to the environment, such as oncology training, proper documentation of assessments and treatment plans, appropriate therapeutic relationships, an understanding of medical terminology and medical devices, infection control, and competencies related to the hospital environment and interdisciplinary collaboration2.
The finalized competencies developed by the HBMT Task Force included some relevant competencies from the ACIH along with new ones that address issues that are specifically relevant to HBMT practice. These include competencies related to:
- The hospital environment: ethics and values, understanding of informed consent, communicating with other hospital staff, roles and responsibilities, medical terminology, accurate and effective charting, and making evidence-informed decisions.
- Massage protocols: indications, contraindications and precautions; working around medical equipment; and appropriate body mechanics.
- Therapeutic presence: appropriate boundaries; recognizing signs of patient distress such as pain, grief, trauma, anxiety; and awareness of working relationships.2
Benefits of Specific HBMT Competencies
There are a number of benefits to having a set list of competencies specifically related to working in the hospital environment. They can be of benefit to massage therapists, to hospital-based massage therapy programs, and to other stakeholders.
Distinct competencies related to HBMT can be of benefit to massage therapists by first helping them to ascertain if this type of work will be a good fit for them. Not only will they be able to determine if they have the skills required, but also if they would enjoy working in this environment. Knowing what competencies are involved will also allow therapists to seek out appropriate training to prepare them to succeed in these roles.
HBMT competencies can help with the development of education. Massage schools and continuing education providers will be able to develop training to address these specific competencies.
Regulatory bodies and professional associations could use the competencies as the basis for specialty certification. We have seen this in other areas, for example in performing arts medicine and in oncology massage.
Hospitals could use these competencies to inform the interview process and to evaluate potential massage therapists for their programs. Additionally, hospitals could benefit from these competencies as they could provide standards for those wishing to establish HBMT programs.
Research is another area that could benefit from these competencies. The rigor of research studies carried out within these programs may be enhanced by ensuring that the delivery of massage interventions are carried out by therapists with specific competencies related to the hospital environment.
And finally, the public would benefit from HBMT competencies. First, patient needs could be better met if massage therapists have training that provides them with the relevant competencies. And secondly, we may find that there is increased interest in and appreciation of massage because of these definitive skills and competencies.
Massage in Integrative Care Settings
There is some overlap between competencies for integrative care settings and those of HBMT, as a number of HBMT programs could be considered to be integrative. However, as integrative care becomes more commonplace, there are opportunities for this type of collaborative and integrative workplace, both outside of the hospital setting and within it in outpatient clinics in which one may not encounter patients with serious or life-threatening illness.
Massage therapists are often working alongside other health care practitioners in collaborative and integrative teams.Regardless of the type of integrative care setting, inter-professional education and integrative health care education are important for anyone working in these environments.
More than 50% of all medical schools in North America now have programs in integrative medicine3. There are a number of programs that have developed in recent years that address inter-professional education, such as the BRIDG (Building Research across Interdisciplinary Gaps) program4. They allow complementary and integrative clinicians to learn alongside biomedical clinicians and researchers. They provide each group with knowledge and understanding of the other so that they might work together more effectively.
Competencies for Massage in Integrative Care Settings
The Academic Consortium for Complementary and Alternative Health Care (ACCAHC), an organization whose aim is to advance collaborative and integrative care, has developed Competencies for Optimal Practice in Integrated Environments5. These competencies emphasize inter-professional education, practice and communication, as well as knowledge of roles and responsibilities6.
There are several specific competencies that may enable massage therapists to work effectively and successfully within integrative settings. One of these is knowledge of other modalities and indications for their use. Coupled with this is a basic understanding of other clinicians’ scope of practice.
Education regarding effective communication across disciplines is also important. Additionally, training around strategies to foster inter- and intra-disciplinary collaboration is beneficial.
The skillful use of electronic patient records (EPR) is another helpful competency. This allows for easy communication with other clinicians regarding patients and patient notes and can enable collaboration.
Benefits of Specific Competencies for Integrative Care Settings
The benefits of specific competencies for working in integrative settings are many. There are benefits for the massage therapist, for other practitioners, for the clinic or program itself and for the patient.
Knowledge of others’ disciplines and scopes of practice can promote a team atmosphere. This ability to work as a team is linked to practitioner satisfaction and well-being, as well as decreased stress7. An understanding of other disciplines, scopes of practice and specializations facilitates appropriate referrals, thus benefitting patients, and fosters respect among practitioners.
A collaborative, cohesive clinical team has also been shown to promote innovation and effectiveness8. Patient needs are more effectively addressed when practitioners have an understanding of how different therapies can be combined to complement and build on each other, providing outcomes that are greater than the sum of their individual parts9.
Programs such as BRIDG, which cultivate knowledge of research best practices among clinicians and knowledge of clinical research amongst researchers, can lead to greater practitioner involvement in research studies4. This will enable massage research that is practice-driven, and which can be used to inform practice.
A Solid Foundation
As massage and other complementary health care practices take on a bigger role in our health care system, specialized training and very specific competencies may be necessary to allow therapists to thrive in a range of environments.
Regardless of the professional path we choose to take, giving ourselves the tools we need to have a successful and satisfying career is the first step of that path. We cannot build the career we wish without a solid foundation upon which to build it.
About the Author:
Leisa Bellmore, MSc, ST, wrote this article on behalf of the Massage Therapy Foundation. She has been practicing shiatsu therapy since 2001 and is part of the integrative team at Toronto Western Hospital’s Artists’ Health Centre. She has presented and published around the world. She is a past president of Natural Health Practitioners of Canada and sits on the Massage Therapy Foundation Writing Committee. Bellmore has an MSc in Complementary Medicine Research. Her research interests include neurological conditions, chronic pain and self-management.
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