Massage Therapy has exploded into mainstream healthcare, it is now a recognized treatment option for a wide range of injuries. This means the profession is moving into new formal settings, these changes to the profession have led to a need to adapt to an evidence based model of care. This does not require us to reinvent the wheel, we can look to the evidence-based medicine model and adapt it to our profession.
Evidence Based Massage
Evidence based massage is a process intended to optimize decision-making by emphasizing the use of evidence from well designed research. This process includes the use of logical reasoning and the gathering of ideas and knowledge from many overlapping disciplines. Evidence-based massage systematically integrates Best Research Evidence with Individual Clinical Expertise and Patient Values & Experiences to achieve the best possible patient management, while minimizing the potential for harm:
Individual Clinical Expertise - This is used to create unique evidence based outcomes and results with patients on a case by case basis. Making sound decisions requires the clinician to expertly assess the patient’s personal, social, and clinical context and integrate this information with the values and preferences of the informed patient.
Patient Values and Experience - A number of biopsychosocial factors may influence your decision making based on patient unique goals and needs. Therapists needs to be able to hear the patient’s values, create a working relationship with the patient, involve the patient in developing the plan of care and use his/her clinical expertise and allow the evidence to guide this process, rather than dictate it.
Best Research Evidence - Research's main role is to help guide clinical decisions and to warn of known harm, the higher the quality of the evidence the more confident we can be as a therapist making an informed decision.
Streamlining The Process
With the emergence of evidence based massage it is important that therapists have the tools and resources to bridge the knowledge gap between scientific research and clinical practice. A 2015 survey of Registered Massage Therapists in Ontario concluded that there is room for improvement when it comes to research awareness in the profession. There are many ways that massage therapists can work together to improve their research literacy skills. Social media sites like Facebook, Twitter and LinkedIn provide massage therapists with a digital meeting ground where they can exchange ideas with their peers at the local, regional and global levels.
Evaluating Scholarly Articles
Users beware – in this age of ‘new media’ it is important to be able to critically evaluate information. If you are evaluating information The CAARP method is a simple acronym will simplify the way you evaluate information.
The CAARP Method
• Currency - Is the information current or out of date for your topic?
• Authority - Who is the author and what are their qualifications?
• Accuracy - Where does that information come from and is it supported by evidence?
• Relevance - Does the information related to your topic or answer your question?
• Purpose - What is the purpose of the information? Are the author’s intentions clear?
The Hierarchy of Scientific Evidence
Evidence hierarchies provide an overview of various types of biomedical research. Systematic reviews sit at the top of the pyramid, followed by randomized control trials and observational studies. Expert opinion and anecdotal experience are ranked at the bottom.
The Reality of Massage Research
The reality is this - Many of the methods used in manual therapy have simply not been studied in large scale research programs, this is because clinical trials are expensive. The fact that there is no research based evidence of usefulness is therefore not always evidence that a method is useless, only that no research has yet been carried out to show its value.
What Resources are Available?
With the ‘CAARP’ method in mind, if you are looking for an authoritative opinion on a given topic, systematic reviews are considered the gold standard. The Cochrane database is the most well-known source of systematic reviews, it is a non-profit body which systematically organizes research information. To date there have been only a few large scale randomized control trials of massage therapy, this means systematic reviews of massage therapy can be hard to come by. So another way to inform your clinical practice is through peer-reviewed publications geared towards massage therapy.
Peer-Reviewed Publications for Massage Therapists
• International Journal of Therapeutic Massage & Bodywork
• The Journal of Bodywork and Movement Therapies
• Journal of Orthopaedic & Sports Physical Therapy
• Musculoskeletal Science & Practice
• The Cochrane Library
If you would like to read articles on a more broad range of topics, you can use a research database. PubMed is the largest medical database, and has many functions that will help you narrow down your search. One limitation with PubMed is that unless you are affiliated with an educational institution, many of these article are behind a paywall which may limit access to the entire article. You will still be able to read the abstract, this will give a brief summary of the key points of the article.
Open Access Research
There are alternatives- There has been a growth in the open access publishing model that provides immediate, barrier-free access to the full text of research articles. The RMT Education Project is an online resource where massage therapists can access a curated list of open access articles. This serves as a starting point in the development of a body of knowledge that massage therapists can use to guide an evidence informed practice.
Laumonier, T., & Menetrey, J. (2016). Muscle injuries and strategies for improving their repair. Journal of Experimental Orthopaedics.
Waters-Banker, C., Dupont-Versteegden, E. E., Kitzman, P. H., & Butterfield, T. A. (2014). Investigating the Mechanisms of Massage Efficacy: The Role of Mechanical Immunomodulation. Journal of Athletic Training.
Vigotsky, A., & Bruhns R. (2015). The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review. Pain Research and Treatment.
Another way to access timely information is through grey literature, this category includes information or research produced by organizations, outside of commercial or academic publishing and distribution channels. It can include: magazines, articles, videos, emails, newsletters, blogs, facebook posts and even tweets. There is an abundance of grey literature available on the internet, this information requires a critical eye to evaluate the content - Think CAARP.
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