What is Effective in Massage Therapy? Well, "It Depends…": a Qualitative Study of Experienced Orthopaedic Massage Therapists

Background

Massage has been used as a treatment for musculoskeletal pain throughout history and across cultures, and yet most meta-analyses have only shown weak support for the efficacy of massage. There is a recognised need for more research in foundational questions including: how massage treatments are constructed; what therapists actually do within a treatment, including their clinical reasoning; and what role therapists play in determining the effectiveness of a massage treatment.

Purpose

The aim of this study was to explore what experienced orthopaedic massage therapists consider to be the aspects of their work that contribute to effectiveness.

Setting and Participants

Semi-structured interviews were conducted via Zoom with six experienced orthopaedic massage therapists in Australia.

Research Design

The interviews were analysed using inductive thematic analysis, seeking insights that might be practically applied, rather than theory-driven interpretations.

Results

The participants focused on the underlying differences between clients, between therapists, and between treatments, and clearly indicated that this concept of "difference" was foundational to their view of their work and was the underlying context for the comments they made. Within that frame of "difference", three key themes were interpreted from the data: (1) "Everyone is different so every treatment is different": how they individualised treatment based on these differences; (2) "How therapists cope with difference": how they managed the challenges of working in this context; and (3) "What makes a difference": the problem-solving processes they used to target each treatment to meeting the client's needs.

Conclusions

Participants did not identify specific techniques or modalities as "effective" or not. Rather, a therapist's ability to provide effective treatment was based on an iterative process of treatment and assessment that allowed them to focus on the individual needs of the client. In this case "effectiveness" could be considered a process rather than a specific massage technique.

A Canadian Massage Therapy Education Environmental Scan

BACKGROUND

Massage therapists have been a part of Canadian's health care since 1919. The profession has gone through great change over the past 100 years including adjustments to entry-to-practice education. An important recent change was the implementation of massage therapy (MT) education program accreditation. In light of the likely disruption as a result of programs becoming accredited, a scan of the current state of MT education in Canada was undertaken.

METHODS

An environmental scan informed by seminal medical education efforts was used to describe the thoughts and opinions of MT education stakeholders in Canada. Specifically, stakeholders were interviewed regarding the current state of MT education and their comments were analyzed for common themes.

RESULTS

Twenty-one stakeholders participated. Four themes were constructed: variation, isolation, stagnation, and accreditation. Variation is described as the impact of differences in content and quality of the education provided in MT colleges. Isolation is described as the feeling of the participant being separated, or disconnected, from the regulator, accreditor, or colleagues due, at least in part, to a lack of communication or networking opportunities. Stagnation is described as a lack of activity, growth, or development within MT education. Participants talked about accreditation, both as a solution for some of the challenges previously mentioned, and as a potential challenge in itself.

CONCLUSIONS

Several challenges to MT education were described by stakeholders that they hoped would be remedied by national MT program accreditation. Despite some limitations, this environmental scan forms a baseline for stakeholder views on massage education in Canada upon which future comparisons can be made. While the environmental scan results are most useful when applied to the MT in Canada context, stakeholders in other countries may also find them interesting and valuable when considering challenges facing their own education programs.

What Should We Do Different, More, Start and Stop? Systematic Collection and Dissemination of Massage Education Stakeholder Views from the 2017 Alliance for Massage Therapy Educational Congress

INTRODUCTION

The Future of MT and Bodywork Forum, held July 27 during the 2017 Alliance for Massage Therapy Education (AFMTE) Educational Congress in Tucson, Arizona, systematically gathered the thoughts and opinions of various massage education stakeholders through an exercise following the principles of the World Café model.

METHODS

Forum attendees participated in three, concurrent 30-minute Breakout Group Sessions (Rounds) in three different adjacent rooms, focused on Continuing Education, Schools, or Employment. During each session, participants rotated for 3, 2.5, 2, and 1.5 minutes between four tables, asking what should be stopped, started, done differently, or changed in massage education related to the focus topic. Participants recorded their responses in marker on large Post-it^® notes (3M, Maplewood, MN). These were reviewed by each of that round's participants who awarded "importance points" to each response, with 6 blue and 3 orange dots each worth 1 and 3 points, respectively. The Post-it^® notes with comments and point allocations were transcribed into a data spreadsheet and analyzed for descriptive statistics and top scoring comments from each room.

RESULTS

85-91 attendees participated in the three breakout sessions resulting in 674 comments with 3,744 assigned value points. The top five scoring comments from each room per session (N = 45) determined stakeholder's most critical views. Stop comments made up the smallest total comments proportion (19%), yet largest top scoring comment proportion (36%)-potentially highlighting unified frustration for various massage education practices. Comparatively, Start comments made up 26% of total comments, but the smallest highest scoring proportion (18%)-perhaps suggesting stakeholders feel it more important to improve what is already being done rather than beginning new endeavors in these areas.

CONCLUSION

Stakeholder opinions on the future of massage therapy education can be systematically gathered in large conference settings and organized, analyzed, and disseminated to inform field decision-making.

Exploring the awareness of research among registered massage therapists in Ontario

BACKGROUND

An increase in available research has highlighted that knowledge changes over time as theories are challenged and adjusted or dismissed. This is particularly important to healthcare practitioners, including massage therapists, who need to frequently review current research and adjust practice accordingly. However, when research findings related to practice are generated, there is considerable delay in implementation. Few studies measure actual knowledge of current evidence for practice. The objectives of the study reported here were to (a) describe current awareness of evidence for practice among registered massage therapists (RMTs) in Ontario and (b) identify the sources of information RMTs use to inform their awareness of current evidence and the reported importance and frequency of use for each source.

METHODS

An online questionnaire-based mixed-methods cross-sectional study was conducted. Ontario RMTs were invited to participate. This report focuses on the quantitative analysis.

RESULTS

In total, 1,762 questionnaires were included. Of seven sources of information provided, respondents rated cumulative professional experience as most important, followed by recent research studies and education. Cumulative professional experience also rated as most frequently used, followed by other RMTs and education.

CONCLUSIONS

There was a tendency for respondents to agree with positive statements about MT, or disagree with negative statements, regardless of correctness. The results suggest that RMTs need to improve their awareness of the current evidence for practice. Furthermore, cumulative professional experience was ranked most frequently used. This has the potential to not include the most current research. Improving communication of research findings to RMTs might improve awareness.

A guiding framework to understand relationships within the profession of massage therapy

An element of professionalization is the development of a body of knowledge and the integration of that knowledge into practice, also known as evidence-informed practice (EIP). EIP was officially adopted in Ontario, Canada, by the massage therapy profession in 2002 when the professional competency document was updated to include competencies related to research literacy (College of Massage Therapists of Ontario, 2002). Despite efforts to increase EIP, there continues to be a research-practice gap in massage therapy. However, there also seems to be interest in finding ways to support the increase massage therapists' capacity to apply research. To support change, it is useful to describe the relationships in the profession that may have an effect on the use of evidence in practice and the development of a broader culture of inquiry. In order to better understand how these relationships may impact on EIP, an ecological model is proposed.