Directions and dilemmas in massage therapy research: a workshop report from the 2009 north american research conference on complementary and integrative medicine

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.

Advancing health promotion through massage therapy practice: A cross-sectional survey study

The human resources needed to provide health promotion services to improve health behaviors in populations are currently limited. Health promotion and education is included in the definition of massage therapy, and many within the massage therapy profession understand that health promotion and education are a part of massage therapy practice. However, the amounts and types of health promotion activities in massage therapy practice have not been thoroughly explored. The objective of this study was to investigate the current attitudes, practices, and barriers toward providing health promotion in a national sample of practicing massage therapists. A descriptive cross-sectional survey disseminated May to August 2016 to practicing massage therapists in the United States. The majority (90.2%) of the 182 participants agree or strongly agree that it is important for massage therapists to provide health promotion. Therapists with less favorable attitudes about providing health promotion reported more barriers to providing the messages to their patients. Barriers to providing health promotion included a lack of guidelines, knowledge, and skills. Training and guidelines for massage therapists regarding health promotion would be a reasonable next step for future research development. Utilizing massage therapists as health promoters may provide opportunities to deliver more prevention messages to patients which may impact public health.

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Most massage therapists feel health promotion is an important part of massage therapy practice.

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Massage therapists report providing health promotion on approximately 10 specific topics.

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The greatest barrier for health promotion in massage therapy practice is lack of guidelines.

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Those with higher levels of education report greater barriers to health promotion.

The Intersection of Massage Practice and Research: Community Massage Therapists as Research Personnel on an NIH-funded Effectiveness Study

Introduction

Few NIH funded studies give community massage therapists the opportunity to become study personnel. A recent NIH/NCCAM-funded study investigating chronic low back pain (CLBP) recruited, trained, and utilized community massage practitioners (CMPs) as study personnel. This study’s aim was to determine whether health-related outcomes for CLBP improve when patients are referred from primary care to select CAM modalities including massage therapy (MT). The purpose of this paper is to report the results of the study’s three massage practice-driven study objectives which were to: 1) identify challenges and solutions to recruiting and retaining ample CMPs, 2) develop a practice-informed protocol reflecting real-world MT, and 3) determine the extent to which CMPs comply with rigorous research methodology in their clinical practices as study personnel.

Methods

Eligible CMPs in urban and rural Kentucky counties were identified through licensure board records, professional organizations, and personal contact opportunities. Interested CMPs completed 6 CE hours of research and Human Subjects Protection training and agreed to comply with a study protocol reflecting MT as practiced. Once trained, study CMPs were matched with study participants to provide and document up to 10 MT sessions per participant.

Results

Utilizing prominent MT community members proved invaluable to CMP recruitment and protocol development. CMP recruitment challenges included mixed interest, low number of available rural CMPs, busy clinic schedules, and compensation. Ethics CE credits were offered to encourage CMP interest. A total of 28 Kentucky licensed massage therapists with 5–32 years of experience completed study training. A total of 127 CLBP patients consented to participate (n = 104 for MT). Twenty-five CMPs were assigned CLBP patients and provided 1–10 treatments for 94 study participants. Treatment documentation was provided by CMPs for 97% of treatments provided.

Conclusions

When recruitment, retention, and protocol compliance challenges are met, CMPs are valuable study personnel for practice-based research reflecting real-world MT practice.

Massage therapy and canadians' health care needs 2020: proceedings of a national research priority setting summit

Background

The health care landscape in Canada is changing rapidly as forces, such as an aging population, increasingly complex health issues and treatments, and economic pressure to reduce health care costs, bear down on the system. A cohesive national research agenda for massage therapy (MT) is needed in order to ensure maximum benefit is derived from research on treatment, health care policy, and cost effectiveness.

Setting

A one-day invitational summit was held in Toronto, Ontario to build strategic alliances among Canadian and international researchers, policy makers, and other stakeholders to help shape a national research agenda for MT.

Method

Using a modified Delphi method, the summit organizers conducted two pre-summit surveys to ensure that time spent during the summit was relevant and productive. The summit was facilitated using the principles of Appreciative Inquiry which included a “4D” strategic planning approach (defining, discovery, dreaming, designing) and application of a SOAR framework (strengths, opportunities, aspirations, and results).

Participants

Twenty-six researchers, policymakers, and other stakeholders actively participated in the events.

Results

Priority topics that massage therapists believe are important to the Canadian public, other health care providers, and policy makers and massage therapists themselves were identified. A framework for a national massage therapy (MT) research agenda, a grand vision of the future for MT research, and a 12-month action plan were developed.

Conclusion

The summit provided an excellent opportunity for key stakeholders to come together and use their experience and knowledge of MT to develop a much-needed plan for moving the MT research and professionalization agenda forward.

Are personal characteristics of massage therapists associated with their clinical, educational, and interpersonal behaviors?

BACKGROUND

Social Cognitive Theory suggests that characteristics of health professionals, such as their beliefs in the effectiveness of their care, influence their behavior. Studying the characteristics of massage therapists may, therefore, provide insight into their clinical, educational and interpersonal behavior, which ultimately affects their client interactions.

PURPOSE

To examine the association of three personal factors (outcome expectations, expectancies, and practice experience) of the massage therapist and the practice environment with the frequency of three interventional behaviors (clinical, educational, and interpersonal) using Social Cognitive Theory as a theoretical framework.

METHODS

A random sample of licensed massage therapists in Iowa completed a mailed questionnaire. Questions included training in massage, use of specific massage techniques and practices, 11 outcome expectations, and 17 different behaviors with their respective expectancies for contributing to favorable client outcomes. Factor analyses were conducted on the behavior and expectancy items. Regression analyses were used to examine the relationship of massage therapist characteristics to the different categories of behavior.

RESULTS

The response rate was 40% (N = 151). The most common techniques employed were Swedish massage, trigger point therapy, and stretching. The most common practices recommended to clients were encouraging water intake, heat application, stretching, stress management, and exercise counseling. Expectancies was the only Social Cognitive Theory variable that significantly predicted the frequency of every category of behavior (clinical, interpersonal, education; all ps < .01). Outcome expectations predicted clinical (p = .03) and educational (p < .01), but not interpersonal behavior. No other associations reached statistical significance.

CONCLUSIONS

Massage therapists' belief in massage to enact a favorable change in a client is strongly associated with their clinical, educational, and interpersonal behavior. Massage therapists were optimistic regarding the ability of massage to provide a favorable outcome, especially if the desired outcome was supported by research.

The development and validation of the client expectations of massage scale

BACKGROUND

Although there is evidence that client expectations influence client outcomes, a valid and reliable scale for measuring the range of client expectations for both massage therapy and the behaviors of their massage therapists does not exist. Understanding how client expectations influence client outcomes would provide insight into how massage achieves its reported effects.

PURPOSE

To develop and validate the Client Expectations of Massage Scale (CEMS), a measure of clients' clinical, educational, interpersonal, and outcome expectations.

SETTING

Offices of licensed massage therapists in Iowa.

RESEARCH DESIGN

A practice-based research methodology was used to collect data from two samples of massage therapy clients. For Sample 1, 21 volunteer massage therapists collected data from their clients before the massage. Factor analysis was conducted to test construct validity and coefficient alpha was used to assess reliability. Correlational analyses with the CEMS, previous measures of client expectations, and the Life Orientation Test-Revised were examined to test the convergent and discriminant validity of the CEMS. For Sample 2, 24 massage therapists distributed study materials for clients to complete before and after a massage therapy session. Structural equation modeling was used to assess the construct, discriminant, and predictive validity of the CEMS.

PARTICIPANTS

Sample 1 involved 320 and Sample 2 involved 321 adult massage clients.

INTERVENTION

Standard care provided by licensed massage therapists.

MAIN OUTCOMES

Numeric Rating Scale for pain and Positive and Negative Affect Schedule-Revised (including the Serenity subscale).

RESULTS

The CEMS demonstrated good construct, convergent, discriminant and predictive validity, and adequate reliability. Client expectations were generally positive toward massage and their massage therapists. Positive outcome expectations had a positive effect on clients' changes in pain and serenity. High interpersonal expectations had a negative effect on clients' changes in serenity.

CONCLUSIONS

Client expectations contribute to the nonspecific effects of massage therapy.

A descriptive study of the practice patterns of massage new zealand massage therapists

Background:

Massage therapy has grown in popularity, yet little is known globally or in New Zealand about massage therapists and their practices.

Purpose and Setting:

The aims of this study were to describe the practice patterns of trained Massage New Zealand massage therapists in New Zealand private practice, with regard to therapist characteristics; practice modes and settings, and therapy characteristics; referral patterns; and massage therapy as an occupation.

Research Design and Participants:

A survey questionnaire was mailed to 66 trained massage therapist members of Massage New Zealand who were recruiting massage clients for a concurrent study of massage therapy culture.

Results:

Most massage therapists were women (83%), NZ European (76%), and holders of a massage diploma qualification (89%). Massage therapy was both a full- (58%) and part-time (42%) occupation, with the practice of massage therapy being the only source of employment for 70% of therapists. Nearly all therapists (94%) practiced massage for more than 40 weeks in the year, providing a median of 16 – 20 hours of direct client care per week. Most massage therapists worked in a “solo practice” (58%) and used a wide and active referral network. Almost all therapists treated musculoskeletal symptoms: the most common client issues or conditions treated were back pain/problem (99%), neck/shoulder pain/problem (99%), headache or migraine (99%), relaxation and stress reduction (96%), and regular recovery or maintenance massage (89%). The most frequent client fee per treatment was NZ$60 per hour in a clinic and NZ$1 per minute at a sports event or in the workplace. Therapeutic massage, relaxation massage, sports massage, and trigger-point therapy were the most common styles of massage therapy offered. Nearly all massage therapists (99%) undertook client assessment; 95% typically provided self-care recommendations; and 32% combined other complementary and alternative medicine therapies with their massage consultations.

Conclusions:

This study provides new information about the practice of massage therapy by trained massage therapists. It will help to inform the massage industry and other health care providers, potential funders, and policymakers about the provision of massage therapy in the NZ health care system.

The ethical implications of research and education in the massage therapy profession

As a therapist operating my own practice, I am constantly reminded of the ethical aspects of my work in dealing with situations involving clients and the everyday running of my business. Professional boundaries and ethical practices are recognized within our profession as an important aspect of our work, as evidenced by mandatory classes on ethics in most U.S. states and also by the clearly stated ethical codes and practices set out by our professional organizations. The reasoning behind these measures is clear. Ethical declarations and a thorough understanding of them and their application are needed. They set standards of integrity. They help to define massage therapy as a profession and have significant repercussions on how massage therapists are perceived by the public.