resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Sell Out: Using Research for the Wrong Reasons
The above chorus is from the ska band Reel Big Fish's 1997 hit song, "Sell Out," from their album, "Turn the Radio Off." In the song, the singer sarcastically relates the plight of a musician who is tired of "flipping burgers" and is willing to get "lots of money" by playing "what they want you to hear" in order to get a recording contract.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
The Amazing Clinical Versatility of Milk Thistle (Part 1)
Most of us know that the standardized extract from the seeds of milk thistle (Silybum marianum) is probably the best-proven herb for protecting the liver from chemical and inflammatory damage.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
The Future of Functional Neurology
Functional is the hot buzzword in health care these days; witness the rising popularity of functional medicine, functional testing and yes, functional neurology.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Preventing ACL Injuries in Female Athletes
For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
The MRI: When and Why to Order One
As I lecture around the country to both chiropractors and medical specialists, it's clear one of the main disconnects between the two professions is that of an accurate diagnosis.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Osteoporosis Isn't Always the Case
What is your diagnosis? The patient is a 58-year-old female with back pain. I am sure all of you see the compression fracture at L2; however, there are some findings that suggest this is not a compression fracture due to osteoporosis.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
Spine Surgery: A Tale of Greed and Corruption
All too often, where there's substantial money to be made, greed and corruption inevitably follow.
We Get Letters & Email
In the Dec. 1, 2015 issue, we have Donald Petersen reporting on "the adapting chiropractic practice," which includes multidisciplinary practice as an option; a ChiroPoll indicating 59 percent of DCs are seeing at least 21 patients per day and 27 percent are seeing more than 40.
News in Brief
A Winner in and Out of the Office; Ready for the "Have-A-Heart" Campaign? New Integrative Medicine Journal.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Do You Teach Patients How to Breathe Properly?
Spinal manipulation often produces quick results in terms of pain alleviation and improved range of motion. Unfortunately, once the patient is no longer in pain, they may discontinue therapy, only to be plagued by the same complaint at a future date.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Top 10 Fitness Trends for 2016
The American College of Sports Medicine (ACSM) published its annual fitness trend forecast in the November / December 2015 issue of ACSM's Health & Fitness Journal.
Elevated Shoulder? Check the QL
As you know, posture reveals a great deal about the body. Posture is a unique mental and physical landscape revealing compensations and adaptations to life. It's a classic mind-and-body story.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
March, 2012, Vol. 12, Issue 03
Trying to Get Something From Nothing
By Keith Eric Grant, PhD, NCTMB
"Sometimes nothing can be a real cool hand" – Paul Newman in the movie, "Cool Hand Luke."
You are going to be hearing more and more about evidence-based massage therapy (EBMT). Partly, this reflects a current trend in health care to re-evaluate treatment and to determine what has a sound basis for use and what doesn't. One example of this is the Institute of Medicine report, "Evidence-Based Medicine and the Changing Nature of Healthcare."
A second factor is the existence of the Massage Therapy Foundation (MTF), which has goals of making those in the profession aware of research, promoting research literacy and integrating research with practice. I would count the forthcoming book on such integration by Dryden and Moyer as among the efforts facilitated by the MTF.
A third factor is massage therapy now being regulated by the majority of states, combined with the legal presumption that such regulation is done for the protection of the public. If we consider that training is necessary for safe practice, the presumption of public protection can only be fulfilled when state-mandated training is based upon a solid foundation of objectively validated knowledge.
A final factor is the modern technology embodied in an interactive web. Communication without regard to physical proximity is facilitating extensive discussions among those both with a stake in massage therapy and with backgrounds in research and statistics. Alice Sanvito discusses evidence-based massage on her web site and provides a number of links there to additional resources. I like the definition she gives for EBMT.
Evidenced based massage therapy is massage therapy founded on ideas and principles supported by evidence. Many of the claims made and practices used by massage therapists are founded on tradition rather than evidence. Since there is not yet a large body of knowledge documenting the physiology of and effects of massage therapy, if we were only able to make statements strictly on the basis of scientific studies, we would be severely limited indeed. Some people prefer the term "evidence informed practice" as more accurate. An evidence informed practice takes into consideration scientific evidence, clinical experience and careful observation.
The concept of being evidence-based, however, necessitates having methods to collect such evidence. In this, we also need to be careful to distinguish between whether or not an intervention can be shown to work (beyond random chance) and the model that we believe is the mechanism underlying the intervention. It is fully possible, as with massage relieving muscle soreness and the lactic acid myth, for an intervention to be effective while the supposed mechanism is incorrect. The randomized controlled trial (RCT) is taken as the "gold standard" of clinical proof, but how does that work? We need three things: a study population, a methodology for the study and the ability to analyze the results for effectiveness.
For example, our study population might be those diagnosed with high blood pressure, over the age of 40, not having other medical complications and not knowing Morse code. The goal of our study might be to determine whether or not listening to relaxing messages keyed in Morse code by a live practitioner were effective in reducing blood pressure. A complicating factor for the study is that people respond to the presence of other people. As put by Ravensara Travillian recently, "As psychosocial beings, we respond psychologically and socially in ways that can be described as healing body and mind due to presence and caring attention from others." Thus, our study will need a means of differentiating the effects of the Morse code from those effects simply from the practitioner's presence and the setup of the trial itself.
After gaining a sufficient number of suitable participants, we would fulfill the "randomized" concept of the trial by randomly dividing them into three groups: control, sham Morse-code and Morse code. The intervention might be three-times per week for 12 weeks. Controls would come in, have their blood pressure (BP) measured, wait 30 minutes, and have their BP measured again. Those in the Morse-code group would, in the 30 minutes wait, listen to Morse-code keyed by one of several live practitioners. Those in the "sham-group" would listen to 30 minutes of keying, similar to Morse-code, but keyed by "practitioners" unfamiliar with Morse-code. With this protocol, we can look for short-term effects between sessions, beginning and session end, as well as for longer term effects over the length of the study. By taking follow-up measurements after the end of the 12 weeks, we can also look for persistence of any changes.
Now we get to the point of getting something from nothing. We assume the null hypothesis, that any differences between the groups is simply from random chance, and calculate the probability (p) that this assumption is true. We conclude that there is a statistically significant difference between groups only when the probability of our observations being due entirely to chance is less than 5% (p<0.05). We have three separate probabilities to check: whether the sham group is statistically different from the control group (psychosocial effect), whether the Morse code group is different from the control group (psychosocial plus Morse code), and whether the difference between the sham and code groups is significant (Morse code effect). In a recent paper, Bakker and Wicherts underscore the importance of doing the third test explicitly, even when the differences between the sham and control groups is not significant.
If there is no difference between the three groups, the study would conclude that, in the clinical trial as designed, neither psychosocial factors nor messages in Morse-code were effective. If the sham group differed statistically from the control, we would conclude that there was a psychosocial effect. Because the psychosocial effect would also be present in the code group, only if the code group was statistically different from the sham group could we conclude that there was an effect from Morse-code itself. Note that this code effect could be of either sign, adding to a psychosocial effect or negating it.
There you have the outline of a randomized control/clinical trial. Assuming initially that we get no difference, we end up with information. Sometimes "nothing can be a real cool hand."
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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