resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
April, 2014, Vol. 14, Issue 04
What Does an Evidence-Based Practice Look Like?
By Ann Catlin, LMT, NCTMB, OTR
We hear a lot these days about evidence-based practice (EBP). As massage therapy becomes more accepted as an allied health profession, I think it's important that we continue to build an evidence-based case for why massage works.So, what makes a practice evidenced-based? I hope to give you a basic understanding of EBP and offer examples from my own work elders in long-term care facilities.
Definitions of EBP vary somewhat but they all seem to agree that EBP is a combination of:
The desired outcome of EBP is optimal service to each client/patient on a case-by-case basis. I've paraphrased the steps presented by Duke University Medical School to determine if an approach, modality or method is indeed evidence-based. What we are really trying to find out is whether the methods or techniques we use really are effective to meet the client's need and why or why not? Then we can be confident in the actions we take in caring for our client and also when we articulate the benefits of our services.
Start with the client's clinical problem or a question which arises from the care of the client. Identify the need or problem of the individual client. What's the reason you are seeing this client? Generally, the reason for referral or the client's stated goal is a good place to start.
For example, I have a client who has Alzheimer's disease who is cared for in a memory support unit of an assisted living facility. She becomes increasingly physically agitated (rummaging through other elder's things and grabbing people's arms as they walk by her) and disoriented (going into other people's rooms) in the afternoons, disturbing those who also live there. She has been referred in hopes of calming her and easing the agitated, restless behavior.
Construct a well-built clinical question derived from this client's problem. The question must be phrased in such a way as to facilitate finding an answer when you look for relevant research. The question should include: 1. The key problem of the patient; 2. What treatment, method or modalities are you are considering using; and 3. The desired outcome.
In the case of my client, I might ask this question: "In people with Alzheimer's disease, is hand massage and/or back massage effective in reducing physical agitation or restlessness?"
Select the appropriate resource(s) and conduct a search. The type of question we ask can help lead us to the best type of study or research to look for. Massage therapy questions often center on how to select treatments that do more good than harm and that are worth the efforts and costs of using them. We're told by the Duke team that randomized controlled trials are best to look for when asking a therapy or treatment question. They offer this explanation of this kind of study: "Randomized controlled clinical trials are carefully planned experiments that introduce a treatment or exposure to study its effect on real patients. They include methodologies that reduce the potential for bias (randomization and blinding) and that allow for comparison between intervention groups and control (no intervention) groups. A randomized controlled trial is a planned experiment and can provide sound evidence of cause and effect."
It's important to understand that just searching the internet for articles isn't enough. We must be careful about the source. The quip, "if it's written on the Web, it must be so," does not apply here! So, where should we look? One recommended source is PubMed/MEDLINE, a respected database of literature. It's beyond the scope of this article to explain how to go about a search in PubMed, however there are tutorials on that website. Since my question is a therapy question, I set out to find studies that used randomized controlled trials about hand and/or back massage to decrease agitation in people with dementia. I found a number of studies exploring massage in dementia care. Several abstracts of the articles report that hand or slow-stroke back massage reduced anxiety, restlessness and other forms of agitation. My next task is to review the articles to see if the methods used for the study meet criteria for valid research.
Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice). Fortunately, there are guides to help with this process. We are looking to answer three basic questions:
In the end, we want to have confidence in the research we cite. One example from my search is a 2008 study, Favorite Music and Hand Massage: Two Interventions to Decrease Agitation in Residents with Dementia. In my best judgment, this study holds up to the criteria for validity. It compares the effectiveness of favorite music (FM) and hand massage (HM) in reducing agitated behaviors. Researchers found that following ten minute sessions of FM and HM individually and combined significantly decreased agitation for up to an hour following the session.
Apply the results to your client. Integrate that evidence with clinical expertise, patient preferences and apply it to practice. So, back to my client. Because the afternoon is the time when she becomes more restless, I schedule sessions for mid-afternoon twice a week. Sessions consists of hand massage, slow-stroke back massage and focused one-to-one attention. I also do staff education, teaching them how to do a simple five minute hand massage and focused touch.
Evaluate client's response to treatment. What result do you see in the individual client? Were they similar or different from results you found in the research? Do you need to make adjustments to your approach? In the case of my client, she was receptive to receiving hand and back massage and she tolerated a thirty minute session without distraction when the session was carried out in a quiet room. She was talkative during the hand massage and often fell asleep during the back massage. At the end of the session, she remained in a calm, quiet state from thirty minutes to an hour. The care staff reported that they noticed a decrease in the restless behaviors, especially her tendency to grab people's arms. The staff used the simple hand massage protocol in the late afternoon and reported it seemed to also help relax her and that she enjoyed the interaction and smiled.
Where does my clinical experience fit in to all this? I've had hundreds of sessions with elders living with Alzheimer's disease and related dementia, many of whom have some degree of agitated behavior, anxiety and restlessness. It's been my experience that human touch, massage and compassionate presence ease these issues and have a profound effect on enhancing quality of life. I've also witnessed the effect of shared human touch on the ability of a person with advanced dementia to engage in relationship.
And last, but certainly not least, what about my client's needs, preferences, expectations? It's a little tricky sometimes to determine what my client might want or need when she can't state them clearly because of dementia. It falls to me to tune in to the non-verbal cues. People with dementia tell us a lot about their inner world and needs through behavior. My client's restless behaviors that annoyed others are her way of communicating a need in the moment. Perhaps she's lonely or is disoriented and thinks she needs to get home to take care of her kids. I also always know that one universal expectation of each client is to have basic human needs met and to be treated with respect.
Taking all this into account, can I state with confidence that my approach is evidence-based? I believe that, yes, I can. I hope this has helped you understand what evidence-based practice is all about so you can perhaps apply it to your own work.
Click here for more information about Ann Catlin, LMT, NCTMB, OTR.
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