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Research With Massage Therapy Foundation

By Massage Therapy Foundation Contributor

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Inconsistencies & Deficits: In Massage and Bodywork Case Reports

Contributed By Jolie Haun, PhD, EdS, LMT, Derek R. Austin, PT, DPT, MS, BCTMB, CSCS, Natalie Lorick, LMT

Editor's Note: This is a review by the Massage Therapy Foundation writing group of a recent publication in the International Journal of Therapeutic Massage and Bodywork (IJTMB) by Munk and colleagues, who used the therapeutic massage and bodywork (TMB) adapted CAse REport (CARE) guidelines to review the reporting quality of TMB case reports in the literature.

The descriptive nature of case reports make them a fundamental tool for practitioners to inform research and impact the field by detailing the presentation, treatment, and follow-up of a single individual treated in practice. Inconsistencies in case reporting can limit their impact as clinical evidence resources.

Critical Thinking

Guidelines serve to facilitate reporting various types of research to help readers critically appraise the methodology and accurately interpret findings. Reporting guidelines have been developed and published for randomized controlled trials (CONSORT), observational studies (STROBE), and systematic reviews and meta-analyses (PRISMA).

Guidelines help one assess the extent to which publications comply with reporting standards. However to date, even with published reporting guidelines, authors' compliance with the reporting criteria varies.


To complete their review process, the authors identified articles, conducted audit development and implementation, and then analyzed audit scores. They identified articles and developed the audit process simultaneously. The authors systematically identified published, peer-reviewed TMB case reports authored by TMB practitioners.

books - Copyright – Stock Photo / Register Mark Outcome

Following PRISMA recommendations, the authors identified 977 articles, of which 35 met study inclusion criteria. The authors report, "On average, reports included approximately 58 percent of the total items identified as necessary by the TMB adapted CARE guidelines. Introduction sections of case reports had the best item reporting (80 percent on average), while the case presentation (54 percent) and results (52 percent) sections scored moderately overall, with only 20 percent of necessary practitioner description items included on average. Audit scores revealed inconsistent abstract reporting and few audited case reports including client race (20 percent), perspective (26 percent), and occupation/activities (40 percent); practitioner practice setting (12 percent), training (12 percent), scope-of-practice (29 percent), and credentialing (20 percent); adverse events or lack thereof (17 percent); and some aspect of informed consent (34 percent). Treatment descriptor item reporting varied from high to low. Various implications of concern are discussed."

Although not included in the audit, the authors proposed that discussion of a case's outcomes and implications for TMB research, practice, and education would provide a meaningful contribution and elevate impact on the TMB field.

Case reports are considered a weak form of scientific evidence, the majority (less than 90 percent) of articles discuss their implications on future research; however, only 32 percent of audited articles address implications for TMB practice. Only a single audited case discussed implications for TMB education.


As with all studies, this review has its limitations. The authors did not consider individual article audit scores compared to the case report author guidelines in place for the publishing journal at the time of article publication.

Their methods and consideration did not allow speculation on the extent to which inconsistent reporting of necessary TMB-related case report items prior to 2015 may have been influenced by journal editorial policy, such as word limits and/or other limiting specifications.

The authors also suggest that case report authors will do well to refer to the pioneering TMB case reports audited in this study, along with the TMB-adapted CARE guidelines, to inform their work for journal submission.

Take-Home Message

In general, the publication findings suggest case reports should follow guidelines and thoroughly include abstract and introduction details, case presentation and results sections. As with most forms of reporting, more details are needed such as practitioner training, scope-of-practice, and credentialing as well as the client's occupation and perspective on the case.

Reports need to thoroughly address practice setting details and client characteristics; reports should also mention adverse events or lack thereof, and informed consent. Further, descriptions of TMB treatments need to be fully developed.

The implications of these findings on research, practice, and the field are paramount. Case reporting guidelines set standards for addressing the potential impact of TMB case reports; however, this audit and analysis highlight several reporting inconsistencies in existing TMB case reports to date.

Adherence to reporting specifications outlined by the TMB-adapted CARE guidelines could improve the impact and usability of TMB case reports to bridge the research-education-practice gap.

Standardizing case reporting in TMB among practitioners is a worthwhile effort, as it will inform best practices and future research, provide case scenarios for education purposes, and in general advance the field.

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