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Research With Massage Therapy Foundation

By Massage Therapy Foundation Contributor

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Massage Therapists Can be Key Players in Research

Contributed by Jolie Haun PhD, EdS, LMT; MK Brennan MS, RN, LMBT; S. Pualani Gillespie LMT, MSN, RN, BCTMB

Historically, few funded studies have given massage therapists opportunity to be involved in massage therapy research as study personnel. However this month's Massage Therapy Foundation review focuses on a recent publication authored by Munk and colleagues, in which a recent NIH/NCCAM funded study investigating chronic low back pain (CLBP) also investigated the use of community massage practitioners (CMPs) as study personnel following recruitment and training. The authors' main study 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 in their own communities.

As indicated by the authors, this study also had three massage practice-driven study objectives, which were to: identify challenges and solutions to recruiting and retaining ample CMPs, develop a practice-informed protocol reflecting real-world massage therapy, and determine the extent to which community massage practitioners comply with rigorous research methodology in their clinical practices as study personnel.

Massage Therapists Can be Key Players in Research - Copyright – Stock Photo / Register Mark CMPs in urban and rural counties were identified through licensure board records, professional organizations, and personal contact opportunities for eligibility. Interested CMPs completed six continuing education hours of research and Human Subjects Protection training. They then agreed to comply with a study protocol reflecting massage therapy as practiced in the community. Once training was completed, the CMPs were matched with study participants who lived in their communities to provide and document up to 10 massage therapy sessions per participant over a 12-week intervention treatment period.

At the completion of their study, Munk and colleagues found challenges for recruitment and retention of MTs included mixed interest, low number of rural community massage practitioners conveniently located near study participants, busy clinic schedules, and compensation for the massage sessions. However, these challenges were overcome with solutions such as:

  • Utilizing previous connections with key CMPs to act as liaisons to eligible community massage practitioners.
  • Involving prominent community massage practitioner community members.
  • Personal invitations mailed to CMPs from the liaisons.
  • CMPs had the option to see participants in alternate locations.
  • Mass mailings and presentations sought to increase interest in community massage practitioner involvement.
  • Allow supplementary documentation to study forms.
  • Ongoing support from community massage practitioner liaison for the study therapist research personnel.
  • Refresher information sessions, as well as study updates.
  • CMP recruitment efforts coordinated with other study activity locations.

These solutions indicate investment in including community massage practitioners in research as personnel and can inform the inclusion of these professionals in future research studies. Maybe most important, CMPs were also compensated $25 per treatment and received six continuing education hours for massage licensure renewal. These benefits for participating practitioners reflect the needs of professionals and support a standard for including CMPs as study personnel.

Another important contribution this research made to the field was in completing its second objective, developing a practice-informed protocol reflecting real-world massage therapy. In contrast to using controlled environments and strict inclusion and exclusion criteria for study participants, this study employed limited exclusion criteria for the patient participants who were referred from primary care providers. As such, patients with complex medical histories and comorbidities were able to participate as part of a physician-directed treatment plan including medications. The CMPs scheduled the patients, provided the massage sessions, communicated treatment with the patients, and documented on the study forms which were similar to typical intake and SOAP-style ones. This approach reflects the practice of providing massage to a diverse and complex client population. Pragmatic participant criteria allowed this study to mirror massage therapy practice which is critical to translating real-world practice into understanding massage therapy outcomes.

The third objective of the study was to determine the extent to which CMPs comply with rigorous research methodology in their clinical practices as study personnel. Munk and colleagues reported that a total of 28 licensed massage therapists with five to 32 years of experience completed study training. A total of 127 chronic low back pain patients consented to participate (n = 104 for massage therapy). Twenty-five community massage practitioners were assigned CLBP patients and provided one to 10 treatments for 94 study participants. Treatment documentation was provided by community massage practitioners for 97% of treatments provided.

The authors concluded CMPs are valuable study personnel for practice-based research which reflects real-world massage therapy practice. Though the findings of this research are compelling, the authors identify limitations which should be noted. The study design does not reflect the advances in massage research methodology and evidence base since 2008; in pragmatic research, variability is expected; and results cannot specifically point to what aspect(s) of the treatment provided the effects. Despite these limitations, the implications of this research are very exciting for research, the field of massage therapy, and massage therapists in particular. Including massage therapy professionals as research personnel is an important advancement in conducting studies. It supports providing a real-world perspective in research findings that is not only relevant but warranted. Including massage therapists as research personnel also creates a new professional experience for therapists that have been limited to providing defined treatments as part of research protocols. Including massage therapists as research personnel is central to supporting the profession and advancing the science of massage therapy.

Reference:

  1. Munk N, Stewart K, Love MM, Carter E, Elder WG. The Intersection of Massage Practice and Research: Community Massage Therapists as Research Personnel on an NIH-funded Effectiveness Study. Int J Ther Massage Bodywork. 2014 Jun 4;7(2):10-9. PMCID: 4051806.

There is still time to register for the International Massage Therapy Research Conference in Seattle May 12-15, 2016. Visit www.massagetherapyfoundation.org for more updates and registration information.

Case reports play an important role in scientific and professional literature. Writing a case report helps develop communication skills, critical thinking skills, and could contribute to future research and clinical practice. The Massage Therapy Foundation offers students the opportunity to advance their research skills with the Student Case Report Contest. Submissions are due by June 1st, 2016. Find out more here: www.massagetherapyfoundation.org/student-practitioner-case-report-contests.

To read other studies regarding massage, please view the Massage Therapy Foundation review article archives, browse accepted MTF Research Grant abstracts, or search PubMed for massage therapy research.

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