Talking About Research: Your Literacy Equals More Effective Communication
Martha Brown Menard
, PhD, LMT
Talking About Research: Your Literacy Equals More Effective Communication
Martha Brown Menard, PhD, LMT
Lately, I've been hearing about a number of misconceptions regarding research and massage therapy in the larger massage community. So, in this column I'm going to take a break from talking about personal finance to offer a brief refresher on research literacy.
The language of science, such as anatomy and physiology, is common to all health care providers, integrative health practitioners and conventional physicians alike. Research literacy, also known as critical evaluation, offers us a branch of that common language that can be used to communicate more effectively with other providers. Because massage therapists and bodywork practitioners are still in the minority within the larger health care field, it is critical that we be able to explain our work in terms that others can grasp. Reading research and learning how to evaluate it helps us do that.
The amount of medical research related to massage therapy has grown by leaps and bounds over the past 15 years. In the mid-1990s, there were less than 900 peer-reviewed articles. Today, if you were to visit PubMed, the website for the National Library of Medicine, and type in the search term "massage therapy" you would instantly retrieve over 14,000 articles—an order of magnitude increase. Increasingly, health care providers and patients/clients will expect massage therapists to be able to discuss recent research findings, especially as these are publicized in the media, and as more therapists begin to practice in conventional health care settings.
Reading Journal Articles
While a thorough discussion of the process of critical evaluation is beyond the scope of this article, here are a few crucial points to get you started. First, be reasonably skeptical and apply a common-sense standard to the articles you read. Next, identify the research question that the study is attempting to answer. This can often be found in the abstract, the executive summary of an article.
As you read through the entire article, ask yourself if another plausible explanation for the study's findings is possible, based on the study's methods and procedures. For example, in a study where participants self-select to two different intervention groups, it is possible that pre-existing differences among the participants, which led them to choose one intervention over the other, may explain the results.
Generally, the degree of credibility you can give an article is based on the study design, the number of participants, and the care with which plausible alternate explanations have been ruled out. Study designs with a strong capacity to link cause and effect are the systematic review, meta-analysis, and clinical trial.
Studies with larger numbers of participants have more statistical power to detect a genuine treatment effect if one is present, compared to those with a small number of participants. Studies with less than 30 participants are usually considered pilot studies—a small scale study designed to test the feasibility of the study's methods and gather preliminary data in preparation for a larger scale study. Random assignment to treatment group and blinding are two design features that add rigor to any study design, and help to rule out other explanations for any observed results.
Talking About Research
One of the biggest reasons for becoming research literate is to be able to speak knowledgeably with clients—both current and potential. Because news about recent research is often reported in the popular media, patients and clients may very well ask you, as a trusted source of health information, what you think about the latest study, or what implications a new study might have for their particular situation.
The results of recent studies are rarely reported in an objective fashion by most popular news media. Frequently, research studies are reduced to catchy sound bites, which may not accurately reflect their findings. It is incumbent upon practitioners to be able to discuss questions that arise from research in our field. But the most important reason for becoming research literate is that being able to locate and critically evaluate research is essential to providing the best possible care.
It's also important to remember that a single study rarely provides compelling evidence that definitively settles a research question. More commonly, a body of evidence, composed of a number of studies using different types of study designs, accumulates over time. Each study contributes a piece of the puzzle, and taken together can help form a more complete and nuanced picture as new studies build on previous findings.
When Discussing With Other Health Care Professionals
Evidence-informed practice is the new standard across health care generally, and massage therapy is being held to it. Other health care professionals regularly read new studies in their field, and if you work in a group setting, you should expect to discuss studies with your colleagues, in your own discipline and perhaps in theirs as well.
Some settings, especially those affiliated with a school or university, have scheduled meetings called journal clubs, where participants take turns presenting and discussing recent research. The ability to speak confidently about the strengths and weaknesses of a given study is part of what identifies us as health care professionals. And if you are trying to create a position for yourself working in such a setting, making a convincing presentation on the benefits of massage as documented by peer-reviewed research can help you make your case.
When discussing research, however, be wary of saying that research "proves" that "massage does so-and-so." Science is based on the idea that new information can always be discovered, and can contradict what we previously thought to be true. So we can never say that something has been definitively "proven." Using the scientific method, we can only demonstrate that a hypothesis is false.
In most clinical studies, where two groups are being compared to see if any difference between them is due to chance or to some treatment effect, we assume that there will be no difference; this is called the null hypothesis—null, meaning none. If the null hypothesis is demonstrated to be false under a number of different conditions, we can say with some confidence that a difference and therefore a treatment effect appears to have occurred. And remember the previous point about single studies. The bottom line is to be cautious about any claims you make, and avoid using absolute statements.
With Discussing With Each Other
Reading research is one of the best ways to stay current on the latest developments, and that can be part of what keeps this work intellectually stimulating, especially for those of us in private practice. Many professionals find that the volume of health care research is increasing rapidly, which makes it difficult for a single individual to stay on top of it. Massage therapy is no different. Consider starting a 15- or 30-minute journal club as part of your local professional meeting, and having two or three therapists present a brief overview of recent research. Rotate the presentations among all the members so that everyone gets an opportunity to practice their research literacy and presentation skills.
Speaking knowledgeably and confidently about research is a necessary skill for today's massage therapist. Practice critical thinking skills, and take advantage of the resources available, many of which are free or low cost, to become research literate. It's an investment that will pay off in terms of your ability to provide the best care for your clients, and perhaps open doors in other health care settings. Being able to talk about the pros and cons of a particular piece of research with other health care providers can increase the professional credibility and confidence of massage and bodywork practitioners. But remember to be careful about making absolute statements about research "proving" that massage works.
Finding the Research
How can busy therapists stay on top of new studies as they are published? If you have not already visited PubMed, check it out at www.ncbi.nlm.nih.gov. PubMed is the publicly accessible version of MEDLINE, the largest medical literature database in the world. It contains over 25 million citations and is updated daily. PubMed has several features that make it easier for therapists to quickly locate articles of interest.
Using the "Advanced" feature, you can specify date ranges, languages, and types of articles such as reviews, practice guidelines, or clinical trials. Review articles are always an excellent choice to read since these summarize a group of studies on a particular topic, and readers can get a handle quickly on where the weight of the evidence as a whole lies.
The "My NCBI" feature allows you to save a search strategy, for example, massage therapy and pregnancy, and automatically rerun it at regular intervals—such as once a week or once a month. A list of citations will be retrieved and emailed directly to you. This feature is free; however, you must register your email address before using it.
While abstracts are freely available in PubMed, the full text of journal articles is not always accessible. If the research was funded by the federal government, however, authors are required to make the resulting journal article available in PubMed Central (PMC). Find the abstract for your article of interest, and look for the icon linking to PubMed Central on the right at the top of the page.