Client-Centered Outcomes: A Biopsychosocial Approach to Massage Practice

By Virginia Cowen , LMT, PhD
2018-10-30

Client-Centered Outcomes: A Biopsychosocial Approach to Massage Practice

By Virginia Cowen , LMT, PhD
2018-10-30

If your website or brochure contains a statement like: "massage improves..." then you are describing a massage outcome. Chances are that you selected the statement to reflect the needs and expectations of your client population. Given the large—and growing—body of massage research, any outcome that you reference should be evidence based. But unfortunately things can get sticky when trying to align massage research and professional practice. Massage research does recognize the biopsychosocial nature of massage. But there is a bit of a chasm between the body of research and massage practice.

Efficacy Studies

In research studies outcomes are dependent variables—things that are expected to change as a result of the intervention. The outcomes selected for massage research studies arise from the phase of the research in the clinical trials process. A study on the safety of massage would examine adverse events. A study on efficacy would compare massage to a control group to identify whether any observed outcomes were due to the massage treatment.

Efficacy studies often employ clinical outcomes like biomarkers (e.g. cortisol, C-reactive protein) or psychosocial outcomes (e.g. mood, anxiety.) A lot of massage research is early phase research that explores mechanisms for massage or seeks to answer the question, "to massage, or not to massage?" Massage therapists are faced with different questions: what approach will likely produce the best outcome for my client who presents with "x" problem or symptom? That is one reason why many research studies do not resonate with massage therapists.

An Important Area of Health Research

Patient-centered outcomes are emerging as an important area of health research. The Patient-Centered Outcomes Research Institute (PCORI) was authorized by Congress in 2010 to fund research that would help patients and other stakeholders make health-related decisions. An important aspect of this research is the real world applicability: the outcomes used in these studies must be important to patients.

This recognizes that outcomes typically tracked in clinical health care or employed in research studies are not necessarily of interest to—or useful for—patients. For optimal patient engagement in health care, assessments of effectiveness of treatment need to be relevant to patients. Indirect outcomes (e.g. well-being, quality of life) and functional outcomes become more important in this context. These are the types of outcomes that are important to track in massage practice.

Postural assessments and goniometer measurements can be useful to document direct outcomes of massage, but are not client-centered. Assessment that measure well-being and quality of life provide client-centered information, but the assessment tools used in research are cumbersome and often proprietary.

So these do not translate well into massage practice. Functional outcomes offer a client-centered and practical approach to document effects of massage by tracking the impact the client's symptoms have on their whole person. Linking a client's symptom to one of the seven areas of biopsychosocial function provides a relatable way to document improvements that may occur with massage:

  • Problems with circulation, digestion, elimination, or metabolism that interfere with well-being
  • Indications that the body is not healing from illness or injury
  • Able to think, concentrate, and process emotions (or having difficulty)
  • Movements that are free from pain or discomfort
  • Productivity (or lost time) at work
  • Performing chores or other daily activities with ease (or feeling challenged)
  • Spending quality time (or missing out on time) with friends or family

Questions or rating scales can easily be added to session notes to document how changes in a client's symptoms affect them on a whole-person (i.e. biopsychosocial) level. Ongoing assessment of a client's functional well-being can provide evidence of the effects of massage that reinforces what the client feels. This information is useful to help massage therapists quantitatively measure how our work affects clients.

Assessing effects of massage in a way that is meaningful to clients is pretty far afield from the current body of massage research. But this type of information is important for clients—and the massage profession. It is vital that we empower ourselves to assess, document, and analyze client-centered outcomes to provide real world evidence for massage effectiveness.