Why Massage Therapy Guidelines?

By Christie Bondurant
May 29, 2009

Why Massage Therapy Guidelines?

By Christie Bondurant
May 29, 2009

If you ask the average consumer what they think of when they hear the phrase massage therapy, they will more than likely tell you about a relaxing "spa day" to enjoy on a special occasion. While this perception is undoubtedly changing as increasing numbers consider massage therapy "health and wellness" care, the overwhelming majority probably doesn't think first of the growing body of evidence-based research promoting its clinical uses.

The era of evidence-based care is here, and more consumers, health care professionals and insurers want definitive answers to why massage and other alternative therapies are effective. Some in the massage community believe massage therapy guidelines are a necessary step in this process. Evidence-based guidelines or "best practice" guidelines would provide baseline knowledge of clinical experiences and research supporting the benefits of massage to practitioners, massage therapy regulators, health care managers, educators and consumers.

A report published in the inaugural issue of the International Journal of Therapeutic Massage & Bodywork, the peer-reviewed journal of the Massage Therapy Foundation, discusses the rationale behind developing massage therapy guidelines and outlines the initial steps that should be taken to do so. It also serves as a report to the profession and other stakeholders about the work done by the foundation's Best Practices Committee (BPC) over the past two years. Massage Today columnists Keith Grant and Whitney Lowe were among the co-authors of the paper, "Steps Toward Massage Therapy Guidelines: A First Report to the Profession."

The stated goal of the BPC is to "develop a conceptual structure of evidence-based best practices for massage therapy," as well as to supply a "health care literature basis for future academic discussions of massage." Once created, the guidelines will be submitted to the National Guideline Clearinghouse, a public resource for evidence-based clinical practice guidelines, which utilizes the Institute of Medicine's definition of clinical practice guidelines: "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances."

According to the authors of the report, the need for massage therapy guidelines is clear: "The maturation of massage as a health care profession increases the need for a process to formalize the synthesis of massage therapy knowledge from clinical experience and research." The report also states, "The greater use and greater visibility of massage therapy has also motivated more research on effectiveness and means of use. Yet, often, knowledge from both clinical experience and research has continued to remain diffusely known and obscure."

In developing these guidelines, the BPC will follow well-accepted methodologies and examine extensive literature on "guideline development and practice competency." Within this literature, four categories will be considered:

  1. methodologies for the development and implementation of guidelines;
  2. outcome-based definitions of competence;
  3. credentialing and malpractice considerations for physicians referring to CAM providers; and
  4. health care informatics (management and processing of data, information and knowledge).

Grant, et al., believe these guidelines should not play a regulatory role, but rather a mentoring one. The guidelines should provide "knowledge management for decentralized decision-makers" such as individual practitioners or stakeholder health care agencies and "a framework to illustrate the intentionality and integrity of massage therapy in addition to appropriate treatment protocols, duration, frequency and outcomes. They can also reflect patient problems and issues or concerns that confront MTs."

The BPC plans to develop the guidelines using feedback from experts engaged in a problem-oriented dialogue. Feedback will be gathered through a process known as the "World Café," a concept taken from the very popular book, The World Café: Shaping Our Futures Through Conversations That Matter (Brown and Isaac). As the report states: "The World Café process provides a structured means of holding discussions and capturing ideas through a symposium of experts drawn from a diversity of experience and perspectives." The first test of the guidelines development process would be in creating guidelines on stress management, low back pain and lymphedema.

The BPC admits it faces challenges in the process of formalizing this collection of clinical experience and research, including the wide diversity of techniques and philosophies that exist within the massage profession.  In addition, as the report states, "Bringing that symposium into being and ensuring the proper data handling and review processes remains a challenge to be bridged, particularly in the context of the fundraising required and the current economic downturn."

However, the process has begun. The report concludes, "This first report to the profession, outlining our learning and thoughts to date, is the first tangible result and, hopefully, the beginning of a discussion."

To read the full report, which includes various scenarios under which the proposed guidelines would be beneficial in interactions with patients, regulatory bodies, other health care professionals and third-party payors, visit http://journals.sfu.ca/ijtmb/index.php/ijtmb/article/view/5/17.