Importance of Research Literacy Webinar Recap
February 24, 2014
In December 2013, the Coalition of Massage Therapy Organizations met to discuss and, thereafter, ratify the ELAP project. At this time, Massage Therapy Foundation President, Ruth Werner, and new NCBTMB Board Chair, Dr. Leena Guptha, had the opportunity to review and discuss research requirements for Board Certification renewal. This important dialog led to NCBTMB approving recommendations from the Massage Therapy Foundation, including credits gained from attendance at Integrative, Complementary and/or Healthcare Research conferences that further advance the goal of Research Literacy among our profession.
On Friday, February 21st, Ruth and Dr. Leena came together for a unique NCBTMB webinar to discuss the importance of research literacy throughout our profession. Tune in to this informative webinar to hear directly from Ruth on how you can advance your research skills and support the movement towards Evidence Informed practice.
Watch the full webinar playback:
Our webinar provided a plethora of important and helpful information regarding research. Below, you will find all pre-submitted questions, as well as any questions received live during the webinar, along with Ruth’s personalized answers.
Questions and Answers:
Janice: Is there any research available on stress and massage? How does stress play a part in decrease and how can massage help?
Ruth: Yes, there is a lot of research about stress and massage. Pubmed.gov is the place to start—then, add your search terms. In addition, the MTF commissioned a systematic review of this question in 2007, which you can access here: http://www.hindawi.com/journals/ecam/2010/292069/abs/.
Tamara: How do I become involved in research?
Ruth: This is a big, complicated question. We will be publishing a free e-book on this within the next week or two – “Like" our Facebook page, and you'll be alerted when it comes out!
Anna: I'm looking for any study metrics (qualitative or quantitative) that help measure the effects of massage in a mental health setting. I'm setting up a pilot study in the next few weeks and this would really help. Thank you!
Ruth: I have two suggestions: one, is to look at published research that is similar to what you want to do and see what measures they used; the other, is to visit the IN-CAM Outcomes Database, a collection of instruments (surveys and so on) for various types of research. Some of these are only available for a fee, but you'll get an idea of what's out there.
Yanmei: There is a 3 hours research for recertification. Is there specific requirements on this?
Ruth: Yes, please see this: http://info.massagetherapyfoundation.org/blog/bid/320458/.
John: The massage profession has many modalities unsupported by clinical evidence, just anecdotal accounts. These well-intended, but questionable approaches, damage our reputation in the eyes of other health care professionals. Why is this not discussed?
Ruth: We discuss it A LOT! And what you describe is essentially the base of the research pyramid. The next step is to write good case reports to get these "anecdotes" into the literature so that MTs don't have to reinvent the wheel…and so that other HCPs can see what MTs really do.
Genevieve: What courses would you recommend to further the career and knowledge of Pathology?
Ruth: Ah, a question after my own heart… but I don't have any specific answers for you, I'm sorry. I came to my level of expertise through sheer staying power: many years of trying to understand complicated material and then translating it into information for MTs to use.
Elizabeth: How can we find ways to meet the recertification criteria for massage research credits?
Ruth: As above, please check here: http://info.massagetherapyfoundation.org/blog/bid/320458/ for details on types of classes. Several CE providers list research courses; you can find those through the NCBTMB site. And a shout-out to Education and Training Solutions: they offer the 8-hour Basics of Research Literacy course, and a 3-hour introductory course.
Barbara: Just what is research?
Ruth: Research is a way of learning about our universe. It is a process of observing a phenomenon, formulating a theory about that observation, and then testing that theory in a way that is credible and repeatable.
Julie: How can a non-profit help in the goal of providing useful data for research proving the benefits of massage for veterans? Any specific protocols? Any participation needed in supporting research literacy? (Veterans Helping Veterans Now, Boulder, CO).
Ruth: First, let's be careful about the word "proving"—we can demonstrate, we can provide evidence, but "proving" is beyond what we are capable at this point. "Proving" something means that it is true all the time in all circumstances – and we all know massage isn't like that. As for working with veterans, any special protocols would depend on what health issues your clients are dealing with. Someone whose primary problem is a new amputation has a different profile from someone who has PTSD that dates from 10 years ago. Many veterans service programs make room for massage, and the MTF has given community service grants for some of these programs. If you'd like to apply for one, I definitely encourage that.
Rosemary: How do we go about satisfying the research portion for recertification? Is there grant money available from the federal government for a massage research?
Ruth: For your 1st question, see here: http://info.massagetherapyfoundation.org/blog/bid/320458/. For your 2nd question: Yes! The NHI gives many millions of dollars to MT research. It's a drop in the bucket compared to some other interventions, but better than it used to be. Among the most promising studies are: Dr. Perlman, looking at whole-body massage for pain management of osteoarthritis at the knee; Dr. Bove looking at abdominal massage to manage post-op internal scarring and terminal ileus; Dr. Rapaport, looking at changes in blood components when healthy people recceive massage. For more, look at clinicaltrials.gov for a snapshot of projects still in process.
Marva: How can you find the best and most up to date info available in the quest for massage research, as it pertains to medical conditions (diabetes, cancer, carpal tunnel) and effects of massage? What publications are usually responsible for keeping us current?
Ruth: I always start at pubmed.gov. Learn how to use that site. MT research appears in nursing, PT, orthopedic, pediatric, oncology, and other journals, so we're all over the map. There is one journal specifically for MTs, the International Journal of Therapeutic Massage and Bodywork (IJTMB), but it's only 5 years old and hasn't had a chance to build up a huge depth of archives yet.
Drew: How many deaths or serious injuries are attributed to massage? Is there data available? Ethics issues seem to be the most common cause for action. Has massage caused many stokes, heart attacks or miscarriages? What is the most common injury or danger?
Ruth: Insurance companies are VERY closed-mouthed about what triggers lawsuits, but I am pretty sure that the leading cause for reported injury related to MT in the US is hot stones. That said, I do try to keep an eye on adverse effects as they reported in the research, and I've found several, including a ruptured renal cyst, the possibility of a spinal cord injury, and one that made a case that the massage caused a DVT leading to a pulmonary embolism. (That was a weird one, and I am a little skeptical about it, but that's another issue.)
Brad: Curious to know what direction (topics) research is currently heading, where (locations) opportunities are in development and all the types of funding available to support research including state/federal grants, donations, etc. Are universities involved?
Ruth: Funding for MT research can come from a lot of sources. The MTF funds small-scale research grants, usually 2 per year depending on our financial situation. The NIH is dong more than ever, especially under NCCAM. The MTF has a relationship with a small family foundation that helped us with funding, and may do that again in the future. Some universities have graduate students in nursing, psychology or other fields who do their capstone or dissertation on massage therapy research. One thing I hope to pursue with the MTF is the possibility of partnerships with disease-related foundations, like the Arthritis Foundation or the American Lung Foundation, for research specifically related to their interest – but this is a process that is tremendously complicated and it can't be done in a hurry.
Catherine: Several questions here.
Question #1:Ruth Werner's book was priceless for introductory discussions and case study presentations for a general understanding of a massage client's personal health conditions which DICTATE CRITICAL contraindications that are restrictions compared to a "healthy person's massage." Her book is a valuable research guide for massage techniques limits. Can she describe her choice of examples of this?
Question #2: What references, other than her books, would Ruth recommend licensed therapists might purchase as good references for more details on HOW DO WE NAVIGATE THE CONTRAINDICATIONS OF auto immune diseases or other primary causes of mortality, like heart disease or cancer for women, in particular? What other questions should be asked in the initial interview of people with these disease challenges?
Question #3: SHOULD WE ALL OBTAIN APPROVAL, IN WRITING, OF OUR MASSAGE SCOPE AND TECHNIQUES? AT SOME POINT IN THE CHRONIC AND DYING PHASE? OF PEOPLE NAVIGATING TERMINAL ILLNESS?
WOULD APPROVAL COME FROM THEIR PRIMARY CARE DOCTOR, WHO MAY NOT KNOW MUCH ABOUT GOOD EFFECTS OR CONTRAINDICATIONS FOR MASSAGE IN TERMINAL ILLNESS? Who is the best professional medical expert to obtain these written approvals to share our risk taken in massage services to terminally ill people?
Question#4: How does Ruth Werner and NCBTMB experts recommend we become more knowledgable in these decisions for specific limits for chronically ill care and hospice massages?
Ruth: 1. Thank you! I don't tend to write about specific techniques, because that's not my field of expertise. Instead, I elucidate risks and benefits, and turn the discussion to how anyone can eradicate the risks while maximizing potential benefits of massage for specific circumstances.
2. Run, don't walk, to get Tracy Walton's Medical Conditions and Massage Therapy. It's really the next step up from my book. You will love it.
3. Seems like a good idea, but that might be guided by local laws and regulations. Approval itself needs to come from the client (or people acting in his or her place). Consultation is what needs to happen with the doctor, to identify specific risks. Informed consent is everything, isn't it?
4. I would recommend that you look for a subject matter expert in end-of-life issues in the context of massage. Lots of people have developed educational pieces about working in hospice settings – start there.
Jandel: Many partnerships are made through the publications, such as Massage Today, to share the research that massage therapists may be conducting throughout the nation. Yes?
Ruth: This is a big question. Truly credible research papers need to undergo peer review. This is part of the process of publishing in an academic journal like the IJTMB. To be published in a trade journal like Massage Today, Massage Therapy Journal, Massage Magazine or Massage and Bodywork does not require peer review. These are good outlets for research discussion, but not for the publication of original findings.
Joy: Is there a standard legal consent form necessary for subject signature? Has there ever been any research coming from the massage industry to be printed in any medical journals like JAMA? Can you incorporate research "tests" during sessions to charge?
Ruth: Great question! I don't know the answer! We require a signed consent form as part of our case report contests; that is part of the application procedure. I can probably get you a copy; contact me through the MTF website.
In answer to your second question, massage therapy research appears in a huge range of journals, some extremely well-established, and some less so. The place to start your search is pubmed.gov. The general search term "massage therapy" (which is narrower than just "massage" but rules out most cardiac and prostate massage) yields 676 articles right now.
In answer to your third question, I don't understand what you're asking. Sorry.
KJ: Is there any research about the effects of drinking water (or not) immediately following massage? I've heard some claim they get sick if they don't drink water after receiving massages. Others claims that massage helps the body "move toxins around" and that drinking water helps to move those "toxins" out of the body. Thanks for your insight.
Ruth: Yes, the "toxin" debate still rages. Lots of people feel better drinking water after a massage and, for most people, we can certainly afford to drink more than we do. The "massage releases toxins" idea, however, has no basis in research: no one (to my knowledge, anyway) has been able to demonstrate the sweat, saliva or urine of a person post-massage has more metabolic wastes in it as compared to pre-massage.
Cindy: Is a Bachelor’s degree in Massage therapy worthwhile and cost? And can it be applied to research?
Ruth: I would love to see a BA in massage for those who are interested, but it probably wouldn't make a difference in earning potential. If I were designing the program, part of the BA in Massage Therapy would definitely be devoted to research!
Luann: Do you know of any academic programs for advanced degrees, specifically in massage therapy? Also, on Ruth's slide on evidence hierarchy, there is no reference to qualitative research, which is considered a cornerstone of long term research agenda. Where would you place qualitative, exploratory research studies?
Ruth: Other countries (notably Australia and soon, I think, Canada) have advanced academic programs in MT. The place of qualitative research could be anywhere on the pyramid, from preliminary research on up (by convention, case reports are usually mainly quantitative). Qualitative research tends to capture wonderful information about MT, and, in many ways, is a good match for our work. It is also MUCH harder to do, and fewer people know how to do it well. That is not a reason not to do it, of course, but there are some obstacles there that are not present with quantitative research. And a lot of the studies about mood and depression are mixed method, gathering both kinds of data.
Christopher: Would a graduate-level class in research as part of an advanced degree program count for the research requirement?
Ruth: You'd have to confirm with NCBTMB, but I would give that a great big yes!
Gregory: What types of conferences are available to sit in for research?
Ruth: Every year there are a few great choices. The Fascia Research Congress happens every two years. The MTF International MT Research Conference is on a three-year cycle. Various organizations do integrative medicine conferences, often with a massage or manual therapy component. The next one that I know of is in Miami in May: http://www.ircimh.org/.
Gayle: Can you direct us toward a resource for the purpose of writing Case Reports?
Ruth: Hi Gayle!!! Check out the case report contest guidelines, here: http://www.massagetherapyfoundation.org/student-practitioner-case-report-contests/. Please note that even if you don't want to participate in the contest, these guidelines are really strong, and will help you write an excellent report.
Holly: Will NCBTMB be offering these research courses? How will this "list of research offerings" be shared?
Ruth: Hi Holly, you can start by going here: http://www.ncbtmb.org/tools/find-approved-provider, and enter "research" into the course category field.
Jamshed: Why do the Massage Therapy Foundation and other massage based organizations , not openly, widely & much in advance, announce new research which is to start in different fields & also announce a selection criteria & application process for Massage Therapists who would like to get involved ? Why does the NCBTMB website not have a list of professionals vetted by either or both the AMTA/NCBTMB Board , who are in a position to be approached by Massage Therapists, who want to learn, how to get into the Massage Research field ?
Ruth: I can't speak for other organizations. I can say that the MTF always announces when the research grant application process is open (which is now, by the way). The selection process is described in the application process —we hope to see you there!
Regarding getting involved in research: Please look for the next MTF e-Book, “How to Connect with a Researcher,” which will be released in the next week or two.
Jill: I am a student that wants to undergo a research project. How do I get started and how do I get it funded? Is there potential to get the research published?
Ruth: As a student, you are best off beginning with writing a case report. The MTF has lots of support materials to help you with that at the website—click on Grants and Contests, and look at the Case Report Contests. Also, watch for the “How to Connect with a Researcher e-Book,” due out very soon!
Alison: I began R&D on an MTF grant application. However, it was difficult to establish a baseline to quantify and/or prove MT efficacy, especially when little or no baseline data exists. I'd love to submit a grant proposal, but need help to get started. Thanks.
Ruth: I wish I had the expertise to help you, but I don't. My best advice is to look at who has gotten a grant, and reach out to them for advice. We will be doing a webinar on this with the World Massage Conference, but not till next spring.
Michele: Is there any research being done on massage and sleep apnea?
Ruth: Hmm, a quick check on PubMed.gov shows a lot of studies with the keywords Massage and Sleep, but not on sleep apnea. Sounds like a good time for a case report!
Victoria: This sounds like a great topic. What kind of research is most beneficial for Board Certified Massage Therapists to enhance their practice and comply with CE's? I have done a lot of research as a nurse and future doctor – how will it differ as a therapist?
Ruth: I don't quite understand the second part of your question… but as far as the first part goes, that's up to you. Are you interested in orthopedic work? Be sure to get on the list for the Fascia Research Congress: 3 days of research all about fascia that happens every 2 years. The MTF's research conference happens every 3 years; next will be in Seattle in 2016. Our website lists upcoming meetings and events that include integrative healthcare meetings as well.
Allison: How is research affecting the ability of massage therapists to be a member of a patient's health care team, and be reimbursed by insurance?
Ruth: Yes—with the caveat that this depends on local rules and regulations. The insurance reimbursement issue is a moving target. The more research we have that demonstrates the benefits of massage, the better case we can make.
Jo Alese: My questions are on certification again in 2015. What are the 3 hours of research required? Can you be clear on what this is exactly? I became Board Certified last year. Are you requiring all the documentation of school and CEU’s again?
Ruth: The MTF and NCBTMB worked together to identify what kinds of classes will qualify for the research requirement. They are described here: http://info.massagetherapyfoundation.org/blog/bid/320458/The-NCBTMB-research-requirements-for-Board-Certification. As for the rest of your question, I have to leave that to the NCBTMB folks.
Judith: If research and literacy education is required to maintain membership, will NCBTMB make the course available or provide links where a course can be found?
Ruth: This is a question for the NCBTMB, but I can suggest you start at massagetherapyfoundation.org and look at our Basics of Research Literacy course. Education and Training Solutions also has a shorter course available that meets the criteria for research education.
James: Thoughts on the idea of a license for medical massage and a license for therapeutic (body worker) massage?
Ruth: I have lots of thoughts on this, but they boil down to a few key (and somewhat contradictory) points. 1. If I were queen, there would be a way for MTs who are academically ambitious to pursue an advanced degree in their field; this doesn't exist at present. Not everyone would HAVE to, but some could if they wanted to. 2. If I were queen there would still be room for the deeply talented MT who doesn't want an academic degree. 3. As a pathology teacher, I see that people with serious, complicated illnesses go to the spa and the salon for massage. This means that these MTs either need to know how to work safely with these folks, or they need to be able and willing to refer out. I don't think we're there yet.
Joanne: What qualifications should I be looking for when attempting to validate any research proposals/papers I read (i.e. how do I know what information to trust)?
Ruth: I LOVE this question, thank you!! Evaluating what we read is a critical skill. I have several suggestions. One is, buy "Making Sense of Research, 2nd ed." by Martha Menard, and have her chapter on reading a research paper available when you're reading. We will also be offering a class on this at AMTA National in Denver in September. In the meantime, go back to what you can identify as possible weaknesses: did the author control for bias? Were the groups randomized? How was the issue of variables or confounding factors handled? Was there enough description of the massage that you could make sense of it? And so on. It's not easy, but it is very, very important.
Deborah: Is there a way to measure pain levels beyond the subjective experience of the recipient? How have drug companies "proven" the effectiveness of pain meds, for instance?
Ruth: There are several questionnaires (called "instruments") that have been developed to look at pain severity, pain bothersomeness, and dysfunction. They all depend on the patient's subjective experience, but as long as the instruments are used consistently, that is not considered a problem. They have been extensively validated through years of use.
Regarding your 2nd question, there's that word "proven" again. The technical answer is no. Meds are easier to research than manual therapies, and, of course, there's a LOT more money to invest in research, but meds still create different reactions in different individuals – just like massage. This is why you'll hear disclaimers like, "Enbrel isn't for everyone..." and so on.
Kimberly: What kind of institutions support and welcome research in the massage therapy arena? What are the changes that support CAM modalities as far as research?
Ruth: Lots of institutions are open-minded to massage, as long as there is a way to pay for it. Different hospitals use different systems for this, but we are increasingly finding a home in this setting. Military programs for disabled vets love massage, but, again, finding a way to do this as a profession and not just for pro bono work is the challenge. The deeper our evidence base, though – the more we can point to high-quality studies that demonstrate that massage is a low-risk, high-benefit intervention – the better off we are.
Kate: I am very interested in hearing how to best keep up with current research as a massage therapist. Thanks!
Ruth: You have so many options! What trade journals do you read? All of them— Massage Therapy Journal, Massage Today, Massage and Bodywork and Massage Magazine, now have a research column—make sure you read that. You can also arrange for alerts from Pubmed.gov and Google Scholar for every time an article with your keywords is published. I review at least the abstracts of several articles each week with the keywords “massage” and “pain.”
Sandra: What kind of sponsorship and support are available if I have a research project in mind? And what procedures are required to obtain this support? I practice in Botswana, primarily with HIV/AIDS patients, and have experienced remarkable results.
Ruth: You might consider our Community Service Grants. These are international and they are designed to help deliver massage to people who would otherwise not have access. They are also a great way to be introduced to the grant-writing process. We have had CSG recipients go on to write successful grants for larger projects.
Mindy: As a massage therapist of 20 years, working in private practice, as well as working with in patients in a local hospital, I am interested in participating in doing massage research. What opportunities are available for a massage therapist?
Ruth: With your experience and expertise you'd probably be very welcome on a research team. Please watch for the MTF's next e-Book, “How to Connect with a Researcher” for some specific ideas about how to pursue that dream.
Thank you to all who joined us for this important webinar! To be notified of future webinars, please register your email address at http://www.ncbtmb.org.
We hope to see you at our next webinar!