The DIY of massage therapy research
by Rebecca Barnett
As busy working clinicians, the evidence-based healthcare agenda can seem burdensome and remote. With clients to treat and businesses to run, how can we be expected to keep up with the proliferation of research and knowledge, let alone contribute to an evidence base that supports, explains and validates the specific work we do in our clinics?
One of the weird ironies of the whole evidence-based practice agenda is that research has demonstrated that the results of health research are only poorly understood by clinicians and even less well applied in clinical practice! This principle holds whether you are a GP working in a family medical practice, a physio specialising in back pain or a massage therapist treating within a whole-person framework.
However, the massage therapy profession cannot avoid the reality of evidence-based practice. It is a pervasive influence on health policy-making, third party payment systems and health economics. The National Health and Medical Research Council report into the efficacy of natural therapies is a stark case in point – massage therapy was spared from private health insurance cuts because its evidence base was stronger than many of the therapies under review. In other words, the evidence saved our collective bacon.
It is easy to fall into the trap of believing that research is somebody else’s job – the domain of a PhD scientist investigating the mating habits of the gall wasp, rather than that of the humble working clinician. However, as a professional community, we do have significant resources to draw upon that could help to foster and grow our research agenda. The most potent and under-utilised of these resources is us. This is especially true now, when patient voices are increasingly being called on to inform, guide and contribute to health research. As a profession, we see a lot of patients. Assuming that AMT’s 3000-strong membership performs an average of 10 consultations a week, that adds up to a whopping 30,000 consultations each week or approximately 1 380 000 consultations a year (allowing for holidays and sick leave). That’s potentially an enormous amount of data – waaay more than the average clinical trial. Imagine if we could harness the power of those numbers in a meaningful way?
We are far more empowered and knowledge-rich than we might think.
“But I don’t know how to conduct research,” I hear you protest “I am just treating clients, not collecting data.” Actually, that’s not true. The notes you keep in your client file are a kind of data. If you have used a tool like a visual analogue pain scale to track and record a client’s progress, then you’ve created a piece of data. And you’ve also created a platform to conduct practice-based research.
Free outcome measurement tools
Massage therapists who treat workers’ compensation clients will already be familiar with some of the available outcomes measurement questionnaires and tools, such as the Oswestry Disability Index (otherwise known as the Oswestry Low Back Pain Disability Questionnaire). Questionnaires like this are a research tool. They provide us with a recognised and accepted framework to organise and quantify our clinical data. We could readily make use of them in our clinics to conduct practice-based research.
There are dozens of questionnaires available in the public domain, including surveys that help us investigate specific conditions such as neck pain and headache. Given that they are freely available, massage therapists can make use of them to organise and record results from treatments, identify trends, and, ultimately perhaps, even contribute to the research base of our profession.
I have compiled a short list of some of the available questionnaires below, along with a brief description and links to where you can download them for free. This list is not exhaustive but contains some of the more commonly used surveys that are in the public domain. You’ll see them turn up repeatedly as the measurement tools used in clinical trials.
Perhaps the best way to select an appropriate survey for something you’d like to explore in practice-based research is to check out the available literature in a comparable area and see which measurement surveys have been selected. A quick search in PubMed is likely to yield hundreds of results and the published extracts always include a summary of how results are measured.
Did you know that PubMed can filter results according to whether full text versions of a citation are available or whether it’s just an abstract?
Or you can dip into AMT’s classified research database and find citations organised broadly by presentation/population. The 2018 update was quietly uploaded to the AMT website about a month ago.
Free Outcome Measurement Questionnaires
MYMOP is designed to measure the outcomes that the client considers to be the most important – in other words, it is a patient-centred measurement tool. It acknowledges the underlying principle that medical outcomes belong to the patient and that their experience of illness should be incorporated into the measurement process. In other words, it’s right up our alley!
Oswestry assesses symptoms and severity of low back pain in terms of disablement and the degree to which back or leg pain impacts functional activities.
NDI assesses pain-related disability associated with activities of daily living in people with neck pain.
HDI is designed to quantify the impact of headache on daily living.
So get measuring! Then we can come back here in a month or so and have a conversation about how to write a case study!
About the Author
As Secretary of AMT, Rebecca Barnett has been at the coalface of professional advocacy for 12 years. Her proudest achievements include the release of the AMT Code of Practice in 2013 and the establishment of AMT’s classified massage therapy research database. She is devoted to neologism and foodstuffs with the same specific gravity as havarti cheese but she remains ambivalent about semi-colons.