In health care, one size fits none
Integrating therapies for pain
Chester ‘Trip’ Buckenmaier III MD and Integrating Massage in Civilian & Military Settings Panel: L-R: Brent Bauer, Brent Jackson & Allison Mitchinson Photo credit: Mandy Vukits, Massage Therapy Foundation
The Massage Therapy Foundation (MTF) hosted its fourth triennial International Massage Therapy Research Conference (IMTRC) in Seattle on May 12-15, 2016. In addition to providing outstanding networking opportunities, this conference consistently delivers an impressive lineup of massage therapy thought leaders, change agents and champions.
Three, well-organized, days of keynotes, panels, breakouts and workshops made for an exciting, user-friendly, and clinically-relevant event. The lovely venue, fabulous vendors, intriguing posters and enthusiastic attendees added further value to this world-class conference. Not one to miss this event, I was there furiously taking notes – here are some highlights.
Integrated pain care
An integrated care approach involves patient-centred, coordinated, collaborative care over time. Such an approach is paramount for improving the patient/client experience and for achieving effective outcomes. This is especially true when addressing a multidimensional issue such as pain.
Current pain science confirms that context is everything when it comes to pain management. Treating a patient's pain requires more than imparting an effect on the person's nervous system, it requires considering, and working with, the whole person. Dr. Buckenmaier (Panel Presentation: Integrating Massage in Civilian & Military Settings) suggested we may be using a wrong or incomplete metric (intensity only) when evaluating chronic pain – encouraging more emphasis on function, quality of life and biopsychosocial considerations.
Pain prompts many to seek-out massage therapy care. Yet, RMTs are infrequently included in mainstream, collaborative teams addressing pain – this seems counterintuitive. So, why are RMTs not routinely part of the team? Answering this question was an overarching theme of the conference. For starters, evidently, our own perception of ourselves and our profession serves as unnecessary barriers to inclusion – consider this a plea to stop shooting ourselves in the foot.
Several physician-presenters strongly urged us to stop considering massage therapy an outlier in health care and encouraged us to firmly take our rightful place in integrated care.
Although we may not, yet, clearly understand massage therapy mechanisms of action, it is widely accepted that massage therapy 'works.' Ever increasingly, we are being called to identify the problems that massage therapy can solve or provide assistance with and, to bring this to the attention of the open arms wanting to embrace our profession and all the good we bring to the table (pun intended). It appears that we just need to, "get the camel's nose under the tent and the rest will follow," said Colonel Chester 'Trip' Buckenmaier III, MD.
Additionally, Buckenmaier, and several other presenters, stated that massage therapy could be much better utilized in the care of returning veterans.
To advance inclusion opportunities, collectively, conference presenters identified three key values the profession needs to establish or improve: standardized education/training, professionalism and knowledge currency. Considerable inconsistencies in education, within a country and worldwide, are confusing to the public, other health-care professionals and other stakeholders, resulting in credibility issues. Credibility can be further hampered by ineffective interprofessional communication and behaviours that are inconsistent with practice standards common to health-care professionals. We were encouraged to steer clear of perpetuating historical misinformation – any information that is inconsistent with current science, is not applicable to modern clinical practice and is confusing to the public and other health-care professionals. Credible resources and evidence informed practices are highly encouraged.
[Great resources to support interprofessional collaboration can be found on the MTF website - in particular, How to connect with a researcher and Working with Physician's – a Massage Therapist's guide]
Wayne Jonas, MD: Translating evidence into practice
Jonas is the president/CEO of the Samueli Institute, the organization that recently conducted a collaborative meta-analysis of research on massage therapy for pain, commissioned by the MTF with support from the AMTA. The first part of the three-part review and analysis has been published online by the journal Pain Medicine.
Meta-analysis, considered an evidence-based resource, is a consolidated and quantitative review of a large body of research. And a meta-analysis in the world of massage therapy is ground breaking. This is the first study to rigorously assess the quality of massage therapy research and evidence for its efficacy and effectiveness in treating pain and function-related and health-related quality of life outcomes for people with various types of pain. Based on the evidence, massage therapy can provide significant improvement for pain, anxiety and health-related quality of life for those looking to manage their pain.
Jonas urged health-care providers and agencies to prepare for the first of the baby boomers hitting 65 and the impending tsunami of chronic illness coming in its wake. It is well established that pain is often partnered with chronic illness.
In the U.S. alone, opioid use escalated by over 60 per cent between the years 2000 and 2010 (likely due to boomers and returning veterans). In 2013, drug overdose was the leading cause of injury death in the U.S., the majority of which related to prescription opioid medications often in combination with benzodiazepines – reinforcing the importance of utilizing other approaches to pain management.
Jonas, a champion of patient-centred, integrated, multidisciplinary, non-pharmacological and patient self-management approaches suggested the massage therapy profession step up (armed with solid evidence that massage therapy works) and identify for stakeholders and policy makers how we can be part-of the solution to this considerable problem.
Brent Bauer, MD: Massage therapy at Mayo clinic – Research transforming practice
Bauer is the director of the complementary and integrative medicine program at the Mayo Clinic.
Mayo Clinic researchers have found that massage therapy can reduce pain and tension in people facing or recovering from many problems, including: heart surgery, breast cancer, colon and rectal surgeries. And so, it seems reasonable that massage therapy be provided in-hospital. Bauer stated that data is the way to change the conventional medical paradigm and that massage therapy research can be an important change agent. The effectiveness of in-patient use of CAM modalities, including massage therapy, at Mayo has influenced 48 hospitals across the U.S. and seven internationally. In addition to massage therapy care being co-located at Mayo, patient charting is integrated into the hospital system, and massage therapists are invited to provide input on protocols, attend grand rounds and meetings and participate in research. This is an unprecedented approached.
Jo Smith, MT, M.Ed. PhD : Changing landscapes and the next generation of massage therapists
Smith is the developer and current program manager of the Bachelor of Therapeutic and Sports Massage (BTSM) at the Southern Institute of Technology and she co-leads the New Zealand Massage therapy Research Center.
Smith asked the pointed question: who are we? Are we technicians or problem-solving, health-care professionals?
It seems intraprofessional perception and clarity issues span the globe – we certainly grapple with this here in Canada. If we, RMTs, stumble over this then it is not difficult to see why it creates confusion (Is massage therapy a luxurious treat or health care?) for the public, other health-care professionals and insurers – lending to the professional credibility issues that underpin accessibility to care and interprofessional inclusion barriers.
Going forward, Smith offered these must dos: research and higher, or at the very least, standardized education. A changing landscape that includes massage therapy educators engaged in research, massage therapy curriculum informed by research and massage therapy students competent in research fundamentals, will have a positive impact on self-perception and credibility perception across stakeholders.
Smith attests that a move toward being motivated by the collective benefit, rather than the individual benefit of higher education, may ultimately shift massage therapy forward in its journey of professionalization. Higher education assists in building a unique body of knowledge required of a profession (Epstein, 1995) and increases the capacity to learn, and to develop skills to become professionally mature practitioners (Gow & Kember, 1990; Hammer et al., 2003). Smith emphasized that expanding our inclusion in integrative care requires developing solid, critical thinking and clinical reasoning skills – hallmarks of highly educated professionals.
Integrated, patient-centred care is the embodiment of biopsychosocial, whole-person, one-size-fits-none health care. And one-size-fits-none is clearly the case in massage therapy as the complexity of the person receiving care, the issue/impairment, the person providing care and the multi-system responsiveness and drivers of massage therapy effectiveness demand case specific consideration and for us to be nimbly responsive and adaptive with our thinking/reasoning, communication and hands.
The presenters did an outstanding job exploring the multidimensional nature of pain. Participants demonstrated a high level of interest in understanding pain and connecting this to massage therapy outcomes and, to the presenters delight, asked highly-informed questions.
For those of you who have a knee-jerk reaction to the "R" word, and a conference dedicated to massage therapy research, I urge to please consider this: the user-friendly delivery of information shared at this event makes the experience ultra-enjoyable and clinically useful. If you have not attended this conference, and/or pine for a high-quality conference experience, I strongly encourage you to move the IMTRC to top of your must-go list. Mark your calendar now for 2019!
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