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Research literacy vital for RMT practice, professional growth

Before you dismiss the value  of research literacy, have a look at the
following information that will explain how this skill can benefit you,
your practice, your clients and, collectively, our profession. At the
very least, they are an important part of upholding our commitment to
ethics and professionalism.

Great strides have been made in the
last few years with respect to evidence-based practice in massage
therapy and, more recently, research literacy has become a mandatory
part of curricula for massage therapists across the country. The
question is, since doctorate level academics are those who are
considered competent to assess and review scientific research articles,
how can we expect massage therapists to do so at the same level? Here is
the answer: we don’t.

No one is expecting massage therapists to
wear lab coats and evaluate the statistical significance of the results
of their practice. The expectation for the research literacy of massage
therapists is simply to know where to find it, how to read it, who to
engage, and how to ask the right questions to determine the
study’s credibility. Another important expectation of massage therapists
is to responsibly educate clients about the results the research
identifies.  

Susan Salvo’s book, Massage Therapy Principles and
Practice, cited Dr. JoEllen Sefton, author of Research Literacy and
Massage Therapy, defining research literacy as the “ability to locate,
read, understand, and evaluate research literature. For massage
therapists, this means being able to incorporate the information found
from reliable studies into your massage practice and to communicate
research findings to others. It gives you the skills necessary to become
good consumers, trustworthy sources of massage information, and
independent lifelong learners.”

Enhancing professional
development
When you have a clear understanding of how a technique works,
you become better at it naturally. By learning how to find, interpret
and criticize research articles, you are enhancing your knowledge on
that particular topic, indirectly impacting your skills in a positive
way.

Because research in massage therapy is still in its infancy,
massage therapists have an opportunity to become a trailblazer in the
field, an expert in a particular modality that not only clients but your
peers will rely on for expertise.  

Grow your business
By
becoming research literate, you will be able to speak the language of
other health-care practitioners. Being able to explain research findings
related to massage therapy to physicians, for example, in a way that
they understand can increase your credibility and the likelihood that
they will send you referrals.

Our profession is always
justifying our role in health care to insurance companies who are often
hesitant to cover massage therapy. What would your clients not being
able to be reimbursed for massage do to your practice? Research literate
massage therapists can help change the way our profession is viewed by
the insurance companies, thereby creating less resistance to coverage
for your clients.  

Having an ability to understand and to
explain how a particular modality works can open the door to many new
markets. Clients coming for massage simply for relaxation may decide to
increase the frequency of their visits to help treat symptoms they
previously believed were off limits to massage.  

Through word of
mouth, people will recognize you as a well-informed practitioner.
Clients are increasingly becoming better consumers these days as they
are becoming more familiar with the “evidence-based practice” movement.
People may be more willing to tell their friends and family about their
massage therapists if they think their therapists are familiar with the
latest information about massage therapy.  

Turning your clients into better consumers
By
educating the client on the difference between what seems to work based
on experience versus what has been shown to work based on scientific
evidence, massage therapists are empowering their clients to become
better consumers of their health care. Massage therapy clients will
appreciate this and may even respect their practitioners’ opinions that
much more because of it.

Making a difference in the profession
I
spent the last few months reviewing articles, and obtaining the
opinions of colleagues (including students), clients (including
potential clients) and other health-care professionals (including
physicians) on research in this profession. It is becoming increasingly
clear that we need to do more to improve our credibility within the
health-care industry.

The results of my informal investigation
revealed a divide amongst the profession. On the one side are massage
therapists who believe the proof of effective practice lies in the
results they have witnessed in their own experiences. On the other side
are those who exclusively support evidence-based practice and believe
there is no more room for such anecdotal data.  

These two
extremes make it difficult to unite as a profession in our goal to
adhere to our commitment to responsible health-care practices.  

Author
Susan Salvo says, “Some MTs do not understand the role of research. It
should inform our practice – enrich what we already do. Good research
improves our understanding and helps us be more effective. On the flip
side, we should use our knowledge and skills to best serve client goals
without inserting our own agendas. For example, when clients request
deep pressure massage to address pain in the neck and shoulders, it
would be ‘professional suicide’ to use only lighter pressure because you
read a study that indicated lighter pressure is more effective to
reduce pain. When you put your own agendas ahead of your client’s goals,
they may leave feeling like you were not listening to them and may not
reschedule.”

Anecdotal information is, by its very nature,
unreliable. However, that is not to say it is not extremely important.
After all, it can form the basis for a research question (hypothesis)
that can change the face of how we practice. Without anecdotal
information, we wouldn’t have research.  

There is room for both
schools of thought: the therapists who are dedicated to their personal
experiences, and those who are dedicated to research. The trick is how
we are conveying the information to our clients.

My discussions
with clients, and other health-care practitioners revealed a gap in the
perception of what massage therapists are capable of. Most clients are
not aware of the extent of our knowledge and skills. Sure, we can expect
the Registered Massage Therapists Association of Ontario (RMTAO) to do
this advertising for us or wait until someone provides us with more
funding. At the end of the day, it is the individual interactions that
massage therapists have day-after-day that will make or break our
credibility.

How can we convince people of our value if we are
not able to support it with reliable information? Coming up with our own
theories of how the treatment works may be satisfactory to some people,
but is that really a responsible way to provide information? Try that
same rationale with physicians who refer clients; you won’t be taken
seriously, and that alone will affect our entire profession.

Professional ethics in research
The
problem with relying solely on anecdotal information is that there are
many other factors that can disprove a direct cause-effect relationship
of a particular modality or technique. For example, you may have
experience treating a hundred clients with trigger points using ischemic
compressions, and in every case, the pain decreased. It is easy to
believe the ischemic compressions caused the decreased pain given that
all of the clients responded in the same way. There is, however, no way
to be certain the clients’ breathing habits, the warm up of effleurage,
or the flushing of petrissage aren’t what actually contributed to the
decrease of pain. There are other possibilities too: the lotion used,
the positioning of the client, the mood and lighting in the room, the
music used. Any one of these factors leaves room for the possibility
that the ischemic compression alone was not the main contributor to pain
reduction among clients yet, many of us feel confident enough to make a
statement to our clients saying, “Ischemic compressions will reduce
your pain.”

Bodhi Haraldsson, research director with the Massage
Therapists’ Association of British Columbia (MTABC) said, “As a
profession, we have the duty to conduct the research that tests the many
hypotheses we have developed over more than a century of our existence.
We cannot just say, we’ve been doing this, let’s keep doing it. We
can’t just say, I see it work in my office every day. The lack of
control makes it impossible to determine if the positive outcome we all
see with our patients is actually due to what we do, rather than the
other non-specific effects of placebo, context and faith in us. This is a
moral duty of our profession to ensure that those things we profess (to
profess expertise is where the word profession comes from) have
validity."  Haraldsson previously sat on the board of the College of
Massage Therapists of British Columbia and served as vice-president at
the MTABC.

Our peers, clients and other health-care professionals
expect massage therapists to have a basic understanding of what to look
for in determining the credibility of evidence-based therapy. So many
clinical trials exist today, but that doesn’t mean they were conducted
properly, yet more and more massage therapists are using these studies
to support their claims that a particular technique will yield a
particular result. Factual statements should not be made on the basis of
studies that are invalid or unreliable. Massage therapists, at the very
least, need to have a basic understanding of how to seek out research
to stay current with the latest information and identify red flags and
know what questions to ask to critically evaluate an article, or any
information suggesting a cause-effect relationship.  

Let us
reflect on our Code of Ethics principles put forth by the College of
Massage Therapists of Ontario (CMTO) and how being research literate is a
basic requirement to adhere to our ethical principles:

• The
  Respect for Persons principle includes “ensuring that clients are as
  fully involved as possible in the planning and implementation of their
  own health care” (CMTO). If we inform our clients that a modality or
  technique will decrease their pain when we are basing it on anecdotal
  data, not factoring in the other potential contributors, our clients are
  planning their health care based on misleading information.

• Responsible
  Caring includes “promoting the client’s best interest and well-being,
  through the highest possible standard of professional practice” (CMTO). 
  Do we define the highest possible standards as providing the client
  with information that leaves room for error?

• The definition of
  Integrity in Relationships is “to practice with integrity, honesty and
  diligence in our professional relationships, with ourselves, our
  clients, our professional colleagues and society” (CMTO). We are not
  acting with integrity when, for example, we know that there may be other
  factors contributing to someone’s pain reduction, yet we say it is
  definitely due to the ischemic compression.

• And finally,
  Responsibility to Society not only dictates our “commitment to
  continuous improvement” (CMTO), it also expects us to participate in
  “the promotion of the profession of massage therapy through advocacy,
  research and maintenance of the highest possible standards of practice”
  (CMTO). Unless we are using scientific evidence to support our claims
  of cause-effect relationships, we are not fulfilling our responsibility
  to society using the highest possible standards of practice.

Responsible communication
When
communicating with our clients, there are ways to educate them about
the difference between anecdotal information and evidence-based
practice. Once you are familiar with what is out there in terms of
trustworthy research, you can say for example, “In my experience,
whenever I perform ischemic compressions, my clients seem to experience a
reduction in pain, but there is no evidence that I am aware of to
support that this is what causes the reduction of pain. If you are
willing to try it, we can get started.”  Or, “Some small studies have
shown that ischemic compressions may result in the reduction of pain,
however more research still needs to be conducted. We can always try
this technique and see if it works for you.”

These types of
responses allow the therapist to continue practicing a modality or
technique that they believe works, while providing responsible, informed
information to the client who now fully understands that ischemic
compressions may not actually cause a reduction in pain before they
provide consent to treatment.

Research in massage therapy is
still in its infancy. We cannot stop our careers while advances in
science are still being hypothesized. We can, however, change our
thinking about the effects of our work by becoming curious and skeptical
– continuing to ask ourselves “why the result is the way it is”,
encouraging those practitioners who are interested in pursuing their
careers in research to answer these questions for us.  

In the
meantime, we can continue to practice modalities and techniques that are
safe and seemingly effective, provided we educate our clients
responsibly about the differences between anecdotal information and
evidence-based practice, so they can make an informed decision about
their own health-care treatment plan.  

Here are some inexpensive
online resources to help you learn more about research literacy and
access articles related to massage therapy.

The Basics of Research Literacy
Massage Therapy Foundation
Cost: $59
Time Commitment: 8 hours

Understanding Research: An Overview for Health Professionals
Coursera: University of California
Cost: Free
Time Commitment: 6 weeks (2-4 hrs per week)

———
Jennifer
Bloch, RMT, is dedicated to research and supporting the integrity of
the massage therapy profession. She was a recipient of the 2013 Award
for Excellence in Research and Interpretive Studies by the Canadian
Council of Massage Therapy Schools. Jennifer is the owner of BusyBodies
Health, a mobile massage company that provides other health-care
services in the interest of saving people time to focus on their healthy
lifestyle. BusyBodies Health also offers professional development
workshops to health-care practitioners leveraging the expertise
of Jennifer’s previous career as a human resources manager. Jennifer plays
an active role in educating the public and her peers on the difference
between anecdotal information and evidence-based practice, enabling
clients to make informed decisions about their health-care plans, and by
providing her peers with resources to help interpret research studies
related to massage.