Features Practice Technique
Why Use Systematic Reviews

What We Don’t Know
The state of research-based knowledge in massage therapy is very incomplete and there are still relatively few studies that are available. Systematic reviews help the profession by teasing out information from mixed (multimodal) trials that include massage to show what possible benefit there is to massage therapy and what future direction research should take.

When appropriate, combining studies to obtain a common estimate can increase the statistical power for discovering treatment efficacy and can increase the precision of the estimate.

By quantitatively combining the results of several small studies, meta-analyses is able to create more precise, powerful, and convincing conclusions (Cook et al, 1997).

Investigators need systematic reviews to summarize existing data, refine hypotheses, estimate sample sizes, and help define future research agendas. Without systematic reviews, researchers may miss promising leads or embark on studies of questions that have been already answered.

Administrators and purchasers need review articles and other integrative publications to help generate clinical policies that optimize outcomes using available resources (Milne R, Hicks N. 1996).

Using the evidence
Systematic reviews can aid in practice and funding guideline development because they involve searching for, selecting, critically appraising, and summarizing the results of primary research. The more rigorous the review methods used and the higher quality primary research that is synthesized, the more evidence-based the guideline is likely to be. Summaries of relevant research incorporated into guideline documents can help to keep practitioners up-to-date with the literature.
 
Systematic reviews have also been published on the dissemination and implementation strategies most likely
to change clinician behaviour and improve patient outcomes. These can be useful in more effectively translating research evidence into practice (Cook et al., 1997). According to Sim et al (2002), evidence has three main life stages. The first stage is evidence generation, where the primary randomized controlled trials are generated.

The second stage is evidence synthesis: the translation of primary trials into systematic reviews. This synthesis or translation of data provides the clinician with one single source, where the clinician can access all the pertinent information in one paper.

The last stage is evidence application, where the systematic review is used to advise on practice guidelines, clinical education and ultimately used by clinicians to translate evidence into practice.

Although systematic reviews of treatment can lay the foundation for practice guidelines, they are not a panacea. The most fundamental limitation of relying on reviews is that they should never exclude the need for at least some critical appraisal of the original studies to understand the populations, interventions, and outcomes evaluated; the heterogeneity of these features; and the individual study results (Cook et al., 1997).

Who is going to pay?
Future funding of massage therapy clinical practice relies on the capability to show the cost-effectiveness of our approach to policymakers. Archie Cochrane said “there will always be limits on health care resources so it is important to be sure the interventions being used are effective.”

Systematic reviews can be a useful way of disseminating information on massage therapy. The reviews also objectively summarize large amounts of data, identify gaps in research and beneficial or ineffective therapies to consumers and policymakers. Health care purchasing organizations are being pressed to make decisions based on the level of clinical evidence to justify the money spent.

Systematic reviews are perceived as having the greatest influence on decisions related to program justification and program planning, and the least influence on program evaluation decision (Dobbins et al, 2001).

Systematic reviews need to address effectiveness, accessibility, relevance, acceptability and efficiency.

Issues that need to be addressed have been pointed out by DM Eddy (1993) in his article “Three battles to watch for in the 1990s. In the article, he discusses how much evidence is needed to justify treatment coverage, how many studies are required, who has the burden of proof, and who claims a treatment modality is effective or ineffective.
 
Teaching good habits
The quickest way to change practises is to modify education so it includes up-to-date information in clinical training. Systematic reviews are a unique powerful mechanism for teaching, and they offer teachers a new opportunity to model effective and rational use of information (Badgett et al, 1997).

The most opportune time to use systematic reviews is in a practical environment, when the student generates patient-relevant questions. This fosters the continuous use of up-to-date information to assist in answering clinical questions.
 
Conclusion
As seen, systematic reviews are an invaluable tool for massage therapists; they showcase what we can do and they tell us where we need to be looking in planning future research.

Having quality systematic reviews on massage therapy available to other health care professionals increases the attention and respect for massage therapy as a valid option for patient care.

Systematic reviews have the potential to become an innovative tool for massage therapists as we develop our profession and take it into the new era of evidence-based health care.