Research conferences offer an engaging environment to do more than listen to presentations on research. Conferences are an opportunity to interact with research, to feel a part of the process of discovery and inquiry.
Academic debate is encouraged: time is provided after each research presentation for peers and clinicians to critique a researcher’s work, offering compliments and constructive criticisms on the study, and suggestions for future research. Groups gather at breaks and during structured networking sessions to explore pertinent topics, such as how to better study the therapeutic relationship, if specific techniques are effective for certain populations, and how massage really works. Collaborations are born during poster sessions, combining fields of study to enhance the quality of information uncovered. Therapists and researchers connect to fulfill teams for upcoming projects, ensuring people with massage expertise are involved in the studies. Conferences can be a stimulating environment for all level of participants, from the top researchers receiving million-dollar grants to the budding somatic therapist trying to understand how research impacts their new profession.
While I may be biased because of my role as planning chair, I do believe the Massage Therapy Foundation’s Highlighting Massage Therapy in Complementary and Integrative Medicine (CIM) Research (Highlighting) conference, held in Seattle, Washington, May 13-15, 2010, was an interactive event of extraordinary proportions.
Newcomers to Research
Not only were current research findings specific to massage and bodywork presented at the Highlighting conference—much of which had yet-to-be published—but unique opportunities were provided to practitioners new to the world of research. A goal of the conference was to level the playing field and promote open dialogue between clinicians and researchers. In the opening remarks of the conference, guidelines for engagement were provided to the practitioners, explaining the process of academic debate and encouraging participation.
Additionally, clinicians were counseled to keep an open mind, understanding that new information might refute theories previously held as truths. Researchers were cautioned against making assumptions about the literacy of participants and were asked to define research terms and explain processes in detail. Researchers were also informed of the prevailing perspective that research is only beginning to catch up to what we already believe to be true about massage and bodywork, and were asked not to ignore the art while attempting to define the science of massage.
Experiential workshops were offered in addition to traditional research breakout sessions. These workshops demonstrated practical applications of research and provided hands-on translational research experience to newcomers. For example, in Whitney Lowe’s workshop, small groups analyzed a variety of case studies, discussing how research might inform all aspects of clinical treatment planning: selecting assessment techniques, identifying indications and contraindications, selecting treatment modalities, and choosing measurement tools to denote progress. To close, the groups identified gaps in the research, such as the lack of dosing studies to assist practitioners in recommending frequency and duration of sessions to clients with various conditions, completing the loop of translational research. (Translational research is the conversion of basic science data into information that informs clinical practice. The reverse is the other critical component: clinical findings must inform research to ensure future research has clinical relevance. In other words, it is as important to influence research as it is to be influenced by research.)
To further enhance the dialogue between clinicians and researchers, mentoring was available during networking sessions. Keynote speakers Dan Cherkin, PhD, Whitney Lowe, and Helene Langevin, MD, were among those who led small group discussions on clinical research, translational research, and educational research over boxed lunches.
In addition, newcomers to research were invited to stay after the close of the conference to ensure all their questions were voiced and hopefully answered. MTF President Ruth Werner and research department chair of the Massage Therapists Association of British Columbia (MTABC) Bodhi Haraldsson fielded questions from about 80 practitioners over lunch. Many massage therapists were relieved to find that research was neither boring nor confusing, and they look forward to participating in more research conferences in the future (per conference evaluations).
Components of a Research Conference
Typically, each day of a research conference begins with keynote presentations. Keynotes speakers are seasoned researchers or clinicians that can speak to a large body of research done throughout their careers, highlighting trends pursued, conclusions drawn, and questions left unanswered. Often, keynote speeches are exhortative, posing new theories and concepts in an attempt to incite debate and encourage future inquiry into promising, yet controversial theories or concepts.
At the Highlighting conference, two keynote presentations began each day, followed by a 45-minute break for networking and viewing poster sessions.
Poster sessions provide opportunities to view summaries of research presented on poster board using a visual format and connect with the researchers one-on-one. Posters often represent smaller studies—surveys, case reports, and pilot studies—and discussion is important for the evolution of these smaller studies into larger projects. At Highlighting, clinicians were able to glean treatment-planning concepts from a number of posters regarding working with seniors, burn survivors, cancer patients, and even enhancing the golf swing.
Panel presentations are a useful tool for provoking discussion and often raise many more questions than answers. This was certainly true for the panels that ended each morning session at Highlighting. Several calls for action were put forth, raising the issue of funding for whole systems research methods—emphasizing research methods other than the standard randomized controlled trials—that adequately evaluate the massage experience verses reducing massage to individual techniques. A request for integrative opportunities in health care—team approaches to care with consistent and respectful open dialogue between massage therapists and all health-care providers—rather than parallel care were declared as critical and defining of true integration.
Breakout sessions provided a venue for topic-related clusters of research data. Breakout sessions took place each afternoon in two different forms: three research presentations and two experiential workshops—a unique format for translational research mentioned earlier. The research presentations were divided by topics, such as Massage Therapy in Collaboration with other Health Care Systems, Massage Therapy Research and the Musculoskeletal System, and Massage Therapy Research on Pain and Anxiety. Five research projects were presented per breakout, with adequate time allotted for questions and discussion. The three-hour workshops were led by a single presenter, and focused on research that defined specific assessment techniques (as in Leon Chaitow’s session) or modalities (Masahiro Takakura and Kinesio Taping for inflammatory conditions).
The final day of Highlighting positioned two reports from the profession in lieu of a panel presentation. John Balletto reported on the Best Practices Symposium held immediately prior to the Highlighting conference, and Chip Hines and members of the Body of Knowledge Task Force announced the release of the profession’s first body of knowledge document and shared the work of creating the document. A body of knowledge document often defines a profession and contains the knowledge, skills, and abilities (KSAs) of the profession. In this case, the information describes the massage therapy profession, outlining the KSAs necessary for therapists to be safe and effective practitioners. Best practices draws from the body of knowledge of the profession and attempts to outline decision-making processes for massage-specific client presentations, such as low-back pain or stress. Both are huge undertakings, the results of which become living documents that inform the profession and all its stakeholders; they will shift and expand based on new information as it arises.
Highlights of Highlighting
Provocative statements abounded from the podium. One stirring bit of data came from Dan Cherkin, PhD, from the Group Health Research Institute (GHRI), during his talk “Is Massage Effective for Back and Neck Pain—Applying the Research to Your Practice.” The following statement was made based on research findings: “Relaxation massage is at least as effective as structural massage.”
The GHRI recently completed a study, which was funded by the National Institutes of Health (NIH), that investigated whether the type of massage matters for low-back pain. The study compared relaxation massage to structural massage in more than 400 people with chronic back pain. Relaxation massage was defined as, “Swedish techniques intended to help back pain by inducing a generalized sense of relaxation.” Structural massage consisted of “various techniques (including neuromuscular and myofascial) intended to identify and alleviate musculoskeletal contributors to pain.”
The participants were randomized into one of three arms: relaxation massage, structural massage, and a “usual care” group. Those randomized into the two massage groups received up to 10 massage treatments over 10 weeks. Assessments were done after 10, 26, and 52 weeks. Both the relaxation and the structural massage groups performed better than the usual care group on the Roland Score, measuring at least 3+ point gains in function. Other benefits that persisted through the 52 weeks included a decrease in the number of days with reduced activity, global ratings of improvement, and satisfaction with overall care for back pain.
The study concluded that relaxation massage is an effective treatment for chronic back pain, with benefits lasting at least one year, and that relaxation massage is at least as effective as structural massage. The study’s results confirmed findings of smaller trials.
The study has not yet been published, but when it is, more debate is anticipated and a flurry of activity is sure to follow. Due to the high level of controversy already expressed, studies will likely be launched to verify the results. The implications of data such as this are far-reaching to clinicians and researchers. Therapists invest dollars and time annually to learn advanced skills to better treat conditions such as back pain. Researchers frequently analyze specific techniques to determine if one more effective than another. On the other hand, results such as this may encourage researchers and clinicians alike to look at other components of a massage session to better understand the benefits of massage: the therapeutic relationship, the quality of communication (listening and educating), and the environment. There is much to learn about what makes a good massage.
Prevailing Themes of Highlighting
Massage for acute care was a persistent theme spoken from the Highlighting podium, in posters, and throughout an entire breakout session. Hospitals investigated the feasibility and effectiveness of providing both in-patient and out-patient massage therapy. Patient satisfaction was a dominant outcome.
Keynote Willem Fourie, a physical therapist from South Africa, spoke of using manual fascia techniques with breast cancer surgical patients, and shared ultrasound images of a cancer patient and her scar tissue before and after manual therapy. It was thrilling to see changes in the density of the scar tissue and the increased continuity and glide of tissue as it normalized post-massage. Perhaps more researchers and clinicians will now employ ultrasounds to map the progress of scar tissue and healing with hands-on therapies after seeing what data can be made available through ultrasound technology.
Five oral research presentations spanned the topic of massage therapy in hospital settings and acute care patients. The following are summary statements from some of the studies presented during the breakout session:
• “Massage therapy may improve the patient experience after colorectal surgery. Results of the study indicated that the massage therapy group had greater improvement in values than the control group [20 minutes of personal attention]. It was feasible to have a massage therapist see patients in the colorectal surgery units. Patient feedback was very positive.” Nikol Delzer, LMT, Enhancing Healing for Colorectal Surgery Patients: The Results of a Randomized Controlled Study of Massage Therapy with Colorectal Surgery Patients.
• “There are benefits to cardiac surgical patients for using massage therapy to reduce pain, anxiety, and tension … Significant benefits for decreasing pain may be better when providing massage therapy later in the hospital stay (day 3 or 4 versus day 2).” Liza Dion, RMT, Nancy Rodgers, CMT, Effects of Massage Therapy on Pain, Anxiety and Tension with Cardiac Surgery Patients: A Randomized Study.
• “Massage therapy can provide pain relief and relaxation, support a patient’s emotional well-being and recovery, and can ultimately aid in the healing process for hospitalized patients.” Rose Adams, MHA, BSW, LMT, Barb White, MS, LMT, Cynthia Beckett, PhD, RNC-OB, LCCE, The Effects of Massage Therapy on Pain Management in Acute Care Setting.
Five of 28 posters presented data on the effectiveness and feasibility of massage therapy for inpatient and outpatient and pre- and post-operative care. Summary statements from the poster sessions include:
• “Massage with or without guided imagery produces an immediate reduction in self-reported anxiety in patients awaiting cardiac catheterization, regardless of patient hospitalization status (inpatient versus outpatient).” Karen Armstrong, NCTMB, et al., Reducing Anxiety in Pre-operative Cardiac Catheterization Patients Following Massage and Guided Imagery.
• “Inpatient massage at the patient bedside produces an immediate reduction in self-reported pain and anxiety levels, regardless of length of massage (15 versus 30 minutes), however a more pronounced effect was found with the longer massage.” Karen Armstrong, NCTMB, et al., Assessing the Effectiveness of Inpatient Massage.
• “Patients undergoing intra-arterial chemotherapy to treat primary glioblastoma multiforme, the most common and most fatal intracranial tumor, experience anxiety and back pain related both to disease and treatment … This case report illustrates how … specific situational anxieties and pains were palliated through a combined use of reflexology and massage therapy provided bedside during hospital admissions.” Anthony Balluff, ARCB, Jeremy E. Miller, NCTMB, and Jeffery A. Dusek, PhD, Inpatient Hospital Treatment of Brain Tumor: Integrating Reflexology and Massage.
In Closing
Attendees participated in the formation and testing of hypotheses, and the debates that ensued will inspire research into the future. One example that incited debate at Highlighting is that fascia is a sensory organ, a complex communications system capable of mediating musculoskeletal function, and is not to be ignored or left out of anatomy texts.
Groups formed at Highlighting are putting ideas into action: one such group is contemplating rewriting CONSORT guidelines for massage therapy research publications. Another is putting together a journal club with monthly meetings.
Dilemmas were identified: hospital internships are being developed, yet there are relatively few employment opportunities currently available in hospitals. Raising the questions and engaging in public discourse may contribute to solving this issue.
Highlighting was an interactive experience that brought the scientific process to life.
A licensed massage practitioner since 1984, Diana Thompson has created a varied and interesting career out of massage: from specializing in pre- and postsurgical lymph drainage to teaching, writing, consulting, and volunteering. Her consulting includes assisting insurance carriers on integrating massage into insurance plans and educating researchers on massage therapy theory and practice to ensure research projects and protocols are designed to match how we practice. Contact her at soapsage@comcast.net.