Antony J. Porcino , BSc, PhD, HSI
Complementary Medicine Education and Outcomes Research Program, British Columbia Cancer Agency, Vancouver, BC, CanadaTherapeutic massage and bodywork (TMB) is now an established field of research with dedicated funding, researchers, and many venues and channels for dissemination of TMB research. Research agendas are a way for a profession to focus the development and funding of research on facets of TMB practice and education that are most needed at a given point of time to best move forward the practice and professionalization of TMB. Of the two TMB research agendas, one is currently being updated, the other is newly developed. Because of the impact on the development of the profession, gaps in research agendas also need to be carefully considered. Three areas that could use further consideration or support within the current agendas include education, methods and methodologies, and underlying assumptions. TMB researchers need to engage with and support the current agendas, and participate in their evolution.
In recent years, research on therapeutic massage and bodywork (TMB) has grown, as evidenced by the increasing numbers of publications with massage-specific research articles, dedicated TMB research infrastructure (TMB-specific funding and journals), and individuals conducting research in this field. As a result of those efforts, complementary and alternative medicine conferences, as well as the International Massage Therapy Research Conference and the International Fascia Congress, have become established venues for presenting research on massage. Research agendas are an important component of this development because they provide guidance for establishing the TMB evidence base and continued professionalization. Based on consensus of the profession, research agendas comprise a roadmap of key areas that deserve increased research focus. In particular, they are important for establishing (a) where the profession (practice and research) is currently at, (b) what the profession wants to be recognized for in coming years, and (c) what the profession needs to do to attain those goals.
There are at least two massage therapy research agendas in development. The American Massage Therapy Research Agenda (AMTRA) was first articulated in 1999.(1) At the International Massage Therapy Research Conference (IMTRC) held in Boston this past April, efforts to update the agenda were begun by looking back at what was achieved and then engaging conference attendees in discussing what research we need now. Last November (2012) , Canadian massage therapists also began a process of developing a massage therapy research agenda focused on the needs of Canadian massage therapists; the IJTMB has received a copy of the proceedings from this meeting for peer-reviewed publication in an upcoming issue. Many aspects of both these agendas are relevant to any TMB practice environment, regardless of the country of origin.
Informal appraisal of the 1999 agenda relative to the state of the research today, as exemplified by the breadth of topics presented at the 2013 IMTRC and in this Journal, indicates uneven progress in different research areas. It is apparent that some progress has been made in establishing the biological basis of massage therapy, in research of the profession, and research from a wellness paradigm. Most TMB research focuses on the efficacy or effectiveness of massage, with solid advances in understanding the value of TMB in health care. However, three areas of TMB research are deficient in progress: education, methods, and definitions.
Education research is highlighted in both research agendas (including the 2013 AMTRA update). TMB education research is needed to ensure that we are educating practitioners who can integrate research and best-practice professional development into their work, know how to integrate with other health care providers, can apply research to their work, and are active learners who ensure their skills remain current in the ever-shifting face of health care. An analysis of how these issues are managed in related fields, such as physiotherapy and chiropractic, could assist the TMB field to move this agenda topic forward.
Despite the occasional development of TMB-specific research theory and methods during the course of research, systematic summaries of what makes a successful massage trial for different methodological and outcome problems or research goals— and the limitations for each approach—have yet to be articulated in a clear, unified, and evidence-based manner. Methodological concerns, such as effective study blinding or identification of optimal techniques or protocols, are important for advancing the field. However, they have been a low priority in the research literature on TMB, even though methodological discourse often becomes a subtext of discussions when reviewing proposed research or manuscripts for publication. Pragmatic and comparative effectiveness trials provide one solution to some TMB methodological concerns such as blinding, but do not address underlying limitations, such as optimizing protocols, and are rarely used to assess the value of different TMB techniques or therapies for a specific condition or desired outcome. Given the dependency of research outcomes on the research methods, more focus is needed on this topic in research agendas, even if it is less sexy (with thanks to Sandelowski and Lynaugh for that phrase(2)).
Finally, while the development of research agendas and methods is important to the development of the research in the field, it must also be stressed that any research agenda will be defined by its nomenclature and underlying contextual assumptions. Not addressing those assumptions will limit the transferability and generalizability of research results, as well as efforts in knowledge translation and clinical adaptation. One such issue to watch is how massage, massage therapy, and therapeutic massage are defined within the scope of each project, and the subsequent interpretation and generalizability or transference of the results. There is often an assumption of similarity of interpretation of “massage”. Similarly, there are still few studies that compare the strengths and weaknesses between different types or techniques of TMB even though mechanistically they may be similar or used to achieve similar outcomes. For example, Swedish massage, fascial massage, shiatsu, and craniosacral therapy are, anecdotally or with limited evidence, employed for headache and neck tension.(3–5)
Opinions regarding the included topics of the current agendas vary; consensus cannot encompass all opinions equally. Regardless, research agendas are an opportunity to bring awareness to issues, direct research efforts, and provide a basis for funding development and allocation. Research agendas are also living documents that must change and evolve according to what has been accomplished in the agenda, as well as in response to the context or environment of the profession’s research need. As TMB practitioners and researchers, we need to engage in and support their development, expect transparency in their application, actively use them (where does our research fit, where can we take projects on?), and participate in their evolution. They are an important factor in the long-term shaping of TMB practice and integration into health care systems.
The author declares there are no conflicts of interest.
1 Kahn J. Massage Therapy Research Agenda, 1st edition. Evanston, IL: American Massage Therapy Association; 2002:1–17.
2 Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334–340.
3 Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA. Are manual therapies effective in reducing pain from tension-type headache? Clin J Pain. 2006;22(3):278–285.
4 Quinn C, Chandler C, Moraska A. Massage therapy and frequency of chronic tension headaches. Am J Public Health. 2002;92(10):1657–1661.
5 Puustjärvi K, Airaksinen O, Pöntinen PJ. The effects of massage in patients with chronic tension headache. Acupunct Electrother Res. 1990;15(2):159–162.
The author thanks colleagues Moraska, Boulanger, Munk, Hymel, and Lowe for their insight during the development of this editorial.
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INTERNATIONAL JOURNAL OF THERAPEUTIC MASSAGE AND BODYWORK , VOLUME 6 , NUMBER 3 , September 2013