Figure 1. BTSM-generated research activities and outputs (n=151) 2002–2023.
Jo Smith, PhD, Donna Smith, PhD*
Massage Therapy, Southern Institute of Technology—Te Pūkenga, Invercargill, New Zealand
As massage therapy educators, we started with a desire to cement a place for massage therapy as a legitimate and viable health service. A bachelor degree, underpinned by research-informed education, was the selected mode. In December 2023, our 20th cohort of bachelor degree students will graduate. This commentary describes and reflects on progress towards developing research capability, and engagement in and promotion of massage therapy research to learners and practitioners of massage therapy in New Zealand.
KEYWORDS: massage therapy, research, education
When massage therapy education in New Zealand began in earnest in the late 1990s there was no internet, few massage therapy textbooks, and no standardized massage therapy education. Early education was informal and revolved around weekend workshops. Three challenges for growing massage therapy as a credible occupation were the lack of cohesive education standards, a lack of research, and the unregulated nature of the industry. Over the next 25 years massage therapy education, at sub-degree level, became more standardized within New Zealand, along with the global expansion of massage therapy research.
The introduction of the first massage therapy bachelor’s degree in 2002—the Bachelor of Therapeutic and Sports Massage (BTSM) at the Southern Institute of Technology (SIT)—provided a higher education opportunity for New Zealand massage therapists to increase their knowledge and skills, and to engage in research.(1) Concurrent with the BTSM development, massage therapy research was making progress.(2) Early research developments in the United States included case report contests,(3) and the launch of the International Journal of Therapeutic Massage and Bodywork (IJTMB) in 2008.(4)
The BTSM education programme sits within the Polytechnic sector of tertiary education in New Zealand, external to the University sector. Currently it is the only massage therapy degree-based qualification in New Zealand for massage therapists. Utilization of higher education has been central to the development of many complementary and alternative medicine (CAM) occupations.(5) Similarly, the BTSM was designed to foster research-literate students, who participate in entry-level research in their 3rd year of study.(6) The curriculum is underpinned by research, teaching is informed by research, students learn beginning research skills, and staff are engaged in ongoing research. Consequently, to teach on a bachelor’s degree, educators (also known internationally as lecturers or professors) are required to hold a higher qualification such as a master’s degree or PhD and be active in research.
In the early years of delivering the BTSM, there was a need to access and engage with other educators with research experience to support the programme. Massage therapy educators also needed to increase their research capability to contribute to the programme, and help create a research culture. Post-graduate studies continued to be a focus for both educators; as there were no master’s degrees in massage therapy, educators undertook postgraduate study in the fields of higher education and physiotherapy (physical therapy) within the university sector. This started a 14-year journey to gain masters and PhD qualifications while continuing to develop educational opportunities for research literacy, critical thinking, and research evidence in the BTSM curriculum.
As educators began to strengthen their knowledge and confidence in research, the BTSM curriculum began to reflect the staircasing of research knowledge through years 1, 2 and 3 of the degree. Now in 2023, the BTSM is no longer seen as a fledgling programme; it continues to provide an opportunity for massage therapists to engage in higher education and small scale research projects. Educators have continued to engage in research opportunities such as postgraduate research supervision and marking, conference presentations, supporting undergraduate research within the BTSM, and engaging in their own research projects. Contribution to the research environment in terms of service includes membership on institutional Ethics and Research committees, developing research driven postgraduate qualifications, and advancing research literacy within the New Zealand and wider massage therapy industry. Research activities are presented in Figure 1.
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Figure 1. BTSM-generated research activities and outputs (n=151) 2002–2023. | ||
The growth in research capability of the educators is evident, with several highlights and milestones reported in Table 1. Growth in research capability has been a progression of small, continual steps, over time, motivated by a vision for the industry, the needs of the BTSM, and the requirement of educators to be research active, albeit in a reduced capacity in comparison to the University sector. While capability has grown, capacity for research has been limited by a lack of funding and the small number of educators engaged in the delivery of the BTSM.
Table 1 Research Activity Highlights and Milestones 2002–2023
Students’ engagement in research and growth of research capability is also apparent. The BTSM has provided a vehicle for fostering research capability and resulted in the establishment of the New Zealand Massage Therapy Research Centre (NZMTRC) at SIT in 2009.(6) On this platform, research posters and publications are shared, and demonstrate the growing research literacy and capability among students and graduates. Supervision of 75 BTSM undergraduate small-scale research projects has been an important contribution to growing literacy, capability, and capacity within the New Zealand massage therapy industry. Access to research funding is still difficult for massage therapists in New Zealand, but these small studies are useful contributions to the profession in New Zealand. Graduates of the BTSM are now publishing their research in peer-reviewed journals such as IJTMB (Table 1). They have also participated in case report contests run through the voluntary professional body for massage therapists in New Zealand, Massage New Zealand (MNZ), and the Massage Therapy Foundation. Similarly, correspondence with graduates and massage therapists report participation of BTSM graduates and other New Zealand-based massage therapists in masters and doctoral studies with their associated research, thus ensuring the capability to generate research in the future.
Education does not happen in a vacuum; the growth of research capability by those engaged in the BTSM has resulted in a growth in research activity/engagement by some members of the New Zealand massage therapy industry. Early activities were modest; it started with a New Zealand massage therapy conference presentation in 2004, where massage therapists were encouraged to begin to engage with the new, but sparse, literature that was becoming more accessible. In future years, there was research education at various conferences in the form of workshops, platform presentations about research findings, and research poster presentations. A ‘Massage Therapy Research Update’ column (2015–2016) was used to share research findings with MNZ members in their quarterly Journal/Magazine. Twenty years on, research-informed discussion pieces, research posters, and research articles are more commonplace in the MNZ magazine. By valuing research and research-informed education, the BTSM has also provided an avenue to publicly demonstrate the role and value of research for the massage therapy profession.
Twenty years on, there are various signposts that indicate progress has been made: research literacy is now included in sub-degree education; New Zealand-based research findings are being disseminated; the concept of evidence-informed practice is discussed by the industry; massage therapy graduates are pursuing higher education opportunities; and communities of practice, such as the ‘New Zealand professional massage therapist network’ and ‘Degree qualified massage therapists NZ’ Facebook groups, are providing another mode for engaging in critical review of massage therapy theories and practices. Many of these practices are not unique to New Zealand, nor to one education provider, but they do offer insight into the evolution of a research culture. There is a growing body of research to support massage therapy to become an evidence-informed therapeutic modality.(7) The BTSM was a New Zealand-based massage therapy education innovation, and the developers were early adopters of the ‘need for a research culture’ and its inherent skill base. Yet, diffusion of the need for a research culture has been slow and, in New Zealand, was limited by the commitment to the BTSM by the massage therapy industry.(8) However, with the development of the internet, social media, and significant resources developed by other agencies (such as the Massage Therapy Foundation), access to information and global trends in massage therapy research is no longer an issue. Using the diffusion of innovation theory,(9) we suggest that more massage therapists (‘early majority’) may now understand the role of, and need for, research knowledge, skills, and evidence for their approach to clinical massage practice. Furthermore, to assist successful innovation in the future, we recommend attention to strategies for innovation diffusion.(9)
What is also less clear, with respect to the New Zealand industry, is the broader effects of engagement in the research journey outlined above. For example, what are the levels of research literacy and use of research by therapists in clinical practice in New Zealand? Is there a level of practitioner research capability to support the Practice-Based Research Networks proposed by Zabel and Munk?(10) How sustainable is massage therapy research in New Zealand? The current approach of using the research practices inherent in bachelor degree education certainly is. This research activity at undergraduate and postgraduate level is funded by higher education practices; however, until massage therapy research becomes more widely recognised by funding agencies in New Zealand, it will be challenging to obtain funding for large scale projects. These are questions with which future researchers, educators, academic leaders, and massage therapists must grapple. The BTSM has seeded a culture of research informed practice in New Zealand, from which new participants can contribute.
In conclusion, we are reminded that research is crucial to moving the massage therapy profession forward.(11) The BTSM and the massage therapy educators leading this change in New Zealand have provided a platform to develop research capacity—both personal and systemic. In 2000, when the BTSM was proposed, bachelor degree education was seen as the best fit for fostering research and legitimacy for massage therapy in New Zealand. Now, with greater access to research globally, the landscape has changed and new research opportunities may arise. Our journey started with small steps on a path of continual learning and practice. It has been a long and sometimes lonely journey, but our vision of building a research-based professional qualification and research capability has been achieved. We are encouraged to see a small number of massage therapists beginning to engage in research activities in New Zealand. We urge all current and future massage therapists to build on this platform so the next 20 years of massage therapy research can continue to inform massage therapy practice.
In summary, we are reminded of the Māori whakataukī (proverb) from the indigenous people of New Zealand, Poipoia te kākano kia puawai—nurture the seed and it will blossom. We believe we are achieving this. Like any great tree, it takes time to mature—20 years on, we think we are getting there.
1. Smith DM, Smith JM, Baxter D, Spronken-Smith R. The drive for legitimation of massage therapy in New Zealand. Int J Therapeut Massage Bodywk. 2012;5(4):21–29
2. Moyer CA, Dryden T, Shipwright S. Directions and dilemmas in massage therapy research: a workshop report from the 2009 North American Research Conference on Complementary and Integrative Medicine. Int J Therapeut Massage Bodywk. 2009;2(2):15–27
3. Massage Therapy Foundation. Case report contest. 2023. Retrieved from Massage Therapy Foundation: http://massagetherapyfoundation.org/grants-and-contests/case-report-contest/ Accessed September 8, 2023
4. Kennedy AB. Celebrating the 10th anniversary of the International Journal of Therapeutic Massage and Bodywork. Int J Therapeut Massage Bodywk. 2018;11(3):1–3
5. Cant SL, Sharma U. Professionalization of complementary medicine in the United Kingdom. Complem Ther Med. 1996;4(3):157–162
6. Smith J, Smith D. (2010, May). Promoting massage therapy research in New Zealand. In: The 2010 Highlighting Massage Therapy in Complementary and Integrative Medicine (CIM) Research Conference, May 13–15, Seattle, WA. Retrieved from https://www.sit.ac.nz/Portals/0/upload/documents/nzmtrc/PromotingMassage%20final%20copy.pdf#7580
7. Ooi SL, Smith L, Pak SC. Evidence-informed massage therapy—an Australian practitioner perspective. Complement Ther Clin Pract. 2018;31:325–331
8. Smith D. Perceptions and benefits of, and barriers to, degree-based education for massage therapy (Thesis, Doctor of Philosophy). University of Otago; 2015. Retrieved from http://hdl.handle.net/10523/5610
9. Kaminski J. Diffusion of innovation theory [article under Theory in Nursing Informatics Column]. Can J Nurs Inform. 2011;6(2). Available from: https://cjni.net/journal/?p=1444
10. Zabel S, Munk N. Practice-based research networks and massage therapy: a scoping review. Int J Therapeut Massage Bodywk. 2020;13(4):25–34
11. Sefton JM, Dexheimer J, Munk N, Miccio R, Kennedy AB, Cambron J, et al. A research agenda for the massage therapy profession: a report from the Massage Therapy Foundation. Int J Therapeut Massage Bodywk. 2020;13(4):42–46
Corresponding author: Donna Smith, PhD, Massage Therapy, Southern Institute of Technology—Te Pūkenga, Invercargill Campus, 133 Tay St., Invercargill, 9810, New Zealand, E-mail: donna.smith@sit.ac.nz
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Published under the CreativeCommons Attribution-NonCommercial-NoDerivs 3.0 License.
International Journal of Therapeutic Massage and Bodywork, Volume 16, Number 4, December 2023