Amanda Baskwill, RMT, PhD, Executive Editor/Editor-in-Chief, IJTMB
Loyalist College, Belleville, ONThe International Journal of Therapeutic Massage and Bodywork (IJTMB) serves as a dedicated platform for advancing the therapeutic massage and bodywork profession through research, practice, and education. In this article, the focus is on the critical aspect of research, exploring various methodologies and methods to unveil the complexities within therapeutic massage and bodywork research. The IJTMB emphasizes the importance of diversifying research types, considering carefully the methods used, and placing all decisions for research study design and methods within relevant ethical considerations. The necessity of knowledge translation, pushing researchers to disseminate their findings widely, and bridging the gap between research and practice for the betterment of the profession and the broader community are emphasized. The IJTMB remains committed to inspiring and facilitating this vibrant exchange of knowledge within the TMB community, thereby advancing the field.
KEYWORDS: massage therapy, methodologies, methods, ethics, knowledge translation
The International Journal of Therapeutic Massage and Bodywork (IJTMB) was developed intentionally to focus on three pillars in the massage and bodywork profession—research, practice, and education. Over the next three issues, we will explore each of these pillars with the intent to inspire researchers, practitioners, and educators to share their work with the IJTMB community. In this article, we examine research—the methodologies, the methods, the ethics, and the translation of knowledge into practice.
Therapeutic massage and bodywork (TMB), like so many caring professions, has struggled to ‘prove’ its efficacy through traditional research methodologies. There has been much debate about whether the complexities of a whole system of care can be captured with reductionist paradigms. As a pragmatist,(1) I believe that the best methodology is the one that fits the question being asked. This means that there is a place for different paradigms in our attempt to understand TMB.
If you are a researcher, student, practitioner, or educator contemplating which methodology to choose for your next TMB research project, the following foundational articles are must-reads for inspiration:
Kania, Porcino, & Vehoef (2008)—This article shares arguments for the use of qualitative research to explore TMB. They assert that “by exploring the lived experience of people providing and receiving massage therapy and the meaning that those people ascribe to those experiences, in-depth understanding of the nature of massage therapy and of how it affects people’s lives is possible.”(2) There are many research questions that are best answered with this group of methodologies including better understanding the experience of patients and practitioners throughout the process of care, in different settings, and for different outcomes.
Ritenbaugh, Verhoef, Fleishman, Boon, & Leis (2003)—Given the complexities of studying caring professions within models that were intended primarily for pharmaceutical interventions, this group of researchers posits a different approach. Whole systems research (WSR) is intended to study complex therapies, such as MTB, as “system-level phenomena, as opposed to single-agent or unidimensional effects.(3) Still not a common methodology, the potential of this paradigm is interesting in the context of integrative and interprofessional models of care.
Baskwill (2017)—In this article, I create a case for the use of mixed methods research to study complex questions TMB researchers are trying to answer.(4) The opportunity in these methodologies is to build upon the strengths of different paradigms.
Until recently, much of TMB research has primarily focused on the quantification of patient outcomes resulting from some type of treatment. While this is valuable, and attempts to contribute to criticism that, as a profession, we do not have evidence for our treatment approach, it is not the only type of research that is of value to the profession.
The IJTMB would like to continue to diversify the types of research we publish. So, bring us your qualitative and mixed methods studies looking at complex phenomena within the wide world of TMB. We are interested in longitudinal studies that follow practitioners or patients. And, of course, we continue to be inspired by case study or case series methodologies, which are a great entry point to research for practitioners.
To differentiate between methods and methodologies, methods are the means and methodologies are the ends. In other words, methodologies outline the philosophy and overarching principles that will guide research. Methods are the tactics researchers take to get there. These include the population and sampling of participants, data collection and analysis, intervention (for those types of studies), researcher positionality (for these types of studies), and numerous others depending on the type of study you are undertaking.
There are so many considerations when choosing your methods that I can’t possibly cover them all here. Instead, I have identified some common and continuing discussions related to TMB research that are worth pondering.
Outcome Measures: The foundation of many quantitative research studies is the reliability and validity of the outcome measurement tool. For TMB, patient-reported measures are often used. These have been criticized for lacking objectivity. Where methods call for patient-reported outcomes, it is important to ensure you choose a tool that best fits your population and the outcome you are endeavouring to measure.
Control Groups and Placebo Effects: An interesting area of study itself is the challenges of designing control groups for TMB research, including the use of sham treatments or waitlist controls, and the impact of placebo effects in massage studies. Wherever you land in your deliberations, it is crucial to the transferability of your results to provide a rationale for your decisions.
Researcher Positionality: An important, but often omitted, aspect of qualitative and mixed methods research is to identify the positionality of the researchers in relationship to their research topic or phenomenon of interest. This is called reflexivity.(5) Both the acknowledgement of the researcher’s position and the steps taken to limit the impact on the research outcomes are important to note in your methods section.
While ethical considerations are often part of methods, they are worthy of a section unto themselves. In TMB research, as with all research, this area is constantly evolving. These are fundamental considerations that all researchers need to contemplate.
Blinding and Bias: Similar to the consideration above regarding patient-reported outcomes and control groups, researchers need to explore the complexities of blinding in massage research, considering how to maintain blinding in studies where therapists and participants are aware of treatment assignments, and discuss strategies to minimize bias. Related to this, are the ethical considerations of providing ineffective treatment or sham treatment options as comparison treatment groups.
Consent and Well-being: The treatments and topics of TMB research require researchers to ensure that ethical issues, such as informed consent, privacy, and ensuring the well-being of study participants, are central to their study design and methods. Often well-being is thought of in relation to studies exploring treatment options, but participants in qualitative research who are asked to recount traumatic or difficult experiences also need strategies in place to support their well-being.
Cross-Cultural Considerations: An emerging area of interest highlights the importance of cultural sensitivity in massage research, including the adaptation of research methodologies to different cultural contexts and traditions. Researchers who consider this at the onset of the development of their research design and methods will be better positioned to support their participants and ensure the trustworthiness of their results.
One of the most important phases of research is knowledge translation, in which the results and lessons of the research study are shared with members of the profession, participants, and public. The most common forms, and least wide-reaching, are presentation at a professional conference and written publication. I encourage authors to think more broadly about their responsibilities to communicate the results and lessons. Where appropriate, outcomes of research should involve:
summaries for patients
integration into policy, advocacy, governance
incorporation into education and entry-to-practice examination
publication of commentaries, protocols, study outcomes, and lessons learned.
The International Journal of Therapeutic Massage and Bodywork is a platform dedicated to the advancement of the massage and bodywork profession through its three core pillars: research, practice, and education. As we embark on this journey, the focus on research is paramount, and the exploration of various methodologies and methods sheds light on the multifaceted nature of therapeutic massage and bodywork research. The IJTMB is committed to fostering a diverse landscape of research, embracing qualitative and mixed methods studies to probe complex phenomena within the realm of TMB, while also acknowledging the significance of longitudinal studies and case series methodologies.
In addition, I hope the discussion around outcome measures, control groups, researcher positionality, and ethical considerations, underscores the meticulous approach required in conducting TMB research. Furthermore, I hope researchers will engage more completely in the imperative phase of knowledge translation. Researchers need to disseminate their findings in varied and impactful ways, bridging the gap between research and practice, ultimately benefiting both the profession and the wider community. The IJTMB’s mission to inspire and facilitate this dynamic exchange of knowledge within the TMB community remains an essential cornerstone in advancing the field.
1. Allemang B, Sitter K, Dimitropoulos G. Pragmatism as a paradigm for patient-oriented research. Health Expect. 2022;25(1):38–47. PMC
2. Kania A, Porcino A, Vehoef M. Value of qualitative research in the study of massage therapy. Int J Ther Massage Bodywk. 2008;1(2):6–10.
3. Ritenbaugh C, Verhoef M, Fleishman S, Boon H, Leis A. Whole systems research: a discipline for studying complementary and alternative medicine. Altern Ther Health Med. 2003;9(4):32–36.
PubMed
4. Baskwill A. A case for mixed methods research in massage therapy. Int J Ther Massage Bodywk. 2017;10(3):14–16.
5. Olmos-Vega FM, Stalmeijer RE, Varpio L, Kahlke R. A practical guide to reflexivity in qualitative research: AMEE Guide No. 149. Med Teach. 2023;45:241–251.
Corresponding author: Amanda Baskwill, RMT, PhD, Loyalist College, School of Health, Human and Justice Studies, 376 Wallbridge Loyalist Rd., Belleville, ON K8N 5B9, E-mail: ExecEditor@IJTMB.org
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Published under the CreativeCommons Attribution-NonCommercial-NoDerivs 3.0 License.
International Journal of Therapeutic Massage and Bodywork, Volume 17, Number 1, March 2024