What is evidence-informed practice in massage therapy?

Posted:Wednesday, September 17, 2014

“Evidence-based medicine,” and “evidence-informed practice” seem to be hot topics these days. At first glance it might appear that this means that using what the research says as the only guideline for how we treat clients or patients. But it turns out that this is not true.

A 3-Legged Stool

Evidence-informed practice is not a simple one-part concept. It is a three-part process of clinical decision-making, or a three footed stool, if you like.deconstructed stool

First Leg: The Client’s Values

What are your client’s goals? What are her priorities for the time you spend together? Are there things she really wants to avoid?

Second Leg: The Practitioner’s Judgment

Part of evidence-informed practice is relying on our own training, experience, and expertise. It is inevitable that our own background will inform the choices that we make with our clients.

Third Leg: What Does The Research Say?

Until recently, this leg of our evidence-informed stool has been spindly at best; the research available about massage therapy was not extensive. But that has changed, and it is now possible to find peer-reviewed case reports, preliminary studies, and even clinical trials and systematic reviews about massage therapy in many contexts, from cancer to chronic pain to scar tissue from burns. Massage therapists who ignore all this information are leaving out a critical part of best practices in clinical decision-making.building the stool

An example:

Let’s take an example of a middle-aged woman who is moderately overweight, and who has a lot of knee pain. She has been diagnosed with osteoarthritis, and her doctor feels that she should have a knee replacement so that she can walk without pain.

But there’s a problem: she is absolutely petrified of surgery. An allergy to anesthetics runs in her family, and having witnessed a close relative’s death to this complication, she has absolutely no interest in going under the knife. Instead, she comes to you, her massage therapist, for relief.

You already know that osteoarthritis involves extensive remodeling of the cartilage and bone inside the joint capsule. With all the best will in the world, even the most skilled fingers cannot reach inside the knee joint to reduce inflammation and to rebuild chipped, worn-out cartilage. You agree with your client’s doctor that a knee replacement is really her best choice – but she does not concur. What are your options?

Following the principles of evidence-informed practice, you need to weigh your client’s desires (reduced pain without surgery), your own skills and expertise, and the current research. A quick search on Pubmed.gov for “massage therapy and osteoarthritis at the knee” leads you to a surprising number of articles. You look at a few, and then you find this:

Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial.

Adam I. Perlman, MD, MPH; Alyse Sabina, MD; Anna-Leila Williams, PA-C, MPH; Valentine Yanchou Njike, MD; David L. Katz, MD, MPH

View the article here.

Wow! This research suggests that full body Swedish massage for an hour a week is an effective way to manage pain for people with osteoarthritis of the knee. It’s not a substitute for surgery, but most of the patients reported high satisfaction with this intervention. Now you can go to your client with your skills, her priorities, and validation from a clinical trial that suggests you have a good option for her.

Add Research To Your Decision-Making

Many massage therapists are really good at the first and second legs of the evidence-informed practice stool: balancing our client’s priorities with our own skills and judgment. But for a variety of reasons, most practitioners are either completely unaware that a body of research about our work even exists, or they are reluctant to consult it on their clients’ behalf, maybe because they feel it’s too difficult, or too abstract, or because of some other obstacles.

When we successfully integrate the three parts of evidence-informed practice, we can be sure that we are providing our clients with the very best service that we can provide. That promotes our profession, because we are behaving professionally; it helps ourselves, because we know we’re doing the best we can; and most of all it serves our clients, who will be the beneficiaries of your excellent clinical decision-making skills.