Massage practitioners and students are increasingly aware of the vital role research plays in providing the best possible care to clients — but not all research is created equal.
There are multiple types of research studies and designs.
Each can provide an important addition to our knowledge base, but some provide better information than others.
We’ll look at each type of research from the lightest to the most substantial:
It helps if we diagram this as a pyramid, with lower levels being less accurate information and the peak being the highest-quality research evidence. Let’s see how each should inform or change your practice.
6. Expert Opinion, Non-EBP Practice Guidelines, Anecdotal Observation
“I do it because it’s always been done that way” — this is classic Level 6 knowledge. Information at Level 6 may not be based on any real evidence. Observations and experience are important, and they often lead to real research, but you don’t want to base your practice on unproven procedures and ideas.
5. Individual Case Reports and Case Series
Case reports are a great first step toward learning more about a novel injury, illness, treatment or condition. In this type of research, careful notes are recorded on the symptoms, signs, diagnosis, treatment and follow-up of the patient or client. Case reports can be the foundation for future research and advancements.
Case series are just like case reports, but are a collection of observations on multiple individuals with the same condition or using the same treatment. Case series provide a bit more information than single case studies, but not enough to make practice changes.
Learn more about the MTF’s Student Case Report Content here.
4. Cohort Studies
A cohort study is research that occurs across a length of time. Researchers choose a group of people who do not have the condition of interest (e.g. an ankle sprain) and compare how often the injury then occurs during the study. This helps determine risk factors for that condition (being a basketball player might be a risk factor for ankle sprains). Cohort studies help determine causes of diseases or conditions.
Two examples of cohort studies are the Framingham Heart Study and the rhythmical massage in chronic disease study.
3. Non-Randomized and Randomized Controlled Trials (RCT)
Now we are getting to real experimental research. Here we use a scientific approach to finding new knowledge. These are intervention studies in which groups are set up and variables of interest measured (e.g. assessing back pain in massage and non-massage groups). There is a hypothesis (a guess based on previous research) about what will happen, and data is analyzed using statistics to try to understand the outcome and what it means.
Randomized trials (RCTs) are the gold standard of experimental research. Participants are randomly placed into groups, which helps ensure the data is accurate. Large RCTs provide important, high-quality knowledge and serve as the foundation for evidence-based practice.
No one study, even an RCT, provides the entire picture. We are constantly learning more, which is why our knowledge base is constantly growing and changing.
Check out a these RCTs featuring massage therapy:
ncbi.nlm.nih.gov/pubmed/16827629
ijtmb.org/index.php/ijtmb/article/view/119
ijtmb.org/index.php/ijtmb/article/view/421
2. Evidence-Based Practice Guidelines
The top two levels of the pyramid contain independent expert assessment and analysis of large sections of the literature. Evidence-based practice guidelines are developed from a body of scientific literature to provide clinicians with the best possible practices based on our current knowledge base.
These guidelines should inform both our practice and our educational curricula. They should also be updated frequently to include new research findings.
Read more thoughts on evidence-based/informed practice:
massagetherapyfoundation.org/what-is-evidence-informed-practice-in-massage-therapy/
ijtmb.org/index.php/ijtmb/article/view/141
1. Meta-Analyses and Systematic Reviews
Meta-analyses are the highest level of evidence for research, with systematic reviews a close second. Reviews are important because independent experts review a body of knowledge to analyze and summarize what has been found.
A meta-analysis takes this to the next level by combining data from multiple studies and completing a new statistical analysis on the combined studies. This process helps improve the overall quality of the data and results.
Systematic reviews are a great place to start if you want to read about what we know in a specific research area. Results of meta-analyses can help you decide if you want to make changes in your practice to provide your patients or clients with the best possible outcomes.
For an example of a meta-analysis and a systematic review click the links below:
massagetherapyfoundation.org/massage-research/mt_and_pain_database/
Learn More
Do you want to learn more? You can find more research articles at the MTF’s International Journal of Therapeutic Massage and Bodywork.
Do you want to learn more about types of research and research in general, in a fun and entertaining way? Visit the MTF website for articles, blogs, and webinars, and sign up for the newsletter and email updates.
JoEllen Sefton, PhD, ATC, LAT, is the director of the Auburn University Warrior Research Center; developed and led the Warrior Athletic Training Program at Ft. Benning, Ga.; and is currently a professor at Auburn University, where she develops and teaches courses related to neuromechanics, research and sports medicine. She has been a massage therapist for 16 years and a certified athletic trainer for 11 years, and is on the Board of Trustees for the Massage Therapy Foundation.