Evidence-Based Practice in Massage Therapy
Evidence for massage is information on massage practice that researchers and therapists collect in a systematic manner (Sackett et al. 2000). In the past, therapists relied heavily on their clinical intuition and past experience to guide treatment decisions. In today’s health care arena, therapists need evidence in order to provide the best care possible to their clients (Achilles and Dryden 2004; Menard and Piltch 2009; Menard 2008),to identify which practices are useful and safe for their clients, and to educate themselves and their clients about what massage can and cannot do. A solid foundation of evidence also facilitates acceptance of the value of massage and accountability for its increased second-party reimbursement. The use of evidence to guide clinical decision making is evidence-based practice (EBP). The transition from an experience-based approach to practice to EBP is not necessarily intuitive; hence, structured methodologies that can provide guidance on these issues are needed.
Defining Evidence-Based Practice
Sackett and colleagues (2000), who developed the concept of evidence-based medicine, define the three components for EBP as best research evidence, clinical expertise, and client values. Best research evidence is the best available clinical, client-centered research that examines the accuracy, safety, and efficacy of assessment tests and therapeutic interventions.Clinical expertise is therapists’ ability to use their clinical skills and past experience to identify each client’s unique health needs and the potential risks and benefits of interventions.Finally, client values are the unique preferences, goals, and expectations that each client brings to the therapeutic relationship. The integration of these components is the goal of EBP.
Many therapists, for whom finding the time to locate and read evidence is challenging enough, find the additional step of evaluating evidence daunting. Fortunately, three approaches provide guidance to therapists. First of all, Sackett and others(2000) created a hierarchy of levels of evidence that ranks research designs based on the extent to which they provide strong evidence of a cause-and-effect relationship between the treatment and the outcome. In this respect, studies at the top of the hierarchy, such as randomized clinical trials, are considered better evidence than those at the bottom, such as qualitative studies. This hierarchy may raise concerns within the field of Massage Therapy (MT) because the lower-ranked research designs are considered by some to be optimal for studying complex, holistic, or wellness-oriented aspects of massage (Finch 2007).
Both Jonas and Finch offer alternatives to this hierarchical approach. Jonas (2001)proposes an evidence house that includes many kinds of rigorous research methods—different rooms in the house—without ranking the types of research designs. He suggests that including a variety of qualitative and quantitative research methodologies provides a more balanced and complete picture of massage and how it works. Finch (2007) describes how practitioners act like an evidence funnel in the sense that they receive evidence from many sources, and then filter it by evaluating its relevance and merits before integrating it with their own expertise and the client’s preferences.
In addition to these systems for evaluating evidence, there are several excellent MT-specific handbooks (Hymel 2006; Menard 2009) that therapists can use for assistance in locating and evaluating evidence. In practical terms, it may be more efficient for a therapist who is new to the concepts of evidence-based practice to use preappraised sources, such as practice guidelines, clinical protocols, or plans of care published by professional associations (Grant et al. 2008).