I'm sorry, I just don't get research....

Comment

Comment by Vlad on April 3, 2010 at 11:48am

Julie,
I edited that last blog post and then you added your previous one, but now mine is on top of yours.

I've a question.

Why didn't you just say "I'm going to write about research in meaningful terms" and write about what you wrote in your last comment there?

If THAT was your intention from the get go (which is a good thing, really) then why not come out and say it instead of saying "I don't get it"?

When someone with a strong online presence with a background in science says "I don't get it with research", do you not see that it could be detrimental in any way?
Even the title of this blog post is detrimental to research.

Just saying.......

Jump on the research bandwagon and teach people - that's great. Please don't go writing that you "don't get it" anymore. It's not good.

There is a site already where people can comment on research: www.mt-researchonline.com - it's free and no one is making money from it. I'll be adding another video to it and some other stuff, including a blog. People are welcome to use it or add to the discussion board on what they'd like added.

Comment by Vlad on April 3, 2010 at 11:36am

There are so many terms that I don't really understand
Getting our heads 'round A&P was difficult too, wasn't it? Most of us seemed to get over that hump.

I have never told a client - this will work because I have this research to back it all up
There's another aspect to that. After researching research I dropped a modality because there wasn't enough evidence to back it up. There were tons of low level studies published in low tier journals and when I looked at the studies I came to the conclusion that they were badly run.
I'm glad I went through that process. I'm glad I took the time to understand the difference in types of studies. That's a direct example of one therapist in her practice applying what she is learning (on her own, by they way, because I can read).
As for not informing clients on what research is showing - we should be doing more of that. Furthermore, teachers should really be paying attention to what research is showing.

When I read articles on research like the one from Diana Thompson that was out in a magazine, at the end of it I say 'huh?"
Thompson's article was good and clear in my view and if people took the time to read Menards book, which is only 150 pages it would be as clear as crystal to anyone.

I can look them up of course but I just don't think that many other massage therapists would take the time to do that but maybe that is just an assumption on my part.
I have more faith in massage therapists than you. I think most of us WILL take the time to look things up.

like showing what a statistic will really be by putting it into real life context
As an easy example from research. Research has shown that anxiety and depression are helped by rmassage in studies that carry good weight evidence-wise. 17 million people are diagnosed with major depressive disorder in the US. Do you think that even being aware of what is going in those 2 areas might have some impact on how we do our work or communications with clients or marketing? What about all the research going on in fascia? Do you presume that none of us will look at what is going on there?
Do you presume that most therapists are totally stupid and can't be proactive in trying to figure things out?

I don't.

Getting to grips with research requires baby steps, but I don't think it is above the head of any therapist and I know that everyone can get to grips with AT least being able to look at a type of study, knowing what level of evidence that carries, knowing the difference between qualitative and quantitative, knowing the aspects of RCTs and why they are there, knowing what the wholism/reductionsim debate is about and and most of all knowing WHY they should pay attention to what research is telling us.

Furthermore, people going on and on about how you don't get it isn't doing any good. Why don't you think about how it can be a good thing and start writing about that instead? I happen to thing that most people seem to recognize that research is a good thing and most people have the common sense to know how it impacts their work.

Comment by Julie Onofrio on April 3, 2010 at 11:14am

Yes on that site I referred to a page on carpal tunnel that the MTF had written on the latest research on carpal tunnel. If it isn't all laid out for me like that I don't know what to make of it.

I also am asking all these questions because I want to be able to write about research myself and how to use it and what it does mean for the profession and put that info on my other sites - www.thebodyworker.com and www.massage-career-guides.com . If I can understand it enough to write about it in a way that helps make sense of it for everyone else so that they can start talking about it.

I picture a reference site where every research article is commented on by you guys who post on here and understand research and let others put their insights too (like in blog form or whatever.)

I write for the internet which is different that in books or mag. It has to be simple because of people's online attention span.

I'd love to know more about your project and maybe even help you with it.

Will you be in Seattle for the conference?

Julie

Comment by Kim Goral on April 3, 2010 at 10:48am

Hi Julie,

Thanks for the clarification. The site I was referring to is http://www.massageseattle.net/. Unfortunately, most research articles are geared towards someone having a research background, at least in order to understand the statistics and methodology behind it. Typically, the introduction (beginning of the paper that talks about background information on the subject, what previous research has indicated, and the goals of the present research they are discussing) and the discussion (the last section of an article that explains the results, what the results mean, and how their results compare with what previous research has shown) are fairly straight forward and easy enough for the average person to follow. In order to understand the "meat" of the articles, though, requires a lot of time and work to fully grasp the what, whys and hows of the methodology (the design of the research, why they chose that method, how they collected the data) and analyzed the results.

I know a lot of people can get really intimindated by stats and research. That is my primary motive for working on this project I am starting. I am really hoping to be able to break it down to an easy-to-understand level so that other therapists can learn and embrace the knowledge. This initial project will not make people experts, by any means, but hopefully it will give them enough knowledge and skills to find, read, and understand research without feeling overwhelmed or intimidated. I'm hoping to have this complete by the end of next fall.

If you want, I can let you know when I'm ready for some test-runs; you would probably be an excellent person to try it and give feedback on it (which I would eagerly welcome).

Comment by Julie Onofrio on April 3, 2010 at 10:32am

What site are you referring to? I don't have many links to research that I know of but I do have links to many online articles. (I also have too many sites and too many pages of info to remember it all! One of my sites has been online for 11 years!) The main piece of research that I have ever talked about was the metanalysis that showed that massage does more psychologically than physically. There were many articles that explained that piece of research and what it meant at the time.

I am interested in research and that is why I started this thread. I just don't get it though as I have stated- I have never told a client - this will work because I have this research to back it all up. When I read articles on research like the one from Diana Thompson that was out in a magazine, at the end of it I say 'huh?" There are so many terms that I don't really understand. I can look them up of course but I just don't think that many other massage therapists would take the time to do that but maybe that is just an assumption on my part.

When talking about research I think most massage therapists are kinetic learners which is why they are in this business. The articles on research mean nothing to me really and that is why I referred to a good book "Made to Stick" to learn to break concepts down into meaningful information so that all can understand. I don't have my copy hand to show you an example of what they are suggesting to do to make information understandable but it is really innovative - like showing what a statistic will really be by putting it into real life context.

That is what I wish could happen with research!

Thats all...

Julie

Comment by Kim Goral on April 3, 2010 at 10:03am

Julie,

I have to admit curiosity got the better of me and I was looking around your website yesterday and noticed how many research articles you have uploaded or link to on different conditions. You have been posting all over this site how you do not understand or believe in research (for various reasons), and yet the impression from your website is the extreme opposite- you have it everywhere.

So I guess my question is, what are your goals in continually repeating that you do not understand or agree with research, despite many attempts from different people to help you understand it, and why, if you think you do not need it, do you still have it all over your website? Clearly you must understand it to an extent and also find it valuable or you would not discuss it and promote it there.

Comment by Kim Goral on April 3, 2010 at 9:57am

Emmanuel,

I agree with you and I think the new COMTA standards are a great start. However, massage schools are not required to be accredited, so there will remain some undoubtably that do not include that material in their curriculum. Hopefully that is a small percentage, though. As for what should be included in schools..it's tough. Research, as many people know, takes time and more importantly effort to learn and learn well. It is not something that can be taught effectively in just a couple of days. I think one thing to do is look at the schools that are including it in their curriculum with success. Cortiva in Seattle is pumping out case-report stars left and right (they have had several MTF case report winners over the years).

I think the important things to cover are things you mentioned from the COMTA standards and learning, even if just skimming the surface, the difference between different types of studies and how you can interpret the results from them. One major concept that should be taught is the difference between correlation (relationships between variables) and causation (cause and effect). So many people assume that when you do a study on a single group of people and see results pre/post (or even in practice when working on clients) that you can then attribute any changes found to the treatment administered and this simply is not accurate. I don't fault people for thinking this way if they have no training in research methods because it is a fairly intuitive thing to do. But once you learn about the different factors that could be involved, much like the example I gave about the amount of hours of training below, you learn how much is involved in the process that can influence the outcome.

Anyways, I'm not going to ramble on forever again, here :) I hope this answered your question.

Comment by Walt Fritz, PT on April 2, 2010 at 1:05pm

Validating the methods that you perform bring credibility, both to yourself as well as to others. We all do things daily, simply because they work, or seem to work. If research studies validate a modality or rationale, your own internal beliefs can reflect this, as well as your credibility in speaking to patients about this work.

Case in point, today I posted regarding a paper that shows a positive correlation between leg length inequality and the development of osteoarthritis of the knee. Research has also shown that corrections can be made to pelvic rotations with soft tissue work, such as MFR. Bringing those two ideas together allows me to see that when I work with someone whith a pelvic rotations, I may be helping to avoid arthritic chages down the road for them.

I was taught this in my MFR training, but only from someone's experience or speculation. Having access to research such as this can give me the authority to back up my claims or beliefs. I really se this as one of the strength of paying attention to research. Don't stop doing things because they work, but look deeper to validate your beliefs.-

Comment by Emmanuel Bistas on April 2, 2010 at 9:00am

Kim, this was an excellent reply.

I think that an entry-level massage program is where people should first be exposed to research because it helps them develop an appreciation for it. COMTA has a basic requirement of research literacy in a massage program that includes explaining the value of research, identifying sources of research, and critically reading and evaluating a published research article in the field. Are there any other topics that you would like to see discussed in an introductory class that is designed for massage students (different from your CE course)?

Comment by Kim Goral on April 1, 2010 at 6:16pm

Hi Julie

You just voiced a lot of really good questions and concerns and I'm guessing that there are probably many other therapists who feel the exact same way that you do. Now I'm going to do my best to address them.

I am interested enough that I do keep trying to learn about it but I am just not getting it. The way researchers talk is beyond me. The best thing I can think of is the theories in a book called "Made to Stick" where they talk about a few things like the "Curse of Knowledge" where people know too much and forget that others don't know what they know and how to take info and put it into usable formats so that all understand.

The point in bold is extremely valid. It's common to do with any area that one has expertise in. The more you know about something, the more you feel is common knowledge- because you know about it, and chances are you associate with many others who are experts in that area. For example- Have you ever started talking to a client rattling off muscles or massage terminology and then realized- oops- they have no idea what I'm talking about? But you could say the same thing to other massage therapists in your network and they know exactly what you are talking about. Research can be the same way. I am actually currently working on a project geared to help massage therapists with zero research background understand what it is, what it means, how to read/interpret it, and how to find it. Daunting, yes, but hopefully sometime in the next year it will be public and available to anyone who wants access to it. After I graduate I hope to begin teaching CE courses about intro to research methods and maybe more advanced courses later. But, that's not for a few years.

What good will it do to have one or two studies that show promise in one area? All of the research on cancer and we still don't have a cure for it although Candace Pert says she has one but she can't get funding to study it. No one wants the answer.

One or two well-run studies could lead to funding of future studies on that particular topic. One or two studies is not enough "proof" or evidence that something is definite, but if the same topic can be replicated with the same results over and over (yes, research can be tedious, but it's the only way to know if the outcome was due to chance, flawed design, etc) without conflicting results, then it's pretty safe to say that the results are accurate and true.
Your statement about cancer is absolutely false and quite honestly, downright insulting to the many people who have dedicated their lives and careers to finding cures for it (and other illnesses). People are surviving cancer at exponentially higher rates than even a couple of decades ago. Are there cures for every type of cancer? No. But doctors and researchers have made huge strides in effective and successful cancer treatment and continue to do so. Cancer isn't a one-size-fits-all illness, and neither is treatment.

So what if there were 20 or 100 studies done on a topic? Would that prove that it works? No, not really. When I took a research class on cancer with Tracy Walton a few years ago she said to say something like 'research shows promising results in this area".

If 100 well-done studies on a single, specific topic consistently showed positive and identical (more or less) results, then yes- that topic no longer needs to be studied and it's safe to say it's "proven" (in science nothing is actually "proven true", but there comes a point where it is taken as known). Perhaps the research Tracy was referring to was still relatively new. Science/research is not like the Internet where you get news flashes every minute- it can take years and many, many replications of studies. But again, if the results are consistently repeated, it's safe to say it's true (whether the results are positive or negative). And it takes less than 100 studies to do that.

I am also quite skeptical having a friend in research at a prominent univ. where she manages researchers who are always skewing the results and throwing out data that doesn't fit their hypothesis. It is funded by big drug companies of course and the researchers want to continue to play and have their jobs.

I've seen you bring this up before and I'll say the same thing I said then. This is absolutely, 100% unethical and should be reported. It is also not the "norm" in research. If someone were to do this and then get caught, their career would be finished. It's not worth the risk (and again, back to that ethics thing..there are ethical review boards for all types of research and this would go against every single one of them). I would also hesitate to compare research in massage therapy to research in pharmaceuticals. One has SIGNIFICANTLY more money, power, and pull than the other. If they are doing this, and remain funded because the drug co's are making big bucks, that's one thing. I can't think of that ever happening in the massage research world- not nearly as much money to be gained, even when talking about research grants (pharmaceuticals get grants in the millions of dollars..massage, probably low to mid 5 figures..). Apples and oranges here.

Who is interpreting research for us? Is there someone who is going through research and analyzing it saying things like who did funded the study, what were the results, how good of a study was it etc? I would guess that people reading research could interpret the results the way they want to see them.

Research that appears in peer-reviewed journals (the most common method of dissemination) are just that: peer-reviewed. In a nutshell, when an author (researcher) submits a research article to a journal, it goes through a panel review process- typically about 3 people, plus the editor- who are experts in the field of research that the article is about. In that process, it is either accepted as is (extremely rare- almost never), accepted with revision (common), or rejected. There are different "tiers" of journals. The higher the tier, the higher the number of submissions, and the harder it is to get accepted. Top tier journals will typically never publish poor-quality research because they have so many better options of which to choose from. Lower tier journals sometimes may publish more questionable research because they need to fill their publication and they have less articles to choose from. The tricky part is learning which journals are which. Once you know more about research though, you tend to become aware of their reputations (plus you also learn how to distinguish the good research from the bad, no matter what source it was printed in).

How is research being used? How will it improve my business or practice? I do mainly injury work but don't feel any need for research. If massage doesn't work within a few weeks or a month, I send people on their way maybe even to another massage therapist. If research says it will work -does that mean my technique and presence will work?

How research is being used will vary. Some therapists do incorporate research into their practice. Learning which techniques are shown to help certain conditions can be extremely beneficial, especially if you typically run into many similar injuries or problems. Laura Allen is teaching a class at the AMTA MA chapter convention in May about using research to build your practice. I used it when I had my own practice- if I was talking to someone and they happened to mention oh I have this problem and I knew from reading research that that problem was helped by massage, I would say gosh, did you know that massage has been shown to be great for X and chances are they would book an appointment. It was great to be able to share with my clients and the general public what conditions massage is great for and know that I wasn't just spewing old myths from school but I could actually show them the evidence to back up my claims. This works even better if you are trying to network with other health professionals (PTs, MDs, Chiros, etc)- they all understand research and practice by it, why shouldn't we??

And speaking of research - What I would like to see researched is how many hours of training do we need as a massage therapist?

You, me, and a lot of people. I tried for a couple months to design a study or evaluation plan that could measure this to use for my Master's thesis. The problem is, there are sooo many different variables involved that it would be difficult to just compare schools that teach 500 hours vs. 700 or 1000 or however many. It would require a lot of money, time, controls, and unfortunately just not feasible. Could you draw some correlations, or relationships, between students who graduate from a 1000 hour program vs those from a 500? Sure, you probably could. But you would not be able to attribute to those relationships to anything specific without proper controls.

For example: Let's say you take 10 students from a program of each of the lengths listed above. We would probably hypothesize (educated guess) that the students who graduated from the longer program are better therapists, and let's say we ran some basic analysis- maybe we had them massage different people who rated them on their effectiveness and we were right- those from the longer program were rated higher. But what made them better? Was it the length of the program? Maybe. What about the quality of the teachers? What about the content of the program- did one program focus more on massage specifically, and one go more into other associated modalities (reiki, reflexology, etc)? What about the quality of the students themselves? Not necessarily, but chances are someone who chooses a 1000 hour program over a 500 might be more dedicated, motivated, maybe more serious about their career? Again, not a given, but a possibility. There are many other things that could factor into it as well that would eliminate the ability to say A student was better than B student because they had 1000 hours of training instead of 500.

Is massage licensing needed or even working to do anything for the profession?

This is a slightly separate can of worms than straight up research on massage techniques/modalities. I do not feel qualified to give an educated answer on this, but my gut feeling would be "yes".

I would love to see research on just using presence and the healing process. How would you measure that?
I do not know that there is a way to measure that. But just to give a hypothetical response, let me ask you a question. I'm going to assume we mean "presence" in the same way, and that it would be defined as being "in the moment", tuned in to your client, the tissue/muscles that you are working on, and watching for subtle changes, etc. In other words- not thinking about what you're making for dinner that night. Wouldn't it be possible, then, to assume that the "presence" is not some sort of energy transfer or magic but just that- you are simply paying more attention to what you are doing, using each technique with a purpose, and that is the difference in the results that you get versus someone else who is not "tuned in"?

Wow. Sorry for the length of this and I hope it all makes sense. I really tried my best to answer everything clearly.

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