Contributed by April V. Neufeld, BS, LMP, Beth Barberree, BA, LMT, and Sandra K. Anderson, BA, LMT, ABT

Have you heard the terms "quantitative" and "qualitative" associated with research? Have you wondered what they meant? More importantly, have you ever wondered how they apply to your work as a massage therapist? This month's column is a review of an article written by a research team from the Department of Community Health Sciences at the University of Calgary for the International Journal of Therapeutic Massage and Bodywork, 2008; 1(2): 6-10.

Generally, research methods are split into two categories. Quantitative methods are highly controlled research studies requiring precise measurement to prevent unwanted influence on the outcome measures and any bias would invalidate the studies findings. Bias means a systematic error introduced into sampling or testing by selecting or encouraging one outcome or answer over others. To this end, these studies may be surveys or randomized, controlled trials. In randomized, controlled trials, the research subjects are randomly allocated to receive treatments, sort of like tossing a coin. After randomization, the groups of subjects are followed in exactly the same way and the only differences between the care they receive should be within the treatments being compared.

According to the article, "Quantitative research . . . often has the goal to describe and predict outcomes in a larger population of interest [by examining] the strength of relationships between variables of interest." In quantitative research, the context of the study is not considered in examining the data, only the methods being used. The researcher is an objective observer.

The other category, qualitative, is "used to understand and describe the subjective world of human experience." (Massage therapists are certainly exposed to the subjective world of human experience as they work with their clients.) The researcher is part of the context and intrinsically linked to the findings with the understanding that the research environment is socially and experientially constructed. The phenomenon being examined is only truly understood when studied as part of the whole, where the research context is taken into consideration. Bias does not invalidate the study. Instead, it informs the researchers.

The choice between a quantitative or qualitative approach depends on the design of the specific research study. The specific method is chosen "to answer different types of research questions and produce different types of information." For example, a qualitative researcher may ask, "What is the experience of massage therapists working in a hospital-based practice?" On the other hand, a quantitative researcher may ask, "Does massage therapy reduce pain in hospitalized motor vehicle accident patients?"

Kania, et al., explain how the qualitative side of research can "provide insights into the outcomes, process and context of massage therapy that cannot be fully achieved through quantification alone." In other words, qualitative research plays a major role in scientifically validating aspects of massage therapy that are not measurable, but are equally important. This helps researchers better understand relevant outcomes based on the participants' experiences. It also allows for the opportunity to examine various factors including the process of the treatment intervention, non-specific effects of the overall experience, the patient-practitioner relationship, the subjects' feelings about their experiences, the environment of the treatment, the culture or beliefs that the subject and massage therapist bring to the treatment and any expectations the subject has of the effects of massage.

Although much of standardized research uses quantitative methods, the article's authors make the case that this approach has limitations. The authors suggest that using a mixed-methods study design, combining qualitative and quantitative methods, is a reasonable option in massage therapy research. By using this combined approach, researchers may gain valuable insight and a more complete understanding of the effectiveness of a specific intervention, while at the same time collecting hard quantitative data.

According to Kania et al.,"Qualitative research findings . . . will not only help massage therapists practice more effectively, but also differently, with greater awareness and mindfulness," which are key skills in a patient-centered practice. This means that researchers are discovering what most massage therapists already know to be true – it is not just the measurable results of treatment that matter; the subjective parts of therapeutic relationship are also important.

For example, the authors describe a research study involving massage therapy for breast cancer patients undergoing chemotherapy treatment. As previous articles have discussed, much of the research on the effects of massage therapy on cancer patients focuses on outcomes such as anxiety and pain associated with chemotherapy and radiation treatments. By examining the "lived experience of the participants" the researchers were able to identify "massage as a distraction from frightening experiences" and "the psychological support that was experienced through massage." By focusing not only on quantifiable pain and anxiety scales, but also the patients' experiences while receiving the massage therapy, the researchers achieved a greater understanding of outcomes that are highly relevant to the patient's physical and emotional well-being.

These kinds of insights are especially important in studies where the participants felt there was change, but there was no statistically significant data to support their claim. In these cases, qualitative research provides the opportunity to examine the context of the intervention, since the context may influence the outcome(s) of the intervention.

Examining the lived experience helps researchers and practitioners alike better understand the impact of massage therapy, as well as all complementary medicine, intervention methods. "Qualitative research has great potential to inform massage therapy practice. Outcomes, context, and process factors enable the development and provision of more effective and appropriate treatment plans," write Kania, et al.

If you found this article interesting and would like to read more about qualitative research, check out the Massage Therapy Foundation's article archive. You can find the article in full at: www.ncbi.nlm.nih.gov/pmc/articles/PMC3091453/.