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Research With Massage Therapy Foundation

By Massage Therapy Foundation Contributor

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Perceptions of the MT During Randomized Control Trials

Contributed by April Neufeld, BS, LMT, BCTMB; Derek R. Austin, PT, DPT, MS, BCTMB, CSCS; Jacqueline Tibbett, BS, LMT

Research evaluating the efficacy of massage therapy has increasingly been of interest to many, including clinical practitioners and researchers. But the aims of clinical practice and research are often quite different. For example, research trials using massage therapy and other complementary and alternative medicine (CAM) must follow specific standardized designs and use control groups, methods that are not always typical during clinical treatment.

In this month's Massage Therapy Foundation research review, we examine a recent study titled "Perceptions of Massage Therapists Participating in a Randomized Controlled Trial" that was published in the International Journal of Therapeutic Massage and Bodywork.

Massage in Randomized Control Trials

In this study, the experiences of licensed massage therapists who provided massage in randomized controlled research trials (RCTs) were evaluated so that future studies can better design and implement CAM research and better understand how attitudes and expectations of practitioners could influence patient outcomes.

To understand the experiences of massage providers in RCTs, the authors set up interviews with licensed massage therapists (LMTs) who "had participated in randomized, three-arm, multisite clinical trial comparing the effects of a Swedish-style massage to a light touch control and a usual care group for treatment of osteoarthritis of the knee."

Perceptions of the MT During Randomized Control Trials - Copyright – Stock Photo / Register Mark The LMTs discussed their experiences and perceptions about the trial they had participated in and included recommendations for future trials. The interviews were analyzed and six themes were identified from the LMTs' statements:

  1. Promoting the profession of massage therapy via research.
  2. LMTs' mixed views on using standardized protocols.
  3. The challenges of sham interventions.
  4. Participants' response to the sham interventions (light touch).
  5. Logistics (views on scheduling and compensation).
  6. The unanticipated benefits of participating in research.

Our readers who are interested in setting up their own case reports or small research studies utilizing other LMTs might be very interested to read this study, as it provides valuable information to consider when involving massage providers in research.

For example, providers may not always know their role within the study. The authors write, "Providers involved in research may be unfamiliar with the rationale of clinical trial design and procedures, and clinicians may need to be reminded of the purpose during a research trial."

Additionally, gathering feedback from providers during and at the end of research trials may help identify any inconsistencies between the priorities of study participants and the provider.

Understanding the Themes

For those who want to design or participate in research with massage interventions, it could be useful to understand how LMTs viewed using standard massage and control protocols.

"LMTs in the current study initially found research protocols to be more difficult than real world practice," because they could not personalize treatment (theme 2). However, the LMTs also clearly understood that it was important to use a standardized treatment for everyone. Beginning researchers or those new to research involving CAM therapists might be particularly interested in the perceptions of the LMTs towards control or "sham" interventions (themes 3 and 4).

The sham intervention  was a standardized light touch protocol, and some LMTs felt that it was deceptive. Despite initial concerns, LMTs appreciated that some patients in the RCT felt that the light touch intervention worked as a sham intervention, (theme 2, 3, and 4), since those participants receiving the light touch found it relaxing and beneficial. This means that, when setting up a study involving LMTs, researchers could spend time helping the providers understand that the control treatment could be beneficial to those subjects receiving the intervention.

Overcoming Obstacles

Another challenge to researchers is finding not only participants to be subjects, but also finding LMTs to provide the interventions. One possible way of overcoming this challenge may be by highlighting the unforeseen benefits of participating in research (theme 6). "Two LMTs said they liked being part of a collaborative academic research team that focused foremost on the well-being of the patient." Underlining this positive aspect of being involved in research, as well as giving LMTs the opportunity to promote massage therapy through research (theme 1), could assist study recruiters in finding LMT providers.

Additionally, by keeping in mind issues involved with the logistics of scheduling and compensation, recruiters and study designers could manage the expectations of participating LMTs. The authors wrote, "Three LMTs expressed concern that clinical trial participants were not motivated to show up, since they were not penalized for missed appointments."  If appointments were scheduled in a way to limit the impact on therapists' schedules, then researchers might avoid LMT frustrations.

Think Before You Speak

The authors demonstrate throughout this article that thoughtful attention should be given to the role of the provider. Since the patient-provider relationship is so important, the language that the LMT uses to discuss the study with the patient could influence study outcomes. For example, the LMTs all gave different responses when patients asked them questions about the sham intervention. One LMT told the patient that it was a type of compression, others told the patient to ask the researchers.

These findings indicate that when setting up a study involving LMTs, researchers should spend time helping the providers understand the function of a control treatment and standardizing what to say when asked for explanation by the patient.

The authors "propose the role of patient and practitioner be considered equally important in complementary and integrative medicine trials. Soliciting and analyzing provider feedback may help identify any inconsistencies between the priorities of study participants and interventionists."

The authors discussed that a limitation of the current study was the small sample size; only seven LMTs were interviewed. It is possible that the experiences of such a small group cannot be generalized to a larger group.  However, the strength of this particular study is that, to date, no other studies have analyzed the experiences of LMTs after they have participated in an RCT.

New researchers who have enjoyed this article should consider spending time on the Massage Therapy Foundation's website. There you will find many links to resources and education, such as the article "How to Connect with a Researcher" by Ruth Werner, which is available on the resources page. You can also apply for a research or comm-unity service grant there.

Resource

  • Perlman A, Dreusicke M, Keever T, Ali A. Perceptions of Massage Therapists Participating in a Randomized Controlled Trial. International Journal of Therapeutic Massage & Bodywork. 2015;8(3):10-15.
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