The role research plays in creating and maintaining an evidence-informed profession..
by Cynthia Piltch, PhD, MPH, CMT, RMT, and Martha Brown Menard, PhD, CMT
Creating An Evidence-Informed Practice
Usually in this column, we focus on a particular condition
and discuss related massage therapy research. With
our backgrounds, we sometimes take our research literacy
skills for granted and assume that everyone realizes
how crucial these are for improving the quality of care
practitioners provide to clients on a daily basis. Recently,
we received a copy of an article[1] written by our colleague
Dr. Paul Finch, former director of education at the
Sutherland-Chan School of Massage in Toronto, Canada.
Originally published in 2007 in the Journal of Bodywork
and Movement Therapies, the article highlights
the role played by the critical evaluation of
original health care research in creating an evidenceinformed
practice. As we begin a new year, we would
like to remind mtj readers of the need for incorporating
research evidence into our clinical decision making.
The evidence-based movement in medicine & health care
Research has always formed the basis of scientific
thought. In health care and medicine, research began
with a combination of clinical observation and empirical
testing—thoughtful trial and error. A practitioner would
note a certain set of symptoms, try various remedies to
see which were effective, and reject those that didn’t
seem to work.
When another patient presented with the same or similar
symptoms, the previously effective remedy would be
tried first. For many years, most health care research
consisted of observational and descriptive studies of
naturally occurring events, and some before-and-after
treatment studies. The widespread use of randomized
controlled trials, where some kind of control or comparison
group is used, is a relatively recent innovation.
The randomized controlled trial (RCT), because of its
design features, shows the strongest link between cause
and effect using a single study. Credit for the modern
RCT is usually given to Sir Austin Bradford Hill[2].
England’s Centre for Evidence-Based Medicine has
defined evidence-based medicine (EBM) as “the conscientious,
explicit and judicious use of current best evidence
in making decisions about the care of individual
patients.” While many aspects of health care depend on
individual preferences related to personal values and
quality of life, the primary goal of EBM is to clarify the
components of medical practice that can be evaluated
using the scientific method and to apply that method to
best predict the outcome of a given course of treatment,
even as dialogue about which therapies or outcomes are
most desirable continues.
The growing trend towards evidence-based health care
is here to stay. Both new and established treatments are
now expected to demonstrate their effectiveness based
on research, and insurance coverage of a treatment is
increasingly likely to be linked to research supporting
its use. An evidence-based focus requires the application
of scientiic method to the clinical practices of the
health care professions. This focus poses a challenge for
complementary and conventional practitioners alike.
Many established treatments have not been tested using
randomized controlled trials, and in evaluating some
treatments or therapies, RCTs may not be appropriate
or feasible.
Fortunately, other types of descriptive and observational
research designs, such as case reports and qualitative
studies, are complementary to the RCT and provide
valuable evidence to support the use of therapies
such as massage and bodywork. Becoming an educated
consumer of the research literature will enhance your
credibility with clients, as well as with conventional
health care practitioners.
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American Massage Therapy Association®
