4 Fallacies About Research and Massage
Navigate the rough landscape between research and massage fact and fiction.
Myth #1: If a study gets published, it must be true.
Fact: There is a great deal of truth in the adage “publish or perish.” There is enormous pressure on faculty at academic institutions to publish—as published material is a key factor in decisions related to hiring, promotion and tenure, and the already fierce competition for full-time academic tenure-track positions continues to increase every year. As new fields of study develop and areas become more specialized, academic publishers create new journals or venues for publication for the glut of scholarly manuscripts submitted. And academic journals do vary in quality. Some have high-quality standards and others, well … not so much. Some are little more than vanity presses that will accept almost any manuscript submitted along with a substantial article processing fee. This practice, known as “predatory publishing,” appears to be on the rise,1 damaging the reputation of open access publishing in the process.
The National Library of Medicine, which hosts the PubMed and Medline databases, does have quality standards2 for the journals it chooses to index in its databases, as do other sources, such as CINAHL, PsycInfo and JSTOR. These are all good places to search for relevant journal articles in massage therapy. When in doubt about a specific journal, go to its website and look around. Does the journal’s title seem overly broad, or does it combine two or more fields not usually treated together, like “The International Journal of Science, Business and Humanities”? Does the website appear to be poorly maintained, with dead links, prominent misspellings and grammatical errors? These are obvious clues that the journal may not be legitimate.
It’s also important to look at the source of a given study’s funding. Reputable journals require all sources of funding and business relationships that might influence authors to be disclosed so readers can decide for themselves whether a conflict of interest exists. Bottom line: Just because a study is published in what sounds like a scientific journal doesn’t make it valid, good or true. Remember, you can’t believe everything you read on the internet.
Myth #2: You can’t trust research because it’s so contradictory: First coffee’s good for you, then it’s bad for you, then it’s good again—so which is it?
Fact: In short: It’s complicated. Science is built on a body of evidence that accumulates over time. It’s rare that a single study definitively answers a question beyond a shadow of a doubt, and most studies build upon previous research to extend the knowledge base. This is why the significance section of a journal article describes the “so what” aspect of a study—why is this particular study important and what new information does it add to the body of knowledge on a particular topic or area? How does this study fit into the context of what we already think we know about a question?
The other important thing to keep in mind is that science is self-correcting because it’s always open to integrating new information as it is discovered. The history of science holds many examples of once widely accepted beliefs that were later demonstrated to be false. So, as we gain new information, we develop a more nuanced and detailed picture of phenomena—and discard faulty or erroneous ideas.
A research question that examines a complex topic like the effects of nutrition on human physiological processes often requires a program of research—a series of related studies that systematically investigates a big question, with each new study building on the results from the previous study. It’s not unusual for a study to raise more questions than it answers, too, or for different researchers pursuing the same question using different methods to get different or conflicting results. These are just two reasons why replicating studies is so important, as well as why you should read the methods section of a study closely. Throw in what we are currently learning about variations in genetic profiles and their potential variations in response to interventions, and you can see why it’s complicated. Sometimes you just have to wait for enough information to accumulate.
Myth #3: Randomized controlled trials are the gold standard of research.
Fact: Randomized controlled trials (RCTs) are unsurpassed at answering a certain type of research question: Namely, does this treatment work better compared to something else—belief or positive expectation, another treatment or just doing nothing at all? However, this is not the only type of research question that is useful. For example, when little is known about a topic, qualitative, descriptive and observational studies are more appropriate than experimental designs. While RCTs are a rigorous type of experimental study, an RCT is a late-stage type of research design. A well-designed RCT is based on a good deal of previous research. And in recent years, the RCT has been supplanted by the systematic review, a quantitatively weighted summary of multiple studies looking at the same research question. Additionally, Cochrane reviews are considered to be especially rigorous at answering the “Does it work?” type of question.
Different types of research designs each have their own strengths and weaknesses. Instead of a hierarchical pyramid of designs, with some types of research being “better” than others, conceptualizing various types of research designs as complementary to one another is much more useful. A great illustration of this idea is the evidence circle, as described by Hal Walach and his co authors in their paper “Circular Instead of Hierarchical: Methodological Principles for the Evaluation of Complex Interventions.” This concept is a much more useful way to approach the investigation of complex interventions like massage therapy. A body of evidence that accumulates over time is likely to have more than one type of study, and this triangulation of methodological approaches makes for a stronger, more trustworthy knowledge base.
Myth #4: There isn’t enough high-quality research on massage therapy to justify its use in conventional health care settings.
Fact: According to PubMed, there were more than 8,550 studies on massage therapy as of February 2017. And to date, at least 114 systematic reviews that include massage have been conducted. The combined studies cover a broad range of conditions, populations and settings, and a number of them discuss cost considerations, including evaluations of costeffectiveness.3, 4, 5 So, there is actually a substantial body of research supporting the role that massage therapy could play in conventional health care settings. Other issues, such as who should pay for that care, low educational standards, and how institutions should credential and employ massage therapists, are more likely to be the real challenges that stand in the way of widespread integration of massage therapy.
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1. Carl Straumsheim (October 2015). https://www.insidehighered.com/news/2015/10/01/study-finds-huge-increasearticles-published-predatory-journals. Accessed February 20, 2017.
2. National Library of Medicine Fact Sheet. https://www.nlm.nih.gov/pubs/factsheets/jsel.html. Accessed February 20, 2017.
3. Eisenberg DM, Kaptchuk TJ, Post DE, Hrbek AL, O’Connor BB, Osypiuk K, Wayne PM, Buring JE, Levy DB. Establishing an Integrative Medicine Program Within an Academic Health Center: Essential Considerations. Acad Med. 2016 Sep;91(9):1223-30.
4. Furlan AD, Yazdi F, Tsertsvadze A , Gross A , Van Tulder M, Santaguida L, Gagnier J, Ammendolia C, Dryden T, Doucette S, Skidmore B, Daniel R, Ostermann T, Tsouros S. A systematic review and meta analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain. Evid Based Complement Alternat Med. 2012;2012:953139.
5. Lin CW, Haas M, Maher CG, Machado LA, van Tulder MW. Cost-effectiveness of guidelineendorsed treatments for low back pain: a systematic review. Eur Spine J. 2011 Jul;20(7):1024-38.