My Current Massage Research

Research is a tough topic to conceptualize for many. This is especially true for massage therapists trying to understand massage therapy research. Coursework in research methods is dry and uninteresting for most. Perhaps reading about research as it develops might provide a more interesting and understandable way to approach the area of massage therapy research.

I have developed this loose “log-book” of my own progress in research. Perhaps seeing research in action will make you understand how an ordinary therapist like yourself can add to the body of knowledge about massage therapy.

January 6th, 2007
Began course OTR 655: Introduction to Clinical Research at Barry University in Miami taught by Dr. Cynthia Creighton . The main book required for this course was Research in Occupational Therapy: Methods of Inquiry for Enhancing Practice by Gary Keilhofner. Though this book was written around occupational therapy, most of the concepts explained in the book would easily apply to any of the therapy disciplines including massage therapy. Supporting books for this course were Concise Rules Of APA Style by the American Psychological Association (an unfortunate nit-picky necessity for writing with research literacy) and Statistics for People Who (Think They) Hate Statistics with SPSS Student Version 13.0 by Neil Salkind. This is probably one of the best written and easily understood books available for any massage therapist to learn the research-relevant statistics necessary for interpreting an article about massage therapy research.

February 4th, 2007
Developed a possible topic worksheet for my graduate project. Notice I started out originally developing a project using massage to induce sleep in children afflicted with ADD. Even though I eventually opted for a different topic to study, this topic worksheet would give any massage therapist thinking about exploring research a way to develop a good massage research topic.

March 18th, 2007
Since I ultimately chose a graduate project which would involve experimentation on human participants, maintaining ethically responsible research is paramount. One part of this process is the concept of informed consent. At this time I began working on my Letter of Informed Consent. Understand that this version is the final version which was finally approved by the Barry University Institutional Review Board (IRB) nearly eight months later (with nearly the same number of revisions before approval).

April 1st, 2007
Completed my initial Literature Review for my topic of research. Though this file shows the name of the project as: Comparison of Three Interventions for Improving Function in the Individual with “Tennis Elbow”: A Single-Subject Design Study, it actually started out as another title which you’ll see in the power point slide show below. You may also notice that both titles identify this study as a single-subject design. It is not a well-known design method in many fields of medicine or healthcare, but has been well-used by the occupational therapy field to develop knowledge. The same study design could be easily used by the massage therapy field for massage research. Single-subject designs are relatively easy to plan and perform, and they do not require great sums of money to fund a project. For more information about Single-Subject design methods, see Kenneth Ottenbacher’s Evaluating Clinical Change: Strategies for Occupational and Physical Therapists.

May 12th, 2007
With the Intro to Clinical Research class done, we started a new class, OTR 625: Advanced Clinical Reasoning. While this course mostly used the above mentioned Kielhofner book, two new books were introduced. Tests & Measurement for People Who (Think They) Hate Tests & Measurement by Salkind of the above previously mentioned Statistics book , puts an easy to understand perspective on tests and measurements. The last new book required for this course was The Thinker’s Guide to Analytical Thinking by the Foundation for Critical Thinking. While this was just a small, simple, easy-to-read booklet, it is, in fact, a book that has made one of the greatest impacts of my life, at least along the lines of the way I think. Lastly, while we used only a small section of Cognitive and Perceptual Dysfunction: A Clinical Reasoning Approach to Evaluation and Intervention by Unsworth, this provided a good introduction and explanation to the entire clinical reasoning process, a must-know for sound evidence-based practice. Any massage therapist contemplating massage therapy research could get much out of reading all three of these books.

May 26th, 2007
Completed my poster presentation for my project approval by the Occupational Therapy Department faculty . Notice what my original title of my project was. As explained above, it has since been modified. Poster sessions seem to be the norm for all the other therapy disciplines. The Massage Therapy profession could pick up the pace and follow a bit better in this area.

June 18th, 2007
Completed the online course, Human Participants Education for Research Teams, available on the National Cancer Institute's website. This course completion is a requirement before submission of a research study protocol proposal to the Barry University IRB. The course is free, and provides some interesting information.

July 30th, 2007
By now I thought I had a well-done Research with Human Participants Protocol Form/Project Information, and thought I was ready to submit it and my other required papers to the IRB for approval. Was I ever wrong. After letting Dr. Creighton review my paperwork, she politely said that there would need to be a number of revisions which we did over the next two months. Besides the protocol form, I needed to revise my final Informed Consent letter, develop a participant recruitment advertisement and obtain copies of the two measurement assessments I would be using during my research study experiment. These consisted of the DASH and the a version of the VAS .

October 2, 2007
By now I was getting fairly tired of this entire process, but luckily all the revisions had been made. I will admit, I would have never been able to do it without the help of Dr. Creighton. She finally signed off on the project, and we submitted it to the IRB office. Now all was that was needed was approval from the IRB which was to meet on October 17th, 2007.

October 17th, 2007
The IRB met and reviewed my application for my research project. As speculated by Dr. Creighton, the application was provisionally accepted pending changes.

October 30th, 2007
The IRB finally sent me a letter outlining the required changes to my proposal, and supporting documentation. I thought some of those changes were a bit nit-picky, but that is what is required. One requirement was the creation of a “Participant Information” form. Luckily, Dr. Creighton was once again very helpful in assisting me make the required changes and within a week, the corrections were submitted.

November 13, 2007
My project was now accepted (approved), and I was finally given permission to start recruiting participants for the study.

January 7, 2008
I finally have my first participant with Tennis Elbow to sign up to begin the study ("A" Phase). Finding participants has turned out to be a much more daunting task than I had expected. I am limited to how I may advertise for participants as defined in my IRB-approved Protocol Form. Looking back now, I wish I had included possibly radio advertising into the Protocol Form before submitting it to the Barry University IRB for approval. Live and learn.

January 28, 2008
My first research participant has just completed the “A” phase of my Single-Subject Design study. For three weeks the participant put a cold pack on the affected elbow for 15 minutes each day. Today the participant came into the office, resubmitted the DASH and VAS for Pain measurements, and we began the first cold laser session. Thus began the “B” phase of the study (3 weeks of low level laser 3x per week).

When the participant initially filled out the pretest DASH and VAS for pain, I never actually looked at the results of these two initial measurements. I have decided now to also not look at results of the DASH and the VAS for pain each time the participant resubmits at the end of each phase. I will only look at all of the results of each phase at the very end of the study. I have also asked the participant to not verbally share with me the effects of the treatment (if any) after each phase. While not a true “blinding”, I am try to keep the results of any one phase from myself as a way to eliminate the validity threat of Compensatory Equalization of Treatment.

February 18, 2008
After 3 weeks of using low level laser to treat the tennis elbow of the participant, the "B" Phase of the study is complete, and I am starting the "C" Phase.

This phase consists of a 15 minute massage session to the affected forearm/elbow using the techniques of cross-fiber friction to the lateral epicondyle, deep strip gliding over the extensor group of the forearm, and pin and stretch techniques over any individual taunt muscle bands in the extensor group or supinator.

March 10, 2008
All research sessions have been completed and the final measurements have been taken. I'll be working on a study report over the next few weeks, so stay tuned for an update!

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