The primary objective of the articles published in the Somatic Research column has focused on enhancing the reader’s research literacy—the ability to locate, evaluate, and effectively use research data to improve treatment and wellness sessions. Research capacity—playing a role in generating research—is a topic of increasing significance and allure. The more we learn about research, the more we question its theories and methods, and the more we want to influence its processes.

Research capacity is indicated when one writes a case report—pursuing it to publication—or participates in a research project, from helping design the protocol on a pilot study with a small number of participants, to training the team of therapists on a large comparison trial. There are those among us who endeavor to be an integral part of clinical research studies, beyond writing case reports, and not just guinea pigs. Without a doctorate, though, this can be a daunting proposition. However, opportunities do exist for massage therapists and bodyworkers to become involved in research studies and get paid for it.

Our Role in Generating Research

The prevalence of research competency—skills and abilities in both research literacy and research capacity—in our profession depends on how our profession, our clients, and the health professionals who refer to us value research.¹ An increasing number of therapists believe that research can enhance the reputation of somatic therapies, with a handful committed to incorporating new evidence into practice. With increased access to information, our clients are reading research, or at least getting the highlights of health research in the The New York Times and on National Public Radio, for example, and want to discuss the findings. The value of your massage may be enhanced if you demonstrate familiarity with the research, having already taken the findings into consideration when planning a treatment or wellness session.

Somatic therapists have a role and a responsibility in the generation and application of new knowledge, as purported in the National Center for Complementary and Alternative Medicine’s (NCCAM) Strategic Plan, 2011.² NCCAM recognizes that while complementary and alternative medicine (CAM) professionals should be research literate and researchers should come from within the CAM disciplines and lead investigations, training opportunities and funding support have been limited to date. The 2011–2015 plan includes the following strategies toward developing research capacity:

• Support a variety of research training and career development opportunities.

• Foster interdisciplinary collaboration and partnerships.

• Collaborate with and leverage the scientific and information resources and activities of other fields, organizations, and countries.³

Thankfully, our professional organizations are also setting goals for advancing research literacy and are working to establish collaborative relationships with allied health institutions, helping to place therapists in research settings, and thereby building research capacity. Fortunately, researchers recognize that massage therapists are necessary to designing and implementing significant massage research projects and they are willing to hire therapists as consultants and providers. Funding sources like the Massage Therapy Foundation require that research projects involve massage therapists in order to receive funding. The presence of licensed or certified therapists on projects assures that the research hypotheses ask meaningful questions and the research protocols match how we practice, leading us closer to uncovering information that can assist us in being more effective in our sessions and provide evidence that can enhance our standing in integrative health care.

We know we should be research savvy. We are slowly but surely getting there, despite the many hurdles of education, access, and support. We know there is an expectation that we participate in research. But until more of us get formal academic training in conducting our own research and obtaining funding as primary investigators, we must find ways to contribute and influence the research going on now.

Opportunities in Research

I am a research consultant, working periodically since 1996 for the Group Health Research Institute. Group Health is a health management organization (HMO) with many health clinics in the Seattle area, originally established in 1947 as a cooperative of physicians with the intent to provide affordable, quality health care. The research arm was created in 1983, and has since published more than 2,200 scientific journal articles, collaborating with various institutions such as Harvard Medical School, the University of Washington, and Fred Hutchinson Cancer Research Center.⁴

I do not have a doctorate in science or medicine; however, I have solid expertise in massage therapy. My expertise was in demand, requested by researchers at Group Health, and my contributions varied over 15 years. I have consulted on six massage research projects with Group Health, each spanning 2–3 years, and was a primary author on the massage taxonomy paper that came out of the protocol development of the studies, with Karen Sherman, PhD, leading the writing team.⁵ My participation ranged from answering basic questions regarding massage therapy and practice posed by researchers unfamiliar with massage, to advising protocol development and selecting and training massage therapists to provide the massage protocols to participants.

A variety of opportunities arise for massage therapists in projects like the ones I work on. Let’s look at one project in particular and dissect the many paid positions a massage therapist can hold. This project is one you might be very familiar with, a study recently published in the Annals of Internal Medicine: “Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain, an RCT.”⁶ The results were featured on National Public Radio,⁷ in the Washington Times, Time magazine’s ezine Healthland, the Los Angeles Times, and Science Daily,⁸ to name a few, and have stirred up a good deal of discussion among therapists. I have referenced this study in two previous articles, citing the presentation Dan Cherkin gave at the Highlighting Massage Therapy in CAM Research conference held in Seattle, May 2010. Now that it is published, we can discuss details of the study and identify the various opportunities for interaction between researchers and consultants.

Let’s start with the finances. Research is expensive. Someone has to pay for our expertise and the salaries of researchers, statisticians, etc. This study was funded by tax dollars—$2.1 million to be precise. The US government funds organizations such as the National Institutes of Health (NIH) to investigate the safety and efficacy of our health-care delivery systems and services. NCCAM is a subdivision of NIH dedicated to investigating the safety and efficacy of nonconventional forms of health care. NCCAM accepts grant proposals from researchers and distributes proposals to research review teams for evaluation and to make recommendations for funding. Once an award has been made, NCCAM staff monitor the use of the funds.

At this point, no massage therapists have been paid for their role in the study. The grant was written by two principal investigators (PIs) with doctorates, neither of whom are massage therapists. The NCCAM staff did not include massage therapists at the time of the study, although they currently have one massage therapist on the National Advisory Council (NACCAM). This is an unpaid position. The review team may have included a massage therapist, but that, too, is an unpaid position. Until recently, massage therapists were not included on research review committees or on NACCAM. Even unpaid, those are positions of great honor, and we can feel proud to have massage therapists sitting at those tables today.

Next, we go to the institute conducting the study: Group Health Research Institute. The organizational chart is impressive on a $2.1 million study, with more than 70 employees, consultants, and practitioners dedicated to the study. Only one of the six administrative and scientific leadership roles was held by a massage therapist: Janet Kahn, PhD, LMT, coinvestigator, a paid consultant. Kahn was instrumental in each phase of the study. In addition to participating in the research method’s design and hypothesis development, she led the team that developed the protocol, created the training materials for the protocol training, and monitored the treatment forms as they were submitted, keeping an eye out for discrepancies. It is critical that the massage therapists adhere to the protocols assigned to each participant; Kahn ensured the protocol was followed.

In research operations, one of 13 positions was held by a massage therapist. This was a full-time research specialist position, held by Marissa Brooks, LMP. Between the leadership, administration, and operations teams, we have two paid massage therapists, one in a high-level position with an advanced degree, the other interested in learning more about research enough to get a full-time job in a low-level research position, and maintain her massage practice on a part-time basis on evenings and weekends.

On the clinical team, Dawn Schmidt, LMP, and myself were the two massage consultants hired to train the licensed massage practitioners in the protocol and in the role of the therapist on a research team. Schmidt was a part of the Massage Therapy Research Consortium, a group of massage schools dedicated to collaboratively building research capacity in massage schools and fostering partnership with research scientists, led by Kahn. Representatives from each school met to develop the protocol for the two different types of massage—relaxation versus focused structural massage—but were not paid for their time. Schmidt, as a representative of a consortium school, was integral to the consulting team as she was intimately familiar with the protocol and the discussion that shaped the final result.

I was also part of the practitioner selection team, reviewing applications and interviewing massage therapists for the study. I helped identify therapists who had at least five years of steady full-time or nearly full-time massage experience, were located in the areas where there were high concentrations of Group Health patients who were selected as participants in the study, and were skilled in both aspects of the protocol: relaxation massage and myofascial and neuromuscular types of massage. The request for applications and resumes went out to therapists credentialed by Group Health—preferred providers who were currently billing for massage therapy care under Group Health Insurance. 

With that, we added two more paid massage therapists, four total, and over a dozen massage therapists with some level of involvement.

Next, we added 27 licensed massage practitioners (LMPs) to the team. Schmidt and I worked closely with the PI, Cherkin, and coinvestigator, Sherman, to prepare the 27 therapists for their role in the study. The training was held over a weekend for a day and a half; the LMPs were paid for their time. The training included:

• Background on massage research for low-back pain.

• Goals and structure of the project, including details of the three protocols.

• Practical training on the two massage protocols, with demos and exchange time.

• Practical training on the homework/self-care protocols.

• Practical training on the assessment protocol, pre- and postmassage.

• Discussion of potential safety issues.

• Training on record keeping.

Record-keeping training was critical because a rigid protocol was not implemented. Instead, clear and specific parameters were provided, detailing what could and could not be included in a session, and time frames were allocated per region of the body. Individualization of the sessions was encouraged. As a result, the massage therapists had to document exactly what they did in each session. The treatment forms collected the data on the intervention, not on the results of the study. Research staff collected data on treatment outcomes during phone interviews at four weeks, 10 weeks, 26 weeks, and 52 weeks.

As contracted providers, the massage therapists worked in their own offices, mailing in the treatment forms to Group Health along with invoices for their time. They were paid monthly for the invoices submitted, which included payment for missed appointments when a client “no-showed.”

Thirty-one massage therapists were paid employees, paid consultants, or paid contractors on the low-back pain study, most with little more than their massage license as a prerequisite. The majority of therapists were hired because they had a relationship with the HMO as preferred providers in the network. Three others were already engaged in massage therapy research at some level. One simply sought a job that did not require traditional research education in order to get some research experience. (Brooks went on to get her master’s degree in public health and is now the project manager for a study on asthma!)

Making Contact with Researchers

Group Health is one of many conducting research on massage therapy and related CAM modalities. Like Group Health,⁹ some are associated with medical institutions, such as the Mayo Clinic,¹⁰ while others are associated with medical schools, such as Harvard’s Osher Center,¹¹ Yale School of Medicine,¹² and the Touch Research Institute at the University of Miami School of Medicine.¹³ Look for a medical center or university in your area with an interest in alternative health care, and read the research they are publishing to see if collaborative opportunities that are of interest exist near you.

Once you become familiar with a body of research from an institute or university, contact the PI. Contact information for the researchers is often included in the citation. Most researchers make themselves available for answering questions and discussing study results, usually via email. Write an introductory email: comment on the body of work of the researcher, acknowledging an aspect of a recent study you find valuable (always start with positive feedback), and ask a specific question that you might have about the project. Let them know you are willing to participate in future studies, should a position become available. Provide some background on your area of expertise (what type of clients you work with, as well as your level of research literacy), and what interests you have in research.

Be prepared to talk about their research and related studies. You do not have to be research capable, just research literate, to get your foot in the door. Show interest in what they are studying, and offer suggestions on how you might contribute to their work. Be willing to start out at the ground level, accepting whatever help they might need in the beginning.

If there are no paid opportunities to participate in clinical trials in your area, become a part of a practice-based research network (PBRN) and contribute research data through surveys. PBRNs commonly exist in various health-care professions with the goal to involve health-care providers working together with researchers to answer community-based health-care questions and translate those research findings back into practice. MassageNet (MassageNet.org) is the first PBRN for the massage community.¹⁴ The mission of MassageNet is to develop a channel for communication between massage therapists, students, researchers, educators, administrators, and health-care policy makers. In addition to surveys, MassageNet conducts primary research and shares the latest research findings in the field to expand the body of knowledge available to the massage profession and other health specialists.

Find a way to participate in generating research, whether through a PBRN, writing case reports, or participating as a paid member of a research team. Go beyond your newly found research literacy skills and play a bigger role in research, influencing the body of knowledge on massage and bodywork.

 A licensed massage practitioner since 1984, Diana Thompson has created a varied and interesting career out of massage: from specializing in pre- and postsurgical lymph drainage to teaching, writing, consulting, and volunteering. Her consulting includes assisting insurance carriers on integrating massage into insurance plans and educating researchers on massage therapy theory and practice to ensure research projects and protocols are designed to match how we practice. Contact her at soapsage@comcast.net.

Notes

1. North American Primary Care Research Group Committee on Building Research Capacity and the Academic Family Medicine Organization Research Subcommittee, “What Does It Mean to Build Research Capacity?” Family Medicine 34, no. 9 (October 2002): 678–84.

2. National Center for Complementary and Alternative Medicine, “Strategic Objective 4, Improve the Capacity of the Field to Carry Out Rigorous Research,” accessed September 2011, http://nccam.nih.gov/about/plans/2011/objective4.htm.

3. Ibid.

4. Group Health website, accessed September 2011, www.ghc.org/about_gh/co-op_overview/index.jhtml.

5. Karen J. Sherman et al., “Development of a Taxonomy to Describe Massage Treatments for Musculoskeletal pain,” BMC Complementary and Alternative Medicine, accessed September 2011, www.biomedcentral.com/1472-6882/6/24.

6. Daniel C. Cherkin et al., “Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain, an RCT,” Annals of Internal Medicine  155 (July 5, 2011): 1–9. Accessed September 2011, www.annals.org/content/155/1/1.full.

7. Patti Neighmond, “Got Low Back Pain? Massage Therapy May Rub It Out,” accessed September 2011, www.wbur.org/npr/137609072/got-low-back-pain-massage-therapy-may-rub-it-out.

8. “Massage Eases Low Back Pain in Randomized Controlled Trial,” Science Daily  July 5, 2011, accessed September 2011, www.sciencedaily.com/releases/2011/07/110704174603.htm.

9. “Working with Group Health Research Institute,” accessed September 2011, www.grouphealthresearch.org/research/collaborate/collaborate-with-ghri.html.

10. “Massage Therapy Research,” accessed September 2011, www.mayoclinic.org/massage-therapy/research.html.

11. Osher Center for Integrative Medicine, “Research,” accessed September 2011, www.osher.ucsf.edu/research/index.html.

12. Yale School of Medicine, Integrative Medicine at Yale, “Active Clinical Trials: Exploring Massage Benefits for Arthritis of the Knee,” accessed September 2011, http://medicine.yale.edu/integrativemedicine/research/trials.aspx.

13. Touch Research Institute, accessed September 2011, www6.miami.edu/touch-research.

14. Massage Therapy Research Network, accessed September 2011,  www.massagenet.org/index.php.