Meaning and challenges in the practice of multiple therapeutic massage modalities: a combined methods study

Abstract

BackgroundTherapeutic massage and bodywork (TMB) practitioners are predominantly trained in programs that are not uniformly standardized, and in variable combinations of therapies. To date no studies have explored this variability in training and how this affects clinical practice.MethodsCombined methods, consisting of a quantitative, population-based survey and qualitative interviews with practitioners trained in multiple therapies, were used to explore the training and practice of TMB practitioners in Alberta, Canada.ResultsOf the 5242 distributed surveys, 791 were returned (15.1%). Practitioners were predominantly female (91.7%), worked in a range of environments, primarily private (44.4%) and home clinics (35.4%), and were not significantly different from other surveyed massage therapist populations. Seventy-seven distinct TMB therapies were identified. Most practitioners were trained in two or more therapies (94.4%), with a median of 8 and range of 40 therapies. Training programs varied widely in number and type of TMB components, training length, or both. Nineteen interviews were conducted. Participants described highly variable training backgrounds, resulting in practitioners learning unique combinations of therapy techniques. All practitioners reported providing individualized patient treatment based on a responsive feedback process throughout practice that they described as being critical to appropriately address the needs of patients. They also felt that research treatment protocols were different from clinical practice because researchers do not usually sufficiently acknowledge the individualized nature of TMB care provision.ConclusionsThe training received, the number of therapies trained in, and the practice descriptors of TMB practitioners are all highly variable. In addition, clinical experience and continuing education may further alter or enhance treatment techniques. Practitioners individualize each patient's treatment through a highly adaptive process. Therefore, treatment provision is likely unique to each practitioner. These results may be of interest to researchers considering similar practice issues in other professions. The use of a combined-methods design effectively captured this complexity of TMB practice. TMB research needs to consider research approaches that can capture or adapt to the individualized nature of practice.

Exploring the Nature of Therapeutic Massage Bodywork Practice

“…The secondary analysis presented here is based on the extensive qualitative interview data collected in a combined methods study consisting of a quantitative survey and qualitative semistructured interviews focused on describing the training choices and decision-making factors that influence clinical practice of TMB practitioners (3) . In the larger study, four themes were developed in relationship to the survey data, two of those themes specific to practice (3) .…”

“…In the larger study, four themes were developed in relationship to the survey data, two of those themes specific to practice (3) . In this study, these two themes are extensively expanded and deepened to rigorously explore and describe the clinical process of practice of experienced, multipletherapy-trained practitioners.…”

“…Therefore, little is understood about how total training and experience, or idiosyncratic differences in treatment application by practitioners, may affect treatment outcomes in clinical practice or research. TMB practitioners have commented that from their perspectives the translation of research to practice is also challenged by the differences in treatment context (i.e., research vs. clinical) (3) . A rich, qualitative description of the process of clinical practice is therefore needed to better inform TMB research design and reduce the research translation gap.…”

“…Most TMB therapies have not been uniformly standardized with respect to their definitions, training components or practice competencies. Given that over 94% of TMB practitioners are trained in two or more forms of TMB (with a median of eight TMB therapies) and may apply more than one TMB during a treatment session, blending of those therapies' techniques likely occurs (3) .…”

“…TMB encompasses at least 170 therapies and their variants; 77 were identified in the larger study from which this article was developed (3) . All use one or more massage techniques (kneading, stroking, pressing, vibrating, holding, etc.)…”