Therapeutic massage bodywork (TMB) therapies are commonly used by the public, nevertheless, research validating TMB is nascent. Practitioner variability may be affecting research outcomes. This study therefore describes and explores the relationship between therapist variables (e.g., training, practice focus) and clinical TMB experience, and the consequent implications for TMB research.
A combined methods design, consisting of a quantitative, population-based survey and qualitative interviews with practitioners trained in multiple therapies, was used to explore the training and practice of TMB practitioners in Alberta, Canada.
Of the 5242 distributed surveys, 791 were returned (15.1%). The sample demographics did not significantly differ from other massage therapist study populations. Practitioners were trained in 77 distinct TMB therapies. Most practitioners (94.4%) were trained in two or more therapies, 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 practitioners trained in multiple TMB therapies were interviewed. Participants reported greatly varying training backgrounds, resulting in practitioners learning and practicing unique combinations of therapy techniques. Moreover, all practitioners described addressing patients’ needs by providing individualized patient treatment based on a responsive feedback process throughout practice. Additionally, practitioners distrust TMB research results because of perceived and actual treatment provision differences between TMB clinical practice and TMB treatments used in research.
The training received, the number of therapies trained in, and the practice descriptors of TMB practitioners are all highly variable. Clinical experience and continuing education may further alter or enhance treatment techniques. Therefore, treatment provision and individualization are likely practitioner-specific. Practitioners surmise that clinical trials do not accommodate practitioner variability or treatment individualization, resulting in limited clinical application of TMB research. The high variability in training and experience between practitioners necessitates improved research reporting of practitioner qualifications and expertise, and the consequent impact on the results.
TMB research designs need to accommodate the inherent individualization of clinical practice and capture relevant contextual outcomes. Knowledge translation of research results must address TMB practitioners’ perceived differences between TMB research treatments and TMB clinical practice.