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      Perceptions of Massage Therapists Participating in a Randomized Controlled Trial

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          Abstract

          Background

          Clinical practice and randomized trials often have disparate aims, despite involving similar interventions. Attitudes and expectancies of practitioners influence patient outcomes, and there is growing emphasis on optimizing provider–patient relationships. In this study, we evaluated the experiences of licensed massage therapists involved in a randomized controlled clinical trial using qualitative methodology.

          Methods

          Seven massage therapists who were interventionists in a randomized controlled trial participated in structured interviews approximately 30 minutes in length. Interviews focused on their experiences and perceptions regarding aspects of the clinical trial, as well as recommendations for future trials. Transcribed interviews were analyzed for emergent topics and themes using standard qualitative methods.

          Results

          Six themes emerged. Therapists discussed 1) promoting the profession of massage therapy through research, 2) mixed views on using standardized protocols, 3) challenges of sham interventions, 4) participant response to the sham intervention, 5) views on scheduling and compensation, and 6) unanticipated benefits of participating in research.

          Conclusions

          Therapists largely appreciated the opportunity to promote massage through research. They demonstrated insight and understanding of the rationale for a clinical trial adhering to a standardized protocol. Evaluating the experiences and ideas of complementary and alternative medicine practitioners provides valuable insight that is relevant for the implementation and design of randomized trials.

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          Most cited references24

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          A meta-analysis of massage therapy research.

          Massage therapy (MT) is an ancient form of treatment that is now gaining popularity as part of the complementary and alternative medical therapy movement. A meta-analysis was conducted of studies that used random assignment to test the effectiveness of MT. Mean effect sizes were calculated from 37 studies for 9 dependent variables. Single applications of MT reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level. Multiple applications reduced delayed assessment of pain. Reductions of trait anxiety and depression were MT's largest effects, with a course of treatment providing benefits similar in magnitude to those of psychotherapy. No moderators were statistically significant, though continued testing is needed. The limitations of a medical model of MT are discussed, and it is proposed that new MT theories and research use a psychotherapy perspective.
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            The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain.

            In a pooled analysis of four randomized controlled trials of acupuncture in patients with migraine, tension-type headache, chronic low back pain, and osteoarthritis of the knee we investigated the influence of expectations on clinical outcome. The 864 patients included in the analysis received either 12 sessions of acupuncture or minimal (i.e. sham) acupuncture (superficial needling of non-acupuncture points) over an 8 week period. Patients were asked at baseline whether they considered acupuncture to be an effective therapy in general and what they personally expected from the treatment. After three acupuncture sessions patients were asked how confident they were that they would benefit from the treatment strategy they were receiving. Patients were classified as responders if the respective main outcome measure improved by at least fifty percent. Both univariate and multivariate analyses adjusted for potential confounders (such as condition, intervention group, age, sex, duration of complaints, etc.) consistently showed a significant influence of attitudes and expectations on outcome. After completion of treatment, the odds ratio for response between patients considering acupuncture an effective or highly effective therapy and patients who were more sceptical was 1.67 (95% confidence interval 1.20-2.32). For personal expectations and confidence after the third session, odds ratios were 2.03 (1.26-3.26) and 2.35 (1.68-3.30), respectively. Results from the 6-month follow-up were similar. In conclusion, in our trials a significant association was shown between better improvement and higher outcome expectations.
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              Research Design - qualitative, quantitative and mixed methods approaches

                Author and article information

                Journal
                Int J Ther Massage Bodywork
                Int J Ther Massage Bodywork
                International Journal of Therapeutic Massage & Bodywork
                Multimed Inc.
                1916-257X
                September 2015
                01 September 2015
                : 8
                : 3
                : 10-15
                Affiliations
                [1 ]Duke Integrative Medicine, Duke University, Durham, NC, USA
                [2 ]Department of Pediatrics, Yale University, New Haven, CT, USA
                Author notes
                Corresponding author: Adam Perlman, MD, MPH, Duke Integrative Medicine, Duke University School of Medicine, 3475 Erwin Rd, Durham, NC 27710, USA, adam.perlman@ 123456duke.edu
                Article
                ijtmb-8-10
                4560530
                2598c42f-013d-4f13-81ac-b6b707bfd01d
                Copyright© The Author(s) 2015. Published by the Massage Therapy Foundation.

                Published under the CreativeCommons Attribution NonCommercial-NoDerivs 3.0 License.

                History
                Categories
                Research

                Complementary & Alternative medicine
                massage therapist,practitioner perceptions,research design,complementary and alternative medicine,qualitative research

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