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on patient health and outcomes through individual, preventive, and community care system approaches. Generalized more broadly, a PBRN can be formed and made up of non-primary care-related clinicians with a commitment to evidence-based care, who practice within a shared context, and who focus on health outcomes for individuals within their care. This more generalized consideration of PBRNs is where I will focus reflection of how the massage therapy field can utilize the construct to produce and promote practice-based research in our field. But first, an aside is needed to situate the PBRN discussion within the context and importance of practice-based research. DISTINCTION AND IMPORTANCE OF EVIDENCE-BASED PRACTICE (EBP) AND PRACTICE-BASED RESEARCH Most Somatic Research readers are familiar with the concept of evidence-based practice (EBP), which derives from evidence-based medicine (EBM). Essentially, EBM/EBP is founded on the principle that individual care decisions made by clinicians are based on input from and a balance between the practitioner's clinical expertise, the best available systematic clinical research, and patient values, circumstances, characteristics, and wishes. 3 In the massage field and elsewhere, these three constructs make up the EBP three-legged stool. In an effort to promote and strengthen the extent to which EBP occurs in massage practice, massage therapy organizations, educators, and advocates have put a lot of effort into increasing research literacy among massage therapists. While practicing EBP does not require practitioners or clinicians to conduct research, it does expect and require them to access, assess, and apply research-derived evidence to their treatment plan efforts. As efforts to improve research literacy in the massage field have progressed, it has become more commonly known to practitioners in our field that relative to other applied health disciplines (e.g., medicine, nursing, dentistry, physical therapy), massage therapy has a very small (but growing) research evidence base. Another massage-related research evidence base aspect that became more apparent as practitioner research literacy rose was the realization that almost all the large, funded, and high-quality massage-related research conducted is led or completely conducted by non-massage therapy clinicians or researchers. The takeaway from this point is that clinicians and other field leaders began to ask the question: How reflective of actual massage therapy practice is the research that is supposed to be providing the evidence base for our field? The concern that research be reflective of massage practice in relation to EBP is based in part on the principle that strictly controlled research protocols examining massage therapy (or any practitioner-applied intervention) only answers the question, "can a treatment in the most controlled and 'perfect' circumstances work?", not "does a treatment work?" Ultimately, clinicians and patients/clients are more interested in the extent to which a treatment does work in practice (treatment effectiveness), not the extent to which a treatment can work (treatment efficacy) in some unrealistic setting with a low probability of replication in their situation. The massage field is not alone in its concern of practice reflective research, particularly when interventions or treatments are clinician applied. Many clinician-applied disciplines (e.g., physical therapy, primary care, nursing) contributed to the movement toward practice-based research and pragmatic/effectiveness designs due to concern that the "gold standard" randomized control trial research approach is ill-suited for practitioner- delivered interventions. If controlled environments are the "labs" in which the highest quality, randomized controlled trials take place, and it is recognized that clinics and practice situations are the antithesis of controlled, then controlled lab settings are not terribly practice reflective. It only makes sense then that the ideal "lab" for practice-reflective research is in the clinic or practice environment; thus, practice-based research derives from and is conducted in clinic or practice environments that inherently preserve practice reflectiveness (i.e., "messy" but real). As most in the massage field understand or can at least imagine, conducting research in practice is hard and often takes a combined skill set that massage education does not provide (and arguably should not at an entry level, given the field's current approach to foundation education). In addition, few massage therapists have the needed skills beyond their clinical training from other secondary education to design, conduct, analyze, or disseminate rigorous research. The same can be said for most, if not all, of the other aforementioned clinicians from applied health disciplines. In clinical practice settings, whether for primary care, physical therapy, chiropractic, or massage therapy, there is enough going on to keep everyone who works there (administrative to clinician) busy just keeping up with the day-to-day clinic, patient/client, and business needs. There is little room in practice for the additional resources and needs a valid and rigorous research study requires. The desire and commitment alone to conduct or even participate in practice-based research is not enough to make it happen. Usually, collaborative partnerships and/or efforts above and beyond those needed for general clinical practice are necessary for the successful implementation and completion of a research study in clinical practice; and infrastructure resources for such endeavors take a lot of time and effort to build. One such infrastructure with a building Yo u r M & B i s w o r t h 2 C E s ! G o t o w w w. a b m p . c o m / c e t o l e a r n m o r e . 43

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