Issue link: https://www.massageandbodyworkdigital.com/i/296580
54 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 4 SOMATIC RESEARCH education Evaluating Different Modalities How Comparative Effectiveness Studies Work By Jerrilyn Cambron There are many different types of massage, and each therapist has an opinion on which is the most effective. But what does the research say? Can we know what type of massage is right for a given condition? One way to determine which technique is most beneficial is by a comparative effectiveness trial: a randomized clinical trial that compares one treatment to another. The traditional randomized clinical trial compares one treatment to a placebo control. More and more researchers are instead moving toward comparative effectiveness trials because not only do they want to know if a treatment is beneficial, they want to know if it is more beneficial than something else. In 2011, Daniel Cherkin and his colleagues completed a comparative effectiveness trial at the Group Health Research Institute, comparing the effect of two types of massage against usual care for chronic low-back pain. 1 Subjects were randomized into one of three groups: usual care or 10 weekly sessions of either structural massage or relaxation massage. At the end of the 10 weeks, subjects in both massage groups had reduced pain and disability, with the improvements lasting at least six months. People with back pain may find it encouraging that both types of massage were effective, but as therapists who want to better understand what this study means, we need to dig a little deeper. TREATMENT The first things to consider in a comparative effectiveness trial are the ability of the health-care professionals, and the actual treatment provided to the subjects in each of the three groups. In Cherkin's study, there were 27 licensed massage therapists. Each had at least five years of experience and underwent one and a half days of protocol training for the study. This gives us the sense that there was capability among the group and consistency in the treatments. The relaxation massage group received weekly 50–60 minute massages that included "effleurage, petrissage, circular friction, vibration, rocking and jostling, and holding." Each body part was only treated for a specific time period; for example, the back and buttocks were allowed 7–20 minutes of treatment time. The structural massage group received the same weekly amount of massage, but the therapists were allowed to treat the clients as they saw necessary, focusing on alleviating each individual's personal contributors to back pain, with no preset protocol.