Issue link: https://www.massageandbodyworkdigital.com/i/68173
LEVELS OF EVIDENCE How to Learn What We Want to Know Levels of evidence are like giving research design a grade. I received an email recently berating the Massage Therapy Foundation for supporting a research study that did not include a control group. It gave me pause to consider that we, too, are going along with the belief that randomized controlled trials (RCTs) are the gold standard for all health-care research. By traditional standards, RCTs are widely touted as gold, but as we look for innovations in health-care delivery and insurance coverage, and create new public health policy, perhaps we should also be looking for new ways of informing our practices and educating the public on the use and benefits of complementary and alternative medicine (CAM) therapies, and support studies that have real world implications and accurately represent how therapies are practiced. Let's start by reviewing the levels of evidence of research (see diagram on page 118). A basic understanding of the research designs commonly used and why will lay the groundwork for thinking beyond what currently exists. Then, we will look at research methods and what type of studies can best tell us what we need to know to be safe and effective with our clients, and secure our place in health care and wellness as the environment for public health shifts to include prevention. Finally, we will place this in the context of what is happening this year as the National Center on Complementary and Alternative Medicine (NCCAM) determines the next five years of research funding priorities and how their decisions may impact somatic research. LEVELS OF EVIDENCE Levels of evidence are like giving research design a grade. An "A," or the highest level of evidence, is awarded to studies that provide information that is applicable to a large group of people. This is known as generalizability. Bias also plays a role in determining level of evidence. Reducing bias, or the study's ability to ensure that the results are directly related to the intervention and not to chance or other outside influences, is the goal of every researcher reaching for high marks. Let's look at some examples of research designs to see how this works. CASE REPORTS Case reports document an interaction between one practitioner and one client. For example, a massage therapist has an elderly client suffering from lack of sleep. After several massage sessions, connect with your colleagues on massageprofessionals.com 117