Issue link: https://www.massageandbodyworkdigital.com/i/68173
intent, the touch itself or type of touch, the relaxing environment—is most critical in an intervention, or if the combination of the various aspects of a session makes the intervention effective. If an individual component of the massage therapy session is isolated, the problem becomes how to remove the healing properties of it to create the placebo—virtually impossible. Control groups may then become comparison groups, as in the example above, comparing massage therapy to music therapy or aromatherapy. Often, the comparison groups include a "usual care" arm—a continuation of what the primary care physician has prescribed, such as stretching, or self-care exercises—to demonstrate if massage therapy is more or less effective than the standard of care. The inherent problem with all of these examples is that a typical massage therapy session may include all of these options: stretching homework or self- care education is common in massage therapy sessions, as is music and scents. All that aside, RCTs are generalizable and limit bias, obtaining the gold standard seal of approval for clinical trials. META-ANALYSES Meta-analyses combine data from like studies to create a larger pool of evidence. For example, a search is done on "massage and sleep," and 300 articles are identified. The articles are eliminated or included according to set criteria, resulting in 50 articles. Measurement tools are evaluated and commonalities are identified so data can be combined. Many meta- analyses only consider RCTs, putting somatic research at a disadvantage. While rigorous scientific research is accumulating on massage therapy in recent years, there are comparatively few RCTs involving massage interventions (of 9,373 research articles on massage in CAM on PubMed, 762 were randomized controlled trials).1 As a result, many meta-analyses simply say there is not enough data available to draw conclusions on the effectiveness of massage therapy. Inclusion/exclusion criteria often eliminate studies that are not generalizable or where bias is evident, producing data that represents the highest level of evidence available. OTHER RESEARCH METHODS TO CONSIDER Are there so few RCTs on massage therapy because there are not enough funds dedicated to large massage studies or because there are enough combining therapies and responding to the complexity of each individual client, altering the session as the tissue changes under our hands. Clients are combining modalities, trying to find the perfect environment for healing to take place. We do not live in an either/or world, but often combine manual lymph drainage with surgery and prescription drugs, or sports massage with nutrition and exercise, or craniosacral therapy with chiropractic and yoga. It seems less important to determine which modality is better than another, beyond the need to ensure safety, without studying the power of how they interact and complement together. This does not mean we should stop investigating basic science (why Somatic therapists are combining therapies and responding to the complexity of each individual client. inherent problems in designing RCTs for massage applications that we should look to other types of research? The answer to both is yes. NIH is the largest funder of health- care research in the United States; NCCAM is the division of NIH that funds complementary health-care research. While massage therapy is the public's number one out-of-pocket CAM expense involving practitioner intervention (verses self-care like vitamins and herbal remedies) only one percent of NCCAM's funding goes to massage therapy research.2 In the real world, while time and money is spent determining whether an intervention is better than a placebo, somatic therapists are connect with your colleagues on massageprofessionals.com 119 and how massage works, for example, what is the mechanism at work when massage helps people sleep) or abandon the RCT design. There are aspects of RCTs that make perfect sense: increase generalizability and reduce bias. But what else is there, and where should the funding go? In February 2009, with the adoption of the American Recovery and Reinvestment Act, $10.4 billion is earmarked for NIH research, renovations, and equipment upgrades.3 President Obama specifically put a call out for funds to be spent on comparative effectiveness research