might want to include all people with muscle spasms , strains , and strains ; but exclude all people with herniated discs or severe degenerative joint disease . The idea of inclusion and exclusion factors becomes more complicated when we start to consider all the other parameters that might affect the study . Are people included who also exercise or meditate or engage in some other activity that might affect the study ? The very essence of a research study is that we try to study just one parameter , the proposed treatment . But so many factors affect health that it is virtually impossible to do this . Therefore , we try our best to identify all of these factors and then make sure that they are equally represented in both the treatment and control groups . If this is achieved , then we assume that any difference between the two groups is due to the proposed treatment technique . However , accounting for all of these factors and then distributing them evenly is not always successfully achieved .
Isolation versus wholistic approach In fact , this points to the larger conceptual difficulty of research . A research study , by design , is meant to evaluate the effectiveness of just one parameter . In other words , a research study , to be valid , must isolate this one parameter and then decide it is effective in improving one ’ s health . However , the concept of wholistic health involves the realization that no one parameter works in a vacuum . Good health is often attained only when a number of treatments are administered in conjunction with each other . For example , the best treatment for a client with low back pain might be to use massage , heat , and stretching together , not to mention advising the client about postures , stress , and diet amongst other things . These multi-faceted treatment approaches are inherently difficult to evaluate with scientific research models .
Treatment administration : validity and bias Another consideration is whether the treatment was administered correctly . This may seem to be a given , but is not always the case . It is not uncommon for treatment to be administered by people who are not experts in that technique . This is especially true with touch / massage research where the people administering the care are often nurses or family members . A valid question is : If the treatment was not administered by experts , can we trust the results ? Ironically , if experts are used to administer the treatment , because of their interest in seeing their technique succeed , bias may creep in . To prevent bias , it is important that the therapists are not the same people who chart the progress of the participants in the study . In this way , the people who chart the progress are blinded in their knowledge of who is in each group .
Client bias and hands-on placebo treatment In fact , even the participants may be biased and want so much to improve that they bias the study . This is why it is important to design the study to include a sham placebo treatment so that the participants do now know whether they are in the treatment group or the control group that received the placebo ; in other words , they are also blinded . This brings up a problem that is particularly challenging when conducting research in the world of manual therapy : it is difficult if not impossible to create a valid hands-on placebo treatment for the control group . In the world of prescription drug research , both groups receive the same little white pill so they cannot know which group they are in . But in the world of massage and other manual therapies , clients know whether hands-on massage is being given to them . Therefore , an ineffective placebo hands-on treatment must be devised . But this is extremely difficult . After all , doesn ’ t all touch involve some therapeutic healing ?
Interpretations and conclusion And on top of all this , the final conclusions at the end of a research study may be open to interpretation , so it is important to read carefully the entire paper to see if you agree with the conclusions drawn by the authors of the study . Yet , most therapists do not read the entire research paper that is published ; rather they read only the short abstract or conclusion ; or worse yet , read or listen to someone else ’ s conclusion about the study .
Not all research is in Which brings us to our last challenge when relying on the research model for what we know . Because valid research is expensive and takes time , there are not always research studies available to prove or disprove the value of every treatment technique . However , we cannot always wait for all the studies to be conclusively done ; our clients need treatment now . In the meantime , it is important to remember that the absence of research does not prove that a technique is not valid . When someone states : “ There is no proof that treatment X works ,” it does not necessarily mean that there is proof that treatment X does not work . To make a comparison , the day before the apple fell on Newton ’ s head , it did not mean that gravity did not exist , we simply did not yet have a scientific formula to explain it . In the absence of definitive proof , we need to be open-minded .
Testing New Knowledge Model
In the face of not blindly trusting an authority , and also not having conclusive valid research upon which to rely , we can always try testing the knowledge / technique in our own practice . For example , on Monday morning , we can practice on our clients whatever we learn in a continuing education workshop over the weekend . However , this can also be problematic for many reasons . In effect , we would be conducting our own limited research study ; and we might not be designing and executing it very well . We might not yet be proficient with the treatment technique to implement it correctly ; we might not have enough clients to test it on to determine if it is effective ; and if we are administering other techniques at the same time , how do we know which one was responsible for a client ’ s improvement , if any ? Beyond all this , there are literally tens if not hundreds of techniques being marketed to manual and movement therapists . Do we need to test them all ? And if we did
14 | vol29 | no1 | JATMS