Steps toward Massage Therapy Guidelines: A First Report to the Profession

Over the last two decades, the massage profession has grown rapidly. As it does with business startups that begin informally and successfully grow into mature enterprises, growth brings new organizational challenges along with greater visibility and opportunity. The maturation of massage as a healthcare profession creates an increasing need for a process to formalize the synthesis of massage therapy knowledge from clinical experience and research. As a profession, we need more expedient means to collect what we know and to make such baseline knowledge widely available to practitioners, consumers, and other healthcare stakeholders. In short, we need to create a process for creating guidelines. This paper lays out the motivations and framework for creating guidelines for massage therapy that are informed both by research and clinical experience. It represents a report to the massage therapy profession and to other stakeholders of the work of the Best Practices Committee (BPC) of the Massage Therapy Foundation over the previous two years. Because there is little or no existing referenceable literature basis for such discussion in the context of massage, the paper also bears the additional goal of providing a healthcare literature basis for future academic massage discussions. The concept of guidelines is discussed based on a definition from the Institute of Medicine (IOM) and research on the nature of expertise. Guidelines are targeted for submission to the National Guideline Clearinghouse. Challenges in creating guidelines for massage therapy are discussed. Different stakeholders are considered, with their needs and potential benefits from guidelines presented as scenarios. Current literature from the wider scope of healthcare is extensively reviewed. Topics include guideline creation, credentialing of complementary and alternative medicine (CAM) practitioners, definition of competence, and the increasing role of technology (i.e. informatics) in managing training and task-necessary competencies. At first glance separate, these topics are interlinked by a healthcare quality initiative from the IOM, by a resultant process of healthcare self-reflection, and by extensive defense and technology industry efforts to create new capabilities and data standards for learning and competency communication and management. Finally, a process for creation of massage therapy guidelines is proposed. A central feature of the proposal is the use of a “World Café” symposium to elicit knowledge and solutions from a diverse collection of experts. The symposium would be aimed at vetting and refining the proposed guideline process by applying it to creation of guidelines for massage interventions for stress management, low-back pain, and lymphedema. The role of transparency and a wide and open peer-review is stressed as essential to the usability and credibility of guidelines.

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