Managing an evidenced based practice is an ever-changing landscape. We must constantly be seeking out the best treatment methodologies that will allow our patients the most effective care. This can mean that a referral to another professional is what is best for our patients. Massage is one of the many modalities that is utilized when treating injuries, acute & chronic. There is more than enough research that shows how massage can significantly impact the outcomes of a balanced treatment plan. There is also plenty of research that indicate other methods may be more effective or complementary to a comprehensive treatment strategy.
However, it’s not always so simple to follow the research. Although we have a world of information right at our finger tips, we also understand (or should) that just because it’s on the internet, doesn’t make it true. Therefore, many of us trust sites that specialize in research. Sites such as PubMed are a great place to locate research from all around the globe. They post all if not most of the research professionals will site in their justification of care. This however is not always the safest means of reliability.
I will admit that I am one of the majority who often just read the abstracts and draw my assumptions based upon the results and conclusions stated. I am not an expert at building research studies, most clinicians are not. We depend upon the scientists to deliver sound conclusions based upon valid methods of research. If a study indicates favorability or contradiction to my understanding, I will continue to dig deeper into it for reliability purposes.
A colleague of mine recently posted the results of a study; Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Trial. The study concluded, “Six weeks of prescription shoe orthotics significantly improved back pain and dysfunction compared to no treatment. The addition of chiropractic care led to higher improvements in function.”
If you are a chiropractor who sells orthotics in conjunction with care, you would think this is a great display of complimentary care. Maybe you even post the abstract in your office with the results highlighted to reinforce your message. However, if you read the study more carefully, the sub-group in the that received chiropractic care, ALSO received massage and hot and cold packs.
Why didn’t the results read;
“The addition of
chiropractic care massage led to higher improvements in function”
“The addition of
chiropractic care hot & cold packs led to higher improvements in function”?
In other words, how did the researchers conclude that it was the chiropractic care and not the massage and/or hot and cold packs that made the difference?
This is one of 1000’s of research articles available to professionals on well-respected and trusted sites that should be cautionary tales. We should not simply scroll down to the ‘results’ section of a study to determine the outcome. As professionals, we must still read the entire study and make certain that its results are consistent with the actual study.
Ultimately, as I state in all my trainings, a truly evidenced based practice MUST consist of three separate components. Scientific research, Subjective findings and individual patient needs. Reliability on one component more than the others will lead to an unbalanced and spotted approach to your overall care.