Explaining the Impact of the COVID-19 Pandemic on Massage Therapists in Australia and Canada: A Mixed Methods Study.

Background: The COVID-19 pandemic was a time of rapid change and uncertainty, with individual jurisdictions within countries implementing a variety of preventative measures. At the onset of the pandemic, as little was known about how COVID-19 was transmitted, restrictions, such as lockdowns, were implemented to prevent further spread of this virus. In many jurisdictions, massage therapists were deemed as nonessential for a period. This disruption to their livelihood, as a professional group and without autonomy to decide, was unprecedented. This prompted the question as to whether this experience had impacted massage therapists' professional identity. Methods: A sequential explanatory mixed methods design was used and massage therapists in Australia and Canada were recruited to participate. Results from a quantitative questionnaire completed by 649 respondents and from 31 semistructured interviews from a subset of the questionnaire participants were used in the mixed analysis. Results: Massage therapists, impacted by the pandemic, experienced a discord between what it means to be a massage therapist, providing patient-centered care and the public health initiatives implemented during the pandemic. This discord occurred in multiple situations and the type of discord was influenced by a number of factors, including how therapists identified themselves within the workforce (i.e., as a health care provider or a service provider). Conclusion: This study sought to understand how the COVID-19 pandemic impacted massage therapists' professional identity. Massage therapists reported that the pandemic impacted their professional identity through a lack of congruence and discord between their identity-constituting beliefs and what it means to be a massage therapist. The sequela to this discord was therapists experiencing different types of moral distress and or moral injury. Future research is needed to determine the longer-term impacts of COVID-19 on massage therapists.

Navigating Generative AI: Opportunities, Limitations, and Ethical Considerations in Massage Therapy and Beyond.

Generative artificial intelligence (AI) has become a hot topic, particularly ChatGPT's quick adoption and popularity, prompting discussions about its disruptive potential in health care, education, and creative sectors. The author, an early adopter, shares personal insights on leveraging generative AI for creative tasks and communication challenges, while also exploring its role as a tool rather than an author. Opportunities and limitations of integrating generative AI in the massage therapy field are explored, reflecting on the profession's reluctance to embrace technology and the potential efficiency gains. While acknowledging generative AI's creative promise, the importance of ethical and regulated utilization, highlighting data biases and limitations, is underscored. Overall, a balanced and responsible approach to incorporating generative AI into various domains is recommended.

Celebrating 15 Years of the International Journal of Therapeutic Massage and Bodywork.

In this editorial, Executive Editor and Editor-in-Chief, Dr. Amanda Baskwill, celebrates 15 years of publications of the IJTMB.

The paradox of the impact of the COVID-19 pandemic on massage therapists in Australia and Canada: The reporting of a qualitative strand of a mixed methods study.

INTRODUCTION: In both Australia and Canada, healthcare providers considered essential were allowed to operate during the COVID-19 pandemic. The impact of the global pandemic on professional identity included opportunities for role expansion, a focus on ethical principles and social accountability, and professional pride. These results were found only for those considered to be essential and do not likely resonate with those classified as non-essential, such as massage therapists, leaving a gap in understanding. MATERIALS AND METHODS: This qualitative strand of a sequential explanatory mixed methods study used qualitative description. Individuals who expressed interest were purposefully selected, based on age, gender, type of practice, and experience with the four key phenomena of interest. Data collected through semi-structured interviews was analyzed using qualitative content analysis. Member checking enhanced the trustworthiness of the results. RESULTS: Thirty-one (16 Australian and 15 Canadian) participants were interviewed. The main theme described was the pandemic paradox. At some point during the pandemic, most participants were labelled by government agencies as a non-essential service. However, participants reported feeling both essential and non-essential. Two subthemes were also described: factors contributing to creating the paradox and consequences of the paradox. CONCLUSION: A number of pre-existing factors around professional identity, such as patient relationships combined with the conditions instituted to manage the COVID-19 pandemic included designating health care services as essential or non-essential, created the paradox experienced by respondents and the subsequent experience of moral distress. Further research into moral distress experienced by massage therapists is needed.

Variation determinants within massage therapists' professional identity.

OBJECTIVES: Individuals have multiple, competing identities that vary in importance to the self. Professional identity is a way in which individuals attribute meaning to their contribution to society and is influenced by complex factors. Globally, the roles and responsibilities of massage therapists (MTs) vary, making it challenging to articulate a cohesive professional identity. This article describes the investigation into the variables which influenced response regarding MTs' professional identity in Ontario, Canada. METHODS: An online questionnaire was distributed to active MTs with available email addresses in the public register of the College of Massage Therapists of Ontario. Chi-square tests of independence were used to compare dependent variables with independent variables. Significance was adjusted post hoc, using Bonferroni's correction, to reduce the chance of a type I error occurring. The threshold for significance was adjusted from p≤0.05 to p≤0.01 as multiple analyses were conducted with a high response rate. RESULTS: The results provided insight into the variables associated with differences in responses. Variation was seen based on gender, primary practice setting, length in practice, additional education, additional roles within the profession, additional designation as a healthcare provider, and membership in the RMTAO (Registered Massage Therapists' Association of Ontario). CONCLUSIONS: While previous studies sought to describe the common and unifying features of MTs' identity, these findings provide insight into variables that determine differences in responses. These findings are valuable for the development of future studies. They provide a priori assumptions regarding the inclusion of these demographic items that can inform decisions regarding enrollment of the sample and data analysis.

Impact of the COVID-19 Pandemic on the Professional Identity of Massage Therapists: The Reporting of a Quantitative Strand of a Mixed-Methods Study.

Introduction: In late 2019, a pathogen outbreak occurred that rapidly spread, resulting in the coronavirus disease 2019 (COVID-19) global pandemic. Governments responded to the pandemic with a range of strategies, including forced quarantines and nationwide lockdowns. Research on professional identity during the pandemic has predominately focused on health care providers declared as "essential" rather than "nonessential." In this study, the authors examine the impacts on the professional identity of massage therapists (MTs) who were predominately deemed as nonessential health care providers during the COVID-19 pandemic. Materials and methods: An online, questionnaire-based study sought to answer "In what ways has the professional identity of MTs in Canada and Australia been impacted by the COVID-19 global pandemic?" MTs in Canada and Australia were recruited using convenience sampling through e-mail and social media. A questionnaire was developed and pilot tested before implementation. Results: Six hundred and forty-nine MTs participated (329 from Canada and 316 from Australia). Known constructs of professional identity that were affected during the pandemic included not feeling respected as a health care practitioner, feeling less professional than other health care providers, and experiencing burnout. New constructs that may have developed out of the pandemic and the measures established to manage them included being classified as nonessential and feeling a sense of camaraderie and belonging. Conclusions: This study is the first of its kind to report the impact of the COVID-19 pandemic on the professional identity of MTs. The emerging constructs reported will be used to create interview questions for the subsequent qualitative strand of this explanatory mixed-methods study. In the qualitative study, respondents will be invited to share their experiences with their own voice to further the understanding of the impact of the COVID-19 pandemic on MTs' professional identity.

Identification of common features within massage therapists' professional identity.

OBJECTIVES: In Ontario, Canada, MTs are regulated and have a common scope of practice. However, diverse practice settings and approaches to care create a need for MTs to articulate their professional identity. This study sought to answer, "what common features are foundational to the professional identity of MTs in Ontario?" METHODS: This quantitative research study was a part of a larger exploratory sequential mixed methods study. An online questionnaire-based cross-sectional study was conducted based on previous qualitative findings. MTs in Ontario, who held an active certificate, were invited to participate. Data were analyzed using descriptive statistics. RESULTS: The analysis revealed 17 common features that were endorsed by most respondents. Participants also reported thinking of themselves as healthcare professionals, rather than service providers, a feeling that was held across practice settings. Interesting and unexpected differences were noted in statements regarding the perception of MTs, areas of profession-specific knowledge, and the establishment of the therapeutic relationship. CONCLUSIONS: This study furthers an understanding of MTs' identity. Specifically, MTs consider themselves to be HCPs who are confident in their knowledge and abilities, especially their communication skills. They believe in providing individualized care and empowering their patients to take charge of their own health. Despite areas of overwhelming agreement, disagreement in endorsement was seen in areas such as MTs perception of their external image, use of evidence in practice, and the establishment of professional boundaries. These areas provide an opportunity for future research to continue to develop a body of knowledge regarding MTs professionalism and identity.

A Canadian Massage Therapy Education Environmental Scan.

BACKGROUND: Massage therapists have been a part of Canadian's health care since 1919. The profession has gone through great change over the past 100 years including adjustments to entry-to-practice education. An important recent change was the implementation of massage therapy (MT) education program accreditation. In light of the likely disruption as a result of programs becoming accredited, a scan of the current state of MT education in Canada was undertaken. METHODS: An environmental scan informed by seminal medical education efforts was used to describe the thoughts and opinions of MT education stakeholders in Canada. Specifically, stakeholders were interviewed regarding the current state of MT education and their comments were analyzed for common themes. RESULTS: Twenty-one stakeholders participated. Four themes were constructed: variation, isolation, stagnation, and accreditation. Variation is described as the impact of differences in content and quality of the education provided in MT colleges. Isolation is described as the feeling of the participant being separated, or disconnected, from the regulator, accreditor, or colleagues due, at least in part, to a lack of communication or networking opportunities. Stagnation is described as a lack of activity, growth, or development within MT education. Participants talked about accreditation, both as a solution for some of the challenges previously mentioned, and as a potential challenge in itself. CONCLUSIONS: Several challenges to MT education were described by stakeholders that they hoped would be remedied by national MT program accreditation. Despite some limitations, this environmental scan forms a baseline for stakeholder views on massage education in Canada upon which future comparisons can be made. While the environmental scan results are most useful when applied to the MT in Canada context, stakeholders in other countries may also find them interesting and valuable when considering challenges facing their own education programs.

Patients' Experiences of Ending Massage Therapy Care: a Commentary.

Patients are best positioned to provide information about their experiences of healthcare services; however, their perspectives are often underutilized. During informal discussions with massage therapists (MTs) and through the authors' own professional experiences, it was noted that there are times when patients decide independently, and without notice, to end the care they are receiving. To date, no research has been published exploring the experiences of patients who choose to discontinue massage therapy care and there is a gap in the quality assurance process of MTs. Lack of understanding of patients' experiences is a missed opportunity to strengthen the therapeutic relationship, ensure patient safety, improve treatment quality, and develop professionally. We recommend researchers explore mixed methods designs, involve patients in the research process, and solicit multiple perspectives when studying patients' experiences of ending massage therapy care.

A Series of Case Reports Regarding the Use of Massage Therapy to Improve Sleep Quality in Individuals with Post-Traumatic Stress Disorder (PTSD).

BACKGROUND: Post-traumatic stress disorder (PTSD) is a common mental health diagnosis in Canada with prevalence estimated at about 2.4% in the general population. Previous studies have suggested massage therapy may be able to reduce the symptoms of PTSD. One of the symptoms commonly experienced is difficulty falling or staying asleep. No previously published massage therapy research has specifically assessed sleep symptoms of PTSD. OBJECTIVES: The research question was, "For individuals who have PTSD as a result of experiencing traumatic events, does MT have an effect on sleep quality?" METHODS: A prospective series of case reports describing 10-week MT treatment plans provided by Registered Massage Therapists at Sutherland-Chan Clinic's Belleville location. Three individuals with PTSD were recruited using promotional posters in the community. Treatment focused on improving sleep quality and followed a pragmatic treatment protocol using light to moderate pressure. Outcomes were measured using a sleep diary, Pittsburgh Sleep Quality Index, and the Leeds Sleep Evaluation Questionnaire. RESULTS: Data collected at baseline and throughout the series showed inconsistent improvement and worsening of symptoms amongst participants. Treatment was well tolerated and attended. No harmful incidents were noted. CONCLUSION: For these participants, MT did not predictably impact sleep quality. It is possible, as the underlying cause of poor sleep quality was unlikely resolved, the participants did not have a significant change in their sleep quality. This differs from findings of previous studies in which MT improved sleep for patients with poor sleep quality due to exposure to traumatic events. There is need for further understanding of how MT affects sleep.

"I am a healthcare practitioner": A qualitative exploration of massage therapists' professional identity.

BackgroundA division has been described among massage therapists, some who identify as healthcare providers while others identify as service providers. The perceived division creates confusion about what it means to be a massage therapist. ObjectiveThis qualitative study answered, "How do massage therapists in Ontario describe their professional identity?" MethodsQualitative description (QD) was used and data were collected from 33 massage therapists using semi-structured interviews. ResultsThe resulting description of massage therapists' identity in Ontario is the first of its kind. The identity described includes passion as professional motivation in practice, the importance of confidence and competence, a focus on the therapeutic relationship, individualized care, and patient empowerment, and a desire to be recognized for their role within the healthcare system. ConclusionThere is still much to be investigated about massage therapists' identity. Future research will explore whether this description resonates with a larger sample of massage therapists in Ontario.

Developing Capability: Transforming Massage Therapy Education through Inquiry-based Learning.

Massage therapy education programs are responsible for preparing graduates for complex professional environments, while also ensuring graduates can access the profession by passing the regulatory body's standardized certification or licensing examination. Massage therapists are regulated health care professionals in four Canadian provinces. They are autonomous practitioners and an integral part of the health care regime for patients with complicated health presentations. As such, they must think critically about patients' presentations and determine the most appropriate care. This article describes the process undertaken by the faculty team of Humber College's Massage Therapy Program in an effort to transform the existing teaching and learning strategies by incorporating principles of inquiry-based learning (IBL).

Shiatsu and Acupressure: Two Different and Distinct Techniques.

BACKGROUND: Although shiatsu has been taught in specialized schools in Japan since 1940, there is a limited amount of research for its practice. As a result, authors substitute shiatsu with acupressure to use available research on acupressure. It is the position of the authors that, while the two share common aspects, they are substantively different. This project was undertaken to describe technical differences and advocate for a clear distinction, especially in research studies and academic discussions. METHODS: To understand whether it is appropriate to include acupressure studies in the evidence for shiatsu an analysis of the references included in a frequently cited systematic review was conducted to collect information about the protocols. In addition, a preliminary exploration of shiatsu practitioners' perceptions about the differences between shiatsu and acupressure is described. This exploration used videos of shiatsu and acupressure techniques and asked practitioners to comment on their perception of similarity. DISCUSSION: The results identified several key technical differences between the two, including type of pressure applied, the positioning of the thumb, and the way in which body weight is used. Researchers should separate shiatsu and acupressure in their designs and purposively choose one or the other. To facilitate such clarification, we have proposed a definition for shiatsu that may facilitate the differentiation between these two techniques. CONCLUSION: The authors hope to stimulate discussion about the differences between shiatsu and acupressure, and to question the appropriateness of using acupressure studies as evidence of the efficacy of shiatsu. A true understanding of the efficacy of shiatsu cannot be determined until studies use a common definition of shiatsu and discontinue substituting acupressure research for evidence of shiatsu efficacy. When this happens, it is proposed that a clearer picture of the safety, efficacy, and mechanism of action of both shiatsu and acupressure will emerge.

"Just don't be creepy": A phenomenological study of the experiences of men in massage therapy.

Background Societal expectations around traditional binary gender roles result in some professions being considered "men's work" or "women's work". Massage therapy (MT) is one such profession that, despite being predominantly female, is joined by an increasing number of men with a desire to help others. Methods This descriptive phenomenological study asked male massage therapists in Ontario, Canada, about their experience of gender in their professional lives. Fourteen men shared their experiences of practice, which included discriminatory hiring and patient preferences for female practitioners. These issues resulted in difficulty establishing a clinical practice. To create a successful practice, men described the need for professionalism, clear communication, and a comfortable treatment environment. Results and conclusions Researchers should explore the impact of discrimination on men in MT, patient preferences based on the therapist's gender, and the role of education in perpetuating societal heterosexual norms. Finally, as with any shift in culture, all levels of organization must take action to remove discrimination and bias within the profession of MT.

A guiding framework to understand relationships within the profession of massage therapy.

An element of professionalization is the development of a body of knowledge and the integration of that knowledge into practice, also known as evidence-informed practice (EIP). EIP was officially adopted in Ontario, Canada, by the massage therapy profession in 2002 when the professional competency document was updated to include competencies related to research literacy (College of Massage Therapists of Ontario, 2002). Despite efforts to increase EIP, there continues to be a research-practice gap in massage therapy. However, there also seems to be interest in finding ways to support the increase massage therapists' capacity to apply research. To support change, it is useful to describe the relationships in the profession that may have an effect on the use of evidence in practice and the development of a broader culture of inquiry. In order to better understand how these relationships may impact on EIP, an ecological model is proposed.

Exploring the awareness of research among registered massage therapists in Ontario.

BACKGROUND: An increase in available research has highlighted that knowledge changes over time as theories are challenged and adjusted or dismissed. This is particularly important to healthcare practitioners, including massage therapists, who need to frequently review current research and adjust practice accordingly. However, when research findings related to practice are generated, there is considerable delay in implementation. Few studies measure actual knowledge of current evidence for practice. The objectives of the study reported here were to (a) describe current awareness of evidence for practice among registered massage therapists (RMTs) in Ontario and (b) identify the sources of information RMTs use to inform their awareness of current evidence and the reported importance and frequency of use for each source. METHODS: An online questionnaire-based mixed-methods cross-sectional study was conducted. Ontario RMTs were invited to participate. This report focuses on the quantitative analysis. RESULTS: In total, 1,762 questionnaires were included. Of seven sources of information provided, respondents rated cumulative professional experience as most important, followed by recent research studies and education. Cumulative professional experience also rated as most frequently used, followed by other RMTs and education. CONCLUSIONS: There was a tendency for respondents to agree with positive statements about MT, or disagree with negative statements, regardless of correctness. The results suggest that RMTs need to improve their awareness of the current evidence for practice. Furthermore, cumulative professional experience was ranked most frequently used. This has the potential to not include the most current research. Improving communication of research findings to RMTs might improve awareness.

Massage for low-back pain.

BACKGROUND: Low-back pain (LBP) is one of the most common and costly musculoskeletal problems in modern society. It is experienced by 70% to 80% of adults at some time in their lives. Massage therapy has the potential to minimize pain and speed return to normal function. OBJECTIVES: To assess the effects of massage therapy for people with non-specific LBP. SEARCH METHODS: We searched PubMed to August 2014, and the following databases to July 2014: MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Index to Chiropractic Literature, and Proquest Dissertation Abstracts. We also checked reference lists. There were no language restrictions used. SELECTION CRITERIA: We included only randomized controlled trials of adults with non-specific LBP classified as acute, sub-acute or chronic. Massage was defined as soft-tissue manipulation using the hands or a mechanical device. We grouped the comparison groups into two types: inactive controls (sham therapy, waiting list, or no treatment), and active controls (manipulation, mobilization, TENS, acupuncture, traction, relaxation, physical therapy, exercises or self-care education). DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures and followed CBN guidelines. Two independent authors performed article selection, data extraction and critical appraisal. MAIN RESULTS: In total we included 25 trials (3096 participants) in this review update. The majority was funded by not-for-profit organizations. One trial included participants with acute LBP, and the remaining trials included people with sub-acute or chronic LBP (CLBP). In three trials massage was done with a mechanical device, and the remaining trials used only the hands. The most common type of bias in these studies was performance and measurement bias because it is difficult to blind participants, massage therapists and the measuring outcomes. We judged the quality of the evidence to be "low" to "very low", and the main reasons for downgrading the evidence were risk of bias and imprecision. There was no suggestion of publication bias. For acute LBP, massage was found to be better than inactive controls for pain ((SMD -1.24, 95% CI -1.85 to -0.64; participants = 51; studies = 1)) in the short-term, but not for function ((SMD -0.50, 95% CI -1.06 to 0.06; participants = 51; studies = 1)). For sub-acute and chronic LBP, massage was better than inactive controls for pain ((SMD -0.75, 95% CI -0.90 to -0.60; participants = 761; studies = 7)) and function (SMD -0.72, 95% CI -1.05 to -0.39; 725 participants; 6 studies; ) in the short-term, but not in the long-term; however, when compared to active controls, massage was better for pain, both in the short ((SMD -0.37, 95% CI -0.62 to -0.13; participants = 964; studies = 12)) and long-term follow-up ((SMD -0.40, 95% CI -0.80 to -0.01; participants = 757; studies = 5)), but no differences were found for function (both in the short and long-term). There were no reports of serious adverse events in any of these trials. Increased pain intensity was the most common adverse event reported in 1.5% to 25% of the participants. AUTHORS' CONCLUSIONS: We have very little confidence that massage is an effective treatment for LBP. Acute, sub-acute and chronic LBP had improvements in pain outcomes with massage only in the short-term follow-up. Functional improvement was observed in participants with sub-acute and chronic LBP when compared with inactive controls, but only for the short-term follow-up. There were only minor adverse effects with massage.

Student perceptions and effectiveness of an innovative learning tool: Anatomy Glove Learning System.

A trend in anatomical education is the development of alternative pedagogical approaches to replace or complement experiences in a cadaver laboratory; however, empirical evidence on their effectiveness is often not reported. This study aimed to evaluate the effectiveness of Anatomy Glove Learning System (AGLS), which enables students to learn the relationship between hand structure and function by drawing the structures onto a worn glove with imprinted bones. Massage therapy students (n = 73) were allocated into two groups and drew muscles onto either: (1) the glove using AGLS instructional videos (3D group); or (2) paper with palmar/dorsal views of hand bones during an instructor-guided activity (2D group). A self-confidence measure and knowledge test were completed before, immediately after, and one-week following the learning conditions. Self-confidence of hand anatomy in the 3D group gradually increased (3.2/10, 4.7/10, and 4.8/10), whereas self-confidence in the 2D group began to decline one-week later (3.2/10, 4.4/10, and 3.9/10). Knowledge of hand anatomy improved in both groups immediately after learning, (P < 0.001). Students' perceptions of AGLS were also assessed using a 10-pt Likert scale evaluation questionnaire (10 = high). Students perceived the AGLS videos (mean = 8.3 ± 2.0) and glove (mean = 8.1 ± 1.8) to be helpful in improving their understanding of hand anatomy and the majority of students preferred AGLS as a learning tool (mean = 8.6 ± 2.2). This study provides evidence demonstrating that AGLS and the traditional 2D learning approach are equally effective in promoting students' self-confidence and knowledge of hand anatomy.