Research Literacy-The Short Course

TABLE OF CONTENTS

"I dare to flatter myself, that the discoveries I have made will push back the boundaries of our knowledge of physics as did the invention of microscopes and telescopes for the age preceding our own." -Franz Friedrich Anton Mesmer “Mémoire sur la découverte du magnétisme animal” (Memoir on the Discovery of Animal Magnetism) (1779) [1]

“Perhaps the history of the errors of mankind, all things considered, is more valuable and interesting than that of their discoveries. Truth is uniform and narrow; it constantly exists, and does not seem to require so much an active energy, as a passive aptitude of soul in order to encounter it. But error is endlessly diversified; it has no reality, but is the pure and simple creation of the mind that invents it. In this field the soul has room enough to expand herself, to display all her boundless faculties, and all her beautiful and interesting extravagancies and absurdities.” -Benjamin Franklin, Report of Dr. Benjamin Franklin, and other commissioners, charged by the King of France, with the examination of the animal magnetism, as now practiced in Paris (1784)

1 Introduction

1.1 Confronted with a client’s problem you should be able to quickly locate relevant research and use it to solve and or understand the problem. Easier said than done, as the access to research is sometimes thwarted by financial as well as conceptual challenges. Yet the potential benefit to the average massage therapist and their clients is enormous and solutions are worth puzzling over. This paper will attempt to examine some of these issues in summary fashion. This is however by no means the final word or the most exhaustive treatment of the subject and this paper will be edited, revised and reworked with additional resources and knowledge.

1.2 Research Literacy is defined by the AMTA [2] as the ability to find, understand, and critically evaluate research information to achieve evidenced based practice (put research in the hands of the practitioner to enhance practice). Evidence-based medicine [3] has been defined as the “conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” [4]

1.3 Technique & Research Literacy

1.3.1 Since technique so directly impacts on clients, research literacy, in this one area is worth discussion. Some efforts have been made to create a Taxonomy (scientific classification) of massage technique, which has been researched. “A total of 36 distinct techniques were identified and described,” [5] However new scientifically unexamined techniques are springing up every day it seems.

1.3.1.1 Example Google Search turned up 1,440,000 references

1.3.1.1.1 http://www.google.com/search?hl=en&q=massage+therapy+technique&btnG=Google+Search

1.3.2 The following questions are likely to impact patient/client care now and in the future. This topic is worthy of great discussion within the massage as well as other professions.

1.3.3 Questions

1.3.3.1 Group Activities-December 2006

1.4 Some would suggest that there is cultural resistance within the massage community to scientific study of massage therapy. A hint of possible resistance was outlined in the following article.

1.4.1 Research: The Key That Opens the Door

1.5 This article brings up the following questions

1.5.1 Questions

1.5.1.1 Group Activities-December 2006

1.6 If there is cultural resistance to scientific study within the massage profession we would want to examine it as a possible roadblock to scientific literacy. It would be important to understand both its roots and continued persistence.

1.7 Example

1.7.1 An example of evidenced based practice. Lets say you have a lovely pregnant client who is suffering from chronic nausea and is wrenching her poor little heart out. She doesn't want to take meds just yet and her doctor has suggested alternative remedies but left the specifics up to you to decide. Wouldn't if be great to quickly search a database to get answers.

1.7.2 Link

1.7.2.1 http://www.anatomyfacts.com/mresearch-pregnancy-nausea.asp

1.7.3 Since these references indicate that alternate remedies may help with the nausea but not the vomiting (which has health risks) you can inform both the client and doctor with research references that can be E-Mailed with a hyperlink. In addition since the P6 acupressure point can be easily self stimulated by the client or practitioner it can be included in the treatment regime. The M.D. also has been educated and can make an informed decision as to whether the vomiting should be controlled pharmacologically. All concerned know more about the problem thru the lenses of scientifically validated research which is easily accessible online.

1.7.4 Reference for P6

1.7.4.1 http://www.anatomyfacts.com/Muscle/Meridian.htm#_Toc52494253

1.7.5 Note

1.7.5.1 This is a free database I am working on which would include full text article links where possible. I need the assistance of a programmer to create an effective search engine (SQL, MS SQL, VBScript, ASP, ASP.NET, JavaScript). If you know of anyone please refer. There is no budget yet to pay them. questions@anatomyfacts.com

2 Finding Research

2.1 Introduction

2.1.1 The internet has made possible quick and easy access to full text or summaries of research papers online. This makes evidenced based practice an achievable goal. With quick online access you can, in theory, take information quickly from computer screen to treatment room. In practice most massage therapists may not go to a physical library to research client care but would be more likely to use information quickly obtained online. The review below is a brief listing of online resources since these are more likely used for evidenced based practice.

2.1.2 For more information online

2.1.2.1 Anatomy Facts Web Site- Go to the projects menu, click on "Links to External Web Sites". You will see a comprehensive list of Web resources

2.1.2.1.1 http://www.anatomyfacts.com/

2.1.2.2 Other Web Resources

2.1.2.2.1 http://www.pcsg.org.uk/html/links_evidence.html

2.2 Pub Med

2.2.1 Pub Med is a free service of the National Library of Medicine and the National Institutes of Health. It contains every conceivable reference and often has an abstract (summary) of the research. It’s worth exploring this online resource. The catch is if you want the full text article you will have to pay approximately $30 per article. This is a comprehensive multidisciplinary resource.

2.2.2 Link

2.2.2.1 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

2.2.3 Example

2.2.3.1 Just type in "low back pain massage", for example, into the FOR BOX. You should retrieve around 103 articles.

2.2.4 Advantages

2.2.4.1 It is FREE!!! At least the abstracts (summary).

2.2.4.2 Abstracts are included in the listing. Abstracts may be useful as a quick reference for practice application.

2.2.4.3 Covers a broad range of scientific subjects and therefore provides multidisciplinary perspective.

2.2.4.4 It is probably one of the most comprehensive online resources with hundreds of thousands of citations.

2.2.4.5 Access ease-You can quickly access research with a keyword search.

2.2.4.6 This database is open to the general public and does not require registration or password.

2.2.5 Challenges

2.2.5.1 The $30 fee for full text articles is a bit steep for most people.

2.2.5.2 The database is huge, and as such, it returns sometimes hundreds of references, which may be, in large measure, irrelevant to your question. It is not just a massage therapy database. It can be time consuming to wade through all of the references and many would just give up without getting the research guidance they sought out.

2.2.5.3 You cannot E-Mail a list of research articles or access your list once you have signed off.

2.2.5.4 There is no research validity rating scale.

2.3 Pedro

2.3.1 Pedro is the PT's professions free online research database to fulfil their goal of enhancing evidenced based practice. Pedro rates some of the research using a number scale so that you can quickly determine research validity.

2.3.2 Link

2.3.2.1 http://www.pedro.fhs.usyd.edu.au/index.html

2.3.3 Example

2.3.3.1 If you put "low back pain massage" in Pedro's simple search engine you get about 164 records with abstracts only. There is no full text article available.

2.3.4 Advantages

2.3.4.1 This is also a FREE service with no hassle, quick online access.

2.3.4.2 In theory all of the citations are rated for validity. This allows you to determine the reliability of the research results.

2.3.4.3 This database is open to the general public and does not require registration or password.

2.3.4.4 Abstracts are included in the listing.

2.3.5 Challenges

2.3.5.1 There are no links to free full text articles.

2.3.5.2 The is also a large database and as such, returns sometimes hundreds of references, which may be, in large measure, irrelevant to your question. It is a physical therapy database. It can be time consuming to wade through all of the references and many would just give up without getting the research guidance they sought out.

2.3.5.3 In practice many of the citations in Pedro were not yet rated.

2.3.5.4 You can’t E-Mail the results.

2.4 Massage Therapy Foundation (MTF)

2.4.1 You will have to fill out a registration and get a user id/password but it’s a free service. The reference includes the citation (name of researches, title, and journal publication ect) and keyword listing. There are no abstracts or full text article links.

2.4.2 Link

2.4.3 http://www.massagetherapyfoundation.org/

2.4.4 http://www.massagetherapyfoundation.org/protected/rd_search.aspx

2.4.5 Example

2.4.5.1 You should retrieve about 35 results using the keywords described above. ("low back pain massage")

2.4.6 Advantages

2.4.6.1 It’s a free service of our own Massage Therapy Foundation, which also funds research studies.

2.4.6.2 The database although not as extensive as aforementioned, is more concentrated with only massage therapy research.

2.4.6.3 You can save the articles online for future reference. (Works as long as you are logged into the site and do not log off)

2.4.6.4 You can use the references to search other databases

2.4.7 Challenges

2.4.7.1 You will have to pre-register and obtain a user id and password before using the service.

2.4.7.2 The keyword list does not allow for a substantive understanding of the research.

2.4.7.3 No abstracts are included.

2.4.7.4 No full text articles are available.

2.4.7.5 No validity research rating scale is used.

2.4.7.6 No E-Mail attachment is possible.

2.4.7.7 The saved references are forgotten by your computer as soon as you log off.

2.4.7.8 The keyword search window require separate entry of each keyword with a specification of quantifier. This is somewhat awkward and time consuming.

3 Understanding Research

3.1 Research Design and Methodology

3.1.1 This includes explanation of the concepts involved in designing a good research project. This will help you understand terms like randomized controlled trial.

3.1.2 Link

3.1.2.1 http://www.socialresearchmethods.net/kb/index.htm

3.1.3 For example you could use this link to better understand random selection and assignment;

3.1.3.1 http://www.socialresearchmethods.net/kb/random.htm

3.2 Statistics

3.2.1 Most statistic books explain both research design and the number crunching methods, which help researchers analyze the outcomes.

3.2.1.1 http://www.anatomyfacts.com/Muscle/statsdisc.htm

3.2.2 This book is still in progress but is still useful) See other online resources below.

3.2.3 For example you could use this link to get a better understanding of Central Values and the Organization of Data;

3.2.4 http://www.anatomyfacts.com/Muscle/statsdisc.htm#_Toc104246172

3.3 Evidenced Based Research

3.3.1 http://www.jr2.ox.ac.uk/bandolier/booth/glossary/ITT.html

4 Analysing Research

4.1 Analysis of research helps you answer the question about whether the research is valid. Did it follow accepted rules of scientific method and can we trust that the results articulate objective truth.

4.2 Sometimes the analysis is done with statistical characterization which can require specialized technical knowledge which was hinted at in the above section, understanding.

4.3 If the research were pre-rated on several important categories statistical knowledge might be less important. Most academic programs, which stress research literacy, do include substantial (2 semesters of statistics and research design and methodology?) coursework in both research design/methodology and statistics.

4.4 For our purposes it would be helpful if the research were pre-rated so that we could easily establish validity. It is unlikely that most massage therapists will have completed the aforementioned coursework and so pre-rating becomes evermore important.

4.4.1 Pedro Criterion

4.4.1.1 http://www.pedro.fhs.usyd.edu.au/scale_item.html#criterion_1

4.4.1.2 http://www.pedro.fhs.usyd.edu.au/tutorial.html

4.4.2 The following criterion may also be useful

4.4.2.1 Evaluation Source

4.4.2.2 Randomized Groups

4.4.2.3 Normal Distribution

4.4.2.4 Sample Size >=30

4.4.2.5 Control Groups

4.4.2.6 Blinded Treatment/Subj

4.4.2.7 Rule Out Confounding Var

4.4.2.8 Equal Variances

5 The Perfect Database

5.1 Enormous database with just articles on massage therapy

5.2 Free to public

5.3 Registration is optional but is attached to some type of reward for the effort

5.4 Abstracts are available

5.5 Full text free articles are available

5.6 All research is rated for validity

5.7 Simple keyword search easy to use

5.8 Advanced search includes specifying validity level of research displayed

6 Reference Summary

6.1 Finding Research (Databases)

6.1.1 Pub Med

6.1.1.1 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

6.1.2 Pedro

6.1.2.1 http://www.pedro.fhs.usyd.edu.au/index.html

6.1.3 Massage Therapy Foundation

6.1.3.1 http://www.massagetherapyfoundation.org/protected/rd_search.aspx

6.1.3.2 http://www.massagetherapyfoundation.org/

6.2 Understanding Research

6.2.1 Statistics

6.2.1.1 http://www.anatomyfacts.com/Muscle/statsdisc.htm

6.2.2 Research Design and Methodology

6.2.2.1 http://www.socialresearchmethods.net/kb/index.htm

6.2.2.2 http://www.anatomyfacts.com/Research/ResearchMethodsKnowledgeBase.pdf

6.2.3 Evidence Based Medicine

6.2.3.1 http://www.cche.net/usersguides/therapy.asp

6.2.3.2 http://www.cche.net/usersguides/economic.asp

6.2.3.3 http://www.bmj.com/cgi/content/full/311/7016/1356?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1070930810948_17542&stored_search=&FIRSTINDEX=0&sortspec=relevance&volume=311&firstpage=1356&resourcetype=1,2,3,4,10

6.2.4 Concepts

6.2.5.4 Central Limit Theorem

6.2.5.5 http://www.anatomyfacts.com/Muscle/statsdisc.htm#centrallt

6.2.6 Confidence intervals

6.2.6.1 http://en.wikipedia.org/wiki/Confidence_Interval

6.2.6.2 http://www.anatomyfacts.com/Muscle/statsdisc.htm#confidencei

6.2.6.3 Mean, Median and Mode (Central Values)

6.2.6.3.1 http://www.anatomyfacts.com/Muscle/statsdisc.htm#_Toc104246172

6.2.6.4 Normal Distributions

6.2.6.5 http://www.anatomyfacts.com/Muscle/statsdisc.htm#normal

6.2.7 P Value

6.2.7.1 http://en.wikipedia.org/wiki/P-value

6.2.7.2 http://www.anatomyfacts.com/Muscle/statsdisc.htm#frefer

6.2.7.3 Skewed Distributions

6.2.7.4 http://www.anatomyfacts.com/Muscle/statsdisc.htm#skew1

6.2.7.5 http://www.anatomyfacts.com/Muscle/statsdisc.htm#skew2

6.2.8 Standard Deviation

6.2.8.1 http://en.wikipedia.org/wiki/Standard_Deviation

6.2.9 Scheffé Test

6.2.9.1 http://www.anatomyfacts.com/Muscle/statsdisc.htm#scheffe

6.2.9.2 http://www.richland.edu/james/lecture/m170/ch13-dif.html

6.3 Analyzing Research