An Introduction to Research Methods for Massage Therapists

by Martha Brown Menard Ph.D
(Massage Therapy Journal – Summer 1994, v. 33, n. 3, pp. 113-118)

Recently, there has been a surge of interest in the research of alternative modalities. Especially since the creation of the National Institutes of Health’s Office of Alternative Medicine, mainstream academic researchers have become interested in these therapies, which are considered to be traditional health care in many other parts of the world. Under the first round of awards, projects investigating massage therapy received four out of the thirty grants awarded. In order to facilitate the type of collaboration envisioned by the Office of Alternative Medicine, academic researchers will need to become better educated regarding alternative therapies. While many of us as massage therapists already consider ourselves mainstream, there is still a large group of potential collaborators in the academic research community who have yet to realize this. We can promote collaboration, and advance the art and science of our profession by becoming better educated regarding research methodology. As a member of both the research and alternative communities, I would like to provide a brief introduction to this topic, from my perspective.

In the previous issue, Dr. Albert Schatz encouraged the idea that “everybody can do research.” All research involves asking questions, and this is the place to start. Some questions, however, are more “researchable” than others. Formulating your research question is the fundamental place to begin thinking about a possible project, and one to which you will need to return periodically in order to define and clarify it. The importance of asking a researchable question cannot be stressed enough. A good question will have embedded within it, hidden like a seed inside a fruit, not only the answer itself but also the most sensible way to go about answering the question. For example, a question like “Does massage have an effect on the immune system?” might be a good place to start, but this is too broad a question for a research study. After doing some initial reading, you might decide to focus on a particular type of immune cell.  After doing some more thinking, you might want to narrow down how you would define “massage” for the purpose of your study. Your question would now be more specific, such as “does effleurage have an effect on T-lymphocytes?” You would want to make this question even more specific for the purposes of an actual study, but this is now a more researchable question than before. A clearly defined, very specific research question is called a hypothesis.

Paradigms in Research

Some philosophers of science, such as Thomas Kuhn, have made explicit the idea that scientific world views, or paradigms, define the kinds of research questions that may legitimately be asked. Within the traditional scientific paradigm, hypotheses are based on the assumption that there is a single external reality that can be observed and measured or expressed in terms of numbers. There is also an assumption of cause and effect, i.e. that a certain treatment causes a specific result. The researcher manipulates the treatment setting, including the subjects of the study, controlling as much of the setting as possible. Research design is employed to rule out rival explanations of the observed results, other than the treatment, as possible explanations for what happened. Statistical analysis is then used to show the probability that the results did not occur by chance (known as the p level, or level of significance). Results obtained in one setting are likely to be reproducible in other similar settings. These approaches toward answering research questions are termed quantitative methods. Their essence is the testing of hypotheses, based on deductive reasoning or theories. The philosophy that underlies the quantitative approach is known as logical positivism.

There is another group of approaches known as qualitative methods. These consist of three types of results of data collection: open-ended interviews, direct observation, and written documents such as journals, correspondence, or written answers to open-ended questionnaires and surveys. Qualitative methods are based on a very different set of assumptions. In the qualitative world view, there can be no distinction between the observer and what is observed—each effects the other and is in an on-going process of change. The observer can describe what she observes but there is no single external reality, and any description may only be one of multiple realities. There are multiple causes, or factors that influence outcomes. Each situation is unique. Another hallmark of qualitative research is the importance placed upon naturalistic observation of phenomena, and the personal contact and insights of the research in relation to the participants in the study, rather than manipulating the research setting. This is a more holistic perspective; its essence is to understand complex systems, and to explore and pursue new paths of discovery as they emerge. The philosophy underlying this approach is sometimes termed post-positivist.
Methods in research are considered somewhat controversial. For many years a great divide separated quantitative from qualitative researchers, with the former looking suspiciously down their noses at the latter. The quantitative paradigm is still the reigning one in much of medical and psychological research. The biological sciences have long tried to model their research after the rigorous methods used in the hard sciences of classical physics and chemistry, and habits can be difficult to change. In recent years, however, there has been a greater openness to the qualitative philosophy—sometimes referred to as the paradigm shift. It is after all closer to the revolutionary and state-of-the-art science of quantum physics. Research studies in the fields of sociology, education, and anthropology frequently employ qualitative methods. Many researchers on both sides of the fence consider qualitative studies more difficult to do, and both sides agree that qualitative methods cannot be applied as a solution to a sloppy or poorly designed qualitative study.

Which Method?

While qualitative methods developed and became popular partly out of dissatisfaction with the narrowness of the quantitative approach, in many ways the qualitative approach has always formed the foundations of science. Theories are developed based on detailed description and observation, and evolve over time as confirmatory data or anomalies that cannot be explained emerge. My own perspective, which is shared by many professional researchers, is that it is not a simple either-or question. Well-designed studies often use elements of both approaches. Often it is a matter of appropriateness given the type of question being asked. In exploratory or pilot studies for example, qualitative methods may be used to describe and attempt to understand phenomena, because there is not enough information yet to form a highly specific hypothesis. Such a study is used to build a theory rather than verify it. Quantitative data may also be collected and can illuminate patterns that would otherwise be overlooked. On the other hand, the double-blind clinical trial (the “gold standard” of the quantitative approach) is usually based on accumulated information, enough so that a theory has been developed and is now ready to be tested. Qualitative data can be collected to suggest rival explanations, or increase the usefulness of the results by gathering information about how easily a treatment can be implemented in a particular setting. Unusual events or unexpected consequences can be described, and used to generate new hypotheses. Both quantitative and qualitative studies involve a great deal of planning and preparation in order to yield useful results.

Summary

The most important aspect of research methodology is to ask yourself what it is you want to know as a result of your study. Think about it, and then think about it some more, until your question is as clear as you can make it. This is initially the most time consuming part of doing research, but in the long run it will save you time, maybe money, and maybe even your mental health. There is a growing consensus that well-designed, rigorous research uses the most appropriate method for the question being asked. Sometimes a strategic combination of quantitative and qualitative methods is the best solution. The old dichotomy of quantitative versus qualitative is at root a false one that reinforces an out-dated world view. To me it is similar to the labeling of alternative versus conventional health care therapies. Complementary is the word that, in my opinion, best describes the relationship of each type of health care method and each type of research method to the other. We have the choice to use both.

Resources for further reading

Cook, T.D., and Campbell, D.T. (1979). Quasi-experimentation: design and analysis issues for field settings. Boston: Houghton Mifflin.

Krathwold, D.R. (1993). Methods of educational and social science research. New York: Longman Publishing Group.

Kuhn, T. (1970). The structure of scientific revolution. Chicago: University of Chicago Press.

Lincoln, Y.L., and Guba, E.G. (1985). Naturalistic inquiry. Newbury Park: Sage Publications, Inc.

Patton, M.Q. (1990). Qualitative evolution and research methods. Newbury Park: Sage Publications, Inc.