Translational research queries, fascia research congress sequels, and beyond....

Theguest editorial (1) by Massage Therapy Foundation president*, Diana L. Thompson, LMP, in the December 2009 issue of the International Journal of Therapeutic Massage and Bodywork (IJTMB) introduced the upcoming Highlighting Massage Therapy in Complementary and Integrative Medicine Research Conference scheduled for 13 – 15 May 2010 in Seattle. Part of Thompson’s overview focused on translational research (TR) as a cornerstone theme of the upcoming conference. As somewhat of a follow-up, the initial part of this current editorial provides, as a brief prelude to the “Highlighting” conference, an admittedly delimited discussion of TR. The editorial goes on to acknowledge certain sequels to the 2009 International Fascia Research Congress, and it then introduces additional entries in the current IJTMB issue that focus on pain management and mixed-methods research, as well as a first interview entry in the Commentaries section of the journal.

The extensive and accelerated attention to TR in general over the past 10 years is indeed well documented, as is the alarming paucity of its focus when addressed specifically in the context of the massage and bodywork professions and related fields. For instance, a recent search of PubMed (conducted on 1 March 2010) using only the expression “translational research” uncovered 511 citations in the time range March 2000 to March 2005, and 2252 hits from March 2005 to March 2010. When “translational research” was combined individually with “massage,” “bodywork,” “massage therapy,” “manual therapy,” and “physiotherapy,” however, the resulting number of citations across all five restrictive searches over the 10-year period from March 2000 to March 2010 was a meager two hits—both occurring only in conjunction with “physiotherapy.” Such disparity is understandable to a certain extent, given the relatively recent onset of interest in massage research per se and the embryonic stage of TR’s application beyond the biomedical industries and academic medical centers. A modest starting point for possibly rectifying this situation, then, in tandem with the pioneering research initiative of the Massage Therapy Foundation’s “Highlighting” conference, might be that of briefly acknowledging basic TR issues already addressed in the literature as a backdrop for posing certain specific queries that may serve as catalysts for action.

For instance, Zerhouni(2) characterized the NIH Roadmap as encompassing three overarching themes, each of which in turn subsumes affiliated implementation groups and initiatives: New Pathways to Discovery, Research Teams of the Future, and Reengineering the Clinical Research Enterprise. Placed in this broader context, TR relates principally to the third theme of the Roadmap as an initiative-focused effort of the Clinical Research Implementation Group. And citing Zerhouni’s(3) subsequent discussion of U.S. biomedical research, Payne et al.(4) noted the bidirectional nature and scope of TR:

The translational research paradigm focuses on the use of basic science knowledge to inform the design and conduct of clinical studies with the ultimate objective of defining new clinical practices capable of improving human health. Additionally, it involves a reciprocal process of informing basic science hypotheses using knowledge and observations derived from the clinical practice and population science domains. (p. 566)

Given the just-cited bidirectional nature of TR, also worthy of note are the contributions by Ericsson and Williams(5), Vernig(6), Marincola(7), and Tashiro and Mortensen(8).

The elaboration by Westfall et al.(9) of the TR paradigm has focused on expanding beyond the two-phase T1 – T2 model of “bench (basic science research) to bedside (human clinical research) to practice (clinical practice)” so as to include a third phase (T3) citing practice-based research as the intermediary between clinical research and clinical practice. An even more inclusive TR model by Kon(10) builds on the aforementioned work of Westfall and colleagues by virtue of introducing yet a fourth phase (T4) that moves scientific knowledge ultimately into the public health sector with the implied intent of altering people’s everyday lives.

The TR literature has also addressed the nomenclature challenges involving the occasionally confused distinctions among the expressions “translational research,” “dissemination research,” and “knowledge transfer”(11–13). Additionally, attention has been given to the training and educational imperatives inherent in the TR movement(14–16) and to promising venues and repositories for advancing TR(9,17).

The preceding discussion of certain sectors of the TR literature—although brief by design for purposes of this editorial—should suffice in providing a context for the following queries that may serve as a starting point for directing the embrace of the TR movement by the massage and bodywork professions:

Which components of TR’s nature and scope are most relevant to the massage and bodywork professions—with overlaps and distinctions both acknowledged among colleagues serving principally as researchers, educators, or practitioners?

How might practice-based research(9), as the intermediary between clinical research and clinical practice, be most appropriately addressed as a possible TR entry point for the massage and bodywork professions?

What contributions are the massage and bodywork professions best postured to make regarding the intervention efficacy and effectiveness emphases in TR?

What are the most prevalent obstacles and challenges facing the massage and bodywork professions with respect to becoming engaged in the TR movement?

What are the curricular and instructional implications of TR for massage and bodywork educators functioning in both school-based and continuing education settings?

What current and potential venues and repositories are available for advancing involvement in TR by the massage and bodywork professions?

Beyond the subset of TR-specific presentations scheduled for the Foundation’s May 2010 “Highlighting” conference, what are the most promising “next steps” to be taken?

How might the IJTMB best serve researchers, educators, and practitioners with regard to involvement in TR by the massage and bodywork professions?

For translational research to be meaningful, research that needs to be translated must obviously first be identified. Illustrating a research genre with the potential to provide some direction in this regard (T. W. Findley, written communication, March 2010), the second of three themes in this editorial speaks to the Second International Fascia Research Congress (27 – 30 October 2009, Amsterdam, Netherlands) that was the focal point of two pre-congress editorials(18–19) by the IJTMB’s editor-in-chief, Thomas W. Findley, MD, PhD, in last year’s June and September issues. Articles by Langevin and Huijing(20) and by van der Wal(21) also served as pre-congress and pre-publication resources made available to congress attendees and published in this journal’s December 2009 issue. This current issue contains a follow-up to the 2009 Fascia Research Congress by way of a full article and three expanded abstracts from presentations in Amsterdam.

More specifically, Bertolucci’s article on Muscle Repositioning expands on a Fascia Congress workshop presentation and highlights subjective and objective feedback in the teaching and practice of a reflex-based myofascial release technique. The PDF and HTML versions of this entry are augmented by an extensive PowerPoint file available to readers seeking further elaboration. Farasyn’s expanded abstract entry on “roptrotherapy” speaks to deep cross-friction massage for the release of myofascial pain and is likewise supplemented by his Amsterdam workshop’s slide presentation. A third Fascia Congress workshop highlighted in this issue is Stecco and Day’s expanded abstract of the biomechanical model for the human fascial system that undergirds the manual technique known as Fascial Manipulation. Completing the array of four post–Fascia Congress entries in this issue is the expanded abstract of a paper by Bertolucci and Kozasa reporting on the preliminary results of a myofascial release technique on increased tonic muscular activity. Eight videos links accessible at the lead author’s website provide media enhancement.

In addition to the four fascia-specific papers just cited, the concluding part of this editorial acknowledges three other noteworthy entries that constitute the remainder of this March 2010 issue. Adams’ article addresses the integration of massage therapy for pain management into a hospital setting’s team-centered approach to patient care. Authors Porcino and Verhoef speak to the integration of quantitative and qualitative components of a mixed-methods research approach with particular attention to the appropriate prioritizing and sequencing of such components in a study. And in the very first interview entry in the IJTMB’s relatively brief history, authors Ferguson and Persinger interact with Marianne Steele regarding her shiatsu and massage therapy work with people who have experienced various forms of trauma and posttraumatic stress disorder. This interview-specific entry in the Commentaries section represents a manuscript genre that we trust will be recognized by our readers as a viable option for future journal contributors in addition to the other commentary alternatives of book reviews and letters to the editor.