title: Exploring the nature of therapeutic massage bodywork practice.
abstract: BACKGROUND
  Research on therapeutic massage bodywork (TMB) continues to expand, but few studies consider how research or knowledge translation may be affected by the lack of uniformly standardized competencies for most TMB therapies, by practitioner variability from training in different forms of TMB, or from the effects of experience on practice.
  
  
  OBJECTIVE
  This study explores and describes how TMB practitioners practice, for the purpose of improving TMB training, practice, and research. PARTICIPANTS SETTING: 19 TMB practitioners trained in multiple TMB therapies, in Alberta, Canada.
  
  
  METHODS
  Qualitative descriptive sub-analysis of interviews from a comprehensive project on the training and practice of TMB, focused on the delivery of TMB therapies in practice.
  
  
  RESULTS
  TWO BROAD THEMES EMERGED FROM THE DATA: (1) every treatment is individualized, and (2) each practitioner's practice of TMB therapies evolves. Individualization involves adapting treatment to the needs of the patient in the moment, based on deliberate and unconscious responses to verbal and nonverbal cues. Individualization starts with initial assessment and continues throughout the treatment encounter. Expertise is depicted as more nuanced and skilful individualization and treatment, evolved through experience, ongoing training, and spontaneous technique exploration. Practitioners consider such individualization and development of experience desirable. Furthermore, ongoing training and experience result in therapy application unique to each practitioner. Most practitioners believed they could not apply a TMB therapy without influence from other TMB therapies they had learned.
  
  
  CONCLUSIONS
  There are ramifications for research design, knowledge translation, and education. Few practitioners are likely able to administer treatments in the same way, and most would not like to practice without being able to individualize treatment. TMB clinical studies need to employ research methods that accommodate the complexity of clinical practice. TMB education should facilitate the maturation of practice skills and self-reflection, including the mindful integration of multiple TMB therapies.
authors.affiliation: School of Nursing, Faculty of Applied Sciences, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Antony J
authors.initials: AJ
authors.lastname: Porcino
authors.forename: Heather S
authors.initials: HS
authors.lastname: Boon
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Page
authors.forename: Marja J
authors.initials: MJ
authors.lastname: Verhoef
keywords: clinical competence; clinical practice; complementary therapies/methods; decision-making; massage; musculoskeletal manipulations; qualitative research