party payers for their work. What is the research agenda most likely to lead to this? Other health care professionals also have concerns and questions that would drive their agenda for our field. For example, physicians and health care administrators want to know when to refer for massage and which kind of massage to recommend for which conditions. What is the research agenda that will help these health care professionals? Thus the AMTA Foundation convened a Massage Research Agenda Workgroup (MRAW) which included physicians, clinical and experimental scientists, social scientists and massage therapists and bodyworkers all selected to represent a relatively broad spectrum of expertise in their fields. It included Americans, Canadians and Europeans. All workgroups of the MRAW included at least one massage therapist, one clinical or survey research scientist, and one bench or biological scientist. Members of the MRAW were struck by how valuable these multi-disciplinary groups were. The MRAW cautioned against the all too frequent practice of research in CAM in general and therapeutic massage specifically, being designed and conducted without the benefit of any practitioners involved in conceptual roles. We highly recommend the creation of multi-disciplinary teams at least during the design phase. In preparation for the meeting, the AMTA Foundation commissioned a background paper1 looking at issues of fit between the realities of massage treatment and the requirements of currently accepted research methodologies; examined claims made in major massage texts about the effects of massage and found many claims and little research cited; reviewed the existing massage research literature; and circulated to participants two recent reviews of the literature, noticing shortcomings and areas of promise. What follows is a review of the recommendations of the MRAW. 1 Cassidy, C. (1999). Methodological issues in investigations of massage/ bodywork therapy. 3 ARENAS OF INQUIRY The MRAW divided the general arena of clinical research on safety and efficacy, into two distinct categories: • studies that compare the relative effectiveness of specific massage modalities to one another, seeking the strongest treatment for each condition/population/ situation, and • studies that examine massage in comparison with other treatments (e.g. massage therapy versus usual allopathic care or chiropractic treatment, etc.). Studies of efficacy and outcome lead to questions of mechanism. There has been little done in this area for the field of massage. For example, premature infants gain more weight when they receive regular massage therapy than premature infants fed the same number of calories but not receiving regular massage therapy. Through what mechanism is massage therapy causing these results? The final arena of inquiry that was identified is socio-cultural knowledge, which includes basic descriptive information about who seeks massage; how it is viewed by consumer, physicians, and others; and how massage therapists define the goals of treatment. SPECIFIC RECOMMENDATIONS The workgroup made a range of recommendations covering not only what kinds of studies ought to be done, but also how they might best be done, and what conditions must be met in order to move the agenda forward. 1. BUILD A MASSAGE RESEARCH INFRASTRUCTURE The MRAW strongly emphasized that a field needs a research infrastructure in order to follow through on any research agenda. It is suggested that this infrastructure, crucial to the development of the profession, may be built through the following activities: • Fund the education of researchers prepared to dedicate their careers to massage therapy research. • Encourage the development of a research literate profession by teaching basic research literacy skills in massage schools and in continuing education contexts. This would include teacher training in this vital area. Continuing education could be supported through the creation of a self-study module, as well as workshops offered in research literacy, research methods and internships for participation on research teams. • Work with the Commission on Massage Therapy Accreditation (COMTA), the AMTA Council of Schools (COS) and the National Certification Board for Therapeutic 4 Massage and Bodywork (NCBTMB) to establish research as a core competency in the professional education of massage therapists, as it is in many other professions. • Create ways for people to be involved in research, including teaching massage therapists how to develop good case histories. A database of solid and informative cases would be a gold mine of ideas and evidence for later research. Encouraging more uniform training in systematic record keeping is also associated with this. • Foster collaboration and mutual education between medical schools and massage schools. • Create pathways for the development of a massage research community including: ongoing workgroups; a virtual community or moderated chat room of massage research enthusiasts; research networks such as the hospital based massage research network; special interest groups on research within AMTA or across professional associations. • Establish linkages between massage therapists and academics / researchers including those