AAMT Bulletin – December 2014
An update on developments in the massage therapy industry
The AAMT Bulletin keeps you informed about developments in the massage sector and the ongoing contributions of the AAMT.
As the leading industry group representing massage in Australia, we have a significant stake in the development and growth of the sector.
The environment in natural health is fast changing, including legislative reform and industry focused training in a struggling VET sector.
Shifting goal posts in 2015 will require professional associations to keep abreast of all these important matters and act when appropriate
for the benefit of members. Some of these developments are highlighted in this bulletin.
Season’s greetings from all of us at the AAMT.
Reviews and regulation
In its submission to the APRAH Accreditation Review for Registered Practitioners, AAMT argued that although the self-regulation system for massage is well run, there are serious risks caused by factors beyond the sector’s control and not directly related to treatments. These risks warrant serious consideration.
AAMT believes that the threshold base of risk for inclusion as a Registered Health Profession continues to be valid. However, the interpretation of the criteria for determining risk exposure requires more flexibility in its applications.
The nature of massage often places patients and therapists in a position of greater vulnerability to risk. This is because the close personal contact involved exposes the patient to a degree of perceived or possible threat to their safety, and exposes therapists to false accusations of misconduct or clinical misjudgment.
As an industry association, AAMT has zero power beyond expulsion from membership of the AAMT, because the expelled therapist can still continue to practice. The lack of transparency with members reviewing complaints against members, and the inability to share information with other regulatory bodies, limits the sector’s ability to manage delinquent individuals who threaten the credibility and reputation of our professional membership.
As a result, sexual misconduct continues to be a serious issue for the massage sector as well as unscrupulous individuals masquerading as legitimate massage therapists while offering illegal sexual services. These issues are emerging with increased regularity, as are alleged abuses of migrant labour.
As a consequence, the AAMT believes that massage falls well within the APRAH criteria in relation to the nature and severity of the risk to the client group.
The advantages of the self-regulated and administered system is that associations like AAMT come to any complaint having a deeper knowledge of the industry and its standards of practice, while being able to process complaints more efficiently, in a less threatening or intimidating manner.
Given this, AAMT has long supported the notion of a co-regulatory framework because it stands to strengthen the current self-regulation system.
A co-regulation system that simplifies and standardises the complaints process is a first step.
This could occur through a single registry body as this would help to improve efficiency of complaint handling, make the process easier to navigate and more accessible for the complainant.
This is important in the case of massage, because the nature of the complaint can often be embarrassing or emotionally traumatic. A simplified central system could possibly reduce re-traumatising complainants and may also offer a more transparent process.
In the end the best outcomes for patients come from trained and professionally-recognised therapists, which come with a more stringent regulatory process and higher education and training standards than exists for massage today.
For example, before the passing of the Private Health Insurance Act including the Private Health Insurance Rebate for Natural Therapies, there was limited control of the standards adopted by various natural therapy associations.
The Act allowed Private Health Funds to legitimately set standards in massage therapy by enforcing membership of a professional association, education standards and currency of all eligibility criteria such as first aid, and insurance. These are now the minimum standard requirements for AAMT members.
The Private Health Insurance Rebate, and the standards subsequently imposed on professional organisations by contract, and thus on their members, brought with it recognised barriers to entry, de facto title of practice, and recognition of formal qualifications in natural medicine.
Thus, for clients and patients, eligibility for the Private Health Insurance Rebate offers some assurance that the remedial massage therapist is recognised as a professional with qualifications that are not only endorsed by a professional association, but also by health funds and government.
A review, conducted by the Canadian Institute of Work and Health, published in the January 2008 edition of The Spine Journal, which considered four high-quality studies published between 2003 and 2006,i concluded that massage was most effective when combined with education and exercise, and when administered by a licensed therapist.
Given the high exposure to risk and the nature of incidents involving threats to personal safety, a strengthened co-regulatory framework offers many benefits for patient, therapists and the professional development of the sector.
AAMT believes that a coordinated approach involving a central compulsory massage registry in situ with the National Code of Conduct, and Accreditation and Registration of massage therapists is warranted in order to deliver better outcomes for patients and to more comprehensively vet therapists, monitor behavior and manage itinerants.
The recent international call by the Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), for researchefellows saw more than 55 applications join the world-first International Complementary Medicine (CM) Leadership and Capacity Building program.
Twelve successful fellows were appointed based on their impressive track records and strong methodological grounding across a number of disciplines including health services research, public health, epidemiology and clinical science.
The appointments will help to enhance the research capabilities for robustly conducted trials in the areas of massage and other complementary medicines that promise significant benefits for patients and the health system.
ARCCIM Director, Professor Jon Adams, said that the international multidisciplinary group of Leadership Fellows are best positioned to be the next generation of leaders in this essential area of research.
Supported by the Australian Association of Massage Therapists, the Australian Chinese Medical Association and Australian Self-Medication Industry, the program will provide ongoing support and career development throughout the initial three-year program.
The appointed ARCCIM Leadership Fellows include: Dr Felicity Bishop (University of Southampton, UK), Dr Brenda Leung (University of Lethbridge, Canada), Dr Holger Cramer (University of Duisburg-Essen, Germany), Dr Romy Lauche (University of Duisburg-Essen, Germany), Dr Lesley Ward (University of Otago, New Zealand), Dr Yan Zhang (Texas Tech University, US), Dr Caragh Brosnan (University of Newcastle, Australia), Dr Matthew Leach (University of South Australia), Dr Helen Hall (Monash University, Australia), Dr Vincent Chung (Chinese University of Hong Kong) and Dr Tobias Sundberg (Karolinska Institute, Sweden).
The first annual residential was held at the University of Technology Sydney (UTS) during October.
Re-launched during 2014, the improved AAMT Massage Therapy Directory enables clients and patients to find qualified AAMT therapists anywhere in Australia.
The directory of AAMT accredited therapists makes it easier for the public to search a therapist based on local area and preferred modality.
This important initiative will help to strengthen the quality of massage delivery and provide greater surety to the community by helping people to access qualified, professional massage therapists who are recognised members of Australia’s leading massage industry association.
All AAMT members receive a free listing on the online directory exclusively featuring AAMT massage therapists – See the directory
Figures tabled in AAMT’s annual report show continuous growth in AAMT’s membership despite declining student enrolments due to changes to Australia’s Vocational Education and Training (VET).
This reflects the general growth in the sector which employs around 25,000 massage therapists, creating industry demands that are in excess of the self-regulatory resources that are derived from membership funding.
Even for AAMT as the peak representative body for massage therapists in Australia with a membership exceeding 7,500, 85 per cent of whom practice remedial massage therapy, growing demand exceeds the available resources required to adequately regulate a member-funded, self-regulatory sector.
The challenges of changing government and Health Fund policies and resources place additional pressure on already limited funds.
The difficulty in meeting a variety of Registered Training Organisation (RTO) training delivery methods and the variations in the quality of training is compounded by the rapid growth in a sector with limited resources.
This is particularly concerning at entry level training. As long as individuals can practice massage with low level or questionable qualifications, the sector remains vulnerable to rogue operators, which continue to sully the sector’s reputation and hinder the pace of professional development and integration with mainstream health.
At the higher education and more professional level, over 50 Australian Private Health Funds and WorkCover Authorities work collaboratively with AAMT in determining therapists’ eligibility for attaining and maintaining Health Fund Provider status.
This includes the two primary national qualifications recognised by the industry and the AAMT— the Certificate IV in Massage Therapy Practice (HLT40312) and the Diploma of Remedial Massage (HLT50307).
A further qualification is the Advanced Diploma of Remedial Massage (Myotherapist/Soft Tissue Therapist) Bachelor of Health Science (Musculoskeletal Therapy). Graduates are required to undertake additional training beyond the minimum level necessary to practice as a Remedial Massage Therapist.
AAMT is actively working to address these challenges, by advocating for change in government consultations and reviews such as the AHMAC Code for Health Workers and NHMRC clinical resources, establishing research partnerships such as the UTS ARCCIM Research Leadership Program and publication of the Massage Directory.
Billhult, A1, Stener-Victorin, E and Bergbom I.
Aim: This study aimed to describe the experience of massage for breast cancer patients during chemotherapy treatment.
Methods: Ten patients received massage on five occasions. They were interviewed and analysis was conducted using Giorgi’s ideas of phenomenological research. The essential meaning of getting massage during chemotherapy was described as a retreat from the feeling of uneasiness toward chemotherapy.
Results: Results revealed five themes: the patients experienced distraction from the frightening experience, a turn from negative to positive attitudes, a sense of relaxation, a confirmation of caring, and finally they just ‘felt good’.
Conclusions: In conclusion, the findings of this study show that massage offered a retreat from uneasy, unwanted, negative feelings connected with chemotherapy treatment. It is a positive treatment that can be added to the arsenal of treatment choices available to the oncological staff.
Braun, LA1, Stanguts, C, Casanelia, L, Spitzer, O, Paul, E, Vardaxis, NJ and Rosenfeldt, F.
Objectives: To determine whether massage significantly reduces anxiety, pain, and muscular tension and enhances relaxation compared with an equivalent period of rest time after cardiac surgery. The feasibility of delivering the treatment, effects on heart rate, blood pressure, and respiratory rate, and patient satisfaction were also assessed.
Methods: Elective cardiac surgery patients were randomised to receive massage or rest time at two points after surgery. Visual analogue scales were used to measure pain, anxiety, relaxation, muscular tension, and satisfaction. Heart rate, respiratory rate, and blood pressure were measured before and after treatment. Focus groups and feedback were used to collect qualitative data about clinical significance and feasibility.
Results: A total of 152 patients (99% response rate) participated. Massage therapy produced a significantly greater reduction in pain (P = .001), anxiety (P < .0001), and muscular tension (P = .002) and increases in relaxation (P < .0001) and satisfaction (P = .016) compared to the rest time. No significant differences were seen for heart rate, respiratory rate, and blood pressure. Pain was significantly reduced after massage on day three or four (P < .0001) and day five or six (P = .003). The control group experienced no significant change at either time. Anxiety (P < .0001) and muscular tension (P < .0001) were also significantly reduced in the massage group at both points. Relaxation was significantly improved on day three or four for both groups (massage, P < .0001; rest time, P = .006), but only massage was effective on day five or six (P < .0001). Nurses and physiotherapists observed patient improvements and helped facilitate delivery of the treatment by the massage therapists on the ward.
Conclusions: Massage therapy significantly reduced the pain, anxiety, and muscular tension and improves relaxation and satisfaction after cardiac surgery.
Am J Hosp Palliat Care. 2014 Feb;31(1):6-12. doi: 10.1177/1049909113476568. Epub 2013 Feb 18. Mitchinson, A1, Fletcher, CE, Kim, HM, Montagnini, M and Hinshaw, DB.
Aims: To describe the integration of massage therapy into a palliative care service and to examine the relationship between massage and symptoms in patients with advanced illnesses.
Methods: Between 1 April 2009, and 31 July 2010, 153 patients received massage at the VA Ann Arbor Health Care System. Data on pain, anxiety, dyspnea, relaxation, and inner peace were collected pre and post massage. Diagnoses, chronic pain, and social support were also abstracted. Analysis of covariance was used to examine changes over time.
Results: All short-term changes in symptoms showed improvement and all were statistically significant. Pain intensity decreased by 1.65 (0–10 scale, P < .001), anxiety decreased by 1.52 (0–10 scale, P < .001), patients’ sense of relaxation increased by 2.92 (0–10 scale, P < .001), and inner peace improved by 1.80 (0–10 scale, P < .001).
Conclusion: Massage is a useful tool for improving symptom management and reducing suffering in palliative care patients.
Australian Association of Massage Therapists Ltd
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