Frequently Asked Questions (FAQs) about Healing Touch Research
1.) I have been asked to conduct a research study in my (hospital, school, place of employment) and I don’t know where to begin.
The first thing that you need to consider is the research question for your study. Research questions usually involve the following components: the patient population; the intervention to be used; the comparison groups involved; and the outcome(s) to be measured. This questions is often referred to as a PICO question (Patients, Intervention, Comparison, Outcome). Your research question will determine your study design, which is how you will answer the question. A clear research question is the key to any good study.
Your research question will then be restated as the aims of your study. The aims describe how you will answer your research question and, again, will guide you in determining the appropriate design for your study. The aims should help to define the outcomes you will measure in the study. These outcomes may be subjective (patient-reported) or objective (e.g., a biological measurement), and should be directly related to your specific research question and patient population.
For example, if you were interested in conducting a study using Healing Touch in persons with dementia, first you would make a decision about what you want to measure. How will you show improvement in this patient population? A typical symptom of dementia is agitation, so this could be an appropriate outcome. To whom will your compare those people who receive Healing Touch? This is the ‘C’ in your PICO question. After thinking about the possibilities and goals of the study, a reasonable research question might be ‘what is the impact of Healing Touch on levels of agitation in persons with dementia compared with persons with dementia who do not receive Healing Touch? In this example, your ‘P’ is persons with dementia, your ‘I’ is Healing Touch, your ‘C’ is persons with dementia who are not receiving Healing Touch, and your ‘O’ is levels of agitation.
Other things that you will need to consider include what resources you have available for conducting research. The resources needed depend on the research question, but generally you will want to consider support services, such as a statistician to analyze your results, or someone who can help in writing the protocol for your study.
Finally, while designing and conducting the study, you need to consider equipoise. Equipoise is the scientific discipline of designing and conducting a research study without bias in what the results might be. As practitioners, we often want our clients to see improvement; however, we let go of outcome and set our intention for the client’s highest good. Equipoise is similar. While conducting designing and conducting the study, we must be mindful that we do know the outcome of the study until it is completed. If we approach the study with a bias toward a particular outcome, this bias may come to pass, limiting the findings of our study.
2.) I am not sure what to do my study on or which patients to include.
This is where that well-defined research question or PICO question comes into play. The question should be as specific as possible to aid you in the design and conduct of the study and the interpretation of the findings. In the above example, you would need to be specific about how you would define someone with dementia. In so doing, you develop inclusion and exclusion criteria for you study to help you establish your study sample. It is impossible to conduct a study of every person with dementia; therefore, we must choose a sample of patients who represent the population of people with dementia, using our inclusion and exclusion criteria. It is recommended that you conduct your study in a patient population in which you have some experience or expertise. This will make designing and conducting your study easier.
3.) What is a protocol for a research study and why might I be asked to write one?
The protocol for your research study spells out exactly what you are going to do, how you are going to do it, and why you’re going to do it. Again, a well-defined research question will help in describing the what, how and why of your study. All of the elements described above will be included in your protocol. Particular attention should be given to the actual study procedures. These should be described in sufficient detail such that someone else could read what you have written and replicate your study.
The research protocol will need be approved by your facility’s Institutional Review Board (IRB) before you begin the study. This is discussed more below.
4.) Will I need to receive permission to do the study from the participants?
Not only will your need the permission of your potential study participants, but you also will need the permission of the facility where the study will be conducted. All research involving humans or animals must be approved by the Institutional Review Board (IRB) of the institution, facility, agency or hospital where the research is conducted, and that IRB would have ethical oversight based on its policies to comply with national laws and regulations regarding research. Healing Beyond Borders cannot provide that oversight.
5.) What if I didn’t follow appropriate procedures for collecting information, for example, I did not get approval or use a consent form.
Without appropriate documentation of informed consent, you will not be able to publish your findings. You also may be in violation of federal and state laws in your country regarding the conduct of research. It is recommended that a practitioner who wants to be engaged in research connects with someone at an institution with an Institutional Review Board. There could be a lot of legal issues/concerns with conducting a research project with human subjects without appropriate oversight.
6.) What is the best research design to use when conducting research?
There is great debate in the area of complementary and alternative medicine (CAM) research regarding appropriate study interventions and controls. In a typical randomized, controlled trial or RCT (often considered the “gold standard” of research design), the study intervention is standardized, meaning that each participant receives the exact same treatment. Moreover, control groups are usually easier in studies of new drugs because placebo treatments that look, taste, and feel like the actual treatment can be used. Many believe that CAM research must use the same standardized types of treatments to provide the most convincing evidence, following the model of the randomized, controlled trial. But CAM therapies do not necessarily lend themselves to such designs, particularly those types of therapies that involve a practitioner, such as Healing Touch, in which it is believed that the person’s field can also influence the outcome.
The RCT can be a very useful, rigorous tool to answer research questions. It also can be poorly designed or not fit the type of questions being asked. Non-pharmacological therapies, such as Healing Touch, make up a great deal of the published scientific literature, something like a quarter to a third. Are all of those studies invalid or useless because they didn’t follow the RCT paradigm? Certainly not. Not every research question can be answered with an RCT. Surgical studies and behavioral therapy studies, such as cognitive behavioral therapy or weight loss regimens, do not lend themselves to an RCT design either, yet there is not always an equal level of criticism.
The type of design to use for your study is the design that is appropriate for your research question and the stage of the research in that area or patient population. It would not make sense to conduct an RCT as the first study in a particular patient population if no study has ever been conducted in that patient population. In that case, you might need to conduct a feasibility study to determine whether you can even get participants from this patient population to agree to participate in such a study.
In the overall timeline of research studies, the RCT comes toward the end of that timeline. Before such a study can be conducted, studies regarding the problem in the patient population, the design of the intervention, the feasibility of the study and the efficacy of the intervention should be explored, with each subsequent study building on the findings of the previous study. Without this groundwork, you may be setting yourself up to fail by trying to conduct an RCT as your first research study.
7.) What is the best technique to use or should I allow the practitioners to do what they think is best?
The Healing Touch curriculum with its standardized techniques lends itself to research in that the techniques and interventions are replicable. However, in a real-world setting, practitioners modify the sequence and types of techniques they use to suit the client’s needs based on an energy field assessment. Sound arguments can be made for using or avoiding standardized Healing Touch interventions in the research setting. What is essential is that the intervention remains true to the tenets and philosophy of Healing Touch while providing the most rigorous scientific research methods possible. Again, your research question will guide you in determining the appropriate intervention.
8.) What is the best questionnaire, measure, or outcome to use?
As discussed earlier, the most appropriate outcome measure will depend on your research question. For example, if you are interested in assessing the effects of Healing Touch on pain in certain patient population, you should use a pain questionnaire that is valid and reliable, and, preferably, one that has been used before in the patient population of interest. What does valid and reliable mean? Validity and reliability are related to the ability of a questionnaire to measure what is intended consistently. Such valid and reliable tools allow researchers to make comparisons between research studies using different types of therapies and patient populations to understand better the impact these therapies might have on the intended outcome. For more information about such questionnaires, including a brief list and description of commonly used outcomes measures, please see the energy research article in the first quarter 2012 issue of Perspectives in Healing Quarterly Publication.
When dealing with physiological or biological objective measures for a research study, these measures should be specific to the research question and patient population. For example, a measure of inflammation such as C-reactive protein (CRP) is far too general for use in research studies of many different types of patients. Why is this? Too many biological processes can affect CRP levels, thereby calling into questions any differences that might be seen in the study. Also, because levels of this measure are so variable between different people, it may not be sensitive enough to detect a meaningful change. For suggestions about potential biological measures for a research study, please contact a member of the Research Committee.
9.) How do I get money to do my study?
This is a more complicated process and usually involves completing an application to a particular group or organization. It is usually easier to procure funding from smaller groups than it would be to submit for funding from a national government, for example. Generally for national funding, preliminary research results are needed. Also, check within your local community to see what groups might be interested in funding Healing Touch research. Keep in mind that funding will infrequently pay you for the amount of work that will be required, and often there may be no salary support.
10.) What kind of support does Healing Beyond Borders, Educating and Certifying the Healing Touch® provide?
Members of the Healing Beyond Borders, Educating and Certifying the Healing Touch® Research Committee can help you think through what you want to do, how to go about setting up your study, review your protocol, give advice on timing and techniques, and provide expertise in Healing Touch. Email or call to receive assistance.