Inherent in the practice of Rolfing Structural Integration (SI) and inseparable from it is the desire of the practitioner to help others improve the quality of their lives. As a holistic enterprise, SI affects all dimensions of the person. To support an integrative, process-oriented, third-paradigm practice – and, above all, to show that Rolfing SI epitomizes a newly emergent paradigm to address the multiple dimensions of the whole human being – we need some standard by which to evaluate the results of our work. The experimental method of isolating and controlling for particular variables within the human experience seems ill suited to the evaluation of integrative practices.
We would prefer a standard that takes into account all dimensions of the human experience our work affects. One possible standard is the World Health Organization Quality of Life index (WHOQOL), as its taxonomies are similar to the ones Rolfing practitioners use to conceptualize and perform their work. Thus, it made sense to explore the possibility of measuring, through the WHOQOL questionnaires, the benefits that clients gain from Rolfing SI.
In the past twenty years, tools to evaluate quality of life (QOL) have evolved and undergone considerable elaboration, departing from the simplistic metric of presence versus absence of illness, or that of objective assessment of material conditions, and moving toward actually considering and integrating the various aspects of human experience (physical, emotional, social, environmental and spiritual, among others). This has spurred the creation of metrics validated internationally, in the context of many languages and cultures.
Aiming first to encourage in Rolf Institute students’ scientific investigation of the outcomes, and also to start a formal investigation of the effects of Rolfing SI on the clients’ QOL, I designed a study that came to include 160 clients, all of whom were treated as teaching models in Rolf Institute classes in either Boulder, Colorado or Sao Paulo, Brazil.
Empirical Evidence
How many structural integrators – freshly minted graduates and old hands alike, favoring manipulation or movement techniques, working in North or South America, East or West – are delighted to see in their clinical practices that their work seems to improve the clients’ QOL?
Whatever the clients’ remaining or ongoing issues or objectives might be, when they perceive improvement in their QOL it is both satisfying and reassuring. It suggests that we’re on the right track and that the work is going in the right direction. Whatever the techniques or strategies, what we see is the actualization of the ultimate and transformative purpose of the work.
Sometimes this happens because clients have fewer or diminished aches and pains, or because they feel more agile, healthy, or emotionally stable. Sometimes they have greater awareness of their bodies and themselves, or even perceive that the work is helping them to move forward in personal life projects. Sometimes this happens for no more reason than the client’s general and nonspecific experience of feeling better. Many reasons factor into this equation.
From a scientific viewpoint, the practitioners’ observations are empirical evidence of a possible relationship between SI and QOL, which relationship has been, in our collective experience over the past fifty years, so abundantly revealed in most of our practices.
Defining Quality of Life
How do we define “quality” in a person’s life? Do we account for internal factors as well as external ones? Do we measure current circumstances, or more abiding conditions? Should the criteria be objective or subjective, the measures individual or societal? Although all aspects of the human experience – ranging from the physical (general state of health, organic function, physiological condition), to the emotional, spiritual, and social – are part of the matrix of variables that coalesce to establish a person’s QOL, many visions of QOL emphasize one or more isolated aspects (e.g., health, personal liberty, material prosperity) of human existence.
Regardless of how a person’s circumstances might appear to an outside observer, it is the perception of one’s own QOL that allows one either to enjoy – or to take charge of things and take steps necessary for improvement. This perception is both subjective (as only the person himself can evaluate his own life), and unique for each person (each person having a particular viewpoint as a function of his objectives, preferences and needs.)
Interest in the formal evaluation of QOL began in 1940, with the development of indices focused primarily on physical well-being, measured according to the presence or absence of illness. Scales to measure functional capacity first appeared around 1950, assessing aptitude for everyday activities such as eating and dressing. These scales, which connected the effects of illness to limitation of function, still came from a medical perspective. The 1970s brought the first studies of the patient’s perception of his own health and related aspects of experience. These were followed, in the 1980s, with the SIP (Sickness Impact Profile) or NHP (Nottingham Health Profile), as well as the SF-36 (Medical Outcomes Study 36) – all generic questionnaires about the quality of life relative to health (QLRH), developed with the goal of heightening perception of the impact of health problems. Thereafter, many QLRH surveys were developed to measure specific effects especially important to particular patient groups.(1)
It was a departure from this thinking when, in 1991, the Mental Health Division of the World Health Organization established a multidimensional vision of heath as “the state of complete well-being, physically, mentally and socially.” This took the mission far beyond simply the absence of infections or physical diseases, and opened the doors to more comprehensive and wide-ranging research and study. Today, there are more than 800 questionnaires and inventories concerning QOL. In today’s world, we see that the definition of QOL needs to be broad, complex, and dynamic, capable of accommodating the diversity of social and individual circumstances.
The WHOQOL Index
Finding a way to assess QOL through the perceptions of the subjects themselves was the task the Mental Health Division of WHO proposed in 1991 when it began the process of constructing a generic tool to measure and quantify QOL. A working group of researchers from fifteen countries defined QOL based not on the presence or absence of disease, but as the subjects’ own perceptions of their circumstances, “as perceptions of their position in life in the context, the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns.” The researchers gathered questions relevant to a person’s QOL, and an instrument was developed using cross-cultural standards. Eventually, the instrument included 100 questions, which covered twenty-four aspects of experience, which aspects were grouped into six domains: physical health, psychological state, level of independence, social relations, environment and spirituality/religion/personal beliefs. The self-administrable instrument was validated in twenty languages.(2)
A subsequently developed short-form instrument, the WHOQOL-BREF, shows a high degree of correlation with the WHOQOL-100, and is now under evaluation as an independent measurement. It has twenty-six questions divided among four domains (physical, psychological, social, and environmental), along with two general questions.
Rolfing SI: Its Idea, Principles, and Paradigms
Rolfing SI began with one principle: that the integration of the human structure in gravity furthered the evolution of the human being.(3) What’s more, a person is seen as a single phenomenon with multiple dimensions, which suggests that the integration of somatic structures has repercussions for all other dimensions of individual human experience. It is a holistic proposition, with its point of departure being the somatic view. Therefore, research about how Rolfing affects the human being requires instruments capable of measuring simultaneously multiple aspects of human phenomena and their relationship.
Because our work of SI takes place in the contexts of many countries, cultures, and languages, we selected the WHOLQOL-BREF as the instrument to measure its results. In addition, this instrument is quick and easy to use, and allows us to attend to the various aspects of human experience that might arise in the clients’ processes. It also lets this research dovetail with related research focused on specific dimensions; e.g., Prado (2006), in “Exploratory Studies on the Psychobiological Dimension of Rolfing,” (4) brought up the existence of psychobiological data, collected on questionnaires developed as part of a NAPER research project,(5) and observed that clients often reported major transformation in this dimension throughout the process of SI.
The Project’s Objectives
One can exercise the faculties of the “scientist” and the “clinician” simultaneously, and observation and investigation can take place in a clinical setting. I also believe it is important to instill and nurture in students the scientific attitude, to plant in their minds a scientific curiosity about the results of the work even as we train them to do it. My hope is that as research techniques are applied across the profession over the long run, we will better understand the practice and outcomes of Rolfing SI. Beyond that, the number of QOL research studies in human sciences and the general interest in the subject brought us to believe that studying the influence of Rolfing SI in QOL had the potential to correlate our work with other areas of understanding and make our work more widely known.
Sample
Between May 2004 and December 2005, a total of 160 clients each participated in one of six Rolf Institute Unit III (professional phase) classes – 105 in the United States and fifty-five in Brazil. Their processes were variously investigated by eighty-four students (sixty in the United States and twenty-four in Brazil), who were instructed by five different teachers.
The sample was distributed as follows:
The totals are:
N = 160
105 US
55 Brazil
Procedure
The study began in May 2004, in a class I taught, assisted by Duffy Allen. To explore the relationship between the effects of Rolfing SI and the clients’ QOL, students were asked to evaluate their class clients’ QOL before and after the Rolfing process by means of the WHOQOL-BREF. The questionnaires were distributed by the students to the clients, who completed them both before the first session and immediately following the end of the series of between ten and thirteen sessions. Other instructors who participated in the project by having their students use the WHOQOL-BREF included: Sally Klemm, Monica Caspari, Patrick Ellinwood, and Paula Mattoli. Later, I tabulated and analyzed the information supplied by the clients. This project had no control group.
Results and Analysis
We calculated the means, standard deviations and the Fisher “t test”, which compares the means for dependent samples. We used a margin of error of 5%. The tables below present the results for each school (Brazil and U.S.) and for the combined sample.
Table 1: Brazil – statistics for paired samples
<img src=’https://novo.pedroprado.com.br/imgs/2010/1128-1.jpg’>
<img src=’https://novo.pedroprado.com.br/imgs/2010/1128-2.jpg’>
<img src=’https://novo.pedroprado.com.br/imgs/2010/1128-3.jpg’>
Discussion and Conclusions
A significant correlation was shown among the clients’ perception of improvement in their QOL following Rolfing SI, both for the study group as a whole (N=160) and for the American (N=105) and Brazilian (N=55) subgroups.
The only domain for which the difference in the “before” and “after” Rolfing SI QOL perceptions was not shown to be significantly correlated was the “environmental” subgroup in the U.S. sample. The result for the U.S. sample (p=0.52) was diluted when the data was put into the context of the total sample of 160 (p=0.002). The data suggest that probably, given the fact that the environmental conditions did not change with Rolfing SI, the subjects’ perception of those conditions did not change significantly (p=052).
This high correlation invites the following important reflections:
By describing this study, I hope to stimulate the same curiosity in others so that we may begin a discussion of our collective observations. Themes for further study and exploration include:
Comments
The school samples having used the WHOQOL-BREF before and after Rolfing SI, we observe that the results are consistent with preexisting empirical evidence, and corroborate the hypothesis that the changes induced by Rolfing SI enhance QOL as a whole and in the various domains of human experience that Rolfing SI considers. The data is meaningful and important because, just as we need to find standards to show the effects of Rolfing SI and its value to society, the WHOQOL questionnaire, a respected instrument with a substantial track record, presents itself as an easy-to-use inventory, validated in twenty languages, which is congruent with the philosophical premises of Rolfing SI. Use of this questionnaire makes possible a collective exploration of how Rolfing SI can help human beings to lead better lives. In that sense, it supports Dr. Rolf’s vision of her work as a means to advance our evolution as upright beings.
Endnotes
Sullivan, Marianne, “Quality of life assessment in medicine.” Nordic Journal of Psychiatry, 1992, Vol. 46, No. 2, 1992, pp. 79-83.
Also: http://informahealthcare.com/doi/abs/10.3109/08039489209103305
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