The efficacy of acupressure for symptom management: a systematic review

The promising application of acupressure for management of cancer-related lymphedema: A scoping review

Objective

Acupressure is widely used to effectively manage cancer-related symptoms; however, limited evidence has been seen on the application of acupressure in managing cancer-related lymphedema (CRL). This study aims to identify, describe, and map the current evidence that used acupressure for CRL prevention and management.

Methods

This review was conducted following Arksey and O'Malley's methodology and Joanna Briggs Institute guidance for scoping reviews. A systematic search was performed in eight English databases and four Chinese databases from inception to Oct 20, 2023, and updated on July 20, 2024. Reference lists were hand-searched. Two independent reviewers performed study selection and data extraction. Disagreements were solved through discussion or consultation with a third reviewer. A narrative synthesis was performed to summarize and synthesize the findings.

Results

A total of 16 articles published from 2010 to 2023 were included. The majority of the studies (n ​= ​11) were from China. There were six randomized controlled trials (RCTs), four quasi-experimental studies, one retrospective cohort study, one qualitative study, three reviews, and one report. Nine studies examined acupressure, one employed tuina, and one utilized Transcutaneous Electrical Acupoint Stimulation. Neiguan (PC 6), Hegu (LI 4), Jianjing (GB 21), Quchi (LI 11), Chize (LU 5) were most commonly used acupoints. The dosage varied among studies. Acupressure was performed by trained nurses or patients. Acupressure showed improvements in lymphedema management, limb function, quality of life, and inflammatory factors.

Conclusions

The review concluded the effectiveness of acupressure in CRL prevention and treatment. Further rigorous research is recommended, particularly well-designed RCTs involving diverse populations.

Somatic acupressure for the management of the fatigue-sleep disturbance-depression symptom cluster in breast cancer survivors: a study protocol for a phase III randomised controlled trial

INTRODUCTION

The fatigue-sleep disturbance-depression symptom cluster (FSDSC) is commonly experienced by breast cancer (BC) survivors, leading to a deteriorated quality of life (QoL). Somatic acupressure (SA) has been recommended as a promising non-pharmacological intervention for cancer-related fatigue (the core symptom of the FSDSC) in the guidelines, showing its encouraging role in relieving cancer-related sleep disorders, fatigue and depression. This phase III randomised controlled trial (RCT) is designed to evaluate the effects, safety and cost-effectiveness of SA for managing the FSDSC in BC survivors.

METHODS

This phase III RCT will be a partial-blinded, sham-controlled, three-arm, parallel clinical trial, involving a 7-week SA intervention period and a 12-week follow-up period. 108 BC survivors will be randomly allocated in a ratio of 1:1:1 to either a true SA group (self-administered acupressure plus usual care), a sham SA group (self-administered light acupressure at non-acupoints plus usual care) or a usual care group. The primary outcomes will be the effectiveness of SA on the FSDSC at both the individual symptom level and cluster symptom level. Each individual symptom will be specifically measured by the Brief Fatigue Inventory (fatigue), the Pittsburgh Sleep Quality Index (sleep disturbance) and the Hospital Anxiety and Depression Scale-Depression (depression). The cluster symptom level will be measured by using an FSDSC composite score, an averaging score of three separated 0-10 numeric rating scales for fatigue, depression and sleep disturbance. The secondary outcomes will include QoL (measured by the Functional Assessment of Cancer Therapy-Breast), adverse events and cost-effectiveness. Outcomes will be assessed at baseline (week 0), immediately after intervention (week 7) and follow-up (week 19). All outcomes will be analysed based on the intention-to-treat principle using the Statistical Package for Social Science (SPSS 25) software.

ETHICS AND DISSEMINATION

Ethical approvals of this study have been granted by the Human Research Ethics Committee at Charles Darwin University (H22110) and the Clinical Trial Ethics Committee at the Affiliated Hospital of Zunyi Medical University (KLL-2023-594), and the Second Affiliated Hospital of Zunyi Medical University (KYLL-2023-058). Findings from this trial will be published in peer-reviewed journals and presented at professional conferences.

TRIAL REGISTRATION NUMBER

NCT06412107.

The Effects of Self-Acupressure on Pain and Sleep Quality in Patients With Coronary Artery Disease: A Randomised Controlled Trial

PURPOSE

The most important cause of death among cardiovascular diseases is coronary artery disease (CAD). Pain and insomnia symptoms are the most common symptoms in CAD patients. Acupressure is used in patients with CAD as one of the energy-based complementary and alternative methods. This study was conducted to investigate the effects of self-acupressure on pain and sleep quality in patients with coronary artery disease.

DESIGN

This is a randomised controlled trial.

METHODS

This study was conducted between June and August 2021 with a total of 80 participants, 40 in the intervention and 40 in the control group. The participants in the intervention group were asked to perform a total of 16 sessions for 4 weeks, 2 days a week in the morning and afternoon, for a total of 23 minutes, depending on the preparation and compression time to be performed on 5 points. The control group did not receive any intervention during the study. Data were collected by using Descriptive Information Form, Visual Analogue Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

After self-acupressure, the VAS total score of the intervention group decreased significantly compared to the control group (t=-11.861; p<.05). After intervention PSQI total and subscale mean scores of the intervention group decreased significantly compared to the control group (t=-7.767; p<.05). It can be seen that self-acupressure application has a negative and significant effect on PSQI total mean scores and VAS total mean score of patients (p<.05).

CONCLUSION

The results of this study showed that self-acupressure was effective in improving the pain and sleep quality of patients with coronary artery disease.

CLINICAL IMPLICATIONS

Self-acupressure is an accessible and inexpensive method, it is recommended to be supported and maintained in the management of coronary artery disease in nursing practice.

Self-administered active versus sham acupressure for diarrhea predominant irritable bowel syndrome: a nurse-led randomized clinical trial

BACKGROUND

Diarrhea-predominant irritable bowel syndrome (IBS-D) significantly impacts patients' quality of life, with existing treatments offering limited relief. Self-administered acupressure presents a potential non-invasive, cost-effective treatment option that could alleviate symptoms and enhance health outcomes in these patients.

AIM

This randomized controlled trial aimed to evaluate the effect of active acupressure compared to sham acupressure on primary and secondary outcomes among IBS-D patients.

METHOD

The study included 63 patients with IBS-D, recruited from Alexandria Main University Hospital, Egypt. Participants were randomized into either an active acupressure group or a sham acupressure group. Both groups underwent two days of training, followed by four weeks of intervention. The active group applied pressure to specific therapeutic acupoints, while the sham group used non-therapeutic points. Outcomes were assessed at baseline, week 2, and week 4.

RESULTS

The active acupressure group showed a significant reduction in symptom severity, improved stool consistency, and frequency, and greater adequate symptom relief by week 4 compared to the sham group. Psychological outcomes, including anxiety and depression, also improved significantly in the active group. Additionally, the active group reported reduced use of rescue medications.

CONCLUSION

Active acupressure is an effective nursing intervention for alleviating symptoms of IBS-D, particularly when applied consistently over time. It improves both physical and psychological outcomes, offering a valuable non-pharmacological treatment option.

IMPLICATIONS

Nurses can integrate self-administered acupressure into IBS-D care plans, teaching patients this technique to manage symptoms independently, thus enhancing their quality of life (QOL) and reducing reliance on conventional medications. This intervention aligns with holistic nursing care and offers a cost-effective, patient-friendly solution for managing IBS-D.

TRIAL REGISTRATION

This study was prospectively registered as a randomized controlled trial in https://clinicaltrials.gov/ Registration Date: January 7, 2023, Registration Number: NCT05702255.

Acupressure versus NSAID for relief of orthodontic pain : A randomized controlled clinical trial

AIM

To compare ibuprofen and acupressure for pain relief after insertion of elastomeric orthodontic separators.

MATERIALS AND METHODS

A randomized control clinical trial was conducted in an orthodontic clinic. A total of 75 orthodontic patients aged 12-16 years participating in the study were randomly allocated to receive either 400 mg of oral ibuprofen, applying acupressure therapy, or no pain-relief approach. Pain scores were recorded on visual analog scales (10 cm) over a week at different times (4, 10, 18, 24 h, and 1 week). The margin of equivalence was defined as 10 mm.

RESULTS

For all timepoints, the control group recorded the highest pain. For the ibuprofen and acupressure group, after 4 h, 18 h, and 1 week, no significant difference was noted. However, after 10 h, no significant difference in pain between the control and acupressure groups was noted and the ibuprofen group showed significantly lower pain. In the acupressure group, the highest pain was noted at 10 h. After this timepoint, pain progressively decreased with time and the lowest pain was noted after 1 week. In the control and ibuprofen groups, the highest pain was after 4 h, and then progressively decreased with time and the lowest pain was noted after 1 week.

CONCLUSIONS

There was no significant difference in pain perception between participants using ibuprofen or acupressure and both groups recorded significantly lower pain than the control group at most of the observed timepoints. Results support the analgesic effect of the acupressure approach.

Hydrogel Sensors in an IoT System for Self-Monitoring and Remote Monitoring of Massage Pressure

The effectiveness of massage can be enhanced if the pressure applied can be monitored continuously. In this study, we described an Internet-of-Things (IoT) system based on hydrogel sensors, which allows for self-monitoring and remote monitoring of massage pressure. The piezoresistive hydrogel with the compressive energy loss coefficient of 15.7% was developed, which was attributed to the strong polarization of ammonium phosphate on water molecules, which was evidenced by nuclear magnetic resonance (NMR) transverse relaxation analyses and atomic force microscopy. Using this hydrogel as a pressure-sensing component, we assembled a wearable sensor capable of quantifying and transmitting massage pressure with insignificant energy dissipation. By integrating RGB LED arrays, the message pressure was indicated by the color states of the LEDs. Furthermore, the wearable sensors and LEDs were connected to a microcontroller (MCU) chip, an IoT chip, and a cloud server to form a sensing-controlled IoT system, enabling visible and remote monitoring of massage pressure.

Acupressure On Chemotherapy-Induced Nausea and Vomiting among Breast Cancer Patients: A Systematic Review and Meta-analysis

BACKGROUND

Nausea and vomiting are one of the common and distressing side effects of chemotherapy in breast cancer patients often impacting their quality of life and treatment adherence. The purpose of this systematic review and meta-analysis was to determine whether acupressure is effective in treating breast cancer patients' acute nausea and vomiting brought on by chemotherapy as well as delayed nausea and vomiting.

METHODS

We systematically searched for Randomized controlled trials and quasi-experimental studies in PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinical Key, Web of Science, EMBASE, and Scopus. Based on the inclusion criteria two reviewers independently identified the articles using key thesaurus and free text terms. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement.

RESULTS

According to the pooled findings, acupressure combined with antiemetics greatly lessens the severity of acute nausea [SMD, (95% CI)] [-0.35(-0.62,-0.08), P=0.01, I2=0%], delayed nausea [SMD, (95% CI)] [-0.52(-0.78,-0.26), P<0.001, I2=16%], and delayed vomiting [SMD, (95% CI)] [-0.46(- 0.83,-0.08), P=0.02, I2=43%] brought on by chemotherapy.

CONCLUSION

For chemotherapy-treated breast cancer patients, acupressure is a helpful complementary therapy for easing nausea and vomiting.

Trends in Korean intervention studies on complementary and alternative therapies in rehabilitation nursing

In nursing, complementary and alternative therapies (CATs) can be provided alongside, or as alternatives, to conventional medical treatments to maximize therapeutic effects, accelerate rehabilitation, and enhance patient satisfaction. Fostering the correct knowledge and attitudes toward CATs is crucial not only for theoretical development but also for practical application. To gain a comprehensive understanding of recent domestic research trends, this study conducted an integrative review to analyze different types of CAT-related intervention studies in rehabilitation nursing in South Korea. A literature search of relevant databases suggested 14 papers. The review revealed that most studies focused on older adult patients, with manipulative and body-based therapies being the most common CAT interventions, followed by energy therapies, mind-body therapies, and others. The efficacy analysis of the CATs used in the selected studies indicated that their effects varied depending on participant characteristics and outcome measures, even when the same CAT was employed. To advance the field of rehabilitation nursing, effective CATs that are proven to be safe for older adult patients need to be developed and actively utilized. Additionally, specialized nurse training programs and clinical and community-based applications for rehabilitation patients requiring interventions need to be developed.

Beyond Pharmacology: A Narrative Review of Alternative Therapies for Anxiety Disorders

BACKGROUND

Anxiety disorders significantly reduce patients' quality of life. Current pharmacological treatments, primarily benzodiazepines and antidepressants, are associated with numerous side effects. Consequently, there is a continual search for alternative methods to traditional therapies that are less burdensome for patients and broaden their therapeutic options. Our objective was to determine the role of selected alternative methods in the treatment of anxiety disorders.

METHODS

In this review, we examined recent evidence on alternative treatments for anxiety disorders, including physical activity, mindfulness, virtual reality (VR) technology, biofeedback, herbal remedies, transcranial magnetic stimulation (TMS), cryotherapy, hyperbaric therapy, vagus nerve stimulation (VNS), 3,4-methylenedioxymethamphetamine (MDMA), electroconvulsive therapy (ECT), and eye movement desensitization and reprocessing (EMDR) therapy. For this purpose we reviewed PubMed and after initial search, we excluded works unrelated to our aim, non-orginal data and animal studies. We conducted second search to cover all minor methods.

RESULTS

We included 116 studies, which data is presented in Tables. We have investigated which methods can support treatment and which can be used as a stand-alone treatment. We assessed the risks to benefits of using alternative treatments.

CONCLUSION

Alternative treatments significantly expand the options available to patients and clinicians, with many serving as adjuncts to traditional therapies. Among the methods presented, mindfulness has the most significant therapeutic potential.

The Feasibility and Effects of Self-Acupressure on Symptom Burden and Quality of Life in Hemodialysis Patients: A Pilot RCT

Background

Symptom burden among long-term hemodialysis (HD) patients is high, and addressing symptoms has been identified as a key research priority by patients. Acupressure has shown some effectiveness in management of symptoms in patients with HD.

Objective

The purpose of this study was to explore the feasibility and the effect of implementing a self-administered acupressure intervention on symptom burden and quality of life for in-center HD patients.

Design

A pilot randomized controlled study.

Setting

Two outpatient community HD clinics between in Calgary, Alberta, Canada.

Patients or Sample or Participants

Patients on HD for at least 3 months and with at least one symptom score rated greater than moderate were eligible for the study.

Methods

Participants were randomized into either the (1) self-acupressure + usual care or (2) usual care alone group. Participants in the acupressure group were given a wooden acupressure tool and taught how to self-administer protocol on 6 acupressure sites for the 4-weeek study duration. Feasibility outcomes were assessed through satisfaction surveys and attrition. Other outcomes included quality of life and symptom scores by validated questionnaires (EQ-5D-5L and Integrated Palliative Outcome Score-Renal [IPOS-Renal]).

Results

Thirty-two participants were successfully enrolled in the study; acceptability was high with study completion at 98% in the intervention group and 82% adherence rate to the 4-week protocol. Participants in the intervention group reported an improved change score in quality of life (EQ-5D-5L Index Score change = +0.053; EQ-5D-5L visual analog scale score change = +6.7). Participants in the intervention group also reported improved symptom scores (IPOS-Renal overall change = -2.8).

Limitations

Small sample size and intervention duration are limitations of this pilot study.

Conclusions

The results from this study suggest that self-acupressure was acceptable and feasible in this sample of HD patients. Self-acupressure may have a role for supporting the management of symptoms in HD patients. These pilot results can be used to inform larger more definitive investigations.

The Effect of Ear Acupressure on Behavioral Problems in Children with Attention-Deficit/Hyperactivity Disorder: A Randomized Clinical Trial

Objective

Due to the limits on treatment for people with attention-deficit/hyperactivity disorder (ADHD), ear acupressure treatment has been considered. This study examined the effect of ear acupressure on behavioral problems of children with ADHD.

Materials and Methods

This randomized controlled trial was conducted in 70 children with ADHD who were randomized into 2 groups. The intervention group received ear acupressure in treatment points and the control group received massage at neutral points. Behavioral problems were measured 3 times: (1) baseline; week 4; and week 8. The last timepoint was a follow-up, using the Child Behavior Checklist.

Results

The intervention group had fewer behavioral problems at all 3 timepoints than the control group (Cohen's ∂ = 1.49; 95% confidence interval at week 4: 20.97, 47.43).The ear acupressure group had a large effect size with respect to reduction of attention problems at week 4 (∂ = 1.88) and week 8 (∂ = 1.48) than the control group.

Conclusions

Ear acupressure induced significant reduction of the behavioral problems of children with ADHD. Further research can evaluate the use and continuity of the effectiveness of this treatment as a complementary treatment in addition to the usual treatments for these children.

Regular use of acupressure mats reduces perceived stress at subjective but not psychophysiological levels: Insights from a three-week relaxation training

Acupressure mats are promoted as stress management tools for easy and effective self-application, promising reduced stress and increased well-being. However, the scientific evidence for these effects is based on few experimental studies and lacks the examination of acupressure mats as a solitary relaxation tool. Our study aimed to examine which changes in stress and well-being can be expected from the use of acupressure mats by healthy young people on the subjective and psychophysiological level. Unexperienced participants practiced relaxation for three weeks either with an acupressure mat or without any tools (active control group [CG]). As a results, subjective well-being and stress decreased, while sleep quality and concentration endurance increased across groups. Blood pressure (BP), heart rate (HR), pain threshold and pain tolerance did not change significantly from pre- to post-training measurements. Most importantly, no significant differences were found between groups, indicating that training with an acupressure mat yielded no superior effects compared with an active control condition in healthy young students. As a conclusion, taking time to relax has some but limited beneficial effects on the subjective levels independent of the specific method for healthy students. Potential beneficial effects of acupressure mats might be bound to specific impairments, such as tension pain.

The Effect of Acupressure on Fatigue in Cancer Patients: A Meta-analysis Study

OBJECTIVES

This meta-analysis study was conducted to determine how acupressure affects fatigue in cancer patients.

MATERIALS AND METHODS

Randomised controlled clinical trials were conducted using the keywords 'acupressure and fatigue' on Google Scholar, PubMed, and ISI Web of Sciences databases. Cochran's Q test statistics and I2 test statistics were used to test the presence of heterogeneity. The random-effect meta-analysis model was used according to the results of the test for heterogeneity. Hedge's g test statistics were used to determine the joint effect between acupressure and control groups in the meta-analysis study.

RESULTS

In this meta-analysis study, 409 patients from the acupressure group and 403 patients from the control group were included. When calculating the average standardised difference value of the acupressure versus the control group, it was determined that acupressure decreased the fatigue score in a statistically significant way.

CONCLUSION

Acupressure is an effective approach to alleviate cancer-related fatigue.

The Effects of Self-Acupressure on Pain, Fatigue, and Sleep Quality in Colon and Pancreatic Cancer Patients Receiving Chemotherapy: A Randomized Controlled Study

BACKGROUND

Pancreatic and colon cancer are among important gastrointestinal cancer diseases. Pain, fatigue, and insomnia are among the most common symptoms in cancer patients receiving chemotherapy. Self-acupressure may improve patients' pain, fatigue, sleep quality, quality of life, and functional well-being.

OBJECTIVE

The aim of this study was to examine the effects of self-acupressure application on pain, fatigue, and sleep quality in colon and pancreatic cancer patients receiving chemotherapy.

METHODS

This randomized controlled study was conducted with 60 patients in treatment for pancreatic or colon cancer, 30 in the intervention and 30 in the control group, between June and October 2021. Participants in the intervention group were asked to complete 16 acupressure sessions for 4 weeks, 2 days a week in the morning and afternoon for a total of 18 minutes, depending on the preparation and pressure time on 4 pressure points. Control group participants did not receive any interventions during the study. The data were collected by using a personal information form, the Pittsburgh Sleep Quality Index, the Piper Fatigue Scale, and the visual analog scale.

RESULTS

After self-acupressure, the visual analog scale, Piper Fatigue Scale, and Pittsburgh Sleep Quality Index scores of the intervention group decreased when compared with the control group scores; the difference between the 2 groups was statistically significant.

CONCLUSION

Self-acupressure was effective in reducing the pain, fatigue, and sleep disorder scores of patients with colon or pancreatic cancer receiving chemotherapy.

IMPLICATIONS FOR PRACTICE

In nursing practice, self-acupressure, an applicable, accessible, and inexpensive method in the management of cancer-related symptoms, can be supported and maintained during a 4-week period.

Effects of PC6 acupressure on acute and delayed nausea and vomiting induced by chemotherapy in patients with malignant neoplasm: a meta-analysis

OBJECTIVE

Evaluating the intervention effect of PC6 acupressure on chemotherapy-induced acute, delayed nausea, and vomiting in malignant tumor patients.

METHOD

Eleven databases had been retrieved from January 2010 through January 2022. The published meta-analysis literature was hand-searched, and the language was limited to English and Chinese. The protocol of this meta-analysis was registered with PROSPERO (registration number: CRD42022323693). Two reviewers independently selected relevant eligible articles, extracted data, and evaluated the risk of bias. Meta-analysis was statistically analyzed using software RevMan 5.3.

RESULT

Ten randomized controlled trials with 975 patients were included. Only two studies were assessed as high quality; eight studies were evaluated as moderate. Meta-analysis showed that compared with the control group, PC6 acupressure reduced the occurrence number of acute (SMD = -0.39,95CI (-0.73, -0.05) P = 0.02), delayed (SMD = -0.51, 95% CI (-0.96, -0.05) P = 0.03) nausea and acute (SMD = -0.42,95% CI (-0.79, -0.06) P = 0.02), delayed (SMD = -0.37, 95% CI (-0.77, 0.03) P = 0.07) vomiting; it reduced the severity of acute (SMD = -0.34, 95% CI (-0.57, -0.11) P = 0.004), delayed (SMD = -0.79, 95% CI (-1.33, -0.25) P = 0.004) nausea and acute (SMD = -0.51, 95% CI (-0.79, -0.23) P = 0.0004), delayed (SMD = -0.50, 95% CI (-0.84, -0.17) P = 0.003) vomiting, while it did not reduced the experience time on acute and delayed CINV.

CONCLUSION

The meta-analysis shows the effectiveness of PC6 acupressure in preventing and treating nausea and vomiting. Large, high-quality, well-designed randomized controlled trials are needed in the future to determine the efficacy of PC6 acupressure on chemotherapy-induced nausea and vomiting.

Self-Acupressure for Symptom Management in Cancer Patients: A Systematic Review

CONTEXT

Acupressure is a popular nonpharmacological intervention that is increasingly proven to effectively alleviate symptoms in patients with cancer. However, the effects of self-acupressure on cancer symptom management are less clear.

OBJECTIVES

This systematic review is the first to summarize the current experimental evidence on self-acupressure for symptom management in cancer patients.

METHODS

Eight electronic databases were searched for experimental studies that examined self-acupressure for cancer patients with symptoms and published in peer-reviewed English or Chinese journals. The methodological quality of the included studies was evaluated using the revised Cochrane risk-of-bias assessment tool and the JBI critical appraisal checklist for quasi-experimental studies. Data were extracted as predefined and synthesized narratively. The Template for Intervention Description and Replication checklist was used to report the intervention characteristics.

RESULTS

A total of 11 studies were included in this study, six as feasibility or pilot trials. The methodological quality of included studies was suboptimal. Substantial heterogeneity was observed in acupressure training, acupoint selection, intervention duration, dosage, and timing. Self-acupressure was only associated with reduced nausea and vomiting (P = 0.006 and P = 0.001).

CONCLUSION

The limited evidence from this review precludes the definitive conclusions on intervention effectiveness for cancer symptoms. Future research should consider developing the standard protocol for intervention delivery, improving the methodology of self-acupressure trials, and conducting large-scale research to advance the science of self-acupressure for cancer symptom management.

Hydrotherapy and acupressure in restless legs syndrome: A randomized, controlled, 3-armed, explorative clinical trial

BACKGROUND

Restless legs syndrome (RLS) is a common neurological disease that has a significant impact on daily activities and quality of life, for which there is often no satisfactory therapy. Complementary medicine, such as acupressure and hydrotherapy, is used to treat patients with RLS; however, the clinical evidence is unclear. This study aims to investigate the effects and feasibility of self-administered hydrotherapy and acupressure in patients with RLS.

METHODS

This is a randomized, controlled, open-label, exploratory, clinical study with 3 parallel arms, comparing both self-applied hydrotherapy (according to the German non-medical naturopath Sebastian Kneipp) and acupressure in addition to routine care in comparison to routine care alone (waiting list control) in patients with RLS. Fifty-one patients with at least moderate restless-legs syndrome will be randomized. Patients in the hydrotherapy group will be trained in the self-application of cold knee/lower leg affusions twice daily for 6 weeks. The acupressure group will be trained in the self-application of 6-point-acupressure therapy once daily for 6 weeks. Both interventions take approximately 20 minutes daily. The 6-week mandatory study intervention phase, which is in addition to the patient preexisting routine care treatment, is followed by a 6-week follow-up phase with optional interventions. The waitlist group will not receive any study intervention in addition to their routine care before the end of week 12. Outcome parameters including RLS-severity, disease and health-related quality of life (RLS-QoL, SF-12), Hospital Anxiety and Depression Score in German version, general self-efficacy scale, and study intervention safety will be measured at baseline and after 6 and 12 weeks. The statistical analyses will be descriptive and exploratory.

CONCLUSION

In the case of clinically relevant therapeutic effects, feasibility, and therapeutic safety, the results will be the basis for planning a future confirmatory randomized trial and for helping to develop further RLS self-treatment concepts.

The Effects of Auricular Acupressure on Physiological Index, Depression, Anxiety, and Stress for Elders With Hypertension

The purpose of the study was to examine the effects of auricular acupressure (AA) on physiological index, depression, anxiety, and stress in elderly people with hypertension. The verum group received verum AA therapy for 8 weeks. Five different acupressure sites were applied in each group. There was a significant difference in systolic blood pressure between the 2 groups after 8 weeks of AA, whereas a significant difference in pulse pressure was found between the 2 groups after 6 weeks of AA. This study is meaningful in comparing intervention and sham groups, verifying the effects by using physiological and psychological variables, and confirming the effects of repetitive measurement. AA therapy is expected to be a practical and efficient health care intervention for elderly people with hypertension.

Effect of Acupressure Applied After Cesarean Section Under Spinal Anesthesia Postpone the Duration of Taking Analgesics and on The Gastrointestinal System: A Randomized Controlled Trial

OBJECTIVES

Cesarean deliveries are one of the primary conditions associated with postoperative decreased motility of the gastrointestinal system and are characterized by acute pain and distention. The aim of the present study was to investigate the application of acupressure and the administration of analgesics for women who underwent cesarean section under spinal anesthesia could be delayed and how spontaneous gastrointestinal system motility could be achieved in the postoperative period.

DESIGN

Randomized controlled trial SETTING: Private Medipol Nisa Hospital, Istanbul, Turkey INTERVENTION: This trial was conducted with 112 primipara pregnant women who delivered via cesarean section under spinal anesthesia and were randomly assigned into the acupressure (n=52) and control (n=60) groups. The participants in the acupressure group (n=52) were treated for 20 minutes. The participants in the control group (n=60) were treated per the hospital protocol (analgesics for pain, flatulation and defecation, no pharmacological or non-pharmacological application was performed).

RESULTS

The time that elapsed for the administration of analgesics was significantly later in the acupressure group than in the control group (p <.001). The first occurrence of flatulation and defecation were significantly earlier in the acupressure group (19 and 23 hours, respectively) than in the control group (34 and 27 hours, respectively) (p <.001).

CONCLUSION

Acupressure is an easy, non-invasive method that postpones the administration of analgesics in the postoperative period and prevents flatulence and constipation caused by the decreased motility of GIS.

The Effects of Acupressure in the Prevention of Nausea and Vomiting Related to Chemotherapy in Children: A Randomized Double-Blinded Placebo-Controlled Study

Background: Acupressure is known to be a nursing intervention used to prevent chemotherapy-induced nausea and vomiting in children. Methods: This study was conducted to evaluate and compare the effectiveness of manual and wristband acupressure in the prevention of chemotherapy-induced nausea and vomiting in children. This double-blinded and placebo-controlled study was conducted with 44 children aged between 5 and 18 years receiving chemotherapy in a university hospital's pediatric oncology clinic. Children were randomized into groups using a 2 × 2 factorial design: (a) The child who was given manual acupressure before the first chemotherapy was given placebo manual acupressure before the next chemotherapy; (b) the same child who was administered wristband acupressure before the first chemotherapy was administered placebo wristband acupressure before the next chemotherapy. After all interventions, the severity and number of episodes of nausea and vomiting and additional antiemetic needs in the children were monitored for 24 h. Results: In both groups, the severity and number of nausea and vomiting were lower according to their own placebo groups. Manual and wristband acupressure were effective in reducing the severity and number of nausea and vomiting, but manual acupressure was more effective in reducing the severity and number of nausea and vomiting in comparison to wristband acupressure (p < .05). No statistically significant difference was found between the groups regarding additional antiemetic drug use. Discussion: In this study, manual and wristband acupressure were determined to be effective in reducing the severity and number of nausea and vomiting related to chemotherapy.

Effect of Acupressure on Health-Related Quality of Life in Patients with Polycystic Ovarian Syndrome: A Randomized Clinical Trial

The present study was conducted to determine the effect of acupressure on health-related quality of life in patients with polycystic ovary syndrome. This study was a double-blind, randomized clinical trial with a control group. Ninety-six patients with polycystic ovary syndrome from Mofateh gynecological clinic in Yasuj in Iran were enrolled according to the inclusion criteria. Patients were randomly assigned to intervention and control groups. In the intervention group, pressure on the points, Ren3, Ren4, Liv3, Sp6, and Sp10 and in the control group, pressure on sham points were performed for 6 weeks (2 sessions per week). The primary outcome was health-related quality of life, measured by the modified polycystic ovary syndrome health-related quality of life questionnaire (MPCOSQ). The secondary outcomes were total testosterone levels and clinical symptoms in patients with polycystic ovary syndrome. The outcome variables were measured before the intervention at week 0 (baseline) and after the intervention at week 18 (12 weeks after the end of intervention). The results indicated that at week 18, the score of clinical symptoms and the total testosterone level of the intervention group were lower than those of the control group. The health-related quality of life score in the intervention group was higher than that in the control group, which was statistically significant (P < 0/05). Therefore, acupressure in these points is recommended as a practical and effective method of treating polycystic ovarian syndrome.

Effects of acupressure and shower applied in the delivery on the intensity of labor pain and postpartum comfort

BACKGROUND AND PURPOSE

Labour pain is a constantly increasing pain. This study thus aims to determine the effects of acupressure and shower on labour pain and postpartum comfort.

METHODS

In this randomized controlled trial (RCT), the control group consisted of 40 pregnant women, while the experimental groups consisted of 80 pregnant women in total. The experimental groups received routine labour care and either acupressure or showers upon reaching three cervical dilations (4-5, 6-7 and 8-10 cm). The control group only received routine labour care. A maternal information form (MIF), the Visual Analog Scale (VAS) and the Postpartum Comfort Questionnaire (PPCQ) were used to collect data.

RESULTS

Pain was significantly reduced in both of the experimental groups, in contrast to the control group, in all periods of the study (p < 0.001). Postpartum comfort also significantly increased in the experimental groups compared to the control group (p < 0.05).

CONCLUSION

Acupressure and showering are effective in reducing labour pain and increasing postpartum comfort. Midwives and nurses can therefore apply them as inexpensive and easy to administer methods for labour pain relief.

Impacts of acupressure treatment on depression: A systematic review and meta-analysis

BACKGROUND

Depression is recognized as a major public health problem with a substantial impact on individuals and society. Complementary therapies such as acupressure may be considered a safe and cost-effective treatment for people with depression. An increasing body of research has been undertaken to assess the effectiveness of acupressure in various populations with depression, but the evidence thus far is inconclusive.

AIM

To examine the efficacy of acupressure on depression.

METHODS

A systematic literature search was performed on PubMed, PsycINFO, Scopus, Embase, MEDLINE, and China National Knowledge (CNKI). Randomized clinical trials (RCTs) or single-group trials in which acupressure was compared with control methods or baseline in people with depression were included. Data were synthesized using a random-effects or a fixed-effects model to analyze the impacts of acupressure treatment on depression and anxiety in people with depression. The primary outcome measures were set for depression symptoms. Subgroups were created, and meta-regression analyses were performed to explore which factors are relevant to the greater or lesser effects of treating symptoms.

RESULTS

A total of 14 RCTs (1439 participants) were identified. Analysis of the between-group showed that acupressure was effective in reducing depression [Standardized mean differences (SMDs) = -0.58, 95%CI: -0.85 to -0.32, P < 0.0001] and anxiety (SMD = -0.67, 95%CI: -0.99 to -0.36, P < 0.0001) in participants with mild-to-moderate primary and secondary depression. Subgroup analyses suggested that acupressure significantly reduced depressive symptoms compared with different controlled conditions and in participants with different ages, clinical conditions, and duration of intervention. Adverse events, including hypotension, dizziness, palpitation, and headache, were reported in one study.

CONCLUSION

The evidence of acupressure for mild-to-moderate depressive symptoms was significant. Importantly, the findings should be interpreted with caution due to study limitations. Future research with a well-designed mixed method is required to consolidate the conclusion and provide an in-depth understanding of potential mechanisms underlying the effects.

Effects of Acupressure on Anxiety: A Systematic Review and Meta-Analysis

Objectives: The research aim was to perform a systematic review and meta-analysis evaluating the ability of acupressure to reduce anxiety. Design: Randomized controlled trials were obtained through a search of electronic medical databases (four in English and one in Chinese) from inception to October 5, 2020. Two authors searched the databases, evaluated studies' methodological quality, and performed data extraction independently. The final studies for analysis were identified after discussion with the third author. Results: We obtained 27 studies for our systematic review and meta-analysis. Eight studies had a low overall risk of bias, and 13 had some bias concerns with methodological quality. According to the results, acupressure significantly reduced patient anxiety (standardized mean difference = 1.152; 95% confidence interval: 0.847-1.459, p < 0.001), and the study heterogeneity was high (Q = 299.74, p < 0.001, I² = 91.333%). Two studies reported acupressure-associated adverse events. We also performed a sensitivity analysis by omitting one outlier study, which had the largest effect size; however, high heterogeneity remained (I² = 87.816%). A subgroup analysis revealed significant differences between participant types (Q = 46.573, p < 0.001), levels of methodological quality (Q = 6.228, p = 0.044), and massage equipment (Q = 4.642, p = 0.031). Conclusions: Our meta-analysis suggests that acupressure can alleviate anxiety. Acupressure was more effective for inpatients and preoperative patients when finger massage was applied. In individuals with anxiety and a stable hemodynamic status, acupressure could be a promising treatment option. However, the substantial heterogeneity across studies means that any inference from the results should be performed cautiously.

Effects of SP6 and ST36 Acupressure on Pain and Physiological Indexes in Addicted Men: A Single-Blind Randomized Clinical Trial

Background

Pain is the most crucial reason to seek treatment, and acupressure is one of the most common ways to relieve pain; therefore, this study was conducted with the aim to investigate the effectiveness of acupressure on the reduction of pain and stability of physiological indexes in addicted men.

Methods

The present single-blind, randomized, clinical trial was performed on 90 participants who were hospitalized in an addiction treatment camp in Masjed-e-Soleyman, Iran. The participants were divided into acupressure group (n = 45) and control group (n = 45) through allocating permutation blocks method. The acupressure group received acupressure on SP6 and ST36 points for 3 consecutive sessions and each session for 10 minutes. The data collection tools used included a demographic information questionnaire, the Short-Form McGill Pain Questionnaire (SF-MPQ), and a physiological index registration form, tympanic thermometer, sphygmomanometer, pulse oximetry device, and digital watch. Repeated measures ANOVA was used to analyze the data. P ≤ 0.05 was considered statically significant.

Findings

There was a statistically significant decrease in the sensory dimension of pain in the acupressure group compared to the control group in all 3 sessions (P ≤ 0.001; P ≤ 0.001; P = 0.001, respectively). There was no statistically significant difference in the overall pain score (P ≥ 0.005), emotional pain dimension (P ≥ 0.005), and physiological indexes of pain (P ≥ 0.005) between the two groups after the intervention.

Conclusion

Acupressure is a non-invasive and cost-effective method that reduces the sensory dimension of painý, and its application does not require special tools; ýthus, the use of such a safe and secure method for relieving pain is recommended.

Effect of qigong exercise and acupressure rehabilitation program on pulmonary function and respiratory symptoms in patients hospitalized with severe COVID-19: a randomized controlled trial

Background

There are several effective complementary and integrative therapies for patients with severe COVID-19. The trial aims to evaluate the efficacy and advantages of the qigong exercise and acupressure rehabilitation program (QARP) for treating patients with severe COVID-19.

Methods

A total of 128 patients with COVID-19 aged 20 to 80 years were recruited and randomly allocated in a 1:1 ratio to receive QARP plus standard therapies or standard therapies alone. QARP consisted of acupressure therapy and qigong exercise (Liu Zi Jue). The primary outcome was measured with the modified Medical Research Council (mMRC) dyspnea scale, and the secondary outcomes included the modified Borg dyspnea scale (MBS), fatigue Scale-14 (FS-14), patient health questionnaire-9 scale (PHQ-9), duration of respiratory symptoms, and vital signs.

Results

In total, 128 patients completed the clinical trial. The QARP group and standard therapies group showed significant improvements in vital signs (except blood pressure) and clinical scales compared with baseline (p<0.05). The QARP group also showed more significant improvement in the mMRC dyspnea scale (-1.8 [-2.1, -1.6], p=0.018) and modified Borg dyspnea scale (-3.7 [95% confidence intervals (CI) -4.3, -3.1], p=0.045). The duration of cough was 14.3 days (95% CI 12.6, 16.1, p=0.046), and the length of hospital stay was 18.5 days (95% CI 17.0, 20.0, p=0.042) in the QARP group, both of which were significantly reduced compared with the standard therapies group (p<0.05).

Conclusion

QARP plus standard therapies improved lung function and symptoms such as dyspnea and cough in patients with severe COVID-19 and shortened the length of hospital stay. Therefore, QARP may be considered an effective treatment option for patients with severe COVID-19.

Trial registration

Clinical Research Information Service Identifier: ChiCTR2000029994

The efficacy of integrated cognitive behavioral therapy (CBT) and acupressure versus CBT for insomnia: a three-arm pilot randomized controlled trial

OBJECTIVES

This pilot study aimed to examine the efficacy of integrated cognitive behavioral therapy (CBT) and acupressure in treating insomnia and its daytime impairments in a Chinese adult population.

METHODS

40 eligible participants with insomnia were randomly assigned to either the integrated CBT and acupressure (CBTAcup) group (n = 14), the CBT group (n = 13), or the waitlist control (WL) group (n = 13). Participants in the CBTAcup group attended a 2-hour integrated CBT and self-administered acupressure group treatment once per week for six consecutive weeks, while participants in the CBT group attended six weekly 2-hour CBT for insomnia. Sleep, mood, daytime impairments, quality of life, and treatment credibility and adherence were assessed at baseline, immediate post-treatment (Week 7), and 4-week post-treatment (Week 11).

RESULTS

Linear mixed-effects models showed that both the CBTAcup and CBT groups had significantly lower insomnia severity (d = -1.74 and d = -2.61), dysfunctional beliefs related to sleep (d = -2.17 and -2.76), and mental fatigue (d = -1.43 and -1.60) compared with the WL group at Week 7. The CBTAcup group provided additional benefits in reducing total fatigue (d = -1.43) and physical fatigue (d = -1.45). Treatment credibility was found to be improved in the CBTAcup group from baseline to Week 7.

CONCLUSIONS

Integrated CBT and acupressure demonstrated comparable efficacy to pure CBT in treating insomnia symptoms, with additional advantages to improve fatigue symptoms and acceptability in the Chinese population. Further methodologically rigorous studies on a larger scale and longer follow-up are warranted to confirm these findings.

Comparative Effectiveness of Western and Eastern Manual Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis

Background: Manual therapy (MT) is considered a promising adjuvant therapy for chronic obstructive pulmonary disease (COPD). Comparing the effectiveness among different Western and Eastern MTs being used for the management of COPD could potentially facilitate individualized management of COPD. This systematic review attempted to estimate the comparative effectiveness of Western and Eastern MTs for COPD patients using a network meta-analysis (NMA) methodology. Methods: Nine electronic databases were comprehensively searched for relevant randomized controlled trials (RCTs) published up to February 2021. Pair-wise meta-analysis and NMA were conducted on the outcomes of COPD, which included lung function and exercise capacity. Results: The NMA results from 30 included RCTs indicated that the optimal treatment for each outcome according to the surface under the cumulative ranking curve was massage, acupressure, massage, and tuina for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and 6 min walking distance, respectively. Conclusions: MTs such as massage, acupressure, and tuina have shown comparative benefits for lung function and exercise capacity in COPD. However, the methodological quality of the included studies was poor, and the head-to-head trial comparing the effects of different types of MTs for COPD patients was insufficient. Therefore, further high-quality RCTs are essential.

The Effect of Acupressure on Relieving Cancer-Related Fatigue: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Fatigue, a common complaint reported by patients with cancer or in survivorship, has been negatively associated with quality of life, emotional health, and cognitive functions. Acupressure, a traditional Chinese medicine, has been increasingly practiced in clinical and community settings. However, little evidence supports the beneficial effects of acupressure on the reduction of general, physical, and mental fatigue in cancer survivors.

OBJECTIVE

The aim of this study was to examine the effect of acupressure on fatigue in cancer survivors and the moderators of the effect of acupressure on cancer-related fatigue relief.

METHODS

Databases, namely, PubMed, Embase, CINAHL, and ProQuest, were searched from their inception to July 17, 2020. No language and publication period restrictions were applied. Only randomized controlled trials that examined the effects of acupressure on cancer-related fatigue were included. A random-effects model was used for data analyses.

RESULTS

Fourteen articles involving 776 participants with cancers were included. Acupressure considerably alleviated cancer-related general, physical, and mental fatigue (g = -0.87, -0.87, and -0.37) compared with controls. Increasing female percentage of participants significantly reduced the effects of acupressure on fatigue (B = -0.01, P < .001). The executor and operation approach as well as treatment period during chemotherapy did not moderate the effects of acupressure on fatigue relief.

CONCLUSION

Acupressure is effective at alleviating cancer-related fatigue.

IMPLICATIONS FOR PRACTICE

Health professionals and patients can use acupressure to alleviate fatigue during and after chemotherapy. Nursing personnel could incorporate acupressure into clinical practice as part of a multimodal approach to alleviating fatigue in cancer survivors.

The Effect of Auricular Acupressure for Chronic Low Back Pain in Elders: A Randomized Controlled Study

Chronic low back pain (CLBP) is a major problem throughout the world and getting worse because of population increase and aging. The cost of treatment increases as the population of people with CLBP increases. This study aimed to examine the effect of auricular acupressure (AA) on pain and disability in elders with chronic low back pain. The randomized, single-blinded, and placebo-controlled study was conducted on 51 elders with CLBP in South Korea from June 2019 to August 2019. The experimental group (n = 26) received AA on low back pain-related points, whereas the placebo control group (n = 25) received AA on points unrelated to low back pain. Participants received 6 weeks of AA in weekly cycles. Collected data were analyzed using IBM SPSS Statistics, version 25. Statistically significant differences between the 2 groups emerged in the visual analog scale (P < .001), pain threshold (P < .001), and Oswestry Disability Index (P < .001). This study showed that 6 weeks of AA improved CLBP and pain-related disability. Therefore, AA can be used as a noninvasive and self-managed alternative intervention for CLBP in older adults.

The effects of psychological counseling and acupressure based on couple therapy procedure for alleviation of vomiting and nausea in pregnant women in Iran country

OBJECTIVES

Nausea and vomiting have psychological negative effects on some pregnant women during gestation. Different strategies have been used for the treatment of nausea and vomiting during pregnancy, such as acupressure and psychological interventions. This study was conducted to evaluate the effects of psychological counseling and acupressure based on couple therapy procedures on vomiting and nausea in pregnant women in Iran.

METHODS

Two hundred and eight women were divided into four groups (n=52): 1) they did not any intervention (control group), 2) they received the psychological intervention, 3) they received acupressure intervention, and 4) they received a combination of psychological + acupressure interventions. To investigate the effects of interventions on nausea and vomiting, the Rhodes index of nausea, vomiting and retching were used. The counseling period has lasted for 4 weeks. The pressure intervention on the site was conducted in clockwise form for 1 min and anticlockwise form for another 1 min.

RESULTS

Groups did not have a significant difference for abortion and income (p>0.05). The effects of counseling, and acupressure interventions on severity and period of vomiting and nausea were not significant (p>0.05), but the intervention based on counseling and acupressure decreased severity of vomiting and nausea (p<0.05).

CONCLUSIONS

The intervention based on counseling and acupressure could not reduce nausea and vomiting during the gestation, but the intervention based on a combination of both decreased nausea and vomiting. It can be suggested to apply an intervention based on a combination of counseling and acupressure in short-time period for decreasing nausea and vomiting in women during pregnancy.

Clinical Efficacy and Safety of Acupressure on Low Back Pain: A Systematic Review and Meta-Analysis

OBJECTIVES

To evaluate the effectiveness and safety of acupressure on low back pain (LBP).

METHODS

We searched 7 electronic databases and 2 trial registries through December 28, 2020. Randomized controlled trials (RCTs) of acupressure on LBP were considered for meta-analysis with Revman 5.3 and Stata 15.0 software. Methodological quality was evaluated using the Cochrane Collaboration's tool. Trial sequential analysis (TSA) was used to quantify the statistical reliability. HETRED analysis and GRADE were used to determine the heterogeneity and quality of the results, respectively.

RESULTS

Twenty-three RCTs representing 2400 participants were included. Acupressure was superior to tuina massage on response rate (RR 1.25; 95% CI, 1.16 to 1.35; P < 0.00001) and in the standardized mean difference (SMD) for pain reduction [SMD -1.92; 95% CI, -3.09 to -0.76; P=0.001]. Likewise, acupressure was superior to physical therapy [SMD, -0.88; 95% CI, -1.10 to -0.65; P < 0.00001] and to usual care [SMD, -0.32; 95% CI, -0.61 to -0.02; P=0.04] in pain reduction. The Oswestry Disability Index was significantly improved by acupressure compared with usual care [SMD, -0.55; 95% CI, -0.84 to -0.25; P=0.0003]. The combination of acupressure with either manual acupuncture or electro-acupuncture showed significant improvements over the adjuvant therapies alone in response rate [RR 1.19; 95% CI, 1.13 to 1.26; P < 0.00001], pain reduction, and the Japanese Orthopedic Association score (JOA). However, each study displayed substantial heterogeneity. Through subgroup sensitivity analysis and -HETRED analysis, the heterogeneity of acupressure compared with manual acupuncture decreased while the results maintained significance with respect to pain reduction [SMD -0.9; 95% CI, -1.21 to -0.6; P < 0.00001] and JOA [SMD, 0.66; 95% CI, 0.33 to 0.98; P < 0.00001]. Similar results were obtained comparing acupressure with electro-acupuncture with respect to pain [SMD, -1.07; 95% CI, -1.33 to -0.81; P < 0.00001] and JOA [SMD, 0.89; 95% CI, 0.51 to 1.27, P < 0.00001]. TSA demonstrated the effectiveness of acupressure as a standalone or as a combinative treatment (with manual acupuncture or electro-acupuncture) for LBP.

CONCLUSION

Acupressure is an effective treatment for LBP. However, GRADE assessments downgraded the evidence in the trials, indicating that additional investigations are needed to confirm these observations.

Tele-Integrative Medicine to Support Rehabilitative Care

Complementary and integrative health (CIH) modalities have therapeutic value in the multidisciplinary rehabilitation of chronic pain patients. Evidence of such has been seen with the Whole Health Model at the (Veterans Affairs) VA Healthcare system. CIH therapies, including yoga, tai chi, mindfulness meditation, hypnosis, self-massage, and acupressure, are significantly effective for managing chronic pain with little to no negative effects, and can be easily incorporated into telemedicine care with great potential benefit. The future of wellness in telemedicine is evolving with great potential, and needs further attention to addressing barriers of care.

Extracorporeal shock wave therapy for treating primary dysmenorrhea: A randomized controlled trial

BACKGROUND

There are scanty data to apply radial extracorporeal shock wave therapy (rESWT) on the acupuncture points in the lower abdomen to reduce the menstrual pain. This trial aimed to test the rESWT safety and efficacy for treating primary dysmenorrhea (PD).

METHODS

Forty-four young-women with PD were randomly assigned to one of the three groups: to receive rESWT on the acupuncture points during the follicular phase (Group A, n = 15) or during the luteal phase (Group B, n = 14), or to apply heat patch to the acupuncture points during the follicular phase as the control (Group C, n = 15) over three menstrual cycles. The pain severity (using 0-to-10 visual analog scale), the pain duration (hours), plasma PGF2α prostaglandin F2alpha and prostaglandin E2 (PGE2), self-rating anxiety scale and menstrual blood loss were assessed before and after interventions.

RESULTS

The pain severity and duration significantly decreased in all groups after interventions. Although the reduced pain duration was not different among the groups, the reduced pain severity was more significant (P = .003) in Groups A (-53.8 ± 33.7%) and B (-59.3 ± 36.7%) than in Group C (-18.7 ± 27.1%). The rESWT intervention did not change plasma prostaglandins in Group A, although there was a decreased prostaglandin F2alpha (-20.5 ± 32.9%) in Group B or a decreased PGE2 (-18.9 ± 17.8%) in Group C. The anxiety level showed no change after intervention. The menstrual blood volume reduced slightly after intervention and the change of menstrual blood loss in Group B was significant (P = .038).

CONCLUSION

The rESWT applications on the abdominal acupuncture points safely and effectively reduced the menstrual pain, which was not associated with the prostaglandin changes. The rESWT-reduced pain seemed equally effective with the intervention applied during the follicular phase or luteal phase of the menstrual cycle. Heat patch placed on the abdominal acupuncture points also reduced the pain severity and duration, indicating that the improved blood flow could effectively alleviate the menstrual pain with PD. The changes in anxiety level and menstrual blood loss were slight after intervention.

The Effect of Acupressure on Blood Pressure Level and Pulse Rate in Individuals With Essential Hypertension: A Randomized Controlled Trial

A total of 91 people including 47 in the intervention group and 44 in the placebo group were included to a randomized controlled study. It can be asserted that acupressure, applied to the Neiguan (PC 6) acupuncture point in individuals with essential hypertension, provides blood pressure regulation and is effective for management of numerous hypertension-related symptoms.

Investigating the Effect of Acupressure on the Patients' Anxiety Before Open-Heart Surgery: A Randomized Clinical Trial

BACKGROUND

Anxiety is a common complaint of patients before diagnostic or therapeutic invasive procedures, especially before open-heart surgery. The most well-known method to reduce anxiety is the use of sedatives, which have pronounced side effects.

OBJECTIVES

The purpose of this study was to determine the effect of acupressure on anxiety in patients undergoing open-heart surgery.

METHOD

This is a randomized clinical trial study conducted on 90 patients who were candidates for open-heart surgery. The patients were randomly assigned into either intervention or control groups. Acupressure intervention was applied at three real acupoints over two consecutive days in the intervention group. The control group received acupressure on sham points. We used Spielberger State-Trait Anxiety Inventory to assess anxiety in our study.

RESULTS

The results showed that before acupressure, there was no statistically significant difference between state anxiety scores and intergroup traits, and this difference was only significant in state anxiety after the second intervention. State and trait anxiety were significant before and after the intervention in the test group, respectively include (p < 0.001) (p = 0.01), but these changes in the control group did not show a statistically significant difference. After completing the second phase of the intervention at the actual sites, systolic blood pressure (p = 0.007) and heart rate (p = 0.001) decreased significantly. However, acupressure did not have a significant effect on diastolic blood pressure in any of the groups.

CONCLUSION

Based on the results of this study, the application of acupressure in patients who are candidates for open-heart surgery can reduce their state anxiety. Further larger-scale and rigorous studies are warranted.

Effects of auricular acupressure on depression and anxiety in older adult residents of long-term care institutions: A randomized clinical trial

The current study was a single-blind clinical trial that evaluated the effect of auricular acupressure on older adults' depression and anxiety. Forty-seven older adults in long-term care institutions were randomly divided into two groups using block randomization. In the experimental group, patches with magnetic beads were pasted onto the auricular Shenmen acupoints for 14 days. In the control group, blank patches were used. Among the older adults in the study institutions, 82.09% scored ≥5 points on the Geriatric Depression Scale (GDS). Significant differences in GDS scores were observed between the two groups after both 7 and 14 days of treatment (p < 0.05). There was no significant difference (p < 0.05) in anxiety scores between the two groups at 7 days, but there was a significant difference after 14 days of the intervention (p < 0.05). Our results suggest that acupressure can reduce depression and anxiety among older adults in long-term care institutions.

Effects of acupressure, gum chewing and coffee consumption on the gastrointestinal system after caesarean section under spinal anaesthesia

This study evaluated the efficacy and safety of postoperative acupressure in the recovery of the gastrointestinal system (GIS) after caesarean section. A total of 160 primipara pregnant women delivered by caesarean section under spinal anaesthesia were randomised into four groups: group 1 (those who received acupressure), group 2 (coffee was provided three times a day), group 3 (chewed sugar-free gum for 15 min with an interval of 4 h from the second postoperative hour), and group 4 (control group). The first gas outflow and defaecation times of the women were compared among the groups. The first flatus and defaecation exit times of the women in the acupressure group were statistically earlier than those of the other groups. No difference was found among the gum-chewing, coffee, and control groups. Acupressure is effective in reducing the flatus and defaecation exit times due to GIS inactivity after abdominal surgery including caesarean section.Impact statementWhat is already known about the topic. The slowing of gastrointestinal system (GIS) motility also occurs after caesarean section aside from other surgical operations. If normal GIS movements do not occur, then several problems, such as the negative increase in the duration of breastfeeding and the mother-baby attachment during the postpartum period, may arise. Therefore, the early onset of bowel functions is important in women who give birth by caesarean section.What do the results of this study add. In the postoperative period, spontaneous GIS motility can be achieved by applying acupressure. The effective use of acupressure in the postoperative period prevents the need for pharmacological methods to eliminate the discomfort caused by the decreased motility of the GIS in women in the postpartum period.What are the implications of these findings for clinical practice and further research. Acupressure, a non-invasive, easy-to-use, and cost-effective method, plays a role in preventing GIS immotility. Midwives or obstetricians should receive training on acupuncture or acupressure and should ensure that acupuncture or acupressure practices are converted into a protocol to be implemented in the postoperative period. With this transformation, the treatment methods to increase GIS motility and the reduced medication use can decrease the mother's and the newborn's duration of hospital stay and the cost of hospitalisation.

The Management of Nausea and Vomiting of Pregnancy: Synthesis of National Guidelines

Importance

Nausea and vomiting of pregnancy (NVP) affects a high proportion of the pregnant population.

Objective

The aim of this study was to compare and synthesize recommendations from national guidelines regarding the management of NVP.

Evidence Acquisition

A descriptive review of 3 recently published national guidelines on NVP was conducted: Royal College of Obstetricians and Gynaecologists on "The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum," American College of Obstetricians and Gynecologists on "Nausea and Vomiting of Pregnancy," and Society of Obstetricians and Gynaecologists of Canada on "The Management of Nausea and Vomiting of Pregnancy." These guidelines were summarized and compared in terms of the recommended management of pregnant women. The quality of evidence was also reviewed based on the method of reporting.

Results

Several differences were identified on the different guidelines regarding the management of NVP. Frequent small meals and avoidance of iron supplements are recommended for prevention. The consumption of ginger, acustimulations, antihistamines, phenothiazines, dopamine, and serotonin 5-hydroxytryptamine type 3 receptor antagonists is routinely recommended for use in the community as treatment.

Conclusions

Evidence-based medicine may lead to the adoption of an international guideline for the management of NVP, which may lead to a more effective management of that entity.

Self-Administered Acupressure for Caregivers of Older Family Members: A Randomized Controlled Trial

OBJECTIVE

To test whether self-administered acupressure reduces stress and stress-related symptoms in caregivers of older family members.

DESIGN

In this randomized, assessor-blind, controlled trial, 207 participants were randomized (1:1) to an acupressure intervention or a wait-list control group.

SETTING

Community centers in Hong Kong, China.

PARTICIPANTS

Primary caregivers of an older family member who screened positive for caregiver stress with symptoms of fatigue, insomnia, or depression.

INTERVENTION

The 8-week intervention comprised four training sessions on self-administered acupressure, two follow-up sessions for learning reinforcement, and daily self-practice of self-administered acupressure.

MEASUREMENTS

The primary outcome was caregiver stress (Caregiver Burden Inventory). Secondary outcomes included fatigue (Piper Fatigue Scale), insomnia (Pittsburgh Sleep Quality Index), depression (Patient Health Questionnaire), and health-related quality of life (QoL) (12-item Short-Form Health Survey version 2). An intention-to-treat analysis was adopted.

RESULTS

Of 207 participants, 201 completed the study. Caregiver stress in the intervention group was significantly lower than that in the control group after 8 weeks (difference = -8.12; 95% confidence interval [CI] = -13.20 to -3.04; P = .002) and at 12-week follow-up (difference = -8.52; 95% CI = -13.91 to -3.12; P = .002). The intervention group, relative to the control group, also had significantly improved secondary outcomes of fatigue (difference = -0.84; 95% CI = -1.59 to -0.08; P = .031), insomnia (difference = -1.34; 95% CI = -2.40 to -0.27; P = .014), depression (difference = -1.76; 95% CI = -3.30 to -0.23; P = .025), and physical health-related QoL (difference = 3.08; 95% CI = 0.28-5.88; P = .032) after 8 weeks.

CONCLUSION

Self-administered acupressure intervention significantly relieves self-reported caregiver stress and co-occurring symptoms in those caring for older family members. Further studies are needed to measure the symptoms objectively and to examine the clinical importance of the observed improvement in caregiver stress. J Am Geriatr Soc 68:1193-1201, 2020.

A comparison of the effect of pressure on the KID21 (Youmen) and P6 (Neiguan) points on the severity of nausea and vomiting of pregnancy

Background Nausea and vomiting of pregnancy (NVP) is the most common problem for women in early pregnancy. The present study was conducted to compare the effect of pressure on KID21 and P6 on the severity of NVP. Methods This single-blind clinical trial was conducted on pregnant women in their first trimester with NVP, referring to the clinic of Ayatollah Rouhani Hospital of Babol, Iran, in 2017. Eighty-two participants were randomly divided into KID21 and P6 pressure groups. The researcher applied pressure on these two points 20 min each day for four consecutive days. The severity of nausea and vomiting was then assessed using the visual analog scale (VAS) by the patient and counting its frequency in 24 h, respectively. Finally, the collected data were analyzed using SPSS 22 by repeated measures ANOVA and paired sample T-Test. Results The severity of NVP in the 82 participating pregnant women decreased in both groups (p<0.001), and there was no significant difference between the two groups in terms of the severity of NVP (p=0.68), although the reduction in nausea was greater in the P6 group than KID21 group, and the reduction in vomiting was greater in the KID21 group than the P6 group. Effect size for vomiting and nausea was 0.28 and 0.16, respectively. No side-effects were observed in the two groups during these four days. Conclusions Pressure on P6 and KID21 points has no advantage over each other in the treatment of NVP, but acupressure is an effective, complication-free, inexpensive and accessible treatment for this complication.

The effect of acupressure on quality of life among female nurses with chronic back pain

BACKGROUND

Chronic back pain is one of the most common work-related diseases and most important of musculoskeletal disorders in nursing professionals and because of the physical and psychological effects, has a significant impact on quality of life (QOL). Acupressure is a holistic form of complementary medicine. This study aimed to investigate the effect of acupressure on QOL among female nurses with chronic back pain.

MATERIALS AND METHODS

This randomized single-blind clinical trial was conducted on 50 nurses with chronic back pain working at the selected hospitals in Isfahan, Iran. After convenient sampling, the subjects were randomly allocated, through lottery, to the two groups of experimental (n = 25) and sham (n = 25). In the experimental group, acupressure techniques were performed during 9 sessions, 3 times a week for 14 min for each patient. In the sham group, points within 1 cm of the main points were only touched. Data were collected using the SF36 questioner, before, and immediately, 2 weeks, and 4 weeks after the intervention. Data analysis was performed using SPSS software.

RESULTS

Independent t-test showed that the mean total score of QOL before the intervention was not significantly different between the two groups before the intervention (P = .68). However, it was significantly higher in the experimental group compared to the Sham group, immediately, 2 weeks, and 1 month after the intervention (P < .001).

CONCLUSIONS

Acupressure on specific points of the foot and back improves back pain and as a result, increases QOL. Therefore, acupressure can be used as a drug-free and low-cost approach without side effects to improve QOL in nurses with chronic back pain.

A Technology-Assisted, Brief Mind-Body Intervention to Improve the Waiting Room Experience for Chemotherapy Patients: Randomized Quality Improvement Study

Background

Patients waiting for chemotherapy can experience stress, anxiety, nausea, and pain. Acupressure and meditation have been shown to control such symptoms.

Objective

This study aimed to evaluate the feasibility and effectiveness of an integrative medicine app to educate patients about these self-care tools in chemotherapy waiting rooms.

Methods

We screened and enrolled cancer patients in chemotherapy waiting rooms at two Memorial Sloan Kettering Cancer Center locations. Patients were randomly assigned into an intervention arm in which subjects watched acupressure and meditation instructional videos or a control arm in which they watched a time- and attention-matched integrative oncology lecture video. Before and after watching the videos, we asked the patients to rate four key symptoms: stress, anxiety, nausea, and pain. We performed the analysis of covariance to detect differences between the two arms postintervention while controlling for baseline symptoms.

Results

A total of 223 patients were enrolled in the study: 113 patients were enrolled in the intervention arm and 110 patients were enrolled in the control arm. In both groups, patients showed significant reductions in stress and anxiety from baseline (all P<.05), with the treatment arm reporting greater stress and anxiety reduction than the control arm (1.64 vs 1.15 in stress reduction; P=.01 and 1.39 vs 0.78 in anxiety reduction; P=.002). The majority of patients reported that the videos helped them pass time and that they would watch the videos again.

Conclusions

An integrative medicine self-care app in the waiting room improved patients’ experiences and reduced anxiety and stress. Future research could focus on expanding this platform to other settings to improve patients’ overall treatment experiences.

Auriculotherapy to control chemotherapy-induced nausea and vomiting in patients with cancer: protocol of a systematic review

BACKGROUND

Due to the worldwide rise in cancer incidence, and therefore the rise in the need for antineoplastic chemotherapy, it is important for both healthcare professionals and patients alike that the side effects of chemotherapy, such as chemotherapy-induced nausea and vomiting (CINV), are treated and prevented. Auriculotherapy is a type of acupuncture and may be a low-cost and safe antiemetic measure to control the side effects of chemotherapy. The goal of this systematic review is to synthesize the available evidence in the literature regarding the auriculotherapy effects to treat CINV in people with cancer.

METHODS

The review will only include randomized controlled trials (RCTs) that compare the clinical effects of the auriculotherapy intervention (used alone or as an add-on), with sham auriculotherapy, routine treatment with antiemetic drugs, or other non-pharmacological interventions in patients with cancer with CINV who are undergoing chemotherapy. The outcomes to be evaluated are nausea and vomiting: in acute, delayed, or anticipated stages, when induced by chemotherapy. A comprehensive search for studies will be carried out in these databases: MEDLINE via PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, ICTRP, LILACS, CUMED, IBECS, BVS MTCI Americas, Web of Science, Scopus, PEDro, CNKI, and CBMdisc up until December 31, 2018. Only articles in English, Portuguese, and Spanish will be selected. Two independent reviewers will evaluate full texts, extract data, and assess the risk of bias of eligible articles. The quality of evidence will be assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). A meta-analysis will be undertaken to assess the interventions and outcomes' homogeneity, assessing statistical heterogeneity using the Cochran's Q test and quantified using Higgins' inconsistency index. If there is insufficient data for a meta-analysis, a narrative synthesis will be presented. This protocol has been prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines.

DISCUSSION

The results of this systematic review will summarize the strength of evidence for the use of auriculotherapy in the control of CINV of patients with cancer and will be used to identify evidence gaps.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018117513.

Acupressure to Reduce Treatment-Related Symptoms for Children With Cancer and Recipients of Hematopoietic Stem Cell Transplant: Protocol for a Randomized Controlled Trial

BACKGROUND

We describe the study design and protocol of a pragmatic randomized controlled trial (RCT) Acupressure for Children in Treatment for a Childhood Cancer (ACT-CC).

OBJECTIVE

To describe the feasibility and effectiveness of an acupressure intervention to decrease treatment-related symptoms in children in treatment for cancer or recipients of a chemotherapy-based hematopoietic stem cell transplant (HSCT).

DESIGN

Two-armed RCTs with enrollment of 5 to 30 study days.

SETTING

Two pediatric teaching hospitals.

PATIENTS

Eighty-five children receiving cancer treatment or a chemotherapy-based HSCT each with 1 parent or caregiver.

INTERVENTION

Patients are randomized 1:1 to receive either usual care plus daily professional acupressure and caregiver delivered acupressure versus usual care alone for symptom management. Participants receive up to 20 professional treatments.

MAIN OUTCOME

A composite nausea/vomiting measure for the child.

SECONDARY OUTCOMES

Child's nausea, vomiting, pain, fatigue, depression, anxiety, and positive affect.

PARENT OUTCOMES

Depression, anxiety, posttraumatic stress symptoms, caregiver self-efficacy, and positive affect. Feasibility of delivering the semistandardized intervention will be described. Linear mixed models will be used to compare outcomes between arms in children and parents, allowing for variability in diagnosis, treatment, and age.

DISCUSSION

Trial results could help childhood cancer and HSCT treatment centers decide about the regular inclusion of trained acupressure providers to support symptom management.