Suggesting the Optimal Control Procedure for Acupressure Studies

Role of acupressure in symptom management in patients with end-stage renal disease: a systematic review

BACKGROUND

Acupressure is a widely used adjunct for various symptoms in patients with nonchronic kidney disease. However, its role for symptom management in end-stage renal disease (ESRD) populations is not clear.

OBJECTIVE

To summarize and critically evaluate the evidence available from randomized clinical trials (RCTs) of acupressure for patients with ESRD.

DESIGN

Systematic review of RCTs.

METHODS

Thirteen databases were searched from their inceptions through December 2009, irrespective of publication status or language.

RESULTS

In total, 7 RCTs out of 86 screened studies were included and analyzed. Most studies lacked sufficient description to gauge the quality of the RCT. Acupressure was not superior to sham acupressure (n = 2) or to transcutaneous electrical stimulation (n = 1), while studies suggested benefits of acupressure compared to usual care (n = 3), sleep medication (n = 1), and undefined control intervention (n = 1). None of these studies reported any adverse events.

CONCLUSION

No definitive conclusion is available. Future trials should adhere to standards of trial methodology and explicitly report relevant information for evaluation of efficacy and safety of acupressure in patients with ESRD.

Acupressure for prevention of pre-operative anxiety: a prospective, randomised, placebo controlled study

Pre-operative anxiety is associated with many unwanted effects such as increased analgesic and anaesthetic requirement, postoperative pain and prolonged hospital stay. In the present study, we investigated the effects of acupressure on pre-operative anxiety and bispectral index (BIS) values. Seventy-six adults, ASA grade I and II, undergoing elective surgery, were randomly assigned to two equal groups. Group 1 (control) received acupressure at an inappropriate site and group 2 (acupressure) received acupressure at extra 1 point. The study was conducted during the pre-operative period and the duration of the study was 40 min (acupressure was applied for 10 min and thereafter patients were observed for another 30 min). Anxiety was recorded on a visual stress scale (VSS) at the start of the study and thereafter at 10 and 40 min. BIS was recorded at 0, 2, 5, 10, 12, 15, 30 and 40 min. The VSS decreased in both groups following pressure application for 10 min: median VSS (interquartile range) were 5 (1) vs. 8 (1) in the acupressure and 7 (0) vs. 8 (1) in the control groups (p < 0.001). Both pre-operative anxiety and BIS decreased significantly during acupressure application at extra 1 point (p < 0.001). Acupressure is effective in decreasing both pre-operative anxiety and BIS; however, these effects are not sustained 30 min following release of acupressure. Further studies are needed to elucidate the duration for which acupressure is effective.

The Influence of Acupressure on the Monitoring of Acoustic Evoked Potentials in Unsedated Adult Volunteers

Approaches for monitoring depth of anesthesia can be influenced by things other than anesthetics. In this study, we evaluated the influence of acupressure on the A-line autoregressive index (AAI) and on stress levels in unsedated volunteers. Fifteen unsedated adult volunteers received pressure on the acupuncture Extra 1 point (EP) and on a control point for 10 min on different days. AAI was recorded 5 min before, during, and 5 min after the interventions. Before and after the procedures, the volunteers quantified their level of stress by means of a visual analog stress scale (VSS; 0-100). Corresponding data were compared by Wilcoxon's signed rank test (Bonferroni correction, P < 0.05). Data are median (range). AAI decreased from 73 (40-99) to 53 (33-94) after 10 min of pressure on EP (P = 0.0044). Five minutes after release of pressure there was no difference compared with initial values. There was a statistically significant difference between VSS before and after pressure on EP (36 [7-67] to 15 [0-44]; P = 0.0066), but not on control point. In conclusion, there was a wide range of AAI values in awake volunteers. The AAI was influenced by acupressure performed on the EP in unsedated adult volunteers. Acupressure on this point significantly reduced stress levels.