Acupressure, reflexology, and auricular acupressure for insomnia: A systematic review of randomized controlled trials

Multi-level exploration of auricular acupuncture: from traditional Chinese medicine theory to modern medical application

As medical research advances and technology rapidly develops, auricular acupuncture has emerged as a point of growing interest. This paper delves into the intricate anatomy of auricular points, their significance and therapeutic principles in traditional Chinese medicine (TCM), and the underlying mechanisms of auricular acupuncture in contemporary medicine. The aim is to delve deeply into this ancient and mysterious medical tradition, unveiling its multi-layered mysteries in the field of neurostimulation. The anatomical structure of auricular points is complex and delicate, and their unique neurovascular network grants them a special status in neurostimulation therapy. Through exploration of these anatomical features, we not only comprehend the position of auricular points in TCM theory but also provide a profound foundation for their modern medical applications. Through systematic review, we synthesize insights from traditional Chinese medical theory for modern medical research. Building upon anatomical and classical theoretical foundations, we focus on the mechanisms of auricular acupuncture as a unique neurostimulation therapy. This field encompasses neuroregulation, pain management, psychological wellbeing, metabolic disorders, and immune modulation. The latest clinical research not only confirms the efficacy of auricular stimulation in alleviating pain symptoms and modulating metabolic diseases at the endocrine level but also underscores its potential role in regulating patients' psychological wellbeing. This article aims to promote a comprehensive understanding of auricular acupuncture by demonstrating its diverse applications and providing substantial evidence to support its broader adoption in clinical practice.

A randomized controlled trial of acupuncture and receptive music therapy for sleep disorders in the elderly-ELAMUS: study protocol

BACKGROUND

Globally, the demographic shift towards an aging population leads to significant challenges in healthcare systems, specifically due to an increasing incidence of multimorbidity resulting in polypharmacy among the elderly. Simultaneously, sleep disorders are a common complaint for elderly people. A treatment with pharmacological therapies often leads to side effects causing a high potential for dependency. Within this context, there is a high need to explore non-pharmacological therapeutic approaches. The purpose of this study is to evaluate the effectiveness of acupuncture and music therapy, both individually and combined as a multimodal therapy, in the treatment of sleep disorders in individuals aged 70 years and older.

METHODS

We conduct a confirmatory randomized controlled trial using a two-factorial study design. A total of n = 100 elderly people receive evidence-based standard care information for age-related sleep disorders. Beyond that, patients are randomly assigned into four groups of n = 25 each to receive acupuncture, receptive music therapy with a monochord, multimodal therapy with both acupuncture and music therapy, or no further therapy. The study's primary outcome measurement is the improvement in sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) (global score), at the end of intervention. Additionally, depression scores (Geriatric Depression Scale), health-related quality of life (Short-Form-Health Survey-12), neurovegetative activity measured via heart rate variability, and safety data are collected as secondary outcomes. Using a mixed-methods approach, a qualitative process evaluation will be conducted to complement the quantitative data.

DISCUSSION

The study is ongoing and the last patient in is expected to be enrolled in April 2024. The results can provide valuable insights into the effectiveness of non-pharmacological interventions for sleep disorders among the elderly, contributing to a more personalized and holistic approach in geriatric healthcare.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00031886).

Effects of Auricular Acupressure on Nurses' Perceived Stress, Sleep Quality, and Presenteeism: A Single-Blind, Randomized Controlled Trial

The physical and psychological health management of nurses is very important not only for individual nurses but also for organizations and patients. However, nurses are exposed to high stress, sleep problems, and high presenteeism. Therefore, this study aimed to examine the effects of auricular acupressure (AA) on nurses' stress, sleep problems, and presenteeism. This randomized controlled trial encompassed 60 nurses divided into an experimental group (n = 30) and a control group (n = 30). Auricular acupressure using AA stickers with small magnets attached was performed in the experimental group, and a placebo AA using simple AA stickers (without the small magnets) was performed in the control group. The treatment lasted 7 weeks. To confirm the results, stress, sleep quality, and presenteeism were measured at pre- and posttest. There was a statistically significant difference in scores for sleep quality (t = -1.98, P = .047), health problems (z = -2.38, P = .017), and work impairment (t = -4.46, P < .001) between the experimental and control groups at posttest. Auricular acupressure increased sleep quality scores and decreased presenteeism. Auricular acupressure using AA stickers with small magnets attached was effective in improving sleep quality and reducing presenteeism in nurses.

Bibliometric analysis of auriculotherapy research trends over the past 20 years

OBJECTIVES

Auriculotherapy has long been used to treat various diseases. We analyzed and visualized auriculotherapy's geographical distribution, key contributors, and thematic trends over the past 20 years to provide current trends in auriculotherapy field and to offer recommendations for future research directions.

DESIGN/SETTING

We searched for relevant studies in the Web of Science between January 10, 2003, and December 31, 2022. A bibliometric analysis was performed using VOSviewer for annual publications, journals, countries, institutions, authors, and keywords.

RESULTS

A total of 800 studies were included in the analysis, and the number of studies steadily increased over the 20 examined years. In 2018, there was a noteworthy rise in publications, nearly twice as many as the preceding year. Integrative & complementary medicine was the most researched area, with most articles published in Evidence-Based Complementary and Alternative Medicine. China was the country with the most published research, and the most active organization was Guangzhou University of Chinese Medicine in China, followed by Kyung Hee University in South Korea. The most prolific author was Yeh Mei-ling, who reported the effects of auriculotherapy on dysmenorrhea and smoking cessation. Keyword analysis revealed four clusters: pain, mental health, obesity, and smoking cessation.

CONCLUSION

Auriculotherapy research primarily focused on clinical studies related to pain, obesity, smoking cessation, and depression. Future research should place greater emphasis on verifying the mechanisms of auriculotherapy for specific ailments and may require efforts to enhance the robustness of clinical trials. Through visual analysis, our study may serve as a foundational resource, offering valuable insights into the trajectory of auriculotherapy research.

Self-Administered Acupressure for Probable Knee Osteoarthritis in Middle-Aged and Older Adults: A Randomized Clinical Trial

Importance

The effects of self-administered acupressure (SAA) on knee osteoarthritis (OA) pain remain unclear.

Objective

To evaluate the effectiveness of SAA taught via a short training course on reducing knee OA pain in middle-aged and older adults.

Design, Setting, and Participants

This randomized clinical trial was conducted among community-dwelling individuals in Hong Kong who were aged 50 years or older with probable knee OA from September 2019 to May 2022.

Interventions

The intervention included 2 training sessions for SAA with a brief knee health education (KHE) session, in which participants practiced acupressure twice daily for 12 weeks. The control group (KHE only) received only education about maintaining knee health on the same schedule and duration.

Main Outcomes and Measures

The primary outcome was the numerical rating scale (NRS) pain score at 12 weeks. Other outcomes included Western Ontario and McMaster University Osteoarthritis Index, Short Form 6 Dimensions (SF-6D), Timed Up and Go, and Fast Gait Speed tests.

Results

A total of 314 participants (mean [SD] age, 62.7 [4.5] years; 246 [78.3%] female; mean [SD] knee pain duration, 7.3 [7.6] years) were randomized into intervention and KHE-only groups (each 157). At week 12, compared with the KHE-only group, the intervention group had a significantly greater reduction in NRS pain score (mean difference [MD], -0.54 points; 95% CI, -0.97 to -0.10 points; P = .02) and higher enhancement in SF-6D utility score (MD, 0.03 points; 95% CI, 0.003 to 0.01 points; P = .03) but did not have significant differences in other outcome measures. The cost-effectiveness acceptability curve demonstrated a greater than 90% probability that the intervention is cost-effective at a willingness to pay threshold of 1 GDP per capita.

Conclusions and Relevance

In this randomized clinical trial, SAA with a brief KHE program was efficacious and cost-effective in relieving knee pain and improving mobility in middle-aged and older adults with probable knee OA.

Trial Registration

ClinicalTrials.gov Identifier: NCT04191837.

Clinical efficacy of traditional Chinese medicine therapy for female stress urinary incontinence: a meta-analysis

OBJECTIVES

To investigate the efficacy of traditional Chinese medicine (TCM) in the treatment of female stress urinary incontinence (SUI).

METHOD

PubMed, Cochrane, Web of Science, Embase, CNKI, Wanfang, and VIP databases were searched for articles published up to September 2022. Variables were analyzed using weighted mean difference (WMD), standardized mean difference (SMD), odds ratios (OR), and 95% confidence interval (CI).

RESULTS

Eight studies containing 744 patients were included in this study. The results demonstrate that TCM therapy had more advantages in improving the clinical outcome of SUI patients (OR = 2.90, 95%CI:1.92-4.37, P = 0.000), reducing the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) score (WMD = -2.41, 95%CI:-2.83- -1.98, P = 0.000), reducing 1-h urinary pad leakage urine volume (WMD = -1.86, 95%CI:-2.23- -1.49, P = 0.000) and increasing Maximum urethral closure pressure (MUCP) (SMD = 0.86, 95%CI: 0.61-1.11, P = 0.000).

CONCLUSION

TCM therapy is effective in improving urinary incontinence symptoms, urodynamics, and quality of life in patients with SUI. This article provides a reference for the application of TCM therapy in women with urinary incontinence.

Acupressure for depression: A systematic review and meta-analysis

Depression is a common mental disorder caused by the interaction of social, psychological, and biological factors. Treatments include psychotherapy, pharmacotherapy, and other therapies, but they have limitations. Particularly, the COVID-19 pandemic may have a negative impact on depressed people. Thus, developing more potential treatments for depression has currently been an urgent challenge. A growing number of studies have found that acupressure is effective in relieving the symptoms of depression. Thus, this study aimed to evaluate the efficacy and safety of acupressure in people with depression. English (PubMed, CENTRAL, EMBASE, APA PsycINFO, and CINAHL) and Chinese databases (CBM, CNKI, Wanfang, and VIP), ClinicalTrials.gov and Chinese Clinical Trial Registry were searched for randomized controlled trials (RCTs) on patients diagnosed with depression from study inception until March 31, 2023. Studies that compared acupressure with sham acupressure, conventional treatments (i.e., medication, usual care, etc.), and acupressure as an adjunct to conventional treatment for depression were included. The primary outcome was depression level measured using the Hamilton Depression Scale, Self-Rating Depression Scale, or Geriatric Depression Scale. A total of 19 RCTs involving 1686 participants were included. The pooled results showed that acupressure exhibited a significant beneficial effect on reducing the severity of depression compared with sham acupressure and served as an adjunct to conventional treatment, although the evidence level was moderate. Thus, acupressure may be a potential treatment for depression.

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.

Effects of auricular acupressure on sleep and pain in elderly people who have osteoarthritis and live in nursing homes: A randomized, single-blind, placebo-controlled trial

OBJECTIVE

This study aimed to examine the effects of auricular acupressure (AA) on sleep and pain among elderly people with osteoarthritis who live in nursing homes.

METHOD

It was a randomized, single-blinded, and placebo-controlled comparative pretest-posttest study that applied AA for eight weeks. The study was conducted among 52 elderly people, comprising an experimental group (n=26), and a control group (n=26). Polysomnography, actigraphy, the levels of melatonin and pressure pain threshold (PPT) were measured. The standardized measurement on sleep quality and pain was also used.

RESULTS

Experimental group scores on sleep quality significantly improved as compared to those of the placebo control group. The polysomnography (sleep efficiency, sleep latency, awakening, stage 2 sleep) and the actigraphy (sleep efficiency, sleep latency, number of awakenings) were shown to be significant. The levels of melatonin significantly increased after terminating the intervention. The result of the pain (visual analogue scale) significantly reduced and the PPT significantly increased among the elderly in the experimental groups.

CONCLUSIONS

AA can be used as an effective intervention to improve their sleep of the elderly living in nursing homes, and it can also reduce the pain.

Adaptive Auricular Point Acupressure for Sleep Disturbance in Women with Breast Cancer: A Randomized Controlled Trial

Objectives

The study aimed to evaluate the preliminary effect and efficacy of auricular point acupressure (APA) on the quality of sleep in women with breast cancer who were undergoing chemotherapy. Sample & Setting. We conducted a randomized controlled trial on 68 patients with breast cancer who reported poor sleep quality based on the Pittsburgh Sleep Quality Index (PSQI) scores (>7). Methods & Variables. Participants were randomly assigned to an APA treatment group or a control group. Patients in the APA group had magnetic pellets attached to selected auricular points and were instructed to apply pressure to these points 4×/day for three consecutive weeks. We objectively measured sleep quality using the Actiwatch Spectrum and the PSQI at the baseline and postintervention. Statistical analyses of changes in sleep data were performed using the t-test, a rank-sum test, and analyses of covariance.

Results

In patients treated with APA, the PSQI total score and sleep onset latency had significantly decreased, while the total sleep time and sleep efficiency had significantly increased. Although the total PSQI score differed between groups at the baseline, ANCOVA results showed that the APA group had a significantly lower total PSQI score.

Conclusion

APA could be an inexpensive and effective approach to improving sleep quality and reducing sleep disturbance in patients with breast cancer. Further research needs a larger sample size to verify our findings.

Efficacy of auricular plaster therapy for sleep disorders in preschool children with autism spectrum disorders: Study protocol for a randomized controlled trial

Background

Children with autism spectrum disorders (ASDs) suffer from sleep disorders to a considerable degree; however, there is no safe and effective treatment available in clinical practice. The objective of the trial is to assess the clinical effectiveness of auricular plaster therapy (APT) in treating sleep disorders in children with ASD.

Method

This is a single-center, patient-assessor blind, randomized controlled trial. A total of 44 preschool children with sleep disorders with ASD will be included in this study. Eligible participants will be randomly assigned to either the auricular plaster group or the sham auricular plaster group in a 1:1 ratio. Participants in the different groups will receive APT or sham APT, respectively, for a total of 30 sessions over 30 days. The primary outcome includes the Children's Sleep Habits Questionnaire (CSHQ), while secondary outcomes include the Autism Behavior Checklist (ABC) and polysomnography (PSG) for total sleep time, sleep latency, awakening duration, and sleep structures. The CSHQ and ABC will be assessed at baseline, 10, 20, 30, 60, 90, and 120 days after randomization, whereas PSG will be assessed at baseline and 30 days after randomization. The follow-up period will be scheduled to be 60, 90, and 120 days after randomization.

Discussion

The results of this study may provide evidence of the efficacy of APT, as well as offer new alternatives for the treatment of sleep disorders in children with ASD.

Trial registration

CHiCTR.org.cn (ChiCTR2100048257). Registered on July 5, 2021.

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.

Effectiveness of Acupuncture, Mind and Body Practices, and Natural Products for Insomnia: an overview of systematic reviews

Objectives

This overview summarizes the evidence for the effectiveness and safety of complementary therapies for insomnia through systematic reviews (SRs) and meta-analyses (MAs).

Methods

A comprehensive literature search on SRs and MAs for complementary therapies for insomnia was conducted using six databases.

Results

This overview included 30 SRs/MAs. The Pittsburgh Sleep Quality Index (PSQI) analysis of insomnia included 383 randomized controlled trials and 31,748 participants. Twenty-four SRs/MAs (80%) out of 30 SRs/MAs reported a positive result, and six SRs/MAs reported a partially positive result. The most frequently used form of acupuncture reported a positive effect in 89.5% (17/19) of SRs/MAs and a superior effect to western medicine, sham/placebo, and no treatment. The lack of protocol registration and the excluded studies list resulted in generally poor methodological and reporting quality in SRs/MAs with AMSTAR 2.

Conclusion

This overview confirmed that complementary therapies positively affected the PSQI scores in patients with insomnia. However, better-designed primary studies are needed to strengthen the relevant evidence in the future. A more stringent assessment of multiple systematic reviews 2 must be followed when performing SR and MA.

Auricular Acupressure for Improving Sleep Quality in Patients With Lung Cancer: A Systematic Review and Meta-analysis

This meta-analysis was conducted to systematically evaluate the efficacy and safety of auricular acupressure on sleep quality in patients with lung cancer. Nine articles with a total of 802 patients were retrieved after searching on 11 electronic databases. Results of the meta-analysis showed that auricular acupressure improved sleep score (standard mean difference: -0.80, 95% confidence intervals: -1.30 to -0.30, P = .002) and reduced sleep disturbance rate (risk ratio: 0.65, 95% confidence intervals: 0.51-0.84, P = .001) and sleep medicine usage (risk ratio: 0.26, 95% confidence intervals: 0.11-0.65, P = .004) significantly. Our review suggests that auricular acupressure is effective and relatively safe in improving sleep quality among patients with lung cancer.

The Subjective and Objective Improvement of Non-Invasive Treatment of Schumann Resonance in Insomnia-A Randomized and Double-Blinded Study

Purpose

Accumulated studies revealed that electromagnetic field can affect human brain and sleep, and the extremely low-frequency electromagnetic field, Schumann resonance, may have the potential to reduce insomnia symptoms. The purpose of this study was to investigate the responses of patients with insomnia to a non-invasive treatment, Schumann resonance (SR), and to evaluate its effectiveness by subjective and objective sleep assessments.

Patients and Methods

We adopted a double-blinded and randomized design and 40 participants (70% female; 50.00 ± 13.38 year) with insomnia completed the entire study. These participants were divided into the SR-sleep-device group and the placebo-device group and were followed up for four weeks. The study used polysomnography (PSG) to measure objective sleep and used sleep diaries, Pittsburgh Sleep Quality Inventory (PSQI), Epworth Sleepiness Scale (ESS), and visual analogy of sleep satisfaction to measure subjective sleep. The 36-Item Short-Form Health Survey (SF-36) was used to evaluate quality of life. Chi-square test, Mann-Whitney U-test, and Wilcoxon test were used to analyze the data.

Results

About 70% of the subjects were women, with an average age of 50±13.38 years and an average history of insomnia of 9.68±8.86 years. We found that in the SR-sleep-device group, objective sleep measurements (sleep-onset-latency, SOL, and total-sleep-time, TST) and subjective sleep questionnaires (SOL, TST, sleep-efficiency, sleep-quality, daytime-sleepiness, and sleep-satisfaction) were significantly improved after using the SR-sleep-device; in the placebo-device group, only such subjective sleep improvements as PSQI and sleep-satisfaction were observed.

Conclusion

This study demonstrates that the SR-sleep-device can reduce the insomnia symptoms through both objective and subjective tests, with minimal adverse effects. Future studies can explore the possible mechanism of SR and health effects and, with a longer tracking time, verify the effectiveness and side effects.

The Role and Clinical Observation of Traditional Chinese Medicine in Relieving Senile Insomnia: A Systematic Review and Meta-Analysis

Objective

To assess the role and clinical observation of traditional Chinese medicine (TCM) in relieving senile insomnia and conduct a systematic evaluation and meta-analysis.

Methods

We searched Chinese literatures from some database, including the China Knowledge Network database, Chongqing CQVIP Chinese database, Wanfang database, and Chinese Biomedical Literature database. In addition, English literature retrieval database PubMed and the Cochrane Library were included in this meta-analysis. The randomized controlled trial (RCT) of cognitive behavioral therapy was found in the treatment of chronic insomnia. All articles were current up to December 1, 2021, and references in the literature were hand searched.

Results

About 16 studies were included, involving 1260 elderly patients with insomnia. Meta-analysis results showed that compared with the control group, the sleep latency of the experimental group MD = -8.02, 95% CI (10.95, 5.01), the number of awakenings of the experimental group MD = -0.41, 95% CI (0.68, 0.14), the total sleep time of the experimental group MD = 39.41, 95% CI (27.05, 51.71), the sleep efficiency of the experimental group MD = 7.82, 95% CI (1.87, 13.75) the Pittsburgh sleep quality index of the experimental group MD = 2.41, 95% CI (3.12, 1.46), the effective rate of the experimental group: OR = 3.12, 95% CI (1.76, 5.48), and the insomnia severity index of the experimental group MD = 1.05, 95% CI (2.04, 0.52).

Conclusion

Our current study has indicated that TCM may play a central role in relieving senile insomnia and may be effective when treating insomnia. However, due to the low quality of trial methodology and publication bias, it cannot be fully confirmed. Further high-quality trials are needed to be investigated in the future.

Self-administered acupressure for insomnia disorder: A randomized controlled trial

BACKGROUND

Insomnia is a significant health problem in the community. Self-administered acupressure (SAA) may be an alternative strategy to alleviate insomnia.

PURPOSE

This study is the first to investigate the effects of SAA delivered through a training course in alleviating insomnia disorder compared with sleep hygiene education (SHE).

METHODS

A randomized controlled trial was conducted on 200 participants with insomnia disorder. The eligible participants were randomized into the SAA or SHE group. Both groups attended the allocated training courses (two sessions, 2 h each) and then were followed up at weeks 4 and 8. The primary outcome was the severity of insomnia symptoms and related daytime impairment as measured by the Insomnia Severity Index (ISI). Other measures included a 7-day sleep diary and actigraphy, Hospital Anxiety and Depression Scale (HADS), and Short-Form Six-Dimension (SF6D).

RESULTS

The SAA group showed a significantly greater improvement in ISI score than the SHE group at week 4 (mean difference: -1.89 units, 95% CI: 0.85, 2.93; Cohen's d = 0.51, p < 0.001) and week 8 (mean difference: -2.89 units, 95% CI: 1.67, 4.11; d = 0.67, p < 0.001). In addition, the SAA group showed a greater reduction in the HADS anxiety score and HADS depression score and increase in SF6D at week 8.

CONCLUSIONS

SAA taught in a short training course is a feasible and effective approach to improve sleep and related daytime impairment and mood problems in individuals with insomnia disorder.

Visualizing Research Trends and Identifying Hotspots of Traditional Chinese Medicine (TCM) Nursing Technology for Insomnia: A 18-Years Bibliometric Analysis of Web of Science Core Collection

Objective

To explore the research hotspot and frontier direction of TCM nursing of insomnia and provide reference for the follow-up study of the optimal scheme of TCM nursing of insomnia.

Background

Insomnia is a common sleep-wake disorder, affects 6–10% of adults and was associated with independent higher risks of cardiovascular disease and diabetes. TCM Nursing Techniques of insomnia has a long history and has shown a definite impact. However, it's still lack of analysis in the field of the most commonly used and effective techniques, as well as the co-morbidities associated with insomnia. Therefore, the database was searched and analyzed to find effective TCM Nursing Techniques for insomnia and related diseases related to insomnia.

Method

Randomized controlled trials on the intervention of TCM Nursing Techniques in insomnia were retrieved from Web of Science Core Collection and imported into CiteSpace 5.6.R5 visualization software. The works of literature were co-cited by keywords authors and institutions for visual analysis, and the co-morbidities associated with insomnia of TCM Nursing Techniques in literature was extracted manually. The symptoms of co-morbidities associated with insomnia were imported into Cytoscape 3.9.0 software and clustered by CytoHubba.

Result

As of October 20, 2021, the literature published in the last 20 years from Web of Science Core Collection was screened, and the publication period of the included literature was from 2004 to 2021. From 2016 to now, the total number of articles has been increasing. A total of 146 articles were included, and the highest production year was 2020. There is little cooperation between states, institutions, and authors. China (including Hong Kong and Taiwan) and Hong Kong Polytech University are leading countries and institutions in this area. MYUNGHAENG HUR is the most cited author, and J ALTERN COMPLEM MED is the most cited journal. According to cluster analysis and keyword frequency, auricular therapy, aromatherapy, and acupressure are the three most commonly used techniques. While the top five co-morbidities are fatigue, anxiety, depression, pain and hemodialysis. The three frontier topics and the main research directions are sleep quality, comorbid insomnia and clinical trial design.

Conclusion

We found that acupressure, aromatherapy, and auricular acupoint therapy are the most commonly used nursing methods of TCM to intervene in insomnia. However, these studies have limitations such as small sample size, lack of objectivity in evaluating sleep quality, and high heterogeneity of intervention measures, which are not conducive to forming TCM clinical nursing guidelines. Therefore, it is necessary to adopt objectified sleep quality evaluation methods, select suitable acupoints according to TCM theories, and design multi-center large-sample clinical trials based on the safety principle of randomized blind control. This study provides an in-depth perspective for insomnia research on TCM Nursing Techniques and includes information for follow-up research on TCM Nursing Techniques of insomnia.

The effect of nonpharmacological interventions on the mental health of high-risk pregnant women: A systematic review

OBJECTIVES

To evaluate the effect of nonpharmacological interventions on the mental health of high-risk pregnant women.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA) statement. The Cochrane Library, Embase, CINAHL, PubMed and Web of Science databases were systematically searched for randomized controlled trials and quasi-randomized controlled trials from inception to April 2021. The quality of the studies was assessed using the Cochrane Risk of Bias Tool 2.0. Data were independently extracted and narratively synthesized.

RESULTS

Fifteen studies involving 1723 pregnant women were selected. Nonpharmacological interventions included cognitive behavioral interventions, yoga, relaxation interventions, psychological and educational support interventions, and acupressure. Cognitive behavioral interventions and yoga for high-risk pregnant women had potential benefits on the symptoms of anxiety, stress and depression. There was insufficient evidence that relaxation interventions, psychological and educational support interventions and acupressure had positive effects on these women's mental health.

CONCLUSIONS

This review showed that cognitive behavioral interventions and yoga during pregnancy may benefit women with high-risk pregnancies. However, due to methodological limitations of this review, further studies with robust methodological designs are needed to verify the efficacy.

Effect of acupressure at the BL67 spot on the spontaneous rotation of fetus with breech presentation: A randomized controlled trial

BACKGROUND

Breech is a common fetal presentation in preterm pregnancies. This study aimed to investigate the effect of acupressure at the BL67 point on the spontaneous rotation of fetus with breech presentation.

METHODS

An unblind, two-armed randomized controlled trial was carried out from September 2017 to April 2020. Research participants were 138 pregnant women at 32 to 35 weeks of gestational age that had fetal breech presentation confirmed by ultrasound. They were randomly assigned into intervention and control groups (n=69 in each group). The intervention group received acupressure at the BL67 point on both feet for 10 minutes daily and for two consecutive weeks. The control group received routine care. Demographic and midwifery data questionnaires were used for data collection.

RESULTS

The spontaneous rotation of fetus with breech presentation into cephalic was observed in the majority of participants in the intervention group (82.6%) compared to the control group (17.4%) (p<0.001). Statistically significant differences in the fetal presentation at delivery was observed between the groups (84.1% cephalic vs. 18.8% breech, p<0.001). Regarding the type of delivery, cesarean section was reported mostly (85.5%) in the control group compared to the intervention group (21.7%) (p<0.001). However, the first- and fifth-minute Apgar scores of newborns had no statistically significant differences between the groups (p=0.773).

CONCLUSION

It is suggested to incorporate acupressure at the BL67 point into the care process for pregnant women to help with the reduction of the rate of cesarean section and avoid its related complications.

Relaxation interventions for improving sleep outcomes in perinatal women: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Sleep problem is common amongst perinatal women, and stress may trigger and intensify sleep problems in a vicious cycle. Relaxation interventions are gradually being adopted to improve sleep quality in various populations, but little is known about their effectiveness in perinatal women.

OBJECTIVE

To evaluate the effects of relaxation interventions on sleep outcomes amongst all perinatal women aged 18 and above, and identify the essential type, regime and approach in designing relaxation intervention.

DESIGN

Systematic review and meta-analysis of 11 studies among 1046 perinatal women.

DATA SOURCES

We searched Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, PsycINFO, ProQuest Dissertations and Theses, PubMed and Web of Science from their inception until December 15, 2019.

REVIEW METHODS

Studies were assessed for clinical and statistical heterogeneity and considered for meta-analysis. Comprehensive Meta-analysis and The Cochrane Risk of Bias tool were used for meta-analyses and assessing of risk of bias, respectively.

RESULTS

A total of 6346 records were identified, and 11 randomised control trials were selected. Significantly large effects were found in relaxation interventions in improving sleep quality (Cohen's d = 2.55), disturbance (Cohen's d = 1.52), latency (Cohen's d = 1.82) and duration (Cohen's d = 1.14) when compared with those in the control groups. Subgroup analyses showed that antenatal women who performed progressive muscle relaxation (PMR) by themselves for preventive function and long-term practice showed improved sleep quality compared with their counterparts.

CONCLUSION

PMR is preferable as a supplementary intervention to current existing antenatal care. The grade of the overall evidence of the outcomes ranged from very low to low.

IMPLICATIONS FOR PRACTICE

The meta-analysis addressed the effect of relaxation interventions on sleep outcomes amongst perinatal women. Relaxation interventions may effectively improve sleep quality, disturbance, latency and duration amongst perinatal women early in antenatal period. However, further well-designed trials in large samples are required.

Pharmacological and non-pharmacological treatments for insomnia: A protocol for a systematic review and network meta-analysis

BACKGROUND

Although nonpharmacological therapies are recommended as first-line treatments for insomnia, they do not widely implement in practice owing to costly or time-consuming. As a result, pharmacotherapy remains to be commonly prescribed for patients with the sleep disorder. Pharmacotherapy for insomnia consists of different types of drugs. Few studies focused on comprehensively evaluating all available drugs for insomnia. Our review aims to compare efficacy and safety of pharmacological and nonpharmacological treatments by synthesizing direct evidence and indirect evidence to help clinicians and patients make informed decisions for insomnia.

METHODS

We will search the MEDLINE, EMBASE, and Cochrane Register of Controlled Trials between January 2000 and June 12, 2021. Randomized controlled trials of pharmacological and nonpharmacological interventions for insomnia will be included. Study quality will be assessed on the basis of the methodology and categories described in the Cochrane Collaboration Handbook. Eight network meta-analyses were conducted. A Bayesian network meta-analysis would be performed, and relative ranking of agents would be assessed. A node splitting method will be used to examine the inconsistency between direct and indirect comparisons when a loop connecting 3 arms exists.

RESULTS

The results of this paper will be submitted to a peer-reviewed journal for publication.

CONCLUSION

The conclusion of our study will provide updated evidence to rank the effectiveness and safety of pharmacological and nonpharmacological interventions for insomnia.

ETHICS AND DISSEMINATION

Ethical approval is not applicable, as this study is a network meta-analysis based on published trials.

INPLASY REGISTRATION NUMBER

INPLASY202160031.

Risks and Safety of Extended Auricular Therapy: A Review of Reviews and Case Reports of Adverse Events

OBJECTIVE

Auricular acupuncture (AA) and extended auricular therapy (AT) are a part of acupuncture practice shown to benefit patients with pain, anxiety, and other conditions, with cost-effective access enhanced when given in a group setting. Yet there are safety concerns and risks, perhaps unnecessary risks, that attend embedded, indwelling needles applied to the ear as a means of extended AT.

METHODS

Electronic searches were conducted in PubMed, MEDLINE, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) for "auriculotherapy," "auricular acupuncture" or "auricular acupressure," "safety," "adverse events," "chondritis," and "perichondritis," with additional manual review of titles, links, and reference lists. Individual auricular therapy adverse event (AE) case reports were included, as well as systematic reviews and or meta-analyses if they evaluated AEs associated with AT.

RESULTS

Nineteen auricular AE case reports and nine safety reviews of or including auriculotherapy were included. Ten systematic reviews of AT with eight specific reviews of auricular acupressure (AP) were also included.

CONCLUSIONS

The primary AE risks is infection, perichondritis, and chondritis stemming from embedded or indwelling needles or potential inadvertent needlesticks from contaminated roaming sharps. Extended AP i.e., application of spheres, preferably seeds (natural, nontoxic botanical Vaccaria seeds) provides clinical benefit without the risks associated with embedded needles. More research is needed to establish if embedded needles at the ear are even necessary or have any advantage over in-session auricular acupuncture for immediate pain relief followed by ear acupressure.

Pilot randomized sham-controlled trial of self-acupressure to manage the symptom cluster of insomnia, depression, and anxiety in cancer patients undergoing chemotherapy

PURPOSE

Current evidence for using self-acupressure to manage the cancer-related symptom cluster of insomnia, depression, and anxiety, while promising, is unknown. This study evaluated the feasibility of self-acupressure to manage this symptom cluster and to explore its potential effectiveness.

METHODS

Participants were assigned randomly to three study groups, namely the true acupressure (TAP), the sham acupressure (SAP), and the enhanced standard care group (ESC). Participants in the TAP and SAP groups received a training session on acupressure and were required to practice self-acupressure at home once per day for 28 days. The duration of participant involvement was 8 weeks. Patients completed a Numerical Rating Scale (NRS) for each symptom, the Insomnia Severity Index, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy-General at baseline (T1), post-intervention (T2, week 4), and post follow-up (T3, week 8).

RESULTS

The results indicated that the intervention had clinical significance in improving the targeted symptoms and quality of life. In the TAP group, the symptom cluster severity was significantly lower than in the other groups at T2 (p < 0.05). The insomnia severity and anxiety scores in the TAP and SAP groups were significantly lower than those in ESC at T2 and T3 (p < 0.05).

CONCLUSION

The trial was feasible. The promising results of the study suggest that further testing of self-acupressure is warranted to inform its effectiveness on the targeted symptom cluster in patients with cancer. A placebo effect was evident alongside therapeutic effects.

TRIAL REGISTRATION

ClinicalTrials.gov (ID: NCT03823456) on January 30th, 2019.

Interventions that Improve Sleep in Caregivers of Adult Care-Recipients: A Systematic Review

The purpose of the present review was to compile and analyze all interventions aimed at improving the sleep-rest pattern of adult caregivers. A database search was performed in PubMed, Embase, Scopus, CINAHL and PsycINFO. Twenty-four papers published between 1998 and 2020 met the inclusion criteria. Informal caregivers can benefit from various types of sleep interventions, including (a) cognitive-behavioral sleep interventions (CBIs), (b) caregiver health interventions (CHIs), and (c) exercise programs. Other types of interventions such as acupressure, back massage, reflexology, music, and heart rate variability biofeedback sessions may have beneficial effects on the sleep of caregivers. Yet, studies on this topic are heterogeneous and often have considerable methodological shortcomings. Few clinical trials have explored sleep problems as a dyadic caregiver-patient relationship. It is necessary to conduct new clinical trials to determine the viability and level of evidence of the various strategies aimed at improving sleep of informal caregivers.

The Efficacy of Combined Electroacupuncture and Auricular Pressure on Sleep Quality in Patients Receiving Methadone Maintenance Treatment

BACKGROUND AND OBJECTIVES

Previous studies have revealed that the electroacupuncture or auricular-point pressure as a single treatment approach is beneficial for relieving insomniac symptoms among patients under methadone maintenance treatment (MMT). This study is designed to evaluate the clinical efficacy of combining two treatments.

METHODS

This study was a randomized, controlled, crossover trial. A total of 50 participants were recruited from the Linsen Chinese Medicine and Kunming Branches of Taipei City Hospital and randomly assigned to Groups A (25 participants) and B (25 participants). In Group A (electroacupuncture at the Hegu point (LI4) and Zusanli point (ST36) and auricular-point pressure on the Shenmen point) and Group B (only auricular-point), the interventions were implemented biweekly for 4 weeks. After a 1-week washout period, a crossover of the groups was performed. Sleep quality, according to the Pittsburgh Sleep Quality Index (PSQI), and daily attendance rate of MMT were evaluated.

RESULTS

Combined therapy significantly improved sleep quality, especially in the PSQI subscales of subjective sleep quality (60.91% vs 20.93%, P < 0.05) and sleep latency (42.59% vs 11.28%, P < 0.05). A significantly higher daily attendance rate was noted in combined therapy than single therapy (87% ± 2% vs 82% ± 2%, P < 0.001).

DISCUSSION AND CONCLUSIONS

The combination of the electroacupuncture with auricular-point pressure demonstrated high efficacy for improving sleep quality and increasing MMT adherence compared with single therapy of auricular-point pressure.

SCIENTIFIC SIGNIFICANCE

Combined therapy of the electroacupuncture and auricular-point pressing should be introduced as a routine, facilitating treatment for patients under methadone maintenance. (Am J Addict 2020;00:00-00).

Can foot reflexology be a complementary therapy for sleep disturbances? Evidence appraisal through a meta-analysis of randomized controlled trials

AIMS

To systematically summarize and quantify the effects of foot reflexology on improvements in sleep disturbances.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Datasets including PubMed, Web of Science, Scopus, EMBASE, Cochrane Library, Google Scholar, CINAHL and two Chinese electronic databases (i.e., AiritiLibrary and China National Knowledge Infrastructure) were used to search from their inception to 31 January 2019.

REVIEW METHODS

Studies which were randomized controlled trials that reported changes in sleep disturbances after the intervention among adults over 18 years old and written in the English or Chinese language were included. Two reviewers' independently assessed the eligibility, extracted data, and conducted a quality assessment. Based on the extracted data, two separate meta-analyses were performed.

RESULTS

Forty-two articles with a total sample of 3,928 participants were included in the systematic review and were eligible for the meta-analysis. The most commonly employed outcome measurement tool was the Pittsburgh Sleep Quality Index, followed by the therapeutic effect between the intervention and control groups (as evaluated by participants with sleep problems compared with those without sleep problems in each group after the intervention). Results revealed that foot reflexology resulted in a greater reduction in the sleep quality score compared with the controls (Hedges' g = -1.37; 95% confidence interval (CI) = -1.81~-0.94). As for the therapeutic effect, participants in the intervention group were less likely to have sleep problems than those in the control group (pooled odds ratio = 0.25; 95% CI = 0.19 ~ 0.31).

CONCLUSION

The findings suggested that foot reflexology produced significant improvements in sleep disturbances.

IMPACT

Foot reflexology is a non-invasive and convenient intervention and regularly receiving foot reflexology can be considered complementary therapy to improve the sleep quality of adults with sleep disturbances. Furthermore, healthcare providers can actively press the solar plexus and heart zones to alleviate sleep disturbances when performing foot reflexology.

The Effect of Auricular Acupressure on Sleep Disturbance Among Patients With Leukemia: A Feasibility Study

Auricular acupressure (AA) is widely used in East Asia and Europe to manage patients with sleep disturbance. This feasibility study was performed to demonstrate the potential of AA for sleep disturbance in patients with leukemia. Thirty-two patients with leukemia with poor sleep quality received AA 3 times a day for a total of 4 weeks. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality at baseline, at a 2-week intervention, and after a 4-week intervention. Compared with baseline scores, PSQI scores and the use of sleep medicine were significantly improved at week 2 and week 4 (P < .05). As a potential safety therapy, AA could be an alternative or complementary intervention to improve sleep quality for patients with leukemia with sleep disturbance.

Effect of Foot Reflexology Intervention on Depression, Anxiety, and Sleep Quality in Adults: A Meta-Analysis and Metaregression of Randomized Controlled Trials

Objectives

The aim of this study was to conduct a systematic review, meta-analysis, and metaregression to determine the current best available evidence of the efficacy and safety of foot reflexology for adult depression, anxiety, and sleep quality.

Methods

Electronic databases (PubMed, ClinicalKey, ScienceDirect, EMBASE, PsycINFO, and the Cochrane Library) were searched till August, 10, 2020, and the validity of the eligible studies was critically appraised. Randomized controlled trials comparing foot reflexology groups with control groups for adult depression, anxiety, and sleep quality were included. Twenty-six eligible studies were included to assess the effect of foot reflexology intervention on the reducing symptoms of depression and anxiety and improving quality of sleep, respectively, as the primary outcome.

Results

Twenty-six randomized controlled trials involving 2,366 participants met the inclusion criteria. The meta-analyses showed that foot reflexology intervention significantly improved adult depression (Hedges' g = −0.921; 95% CI: −1.246 to −0.595; P < 0.001), anxiety (Hedges' g = −1.237; 95% CI −1.682 to −0.791; P < 0.001), and sleep quality (Hedges' g = −1.665; 95% CI −2.361 to −0.970; P < 0.001). Metaregression reveals that an increase in total foot reflexology time (P = 0.002) and duration (P = 0.01) can significantly improve sleep quality.

Conclusions

Foot reflexology may provide additional nonpharmacotherapy intervention for adults suffering from depression, anxiety, or sleep disturbance. However, high quality and rigorous design RCTs in specific population, along with an increase in participants, and a long-term follow-up are recommended in the future.

Efficacy of Electroacupuncture Combined with Auricular Point Pressing in Improving Mental Well-Being among Individuals with Heroin Use Disorder: A Randomized Controlled Crossover Trial and Pilot Study

Objective

To evaluate the clinical efficacy of combining electroacupuncture with auricular point pressing in improving quality of life of individuals with heroin use disorder undergoing methadone maintenance treatment.

Design

A randomized controlled crossover trial.

Subjects

50 participants were recruited from Taipei City Hospital, Linsen Chinese Medicine and Kunming branches, and randomly allocated to treatment groups.

Method

The 36-Item Short Form Health Survey (SF-36) was used. Group A received electroacupuncture at the Hegu (LI4) and Zusanli (ST36) and auricular point pressing on Ear Shenmen, and Group B received only auricular point pressing on Ear Shenmen biweekly for 4 weeks. After a 1-week washout period, crossover of the groups was performed.

Results

The SF-36 mental component scores of the combined treatment group improved relative to the single treatment group (11.09 vs. 10.33, p=0.023). Methadone dosage was reduced in both groups (combined therapy group: 8.58 ± 4.17/7.76 ± 4.11 (baseline/posttreatment) vs. single therapy group: 8.36 ± 4.20/8.30 ± .28, p=0.001).

Conclusion

Combined therapy of high-frequency electroacupuncture with auricular point pressing had better efficacy in enhancing quality of life, especially for mental well-being, and in gradually reducing methadone dosage.

Patient-centred, self-administered acupressure for Chinese advanced cancer patients experiencing fatigue and co-occurring symptoms: A pilot randomised controlled trial

OBJECTIVES

To evaluate the feasibility and potential effects of patient-centred self-administered acupressure for alleviating fatigue and co-occurring symptoms among Chinese advanced cancer patients receiving treatment.

METHODS

Thirty advanced cancer patients who screened positive for moderate/severe fatigue with symptoms of insomnia and/or pain were recruited from a hospital in Hong Kong. They were randomly assigned (1:1) to receive a 4-week patient-centred self-administered acupressure intervention or health education. Fatigue (primary outcome) and secondary outcomes (sleep quality, pain, fatigue-sleep disturbance-pain symptom cluster severity, anxiety, depression and quality of life) were measured by questionnaires and actigraphy.

RESULTS

Twenty-four participants (80%) completed the study. Adherence to self-administered acupressure practice was satisfactory, with all retained participants attending all sessions and 90.9% practising acupressure daily. All completers rated the class as very enjoyable or quite enjoyable. Fatigue, pain, symptom cluster severity, anxiety, depression and quality of life appeared to improve from baseline to post-intervention in the intervention group. Among these outcomes, only the between-group difference in anxiety post-intervention was significant. The group × time interaction effect was nonsignificant for all outcomes.

CONCLUSIONS

Patient-centred self-administered acupressure appears to be feasible and acceptable among advanced cancer patients. A fully powered trial is warranted to confirm the intervention effect.

Effectiveness of Self-administered Acupressure for Family Caregivers of Advanced Cancer Patients With Insomnia: A Randomized Controlled Trial

BACKGROUND

Sleep disturbances are common among family caregivers (FCs) of patients with advanced cancer. Self-administered acupressure can combat insomnia, but no study has been conducted to evaluate its efficacy in caregivers of patients with advanced cancer.

OBJECTIVE

The aim of this study is to investigate whether self-administered acupressure improves sleep quality for FCs of patients with advanced cancer.

METHODS

Family caregivers of patients with advanced cancer who reported sleep disturbance (Pittsburgh Sleep Quality Index scores >5 in recent months) were recruited. The experimental group self-administered acupressure at the Baihui (GV20), Fengchi (GB20), Neiguan (PC6), and Shenmen (HT7) points over a 12-week period, whereas the comparison group received sleep hygiene education. Sleep quality was assessed subjectively at 4, 8, and 12 weeks after the intervention using the Pittsburgh Sleep Quality Index and objectively using actigraphy measurements. Improvements in sleep quality were analyzed using a generalized estimating equation.

RESULTS

Compared with the control group, the experimental group demonstrated significantly lower sleep latency (Wald χ2 = 11.49, P = .001) and significantly better sleep efficiency (Wald χ2 = 5.24, P = .02) according to actigraphy measurements, but Pittsburgh Sleep Quality Index scores did not differ significantly between the groups.

CONCLUSIONS

Self-administered acupressure did not demonstrate favorable effects on subjective sleep quality, but did reduce sleep latency and improve sleep efficiency, according to actigraphy measurements. Self-administered acupressure may help relaxation and sedation and promote sleep in FCs.

IMPLICATIONS FOR PRACTICE

Healthcare providers may consider advising FCs to apply this self-administered acupressure to improve their sleep latency and sleep efficiency.

Effect of Foot Reflexology on Pain, Fatigue, and Quality of Sleep after Kidney Transplantation Surgery: A Parallel Randomized Controlled Trial

Materials and Methods

The study was a parallel randomized controlled trial. Patients admitted to the transplantation ward participated in the study. Fifty-three eligible patients were allocated into the foot reflexology group (n = 26) and the control group (n = 27) by using the stratified randomization method. Finally, 25 participants in each group finished the study. The intervention group received foot reflexology for 30 minutes once a day for three consecutive days, and no reflexology was applied in the control group. The intervention started on the second day after surgery. Pain, fatigue, and quality of sleep were measured on the first, second (before intervention), third, fourth, and eleventh days after surgery. Data were collected using visual analogue scale for measuring pain and fatigue and Verran and Snyder-Halpern sleep scale for measuring quality of sleep.

Results

In each group, 25 patients finished the study. The mean pain score in the foot reflexology and control groups decreased from 9.44 ± 0.96 and 9.36 ± 0.91 on the day of surgery to 1.32 ± 0.94 and 4.32 ± 1.68 on the eleventh day after surgery, respectively. The mean fatigue score in the reflexology and control groups decreased from 8.76 ± 1.27 and 8.6 ± 1.26 on the day of surgery to 1.24 ± 1.2 and 3.92 ± 1.63 on the eleventh day after surgery, respectively. The mean sleep score in the foot reflexology and control groups increased from 33.38 ± 11.22 and 39.59 ± 12.8 on the day of surgery to 69.43 ± 12.8 and 56.27 ± 8.03 on the eleventh day after surgery, respectively. While pain, fatigue, and sleep quality scores improved in both groups, those in the intervention group showed significantly greater improvement compared with the control group (P < 0.001). No significant difference was found between the two groups in the use of acetaminophen on the first, second, third, fourth, and eleventh days after surgery (P > 0.05).

Conclusion

Foot reflexology may reduce pain and fatigue and improve sleep quality of patients after kidney transplantation.

The Effect of Foot Reflexology on Fatigue, Sleep Quality and Anxiety in Patients with Multiple Sclerosis: A Randomized Controlled Trial

Background: Fatigue, sleep disorders, and anxiety are common symptoms in multiple sclerosis (MS) patients. MS reduced the quality of life by these symptoms in patients. Studies have shown that foot reflexology may reduce some problems of this disease. Objectives: The present randomized controlled trial study investigated the effect of reflexology on fatigue, sleep quality, and anxiety in patients with multiple sclerosis. Methods: This study included 63 patients with MS referred to Arak MS society in 2018 - 2019. Reflexology and placebo intervention had applied twice a week for 4 weeks, and each session lasted about 30 - 40 minutes. Fatigue Impact scale (FIS), Pittsburgh sleep quality index (PSQI) and state-trait anxiety inventory (STAI) was used for data collection before and after the intervention. A significant statistical level was considered 0.05. Data were analyzed using the SPSS software (V. 16.0). Results: Significant improvement was observed in physical fatigue (P = 0.042), sleep quality (P = 0.001) and anxiety (P = 0.034) in the reflexology group after the intervention. Fatigue Impact Scale (FIS) revealed a decrease in fatigue level in MS patients, but these alterations were not significant (P = 0.134). Conclusions: Reflexology is a non-invasive, simple, affordable, and low-cost nursing intervention that can be helpful in reducing physical fatigue, anxiety, and improving sleep quality of people with MS.

Effect of Auricular Acupressure on Sleep and Pruritus in Patients Undergoing Hemodialysis

Purpose: The aim of this study was to evaluate the effects of auricular acupressure on sleep quality and pruritus in patients undergoing hemodialysis and to propose an effective and evidence-based nursing intervention.Methods: This was a single-blind, nonequivalent, group comparison study with 42 participants. The experimental period was a total of 8 weeks, and five different acupressure sites were applied in each group. Dependent variables were measured before the intervention, at the 4th week of the intervention, and at the 8th week of the intervention.Results: There were significant differences in the Pittsburgh sleep quality index, total sleep time, sleep efficiency, sleep onset latency, light sleep, deep sleep, number of awakenings, serum melatonin levels, subjective pruritus and skin hydration. No significant difference was found in skin pH between the two groups. Conclusion: Auricular acupressure was found to be an effective nursing intervention to improve sleep quality and to reduce pruritus in patients undergoing hemodialysis.

Effectiveness of Auricular Acupuncture for Insomnia: An Overview of Systematic Reviews

Objectives

The effectiveness of auricular acupuncture (AA) for insomnia is far from uniform. The aim of this overview was to summarize and critically evaluate the evidence from systematic reviews (SRs)/meta-analysis (MAs) and provide an overall verdict about the therapeutic value of AA for insomnia.

Methods

A search of relevant literature for SRs/MAs was performed on major medical databases. The methodological quality was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) and the evidence quality was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Results

Seven SRs/MAs were deemed eligible for the present overview. According to the evaluation results of AMSTAR-2, the methodological quality of all included SRs/MAs was critically low. Consistent methodological deficiencies were item 2 (the lack of a protocol), item 4 (the lack of a specific search strategy), item 7 (the lack of a list of excluded studies), and item 15 (the lack of an assessment of publication bias). For GRADE, of the 17 outcomes, only 1 (5.9%) was rated of high-quality, 4 (23.5%) were rated of moderate-quality, and the remaining 12 (70.6%) were rated of low-or critically low-quality. Descriptive analysis of the outcomes reveals a positive effect of AA for insomnia.

Conclusions

AA may be beneficial for insomnia, but the evidence is plagued by important limitations, e.g., the poor quality of SRs/MAs and primary studies.

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.

The effects of foot reflexology on depression during menopause: A randomized controlled clinical trial

OBJECTIVE

The purpose of this study was to determine the effects of foot reflexology on depression during menopause.

DESIGN

Randomized controlled clinical trial.

SETTING

Gynecology outpatient clinic.

INTERVENTIONS

We enrolled 90 menopausal women with depression. Participants were assigned to the intervention (n = 45) and control (n = 45) groups by block randomization. Participants in the intervention group received 15 min of foot reflexology on each foot for a total of 30 min in evenings, twice a week for six weeks. Participants in the control group received only the routine care for menopause patients.

MAIN OUTCOME MEASURES

The Beck Depression questionnaire was completed by all participants at the beginning of the trial and the end of the intervention and two months after completion of the intervention.

RESULTS

A total of 121 patients were assessed for eligibility to participate in the study. One-hundred patients met the criteria to participate, and 90 participants-45 participants in each group-completed the study. In the intervention group, the mean scores of depression before, immediately after, and two months after the study were 26.97 ± 4.47 (95% CI = 25.3-28.3), 22.55 ± 5.18 (95% CI = 20.9-24.1), and 21.20 ± 5.74 (95% CI = 19.4-22.9), respectively. In the control group, these scores were 26.15 ± 5.01 (95% CI = 24.6-27.6), 26.22 ± 5.14 (95% CI = 24.7-27.7), and 26.66 ± 3.87 (95%CI = 25.5-27.8), respectively. Using Repeated Measures ANOVA, the comparison of the mean scores of depression in the two groups indicated that the scores were decreased over time.

CONCLUSION

The findings indicated that the foot reflexology technique can be effective for reducing women's depression during menopause. However, considering the study's limitations, including a small sample size and no intervention in the control group, more studies are needed to verify the findings.

Effectiveness and safety of acupuncture for insomnia: Protocol for a systematic review

BACKGROUND

Insomnia is one of the most common diseases in modern society, the main characteristics of the patients were difficulty in falling asleep at night and/or failure to maintain effective sleep after falling asleep. It can lead to early awakening, short sleep, heavy sleeplessness, dreaming, poor sleep quality, and working hours after waking up, causes a series of negative emotions, such as fatigue, inefficiency, cognitive decline, social interaction, tension, and anxiety, which affect social harmony and stability. So Insomnia has gained more and more attention. At present, acupuncture has been proved effective in the treatment of insomnia by many studies. The purpose of this study is to evaluate the efficacy and safety of acupuncture in the treatment of insomnia, and to provide the latest evidence for clinical application.

METHODS AND ANALYSIS

We collected the qualified literature on acupuncture treatment of insomnia by electronic retrieval of Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Disc (CBMDISC), PubMed, China Science and Technology Journal Database (VIP) and Wanfang Database, and manual retrieval of papers and internal reports. We will select the eligible studies published up to September 30, 2019. We use Insomnia Severity Index (ISI) as the main outcome of insomnia and Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale(HAMD) and Self-Rating Anxiety Scale (SAS) as secondary indicators to evaluate the efficacy and safety of acupuncture treatment of insomnia, we will use Revman v.5.3 software to calculate data synthesis, and if the results are appropriate, meta-analysis can also be carried out.

RESULTS

This study will provide comprehensive evidence of high quality of acupuncture treatment for insomnia from ISI, PSQI, HAMD, SAS, and adverse reactions.

CONCLUSION

The systematic review will provide a basis for evaluating the efficacy and safety of acupuncture in the treatment of insomnia.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42019131957.

Comparing acupressure with aromatherapy using Citrus aurantium in terms of their effectiveness in sleep quality in patients undergoing percutaneous coronary interventions: A randomized clinical trial

INTRODUCTION

Poor sleep quality is prevalent in candidates for percutaneous coronary interventions (PCIs). The present study was conducted to compare aromatherapy with acupressure in terms of their effectiveness in sleep quality in patients undergoing PCIs.

MATERIALS AND METHODS

The present study was conducted on 85 patients undergoing PCIs and randomly assigned, using block randomization, to five groups, namely (1)aromatherapy, (2)placebo aromatherapy, (3)acupressure, (4)placebo acupressure (acupressure applied to a point not traditionally associated with improving sleep) and (5)control. The intervention groups received aromatherapy or acupressure or placebo from 10pm to 8am the following day. The control group received only routine care. Sleep quality was measured in the patients using a visual analog scale (VAS) that was completed by them before and after the intervention.

RESULTS

The mean pretest score of sleep quality was 2.91 ± 0.53 in the aromatherapy group, 2.84 ± 0.47 in the placebo aromatherapy group, 2.98 ± 0.59 in the acupressure group, 2.75 ± 0.41 in the placebo acupressure group and 2.88 ± 0.41 in the controls. ANOVA suggested no significant differences among these groups in the pretest (P = 0.746). The mean posttest score of sleep quality was 3.72 ± 1.84 in the aromatherapy group, 3.70 ± 1.83 in the placebo aromatherapy group, 7.35 ± 0.99 in the acupressure group, 2.67 ± 0.41in the placebo acupressure group and 2.72 ± 0.34 in the controls, suggesting significant differences among the five groups based on the ANOVA results showed significant differences among the five groups (P < 0.001). The mean posttest score of sleep quality was higher than the pretest score by 4.37 in the acupressure group compared to in the other groups (P < 0.001).

CONCLUSION

The present findings provided scientific evidence for the benefits of using different methods, including acupressure, for sleep quality in patients undergoing PCIs.

IRANIAN REGISTRY OF CLINICAL TRIALS NUMBER

IRCT201707248665N6.

Research trends of acupuncture therapy on insomnia in two decades (from 1999 to 2018):a bibliometric analysis

Objectives

We aimed to evaluate the global scientific output of research of acupuncture on insomnia and explore the hotspots and frontiers from 1999 to 2018, by using bibliometric methods.

Methods

Articles about acupuncture therapy on insomnia were retrieved from the Web of Science Core Collection (WoSCC). We used Citespace V to analyze publication years, journals, countries, institutions, authors and cited authors. We plotted the reference co-citation network and key words to analyze the research hotspots and trends.

Results

Until August 31, 2018 31, 2018, a total of 292 records in acupuncture therapy on insomnia research were identified from 1999 to 2018. The number and rate of the annual publication gradually increased. Respectively, SLEEP and J NEUROPSYCH CLIN N (journal of neuropsychiatry and clinical neurosciences) ranked the first in the frequency and centality of cited joural. Among countries, China ranked highest in the number of publications and the top 3 institutes were in Hong Kong. Chung KF and Yeung WF were the most productive authors and YEUNG WF ranked the first in the cited authors. In the ranking of frequency and in cited reference, the first was the article published in by CAO HJ and KALAVAPALLI R. ‘Randomized controlled trial’ had a high frequncy and centrality in keyword.

Conclusions

A higher degree of acceptance acupuncture was obtained in the Asian. Recently, systematic reviews and clinic trials most focused on electrocacupuncture and acupressure among the acupuncture therapy.

Effects of Auricular Acupressure on Women With Irritable Bowel Syndrome

The purpose of this study was to examine the effect of auricular acupressure on bowel symptoms, stress, mental health, and heart rate variability in women with irritable bowel syndrome (IBS). A quasi-experimental study design with a nonequivalent control group assessed a total sample of 56 women diagnosed with IBS according to Rome III criteria. There were 29 women in the experimental group who received auricular acupressure; 27 women were in the control group. Semen sinapis albae seeds were used to administer acupressure to four auricular points: endocrine, large intestine, lung, and Shenmen for 5 days/week for 4 weeks; the control group received no treatment. Bowel symptoms, stress, mental health, and heart rate variability were measured twice, once before and once after the intervention. Chi-square tests, t tests, and paired t tests were used for analysis. The experimental group had decreased loose stools, abdominal pain, diarrhea, abdominal discomfort, stress, and heart rate variability compared with the control group (p < .05). Auricular acupressure was effective for symptom improvement in patients with IBS.

Auricular acupressure as a complementary therapy for psoriasis vulgaris: study protocol for a multicenter randomized controlled trial

INTRODUCTION

Psoriasis vulgaris is a common skin disease characterized by persistent localized erythematous scaly plaques, typically on the elbows, knees, and scalp. It is an immune-abnormal disease that progresses slowly over a long period with frequent symptom recurrence. Current studies have shown that acupuncture is an effective therapy for psoriasis. However, the scientific evidence of the efficacy of auricular acupressure treatment for patients with psoriasis is still insufficient. Therefore, we designed a randomized controlled clinical trial to investigate the effect, safety, and cost-effectiveness of auricular acupressure in addition to medication in patients with psoriasis.

METHODS AND ANALYSIS

This on-going study is a two-arm parallel, assessor-blinded, randomized controlled trial in which 180 participants with psoriasis will be recruited and then randomly allocated into two groups in a 1:1 ratio. Equal randomization will be conducted using a computer-generated random allocation sequence. Participants in the intervention group will receive auricular acupressure treatment once per week for 4 weeks, and calcipotriol betamethasone ointment for topical use once daily for 4 weeks. Participants in the control group will receive only calcipotriol betamethasone ointment treatment once daily for 4 weeks. All patients will be followed up for 12 weeks. The primary outcome is relapse rate. The secondary outcomes include time to relapse, rebound rate, time to new onset, Psoriasis Area and Severity Index score improvement rate, body surface area affected, a visual analogue scale, and Dermatology Life Quality Index. Cost-effectiveness analysis will be carried out from a health and community care provider perspective.

DISCUSSION

This multicenter randomized controlled trial will provide important clinical evidence for the effect and safety of auricular acupressure as a complementary therapy in patients with psoriasis.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-TRC-14004916 . Registered on 20 May 2014. This protocol is version 3.0 which was updated on 24 September 2016.

Non-pharmacological and pharmacological interventions relieve insomnia symptoms by modulating a shared network: A controlled longitudinal study

BACKGROUND

Primary insomnia (PI) is one of the most common complaints among the general population. Both non-pharmacological and pharmacological therapies have proven effective in treating primary insomnia. However, the underlying mechanism of treatment remains unclear, and no studies have compared the underlying mechanisms of different treatments.

METHODS

In this study, we investigated gray matter volume (GMV) and resting-state functional connectivity (rsFC) changes following both pharmacological and non-pharmacological treatments in patients with PI. A total of 67 PI patients were randomized into benzodiazepine treatment, cupping treatment, or a wait-list control group for 4 weeks. The Pittsburgh Sleep Quality Index (PSQI), gray matter volume (GMV), and resting-state functional connectivity (rsFC) of the hippocampus were measured at the beginning and end of the experiment.

RESULTS

We found 1) significantly decreased PSQI scores in the cupping and benzodiazepine treatment groups compared to the control group with no significant differences between the two treatment groups; 2) significant GMV increases in the cupping group compared to the control group at the right hippocampus after 4 weeks of treatment; 3) significantly increased rsFC between the right hippocampus and left rostral anterior cingulate cortex/medial prefrontal cortex (rACC/mPFC) in the two treatment groups, which was significantly associated with PSQI score decreases.

DISCUSSION

Our findings suggest that benzodiazepine and cupping may share a common mechanism to relieve the symptoms of patients with PI.