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Liang X, Wu S, Li K, Zhang H, Yang F, Wang X, Yang G. The effects of reflexology on symptoms in pregnancy: A systematic review of randomized controlled trials. Heliyon 2023; 9:e18442. [PMID: 37533996 PMCID: PMC10391945 DOI: 10.1016/j.heliyon.2023.e18442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023] Open
Abstract
Objective This review assessed the effects of reflexology on symptoms in pregnancy. Methods and analysis PubMed, Embase, Springer, Web of Science, the Cochrane Library, and reference lists of previous systematic reviews were searched for the eligible randomized controlled trials (RCT) from the inception date of each predefined database up to May 31st, 2023. Data were extracted, and methodological quality was evaluated by the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). The efficacy of treatment was assessed using pooled effect sizes (Hedges' g) and 95% confidence intervals (CI). Meta-analysis was performed using the RevMan 5.4 manager, and publication bias was evaluated by Begg's test. Results The included a total of 13 RCTs in this review, of eleven was high risk of bias and two were low, reported the effects of reflexology on low back and/or pelvic pain (LBPP), labor pain, duration of labor, anxiety, fatigue, sleep quality, constipation symptoms, and ankle and foot edema in pregnancy. The effect sizes (Hedges' g) for reflexology in labor pain, duration of labor, anxiety, fatigue, and sleep quality showed statistical significance, which the meta-analysis also confirmed except for fatigue and sleep quality due to insufficient studies. Conclusion Reflexology is probably effective and safe for labor pain, duration of labor, and anxiety in pregnancy, while the evidences for reflexology in LBPP, fatigue, sleep quality, constipation symptoms, and ankle and foot edema during pregnancy were insufficient. Based on the low to high quality of included studies, strong supportive evidence is not yet available. Rigorous-design and large-scale clinical trials should be conducted to provide higher-quality, reliable evidence.
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Affiliation(s)
- Xiaoyu Liang
- Qi-Huang Chinese Medicine School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Shangping Wu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Ke Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Haolin Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Fujing Yang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xinhui Wang
- School of Management, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Guangyi Yang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
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Öztürk R, Emi̇nov A, Ertem G. Use of complementary and alternative medicine in pregnancy and labour pain: a cross-sectional study from turkey. BMC Complement Med Ther 2022; 22:332. [PMCID: PMC9749170 DOI: 10.1186/s12906-022-03804-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
This study aimed to determine the prevalence and pattern of complementary and alternative medicine (CAM) use by and attitudes towards CAM of Turkish women during pregnancy and birth.
Methods
This was a descriptive, cross-sectional study that included 260 women who gave birth in a university hospital. The Personal Information Form and Complementary, Alternative and Conventional Medicine Attitudes Scale (CACMAS) were used as data collection tools.
Results
A total of 71.5% of the pregnant women received CAM. Phytotherapy, spiritual meditation and therapeutic touch techniques were the most frequently used techniques. A total of 42.7% women used herbal products. The mean score of the women on the CACMAS scale was 108.37 ± 7.71; this result indicates that pregnant women had a positive attitude. There were significant differences in attitudes according to marital status, education level and place of residence. It was determined that there was a significant difference in the CACMAS scores of the women according to the symptoms experienced during pregnancy, CAM use during pregnancy and the concerns about triggering preterm birth by using CAM methods (p < 0.05).
Conclusion
Although the women commonly used CAM methods during pregnancy, the rate of using these methods during birth considerably decreased. Despite such widespread use, pregnant women have concerns about CAM methods. Therefore, health professionals must actively provide counselling on CAM methods for the protection of maternal and infant health.
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Ranjan P, Baboo AGK, Anwar W, Kumari A, Pradhan B, Maharana S, Venkataraman S. Physical Activity, Yoga, and Exercise Prescription for Postpartum and Midlife Weight Management: A Practical Review for Clinicians. J Obstet Gynaecol India 2022; 72:104-113. [PMID: 35492861 PMCID: PMC9008094 DOI: 10.1007/s13224-022-01627-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/17/2022] [Indexed: 10/18/2022] Open
Abstract
This narrative review is aimed to practically review and evaluate the existing evidence and illuminate the effectiveness of physical activity, yoga, and exercise for postpartum and midlife weight management. A comprehensive review was conducted using electronic databases such as PubMed and google scholar using search terms physical activity, exercise, yoga, postpartum, midlife, weight loss, weight reduction, and all the probable terms. This helped in generating evidence-based information and formulating practical physical activity prescriptions to be used by obstetricians, general clinicians, nutritionists, and other allied healthcare personnel. Overweight and obesity in postpartum and midlife women present long-term health risks and complications. Indulging in optimum physical activity comprising exercise and yoga will help in weight management, increasing muscular strength, and endurance thus improving overall health and well-being. Supplementary Information The online version contains supplementary material available at 10.1007/s13224-022-01627-w.
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Jodzis A, Walędziak M, Czajkowski K, Różańska-Walędziak A. Intrapartum Analgesia-Have Women's Preferences Changed over the Last Decade? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010087. [PMID: 35056395 PMCID: PMC8780736 DOI: 10.3390/medicina58010087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
Background: Global access to social media has supposedly changed women’s awareness about the pharmacological and alternative methods of pain relief during vaginal delivery. The purpose of the study was to analyze changes in women’s preference and opinion about different forms of labor analgesia over the past decade. Materials and methods: The study was designed as an anonymous survey with questions about women’s knowledge and preference of different forms of pain relief in labor. The survey was conducted in 2010 and 2020, with data collected from 1175 women in 2010 and 1033 in 2020. Results: There were no differences between 2010 and 2020 in the proportion of women who wanted to receive analgesia in labor, at, respectively 67.9% of women in 2010 and 73.9% in 2020. About 50% of women chose epidural analgesia as the only efficacious method of pain relief in labor both in 2010 and 2020. There were no differences between the two time-points in the distribution of chosen methods of pain relief. In total, 92.3% of women in 2010 and 94.9% in 2020 thought that they should have the possibility of independent choice of analgesia method before the delivery (p < 0.04). Conclusions: A high proportion of Polish women choose EDA over other pharmacological and nonpharmacological methods of pain relief in labor, and this preference has not changed over the last decade. Increasing women’s knowledge about different methods of intrapartum pain relief may lead to wider use of nonpharmacological methods of pain relief.
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Affiliation(s)
- Agnieszka Jodzis
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Karowa 2 St., 00-315 Warsaw, Poland; (A.J.); (K.C.); (A.R.-W.)
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., 04-141 Warsaw, Poland
- Correspondence: ; Tel.: +48-261-816-210
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Karowa 2 St., 00-315 Warsaw, Poland; (A.J.); (K.C.); (A.R.-W.)
| | - Anna Różańska-Walędziak
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Karowa 2 St., 00-315 Warsaw, Poland; (A.J.); (K.C.); (A.R.-W.)
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Smith CA, Hill E, Denejkina A, Thornton C, Dahlen HG. The effectiveness and safety of complementary health approaches to managing postpartum pain: A systematic review and meta-analysis. Integr Med Res 2021; 11:100758. [PMID: 34485073 PMCID: PMC8408636 DOI: 10.1016/j.imr.2021.100758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/05/2022] Open
Abstract
Background Women experience pain from a number of causes during the postpartum period. Although pharmacological pain relief has shown to be effective, the efficacy of non-pharmacological methods of pain relief will be of interest to breastfeeding women. The aim of this systematic review was to examine the efficacy and safety of complementary approaches to manage postpartum pain. Methods A search of English language databases from their inception to 2020 was undertaken for randomised controlled trials and included primiparous and multiparous women who experienced postpartum pain up to two weeks post birth. The primary outcome was pain. The risk of bias was assessed using the Cochrane risk of bias tool. Results Thirty trials were included in the review, 25 trials (2,413 women) were included in the meta-analysis. Two trials of massage found a reduction in pain following caesarean birth within the first 24 h post birth (MD -2.64, 95–2.82 to -2.46, 184 women, I2 0%), and at seven days postpartum (MD -1.91, 95%CI -2.42 to -1.40, 2 trials, 120 women I2 37%). Two trials conducted with women receiving an episiotomy found reduction in perineal pain from herbal ointments within 24 h (MD -1.33, 95% CI -.96 to -0.70, 221 women) and at 14 days postpartum (MD -0.74, 95% CI -1.02 to -0.47, 4 trials). Few trials reported on safety, few trials were at an overall low risk of bias, and overall the quality of evidence was very low. Conclusion Further high quality trials are needed to determine the safety and effectiveness of herbal ointment and massage during the early postpartum period.
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Affiliation(s)
- Caroline A Smith
- Graduate Research School, Western Sydney University, Penrith, NSW, Australia.,THRI, Western Sydney University, Penrith, NSW, Australia
| | - Emma Hill
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Anna Denejkina
- Graduate Research School, Western Sydney University, Penrith, NSW, Australia.,THRI, Western Sydney University, Penrith, NSW, Australia.,Young and Resilient Research Centre, Western Sydney University, Penrith, NSW, Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
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Akgün M, Boz İ. The effects of acupressure on post-cesarean pain and analgesic consumption: a randomized single-blinded placebo-controlled study. Int J Qual Health Care 2021; 32:609-617. [PMID: 32877509 DOI: 10.1093/intqhc/mzaa107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/14/2020] [Accepted: 08/27/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the effects of P6 and LI4 acupressure on post-caesarean pain and analgesic consumption. DESIGN This was a randomized, single-blinded, placebo-controlled study conducted in a university-affiliated obstetrics clinic between July 2017 and July 2018. PARTICIPANTS Women (n = 132) were randomly assigned to acupressure (n = 44), placebo (n = 44) and control (n = 44) groups. SETTING All groups received routine nursing care and analgesia protocol for post-cesarean pain. Acupressure was performed in two sessions, the postpartum second and fourth hours, with the following protocol: bilaterally to P6 (point on wrist) and LI4 (point on hand) points (for 3 minutes on each point). In the placebo group, it was just touched without the pressure on acupressure points, but the main difference was that touching was too superficial to have a therapeutic effect. The control group received only routine nursing care and analgesia protocol for post-cesarean pain. MAIN OUTCOME MEASURES The post-caesarean pain was evaluated four times before and after each session using Visual Analog Scale for pain. Also, the analgesia protocol for post-cesarean pain was recorded for all women. RESULTS The acupressure group experienced the lowest level of post-cesarean pain compared with the placebo and control groups (P = 0.000). The consumption of pethidine hydrochloride and paracetamol was statistically lower in the acupressure group compared with the placebo and control groups (respectively, P = 0.002 and P = 0.040). CONCLUSION Acupressure is an effective method for reducing post-cesarean pain and analgesic consumption. Clinical trial registration: ClinicalTrials.gov: NCT04337801.
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Affiliation(s)
- Mehtap Akgün
- Nursing Faculty, Akdeniz University, Antalya, Turkey
| | - İlkay Boz
- Nursing Faculty, Akdeniz University, Antalya, Turkey
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Iskender Ö, Kaplan S. The association between quality of life and complementary and alternative medicine use in pregnant women with hyperemesis gravidarum. J Obstet Gynaecol Res 2021; 47:2005-2013. [PMID: 33754438 DOI: 10.1111/jog.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 02/17/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
AIM This study investigated the association between quality of life and complementary and alternative medicine (CAM) use in pregnant women with hyperemesis gravidarum in Turkey. METHODS This cross-sectional descriptive study was conducted between October 2017 and July 2018 in Turkey. The sample consisted of 240 pregnant women with hyperemesis gravidarum. Data were collected using a Demographic Information Form, the Index of Nausea, Vomiting, Retching, and the 36-item Short-Form Health Survey. RESULTS The majority (84.2%) of participants stated that they used CAM, mostly "biologically based therapies" (97.5%). They were most satisfied with the "mental and physical treatments" (3.71 ± 1.74). Participants who did not use CAM had a higher quality of life "emotional role" than those who used CAM (p = 0.038). However, there were no statistically significant differences in the other quality of life subscale scores between the two groups. CONCLUSION There is limited evidence for the association between quality of life and CAM use in pregnant women with hyperemesis gravidarum in Turkey. Therefore, more evidence-based research is warranted to evaluate the association between CAM use and quality of life in pregnant women with hyperemesis gravidarum.
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Affiliation(s)
- Özlem Iskender
- Hacettepe University Hospitals, Obstetrics Service, Ankara, Turkey
| | - Sena Kaplan
- Nursing Department, Ankara Yıldırım Beyazıt University Faculty of Health Sciences, Ankara, Turkey
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Steel A, Diezel H, Frawley J, Wardle J, Adams J. Providing maternity care from outside the system: perspectives of complementary medicine practitioners. J Interprof Care 2020:1-9. [PMID: 32130068 DOI: 10.1080/13561820.2020.1711717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 08/02/2019] [Accepted: 01/02/2020] [Indexed: 10/24/2022]
Abstract
One in two women in Australia use complementary medicine (CM) during pregnancy including consulting with CM practitioners for pregnancy-related health concerns. Yet, very little is known about the everyday care and practice of this group of health professionals as it relates to the provision of care to childbearing women. As such, this study aims to examine the perceptions and experiences of CM practitioners who provide care to childbearing women. Semi-structured interviews were conducted with 23 practitioners from six CM professions (acupuncturists, doulas, chiropractors, massage therapists, naturopaths, and osteopaths) who identified as providing care to pregnant and birthing women in their clinical practice. The participants described professional issues affecting their provision of care to childbearing women including scope of practice, regulation and standards, and practice-specific issues, all of which they linked back to their profession and the reputation of their profession among other health professionals and the community. The study results draw attention to the importance of considering the perspectives of CM maternity care providers and place on interprofessional collaboration, as well as the barriers they face to achieving this collaboration. The insights afforded by this study have the capacity to inform new policy and practice initiatives to support improved interprofessional maternity care.
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Affiliation(s)
- Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Sydney, Australia
- Office of Research, Endeavour College of Natural Health, Brisbane, Australia
| | - Helene Diezel
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Sydney, Australia
- Office of Research, Endeavour College of Natural Health, Brisbane, Australia
| | - Jane Frawley
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Sydney, Australia
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Sydney, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Sydney, Australia
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Smith CA, Collins CT, Levett KM, Armour M, Dahlen HG, Tan AL, Mesgarpour B. Acupuncture or acupressure for pain management during labour. Cochrane Database Syst Rev 2020; 2:CD009232. [PMID: 32032444 PMCID: PMC7007200 DOI: 10.1002/14651858.cd009232.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined evidence about the use of acupuncture and acupressure for pain management in labour. This is an update of a review last published in 2011. OBJECTIVES To examine the effects of acupuncture and acupressure for pain management in labour. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, (25 February 2019), the Cochrane Central Register of Controlled Trials (the Cochrane Library 2019, Issue 1), MEDLINE (1966 to February 2019), CINAHL (1980 to February 2019), ClinicalTrials.gov (February 2019), the WHO International Clinical Trials Registry Platfory (ICTRP) (February 2019) and reference lists of included studies. SELECTION CRITERIA Published and unpublished randomised controlled trials (RCTs) comparing acupuncture or acupressure with placebo, no treatment or other non-pharmacological forms of pain management in labour. We included all women whether nulliparous or multiparous, and in spontaneous or induced labour. We included studies reported in abstract form if there was sufficient information to permit assessment of risk of bias. Trials using a cluster-RCT design were eligible for inclusion, but quasi-RCTs or cross-over studies were not. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 28 trials with data reporting on 3960 women. Thirteen trials reported on acupuncture and 15 trials reported on acupressure. No study was at a low risk of bias on all domains. Pain intensity was generally measured on a visual analogue scale (VAS) of 0 to 10 or 0 to 100 with low scores indicating less pain. Acupuncture versus sham acupuncture Acupuncture may make little or no difference to the intensity of pain felt by women when compared with sham acupuncture (mean difference (MD) -4.42, 95% confidence interval (CI) -12.94 to 4.09, 2 trials, 325 women, low-certainty evidence). Acupuncture may increase satisfaction with pain relief compared to sham acupuncture (risk ratio (RR) 2.38, 95% CI 1.78 to 3.19, 1 trial, 150 women, moderate-certainty evidence), and probably reduces the use of pharmacological analgesia (RR 0.75, 95% CI 0.63 to 0.89, 2 trials, 261 women, moderate-certainty evidence). Acupuncture may have no effect on assisted vaginal birth (very low-certainty evidence), and probably little to no effect on caesarean section (low-certainty evidence). Acupuncture compared to usual care We are uncertain if acupuncture reduces pain intensity compared to usual care because the evidence was found to be very low certainty (standardised mean difference (SMD) -1.31, 95% CI -2.14 to -0.49, 4 trials, 495 women, I2 = 93%). Acupuncture may have little to no effect on satisfaction with pain relief (low-certainty evidence). We are uncertain if acupuncture reduces the use of pharmacological analgesia because the evidence was found to be very low certainty (average RR 0.72, 95% CI 0.60 to 0.85, 6 trials, 1059 women, I2 = 70%). Acupuncture probably has little to no effect on assisted vaginal birth (low-certainty evidence) or caesarean section (low-certainty evidence). Acupuncture compared to no treatment One trial compared acupuncture to no treatment. We are uncertain if acupuncture reduces pain intensity (MD -1.16, 95% CI -1.51 to -0.81, 163 women, very low-certainty evidence), assisted vaginal birth or caesarean section because the evidence was found to be very low certainty. Acupuncture compared to sterile water injection We are uncertain if acupuncture has any effect on use of pharmacological analgesia, assisted vaginal birth or caesarean section because the evidence was found to be very low certainty. Acupressure compared to a sham control We are uncertain if acupressure reduces pain intensity in labour (MD -1.93, 95% CI -3.31 to -0.55, 6 trials, 472 women) or assisted vaginal birth because the evidence was found to be very low certainty. Acupressure may have little to no effect on use of pharmacological analgesia (low-certainty evidence). Acupressure probably reduces the caesarean section rate (RR 0.44, 95% CI 0.27 to 0.71, 4 trials, 313 women, moderate-certainty evidence). Acupressure compared to usual care We are uncertain if acupressure reduces pain intensity in labour (SMD -1.07, 95% CI -1.45 to -0.69, 8 trials, 620 women) or increases satisfaction with pain relief (MD 1.05, 95% CI 0.75 to 1.35, 1 trial, 105 women) because the evidence was found to be very low certainty. Acupressure may have little to no effect on caesarean section (low-certainty evidence). Acupressure compared to a combined control Acupressure probably slightly reduces the intensity of pain during labour compared with the combined control (measured on a scale of 0 to 10 with low scores indicating less pain) (SMD -0.42, 95% CI -0.65 to -0.18, 2 trials, 322 women, moderate-certainty evidence). We are uncertain if acupressure has any effect on the use of pharmacological analgesia (RR 0.94, 95% CI 0.71 to 1.25, 1 trial, 212 women), satisfaction with childbirth, assisted vaginal birth or caesarean section because the certainty of the evidence was all very low. No studies were found that reported on sense of control in labour and only one reported on satisfaction with the childbirth experience. AUTHORS' CONCLUSIONS Acupuncture in comparison to sham acupuncture may increase satisfaction with pain management and reduce use of pharmacological analgesia. Acupressure in comparison to a combined control and usual care may reduce pain intensity. However, for other comparisons of acupuncture and acupressure, we are uncertain about the effects on pain intensity and satisfaction with pain relief due to very low-certainty evidence. Acupuncture may have little to no effect on the rates of caesarean or assisted vaginal birth. Acupressure probably reduces the need for caesarean section in comparison to a sham control. There is a need for further high-quality research that include sham controls and comparisons to usual care and report on the outcomes of sense of control in labour, satisfaction with the childbirth experience or satisfaction with pain relief.
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Affiliation(s)
- Caroline A Smith
- Western Sydney UniversityNICM Health Research InstituteLocked Bag 1797PenrithNew South WalesAustralia2751
| | - Carmel T Collins
- South Australian Health and Medical Research InstituteWomen and Kids72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Kate M Levett
- Western Sydney UniversityNICM Health Research InstituteLocked Bag 1797PenrithNew South WalesAustralia2751
- University of Notre DameSchool of MedicineSydneyAustralia
| | - Mike Armour
- Western Sydney UniversityNICM Health Research InstituteLocked Bag 1797PenrithNew South WalesAustralia2751
| | - Hannah G Dahlen
- Western Sydney UniversitySchool of Nursing and MidwiferyLocked Bag 1797PenrithNSWAustralia2751
| | - Aidan L Tan
- National University HospitalDepartment of Preventive MedicineSingaporeSingapore
| | - Bita Mesgarpour
- National Institute for Medical Research Development (NIMAD)Cochrane Iran Associate CentreTehranIran
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Smith CA, Levett KM, Collins CT, Armour M, Dahlen HG, Suganuma M. Relaxation techniques for pain management in labour. Cochrane Database Syst Rev 2018; 3:CD009514. [PMID: 29589650 PMCID: PMC6494625 DOI: 10.1002/14651858.cd009514.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute to the popularity of complementary methods of pain management. This review examined currently available evidence on the use of relaxation therapies for pain management in labour. This is an update of a review first published in 2011. OBJECTIVES To examine the effects of mind-body relaxation techniques for pain management in labour on maternal and neonatal well-being during and after labour. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (9 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 5 2017), MEDLINE (1966 to 24 May 2017), CINAHL (1980 to 24 May 2017), the Australian New Zealand Clinical Trials Registry (18 May 2017), ClinicalTrials.gov (18 May 2017), the ISRCTN Register (18 May 2017), the WHO International Clinical Trials Registry Platform (ICTRP) (18 May 2017), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (including quasi randomised and cluster trials) comparing relaxation methods with standard care, no treatment, other non-pharmacological forms of pain management in labour or placebo. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We attempted to contact study authors for additional information. We assessed evidence quality with GRADE methodology. MAIN RESULTS This review update includes 19 studies (2519 women), 15 of which (1731 women) contribute data. Interventions examined included relaxation, yoga, music and mindfulness. Approximately half of the studies had a low risk of bias for random sequence generation and attrition bias. The majority of studies had a high risk of bias for performance and detection bias, and unclear risk of bias for, allocation concealment, reporting bias and other bias. We assessed the evidence from these studies as ranging from low to very low quality, and therefore the effects below should be interpreted with caution.RelaxationWe found that relaxation compared to usual care provided lowered the intensity of pain (measured on a scale of 0 to 10 with low scores indicating less pain) during the latent phase of labour (mean difference (MD) -1.25, 95% confidence interval (CI) -1.97 to -0.53, one trial, 40 women). Four trials reported pain intensity in the active phase; there was high heterogeneity between trials and very low-quality evidence suggested that there was no strong evidence that the effects were any different between groups for this outcome (MD -1.08, 95% CI -2.57 to 0.41, four trials, 271 women, random-effects analysis). Very low-quality evidence showed that women receiving relaxation reported greater satisfaction with pain relief during labour (risk ratio (RR) 8.00, 95% CI 1.10 to 58.19, one trial, 40 women), and showed no clear benefit for satisfaction with childbirth experience (assessed using different scales) (standard mean difference (SMD) -0.03, 95% CI -0.37 to 0.31, three trials, 1176 women). For safety outcomes there was very low-quality evidence of no clear reduction in assisted vaginal birth (average RR 0.61, 95% CI 0.20 to 1.84, four trials, 1122 women) or in caesarean section rates (average RR 0.73, 95% CI 0.26 to 2.01, four trials, 1122 women). Sense of control in labour, and breastfeeding were not reported under this comparison.YogaWhen comparing yoga to control interventions there was low-quality evidence that yoga lowered pain intensity (measured on a scale of 0 to 10) with low scores indicating less pain) (MD -6.12, 95% CI -11.77 to -0.47, one trial, 66 women), greater satisfaction with pain relief (MD 7.88, 95% CI 1.51 to 14.25, one trial, 66 women) and greater satisfaction with childbirth experience (MD 6.34, 95% CI 0.26 to 12.42 one trial, 66 women (assessed using the Maternal Comfort Scale with higher score indicating greater comfort). Sense of control in labour, breastfeeding, assisted vaginal birth, and caesarean section were not reported under this comparison.MusicWhen comparing music to control interventions there was evidence of lower pain intensity in the latent phase for women receiving music (measured on a scale of 0 to 10 with low scores indicating less pain) (MD -0.73, 95% CI -1.01 to -0.45, random-effects analysis, two trials, 192 women) and very low-quality evidence of no clear benefit in the active phase (MD -0.51, 95% CI -1.10 to 0.07, three trials, 217 women). Very low-quality evidence suggested no clear benefit in terms of reducing assisted vaginal birth (RR 0.41, 95% CI 0.08 to 2.05, one trial, 156 women) or caesarean section rate (RR 0.78, 95% CI 0.36 to 1.70, two trials, 216 women). Satisfaction with pain relief, sense of control in labour, satisfaction with childbirth experience, and breastfeeding were not reported under this comparison.Audio analgesiaOne trial evaluating audio analgesia versus control only reported one outcome and showed no evidence of benefit in satisfaction with pain relief.MindfulnessOne trial evaluating mindfulness versus usual care found an increase in sense of control for the mindfulness group (using the Childbirth Self-Efficacy Inventory) (MD 31.30, 95% CI 1.61 to 60.99, 26 women). There is no strong evidence that the effects were any different between groups for satisfaction in childbirth, or for caesarean section rate, need for assisted vaginal delivery or need for pharmacological pain relief. No other outcomes were reported in this trial. AUTHORS' CONCLUSIONS Relaxation, yoga and music may have a role with reducing pain, and increasing satisfaction with pain relief, although the quality of evidence varies between very low to low. There was insufficient evidence for the role of mindfulness and audio-analgesia. The majority of trials did not report on the safety of the interventions. Further randomised controlled trials of relaxation modalities for pain management in labour are needed. Trials should be adequately powered and include clinically relevant outcomes such as those described in this review.
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Affiliation(s)
- Caroline A Smith
- Western Sydney UniversityNational Institute of Complementary Medicine (NICM)Locked Bag 1797PenrithNew South WalesAustralia2751
| | - Kate M Levett
- The University of Notre DameSchool of MedicineSydneyAustralia
| | - Carmel T Collins
- South Australian Health and Medical Research InstituteHealthy Mothers, Babies and Children72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
| | - Mike Armour
- Western Sydney UniversityNational Institute of Complementary Medicine (NICM)Locked Bag 1797PenrithNew South WalesAustralia2751
| | - Hannah G Dahlen
- Western Sydney UniversitySchool of Nursing and MidwiferyLocked Bag 1797PenrithNSWAustralia2751
| | - Machiko Suganuma
- South Australian Health and Medical Research InstituteHealthy Mothers, Babies and Children72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
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Smith CA, Levett KM, Collins CT, Dahlen HG, Ee CC, Suganuma M. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database Syst Rev 2018; 3:CD009290. [PMID: 29589380 PMCID: PMC6494169 DOI: 10.1002/14651858.cd009290.pub3] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Many women would like to avoid pharmacological or invasive methods of pain management in labour, and this may contribute towards the popularity of complementary methods of pain management. This review examined the evidence currently available on manual methods, including massage and reflexology, for pain management in labour. This review is an update of the review first published in 2012. OBJECTIVES To assess the effect, safety and acceptability of massage, reflexology and other manual methods to manage pain in labour. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register (30 June 2017), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 6), MEDLINE (1966 to 30 June 2017, CINAHL (1980 to 30 June 2017), the Australian New Zealand Clinical Trials Registry (4 August 2017), Chinese Clinical Trial Registry (4 August 2017), ClinicalTrials.gov, (4 August 2017), the National Center for Complementary and Integrative Health (4 August 2017), the WHO International Clinical Trials Registry Platform (ICTRP) (4 August 2017) and reference lists of retrieved trials. SELECTION CRITERIA We included randomised controlled trials comparing manual methods with standard care, other non-pharmacological forms of pain management in labour, no treatment or placebo. We searched for trials of the following modalities: massage, warm packs, thermal manual methods, reflexology, chiropractic, osteopathy, musculo-skeletal manipulation, deep tissue massage, neuro-muscular therapy, shiatsu, tuina, trigger point therapy, myotherapy and zero balancing. We excluded trials for pain management relating to hypnosis, aromatherapy, acupuncture and acupressure; these are included in other Cochrane reviews. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality, extracted data and checked data for accuracy. We contacted trial authors for additional information. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included a total of 14 trials; 10 of these (1055 women) contributed data to meta-analysis. Four trials, involving 274 women, met our inclusion criteria but did not contribute data to the review. Over half the trials had a low risk of bias for random sequence generation and attrition bias. The majority of trials had a high risk of performance bias and detection bias, and an unclear risk of reporting bias. We found no trials examining the effectiveness of reflexology.MassageWe found low-quality evidence that massage provided a greater reduction in pain intensity (measured using self-reported pain scales) than usual care during the first stage of labour (standardised mean difference (SMD) -0.81, 95% confidence interval (CI) -1.06 to -0.56, six trials, 362 women). Two trials reported on pain intensity during the second and third stages of labour, and there was evidence of a reduction in pain scores in favour of massage (SMD -0.98, 95% CI -2.23 to 0.26, 124 women; and SMD -1.03, 95% CI -2.17 to 0.11, 122 women). There was very low-quality evidence showing no clear benefit of massage over usual care for the length of labour (in minutes) (mean difference (MD) 20.64, 95% CI -58.24 to 99.52, six trials, 514 women), and pharmacological pain relief (average risk ratio (RR) 0.81, 95% CI 0.37 to 1.74, four trials, 105 women). There was very low-quality evidence showing no clear benefit of massage for assisted vaginal birth (average RR 0.71, 95% CI 0.44 to 1.13, four trials, 368 women) and caesarean section (RR 0.75, 95% CI 0.51 to 1.09, six trials, 514 women). One trial reported less anxiety during the first stage of labour for women receiving massage (MD -16.27, 95% CI -27.03 to -5.51, 60 women). One trial found an increased sense of control from massage (MD 14.05, 95% CI 3.77 to 24.33, 124 women, low-quality evidence). Two trials examining satisfaction with the childbirth experience reported data on different scales; both found more satisfaction with massage, although the evidence was low quality in one study and very low in the other.Warm packsWe found very low-quality evidence for reduced pain (Visual Analogue Scale/VAS) in the first stage of labour (SMD -0.59, 95% CI -1.18 to -0.00, three trials, 191 women), and the second stage of labour (SMD -1.49, 95% CI -2.85 to -0.13, two trials, 128 women). Very low-quality evidence showed reduced length of labour (minutes) in the warm-pack group (MD -66.15, 95% CI -91.83 to -40.47; two trials; 128 women).Thermal manual methodsOne trial evaluated thermal manual methods versus usual care and found very low-quality evidence of reduced pain intensity during the first phase of labour for women receiving thermal methods (MD -1.44, 95% CI -2.24 to -0.65, one trial, 96 women). There was a reduction in the length of labour (minutes) (MD -78.24, 95% CI -118.75 to -37.73, one trial, 96 women, very low-quality evidence). There was no clear difference for assisted vaginal birth (very low-quality evidence). Results were similar for cold packs versus usual care, and intermittent hot and cold packs versus usual care, for pain intensity, length of labour and assisted vaginal birth.Music One trial that compared manual methods with music found very low-quality evidence of reduced pain intensity during labour in the massage group (RR 0.40, 95% CI 0.18 to 0.89, 101 women). There was no evidence of benefit for reduced use of pharmacological pain relief (RR 0.41, 95% CI 0.16 to 1.08, very low-quality evidence).Of the seven outcomes we assessed using GRADE, only pain intensity was reported in all comparisons. Satisfaction with the childbirth experience, sense of control, and caesarean section were rarely reported in any of the comparisons. AUTHORS' CONCLUSIONS Massage, warm pack and thermal manual methods may have a role in reducing pain, reducing length of labour and improving women's sense of control and emotional experience of labour, although the quality of evidence varies from low to very low and few trials reported on the key GRADE outcomes. Few trials reported on safety as an outcome. There is a need for further research to address these outcomes and to examine the effectiveness and efficacy of these manual methods for pain management.
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Affiliation(s)
- Caroline A Smith
- Western Sydney UniversityNational Institute of Complementary Medicine (NICM)Locked Bag 1797PenrithNew South WalesAustralia2751
| | - Kate M Levett
- The University of Notre DameSchool of MedicineSydneyAustralia
| | - Carmel T Collins
- South Australian Health and Medical Research InstituteHealthy Mothers, Babies and Children72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
| | - Hannah G Dahlen
- Western Sydney UniversitySchool of Nursing and MidwiferyLocked Bag 1797PenrithNSWAustralia2751
| | - Carolyn C Ee
- Western Sydney UniversityNational Institute of Complementary Medicine (NICM)Locked Bag 1797PenrithNew South WalesAustralia2751
| | - Machiko Suganuma
- South Australian Health and Medical Research InstituteHealthy Mothers, Babies and Children72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
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Fouly H, Herdan R, Habib D, Yeh C. Effectiveness of injecting lower dose subcutaneous sterile water versus saline to relief labor back pain: Randomized controlled trial. Eur J Midwifery 2018; 2:3. [PMID: 33537564 PMCID: PMC7848597 DOI: 10.18332/ejm/85793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/03/2018] [Accepted: 02/26/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the effect of a lower dose subcutaneous sterile water injection technique versus subcutaneous saline injection, on the relief of low-back pain for women during childbirth, and to explore the lasting effects of pain relief after administration (followed at 15, 30, 45, 90 and 120 minutes). METHODS A prospective randomized controlled single-blinded study was conducted, with trial registration (NCT02813330). Women received one-time injections (sterile water or saline) and the effectiveness was observed at 15, 30, 45, 90 and 120 minutes after the intervention. RESULTS The intervention group had statistically significant pain reduction. Assessment of subsequent pain, followed at 30, 45, 90 and 120 minutes, reflected an increasing change with a statistically significant difference. The intervention group had more burning sensations than the control group with a statistically significant difference. CONCLUSIONS The modified technique of double injections of subcutaneous ‘water/ saline’ resulted in significant relief of low-back pain during childbirth.
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Affiliation(s)
- Howieda Fouly
- Obstetrics & Gynecology Nursing, Faculty of Nursing, Assiut University, Egypt
| | - Ragaa Herdan
- Anesthesia & Intensive Care, Faculty of Medicine, Women's Health Hospital, Assiut University, Egypt
| | - Dina Habib
- Obstetrics & Gynecology, Faculty of Medicine, Women's Health Hospital, Assiut University, Egypt
| | - Chao Yeh
- School of Nursing, Johns Hopkins University, USA
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Levett KM, Dahlen HG, Smith CA, Finlayson KW, Downe S, Girosi F. Cost analysis of the CTLB Study, a multitherapy antenatal education programme to reduce routine interventions in labour. BMJ Open 2018; 8:e017333. [PMID: 29439002 PMCID: PMC5829839 DOI: 10.1136/bmjopen-2017-017333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess whether the multitherapy antenatal education 'CTLB' (Complementary Therapies for Labour and Birth) Study programme leads to net cost savings. DESIGN Cost analysis of the CTLB Study, using analysis of outcomes and hospital funding data. METHODS We take a payer perspective and use Australian Refined Diagnosis-Related Group (AR-DRG) cost data to estimate the potential savings per woman to the payer (government or private insurer). We consider scenarios in which the intervention cost is either borne by the woman or by the payer. Savings are computed as the difference in total cost between the control group and the study group. RESULTS If the cost of the intervention is not borne by the payer, the average saving to the payer was calculated to be $A808 per woman. If the payer covers the cost of the programme, this figure reduces to $A659 since the average cost of delivering the programme was $A149 per woman. All these findings are significant at the 95% confidence level. Significantly more women in the study group experienced a normal vaginal birth, and significantly fewer women in the study group experienced a caesarean section. The main cost saving resulted from the reduced rate of caesarean section in the study group. CONCLUSION The CTLB antenatal education programme leads to significant savings to payers that come from reduced use of hospital resources. Depending on which perspective is considered, and who is responsible for covering the cost of the programme, the net savings vary from $A659 to $A808 per woman. Compared with the average cost of birth in the control group, we conclude that the programme could lead to a reduction in birth-related healthcare costs of approximately 9%. TRIAL REGISTRATION NUMBER ACTRN12611001126909.
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Affiliation(s)
- Kate M Levett
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Caroline A Smith
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, New South Wales, Australia
| | | | - Soo Downe
- School of Midwifery and Community Health, University of Central Lancashire (UCLan), Preston, UK
| | - Federico Girosi
- School of Medicine, Centre for Health Research, Western Sydney University, Sydney, New South Wales, Australia
- Research, Health Market Quality program, Capital Markets CRC, Sydney, New South Wales, Australia
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Fairchild E, Roberts L, Zelman K, Michelli S, Hastings-Tolsma M. Implementation of Robert's Coping with Labor Algorithm © in a large tertiary care facility. Midwifery 2017; 50:208-218. [PMID: 28477459 DOI: 10.1016/j.midw.2017.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 02/12/2017] [Accepted: 03/14/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE to implement use of Roberts' Coping with Labor Algorithm© (CWLA) with laboring women in a large tertiary care facility. DESIGN this was a quality improvement project to implement an alternate approach to pain assessment during labor. It included system assessment for change readiness, implementation of the algorithm across a 6-week period, evaluation of usefulness by nursing staff, and determination of sustained change at one month. Stakeholder Theory (Friedman and Miles, 2002) and Deming's (1982) Plan-Do-Check-Act Cycle, as adapted by Roberts et al (2010), provided the framework for project implementation. SETTING the project was undertaken on a labor and delivery (L&D) unit of a large tertiary care facility in a southwestern state in the USA. The unit had 19 suites with close to 6000 laboring patients each year. PARTICIPANTS full, part-time, and per diem Registered Nurse (RN) staff (N=80), including a subset (n=18) who served as the pilot group and champions for implementing the change. FINDINGS a majority of RNs held a positive attitude toward use of the CWLA to assess laboring women's coping with the pain of labor as compared to a Numeric Rating Scale (NRS). RNs reported usefulness in using the CWLA with patients from a wide variety of ethnicities. A pre-existing well-developed team which advocated for evidence-based practice on the unit proved to be a significant strength which promoted rapid change in practice. IMPLICATIONS FOR PRACTICE this work provides important knowledge supporting use of the CWLA in a large tertiary care facility and an approach for effectively implementing that change. Strengths identified in this project contributed to rapid implementation and could be emulated in other facilities. Participant reports support usefulness of the CWLA with patients of varied ethnicity. Assessment of change sustainability at 1 and 6 months demonstrated widespread use of the algorithm though long-term determination is yet needed.
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Affiliation(s)
- Esther Fairchild
- Baylor University, Louise Herrington School of Nursing, 3700 Worth St, Dallas, TX 75246, United States.
| | - Leissa Roberts
- University of Utah, School of Nursing,10 South 2000 East, Salt Lake City, Utah 84112, United States
| | - Karen Zelman
- Baylor University, Louise Herrington School of Nursing, 3700 Worth St, Dallas, TX 75246, United States
| | - Shelley Michelli
- Baylor Scott & White, Fort Worth's Andrews Women's Hospital,1400 8th Avenue Fort Worth, TX 76104, United States
| | - Marie Hastings-Tolsma
- Baylor University, Louise Herrington School of Nursing, 3700 Worth St, Dallas, TX 75246, United States
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Sibbritt D, Ladanyi S, Adams J. Healthcare practitioner utilisation for back pain, neck pain and/or pelvic pain during pregnancy: an analysis of 1835 pregnant women in Australia. Int J Clin Pract 2016; 70:825-831. [PMID: 27620139 DOI: 10.1111/ijcp.12870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/02/2016] [Indexed: 11/28/2022] Open
Abstract
AIMS Back, neck and/or pelvic pain are common symptoms experienced by pregnant women. Although pregnant women are known to use complementary and alternative medicine (CAM) frequently, no research to date has provided in-depth examination of healthcare practitioner utilisation of pregnant women who experience back, neck and/or pelvic pain. METHODS A sub-study of 1835 pregnant women from the nationally representative Australian Longitudinal Study on Women's Health (ALSWH). Demographics, health status and healthcare utilisation measures were analysed for symptoms of back, neck and/or pelvic pain during pregnancy, using regression models. RESULTS During their pregnancy, 39.5% women experienced back pain, 12.4% experienced neck pain and 16.3% women experienced pelvic pain. Pregnant women were more likely to consult a massage therapist for their back pain (32.3%) and neck pain (39.9%), and another alternative practitioner (27.3%) or obstetrician (22.1%) for pelvic pain, while some women did not seek treatment (<30%). Women who sought help for each symptom reported significantly worse levels of mental and physical health across most SF-36 domains (P<.05). Women without health insurance, or pregnancy-related healthcare insurance were less likely to seek treatment. DISCUSSION AND CONCLUSION Pregnant women experiencing back, neck and/or pelvic pain frequently consult CAM practitioners, particularly if they have healthcare insurance. There is a need for all healthcare practitioners providing maternity care to enquire about possible back, neck and pelvic pain amongst women in their care and be cognisant of possible corresponding CAM use for such symptoms.
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Affiliation(s)
- David Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Suzy Ladanyi
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
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Levett KM, Smith CA, Bensoussan A, Dahlen HG. Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour. BMJ Open 2016; 6:e010691. [PMID: 27406639 PMCID: PMC4947718 DOI: 10.1136/bmjopen-2015-010691] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the effect of an antenatal integrative medicine education programme in addition to usual care for nulliparous women on intrapartum epidural use. DESIGN Open-label, assessor blind, randomised controlled trial. SETTING 2 public hospitals in Sydney, Australia. POPULATION 176 nulliparous women with low-risk pregnancies, attending hospital-based antenatal clinics. METHODS AND INTERVENTION The Complementary Therapies for Labour and Birth protocol, based on the She Births and acupressure for labour and birth courses, incorporated 6 evidence-based complementary medicine techniques: acupressure, visualisation and relaxation, breathing, massage, yoga techniques, and facilitated partner support. Randomisation occurred at 24-36 weeks' gestation, and participants attended a 2-day antenatal education programme plus standard care, or standard care alone. MAIN OUTCOME MEASURES Rate of analgesic epidural use. Secondary: onset of labour, augmentation, mode of birth, newborn outcomes. RESULTS There was a significant difference in epidural use between the 2 groups: study group (23.9%) standard care (68.7%; risk ratio (RR) 0.37 (95% CI 0.25 to 0.55), p≤0.001). The study group participants reported a reduced rate of augmentation (RR=0.54 (95% CI 0.38 to 0.77), p<0.0001); caesarean section (RR=0.52 (95% CI 0.31 to 0.87), p=0.017); length of second stage (mean difference=-0.32 (95% CI -0.64 to 0.002), p=0.05); any perineal trauma (0.88 (95% CI 0.78 to 0.98), p=0.02) and resuscitation of the newborn (RR=0.47 (95% CI 0.25 to 0.87), p≤0.015). There were no statistically significant differences found in spontaneous onset of labour, pethidine use, rate of postpartum haemorrhage, major perineal trauma (third and fourth degree tears/episiotomy), or admission to special care nursery/neonatal intensive care unit (p=0.25). CONCLUSIONS The Complementary Therapies for Labour and Birth study protocol significantly reduced epidural use and caesarean section. This study provides evidence for integrative medicine as an effective adjunct to antenatal education, and contributes to the body of best practice evidence. TRIAL REGISTRATION NUMBER ACTRN12611001126909.
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Affiliation(s)
- Kate M Levett
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, Australia
| | - C A Smith
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, Australia
| | - A Bensoussan
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, Australia
| | - H G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Hwang JH, Kim YR, Ahmed M, Choi S, Al-Hammadi NQ, Widad NM, Han D. Use of complementary and alternative medicine in pregnancy: a cross-sectional survey on Iraqi women. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:191. [PMID: 27389024 PMCID: PMC4936269 DOI: 10.1186/s12906-016-1167-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 06/29/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Due to the lack of strong evidence on safety and efficacy of complementary and alternative medicine (CAM) approaches, the use of CAM in women during pregnancy could be hazardous for mother and fetus. Meanwhile, little is known regarding the patterns, the reasons and the factors affecting use of CAM among pregnant women in Iraq. METHODS A cross sectional survey design was used to carry out face-to-face interviews with 335 consecutive pregnant women. The questionnaire comprised of three sections: socio-demographic characteristics, pregnancy-related aspects and the patterns and attitudes towards use of CAM. Determinants of CAM use were assessed through the logistic regression analysis. RESULTS Three hundred thirty-five pregnant women completed the questionnaire. 56.7 % reported using at least one form of CAM modalities. In total, 24 different types of CAM were used; with herbal medicine (53.7 %) and multivitamins (36.3 %) the most commonly used modalities. From the logistic regression analysis, the variables positively associated with CAM use were: rural residence (odds ratio (OR) 2.0, p < 0.01), no occupation (OR 2.7, p < 0.05), high income (OR 2.0, p < 0.05), perceived healthy status (OR 2.6, p < 0.05) and ever use of contraception (OR 2.0, p < 0.01). Only 0.5 % of CAM users disclosed their CAM use to physicians. CONCLUSIONS The proportion of CAM users among pregnant women is relatively high and it is important to learn what types of CAM they use. However, disclosure of CAM use was extraordinarily low. Given the low rate of disclosure, it should be ensured that physicians establish good level of communication with pregnant women and have adequate knowledge of CAM.
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Affiliation(s)
- Jung Hye Hwang
- />Department of Obstetrics and Gynecology, University of Hanyang College of Medicine, Seoul, South Korea
- />Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Yu-Rim Kim
- />Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Mansoor Ahmed
- />Institute of Health Services Management, Hanyang University, Seoul, South Korea
- />Department of Global Health and Development and Department of Preventive Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763 South Korea
| | - Soojeung Choi
- />Institute of Health Services Management, Hanyang University, Seoul, South Korea
- />Department of Global Health and Development and Department of Preventive Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763 South Korea
| | | | | | - Dongwoon Han
- />Institute of Health Services Management, Hanyang University, Seoul, South Korea
- />Department of Global Health and Development and Department of Preventive Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763 South Korea
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Reid R, Steel A, Wardle J, Trubody A, Adams J. Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:176. [PMID: 27289517 PMCID: PMC4902999 DOI: 10.1186/s12906-016-1143-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is increasing evidence that complementary medicine (CM) services are being used by a substantial proportion of the Australian population and this topic has attracted keen interest from primary health care providers and policy makers. This article outlines the first summative critical review of the predictors of CM use in Australia as well as the characteristics and perceptions of Australian CM users over the last 14 years. METHODS A literature search was conducted to ascertain original research from 2000 to 2014 in the AMED; CINAHL; and PubMed databases. Selected articles were subject to a critical appraisal analysis to identify the quality of the article. The search was confined to peer reviewed original articles published in English which identified the nature of CM services use in Australia. RESULTS The findings indicate a correlation between CM users and gender, with reports of a higher rate of use from females compared to males. Female CM users are more likely to be middle-aged with a higher education and higher annual income in comparison to female non-CM users. An association between resident location and use of CM disciplines was also identified with reports of rural residents utilising manual therapies more frequently compared to urban residents. CM users are more likely to seek CM services for a range of chronic conditions including diseases identified as National Health Priority Areas by the Australian Government. CONCLUSIONS This article provides the first comprehensive review examining the nature of CM use in Australia. The review findings offer important insights into the characteristics and features of CM use in Australia and provide insights for national and regional primary health care initiatives and of interest to medical doctors, allied health professionals, CM practitioners, researchers and policy makers.
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Affiliation(s)
- Rebecca Reid
- Endeavour College of Natural Health, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology, Sydney, Ultimo, NSW, 2007, Australia.
- Endeavour College of Natural Health, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia.
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology, Sydney, Ultimo, NSW, 2007, Australia
| | - Andrea Trubody
- Endeavour College of Natural Health, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology, Sydney, Ultimo, NSW, 2007, Australia
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Levett KM, Smith CA, Bensoussan A, Dahlen HG. The Complementary Therapies for Labour and Birth Study making sense of labour and birth - Experiences of women, partners and midwives of a complementary medicine antenatal education course. Midwifery 2016; 40:124-31. [PMID: 27428108 DOI: 10.1016/j.midw.2016.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/03/2016] [Accepted: 06/08/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE to gain insight into the experiences of women, partners and midwives who participated in the Complementary Therapies for Labour and Birth Study, an evidence based complementary medicine (CM) antenatal education course. DESIGN qualitative in-depth interviews and a focus group as part of the Complementary Therapies for Labour and Birth Study. SETTING AND PARTICIPANTS thirteen low risk primiparous women and seven partners who had participated in the study group of a randomised controlled trial of the complementary therapies for labour and birth study, and 12 midwives caring for these women. The trial was conducted at two public hospitals, and through the Western Sydney University in Sydney, Australia. INTERVENTIONS the Complementary Therapies for Labour and Birth (CTLB) protocol, based on the She Births® course and the Acupressure for labour and birth protocol, incorporated six evidence-based complementary medicine (CM) techniques; acupressure, relaxation, visualisation, breathing, massage, yoga techniques and incorporated facilitated partner support. Randomisation to the trial occurred at 24-36 weeks' gestation, and participants attended a two-day antenatal education programme, plus standard care, or standard care alone. FINDINGS the overarching theme identified in the qualitative data was making sense of labour and birth. Women used information about normal birth physiology from the course to make sense of labour, and to utilise the CM techniques to support normal birth and reduce interventions in labour. Women's, partners' and midwives' experience of the course and its use during birth gave rise to supporting themes such as: working for normal; having a toolkit; and finding what works. KEY CONCLUSIONS the Complementary Therapies for Labour and Birth Study provided women and their partners with knowledge to understand the physiology of normal labour and birth and enabled them to use evidence-based CM tools to support birth and reduce interventions. IMPLICATIONS FOR PRACTICE the Complementary Therapies for Labour and Birth Study introduces concepts of what constitutes normal birth and provides skills to support women, partners and midwives. It appears to be an effective form of antenatal education that supports normal birth, and maternity services need to consider how they can reform current antenatal education in line with this evidence.
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Affiliation(s)
- K M Levett
- National Institute of Complementary Medicines (NICM), Western Sydney University, Sydney, Australia.
| | - C A Smith
- National Institute of Complementary Medicines (NICM), Western Sydney University, Sydney, Australia.
| | - A Bensoussan
- National Institute of Complementary Medicines (NICM), Western Sydney University, Sydney, Australia.
| | - H G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia.
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20
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Osteopathic manipulative treatment in gynecology and obstetrics: A systematic review. Complement Ther Med 2016; 26:72-8. [PMID: 27261985 DOI: 10.1016/j.ctim.2016.03.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/02/2016] [Accepted: 03/05/2016] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The aim of the review was to evaluate the effects of the osteopathic manipulative treatment (OMT) on women with gynaecological and obstetric disorders. MATERIALS AND METHODS An extensive search from inception to April 2014 was conducted on MEDLINE, Embase, the Cochrane library using MeSH and free terms. Clinical studies investigating the effect of OMT in gynaecologic and obstetric conditions were included as well as unpublished works. Reviews and personal contributions were excluded. Studies were screened for population, outcome, results and adverse effects by two independent reviewers using an ad-hoc data extraction form. The high heterogeneity of the studies led to a narrative review. RESULTS 24 studies were included (total sample=1840), addressing back pain and low back functioning in pregnancy, pain and drug use during labor and delivery, infertility and subfertility, dysmenorrhea, symptoms of (peri)menopause and pelvic pain. Overall, OMT can be considered effective on pregnancy related back pain but uncertain in all other gynaecological and obstetrical conditions. Only three studies (12.5%) mentioned adverse events after OMT. CONCLUSIONS Although positive effects were found, the heterogeneity of study designs, the low number of studies and the high risk of bias of included trials prevented any indication on the effect of osteopathic care. Further investigation with more pragmatic methodology, better and detailed description of interventions and systematic reporting of adverse events are recommended in order to obtain solid and generalizable results.
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Cramer H, Frawley J, Steel A, Hall H, Adams J, Broom A, Sibbritt D. Characteristics of women who practice yoga in different locations during pregnancy. BMJ Open 2015; 5:e008641. [PMID: 26297372 PMCID: PMC4550706 DOI: 10.1136/bmjopen-2015-008641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Yoga practice during pregnancy is gaining increasing popularity. This study examined the characteristics of pregnant women who practiced yoga in regard to the different locations (at home, in yoga classes, or both). DESIGN The study sample was drawn from the Australian Longitudinal Study on Women's Health (ALSWH), a national longitudinal study of women to investigate multiple factors affecting health and well-being of women over a 20-year period. SETTING Postal survey. PARTICIPANTS Women born between 1973 and 1978, who were randomly selected from the national Medicare database and identified as being pregnant or having recently given birth (n=2316). OUTCOME MEASURES Relationships between yoga use (attending yoga classes and/or practising yoga at home) and women's characteristics (demographic measures, pregnancy-related health concerns, health service utilisation, attitudes to complementary and alternative medicine). RESULTS Practising yoga both at home and in classes was associated with perceiving complementary and alternative medicine (CAM) as preventative (odds ratio (OR)=1.62); perceiving CAM as affording health control (OR=1.50); experiencing sadness (OR=1.72); preparing for labour (OR=2.31); birthing in a birth centre (OR=7.97); and experiencing less vomiting (OR=0.38). Practising at home only was associated with perceiving CAM as affording health control (OR=1.76); perceiving CAM as promoting a holistic health approach (OR=1.65); and birthing in a birth centre (OR=3.54). Practising in classes only was associated with experiencing stress (OR=1.97); and birthing in a birth centre (OR=4.85) (all p<0.05). CONCLUSIONS The findings suggest that the location in which a woman practices yoga is associated with attitudinal, health-related and birth environmental factors.
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Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jane Frawley
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Amie Steel
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, New South Wales, Australia
- Endeavour College of Natural Health, Brisbane, Queensland, Australia
| | - Helen Hall
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, New South Wales, Australia
- School of Nursing & Midwifery, Monash University, Frankston, Victoria, Australia
| | - Jon Adams
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Alex Broom
- Faculty of Arts and Social Sciences, School of Social Sciences, University of New South Wales, Sydney, Australia
| | - David Sibbritt
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, New South Wales, Australia
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Levett KM, Smith CA, Dahlen HG, Bensoussan A. Acupuncture and acupressure for pain management in labour and birth: a critical narrative review of current systematic review evidence. Complement Ther Med 2014; 22:523-40. [PMID: 24906592 DOI: 10.1016/j.ctim.2014.03.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/27/2014] [Accepted: 03/30/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Reviews of maternity services highlight the need for a reduction of medical interventions for women with low risk pregnancies and births to prevent the potential cascade of interventions and their associated risks. Complementary medicines (CM) such as acupuncture and acupressure have claimed to be effective in reducing interventions in labour; however, systematic reviews of evidence to date are conflicting. AIMS To examine current evidence from systematic reviews on the topic of acupuncture and acupressure for pain management in labour and birth, and to evaluate the methodological and treatment frameworks applied to this evidence. METHODS A search limited to systematic reviews of the MEDLINE, CINAHL, PUBMED, EMBASE and Cochrane databases was performed in December 2013 using the keywords 'CAM', 'alternative medicine', 'complementary medicine', 'complementary therapies', 'traditional medicine', 'Chinese Medicine', 'Traditional Chinese Medicine', 'acupuncture', 'acupressure', cross-referenced with 'childbirth', 'birth', labo*r', and 'delivery'. The quality of the evidence is also evaluated in the context of study design. RESULTS The RCTs included in these systematic reviews differed in terms of study designs, research questions, treatment protocols and outcome measures, and yielded some conflicting results. It may be inappropriate to include these together in a systematic review, or pooled analysis, of acupuncture for labour with an expectation of an overall conclusion for efficacy. Trials of acupuncture and acupressure in labour show promise, but further studies are required. CONCLUSION The use of current systematic reviews of the evidence for acupuncture and acupressure for labour and birth may be misleading. Appropriate methods and outcome measures for investigation of acupuncture and acupressure treatment should more carefully reflect the research question being asked. The use of pragmatic trials designs with woman-centred outcomes may be appropriate for evaluating the effectiveness of these therapies.
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Affiliation(s)
- K M Levett
- National Institute for Complementary Medicine, University of Western Sydney, Penrith, New South Wales, Australia.
| | - C A Smith
- National Institute for Complementary Medicine, University of Western Sydney, Penrith, New South Wales, Australia.
| | - H G Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales, Australia.
| | - A Bensoussan
- National Institute for Complementary Medicine, University of Western Sydney, Penrith, New South Wales, Australia.
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