Efficacy of acupressure on quality of recovery after surgery: Randomised controlled trial.

BACKGROUND: Acupressure therapy is associated with favourable efficacies on postoperative nausea, pain and sleep disturbance, although the quality of the evidence is generally low. No randomised clinical trial has yet assessed the effect of acupressure on postoperative quality of recovery (QoR). OBJECTIVE: The objective was to study acupressure efficacy on patient-reported postoperative recovery. DESIGN: We conducted a single centre, three-group, blind, randomised controlled, pragmatic trial assessing acupressure therapy on the PC6, LI4 and HT7 acupoints. PATIENTS: Postoperative patients expected to stay in hospital at least 2 days after surgery. INTERVENTIONS: In the acupressure group, pressure was applied for 6 min (2 min per acupoint), three times a day after surgery for a maximum of 2 postoperative days during the hospital stay. In the sham group, extremely light touch was applied to the acupoints. The third group did not receive any touch. MAIN OUTCOME MEASURES: The primary outcome was the change in the QoR, using the QoR-15 questionnaire, between postoperative days 1 and 3. Key secondary outcomes included patients' satisfaction, postoperative nausea and vomiting, pain score and opioid (morphine equivalent) consumption. Assessors for the primary and secondary endpoints were blind to the group allocation. RESULTS: Overall, 163 patients were randomised (acupressure n=55, sham n=53, no intervention n=55). The mean (SD) postoperative change in QoR-15 did not differ statistically (P = 0.27) between the acupressure, sham and no intervention groups: 15.2 (17.8), 14.2 (21.9), 9.2 (21.7), respectively. Patient satisfaction (on a 0 to 10 scale) was statistically different (P = 0.01) among these three groups: 9.1 (1.5), 8.4 (1.6) and 8.2 (2.2), respectively. Changes in pain score and morphine equivalent consumption were not significantly different between the groups. CONCLUSION: Two days of postoperative acupressure therapy (up to six treatments) did not significantly improve patient QoR, postoperative nausea and vomiting, pain score or opioid consumption. Acupressure, however, was associated with improved patient satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02762435.

Feedback Simulation for Acupressure Training and Skill Assessment.

INTRODUCTION: Previous acupressure studies have yielded varying results. This could be due to differences in the amount of pressure applied to the acupressure point (acupoint) by study personnel within a study as well as between studies. Standardizing the level of pressure applied at an acupoint could improve clinical care and future research. METHODS: As part of an ongoing randomized clinical trial of postoperative acupressure, five trainees were asked to perform 2 minutes of acupressure and light touch sessions on a simulator. The applied weight was recorded every minute. Individual skill assessment was performed using cumulative sum analysis. Six pretraining and 20 posttraining measurements in each acupressure and light touch group were compared with an expert's simulation values. RESULTS: Before training (baseline), there was significant difference in applied weight (grams) between the expert [5705 (636)] and five trainees [2998 (798), P = 0.004]. Four of the five trainees crossed the lower decision limit assessing proficiency in the acupressure group, and all five trainees were successful in the light touch group. The trainees' average number of measurements needed to cross the lower decision limit (H0), that is, defining that an individual failure rate does not statistically differ from the acceptable failure rate, was 21.3 measurements for acupressure. After this feedback simulation, trainees' scores showed no significant difference (P > 0.05) when assessed against the expert. CONCLUSIONS: Feedback simulation for acupressure training and skill assessment, evaluated by cumulative sum analysis, may help in improving the standardization of acupressure therapy performed during clinical practice or research.

Randomized trial of acupressure to improve patient satisfaction and quality of recovery in hospitalized patients: study protocol for a randomized controlled trial.

BACKGROUND: Acupressure therapy may be potentially beneficial in improving postoperative symptoms like postoperative nausea and vomiting (PONV), pain and sleep disorder and improving postoperative quality of recovery. The primary aim of this study is to investigate the efficacy of acupressure therapy on postoperative patient satisfaction and quality of recovery in hospitalized patients after surgical treatment. METHODS/DESIGN: This three-group, parallel, superiority, blinded, randomized controlled trial will test the hypothesis that a combination of PC6, LI4 and HT7 acupressure is superior to sham or no intervention for improving postoperative quality of recovery in hospitalized patients. A minimum of 150 patients will be randomly allocated to one of the three experimental groups: control (no visit), light touch (sham acupressure) or active acupressure therapy in a 1:1:1 ratio. Interventions will be performed three times a day for 2 days. Patient satisfaction, quality of recovery, PONV and pain will be measured during the 3 days following randomization. The study protocol was approved by the Stony Brook University Institutional Review Board on 21 March 2016. Written informed consent will be recorded from every consented patient. DISCUSSION: This study has the potential to improve the recovery of hospitalized patients by adding knowledge on the efficacy of acupressure therapy in this setting. A multipoint acupressure protocol will be compared to both a no intervention group and a light touch group, providing insight into different aspects of the placebo effect. TRIAL REGISTRATION: ClinicalTrial.gov, NCT02762435 . Registered on 14 April 2016.