The contribution made to the evidence base by each study, based on the study design, rigour of methods and reporting, was evaluated independently by two reviewers, with an independent adjudicator.
Studies were evaluated on the following quality indicators to determine its contribution to the evidence base:. Results of this evaluation are given for each study in Additional file 1. Studies were grouped into either Shiatsu or acupressure and within these categories according to health condition treated. For each health condition evidence was categorised according to criteria from Waddell [ 16 ].
Category 1: Generally consistent finding in a range of evidence from well-designed experimental studies. Category 2: Either based on a single acceptable study, or a weak or inconsistent finding in some multiple acceptable studies. Category 3: Limited scientific evidence, which does not meet all the criteria of acceptable studies, or an absence of directly applicable studies of good quality.
This includes published and unpublished expert opinion. After duplicate items, newspaper articles and commentaries were removed items remained. From screening the abstracts articles were excluded. Two reviewers screened the full texts of the remaining articles using exclusion criteria and quality assessment and excluded Of those remaining, 56 were used for background information only, leaving 89 studies.
A further 9 were excluded as they were already included in systematic reviews included in this review. The total included studies were 9 Shiatsu and 71 acupressure publications. Details of included studies are presented in Additional file 1 , grouped by health condition.
Just under one third Only 9 Shiatsu studies were of sufficient quality to be included in the review. These comprised 1 randomised controlled trial RCT , three controlled non-randomised, one within-subjects trial, one observational study and 3 uncontrolled studies. These studies investigated quite separate health issues, did not use comparable methodology and data could not be pooled due to their heterogeneity. They are grouped by methodology and discussed below. One RCT was identified integrated care, which included Shiatsu , for back and neck pain [ 19 ].
No significant effects, compared to standard care were identified. Three studies compared two or more treatments with non-random group allocation, rather by preference [ 20 ], participants in another study [ 21 ] or staff on duty [ 22 ]. Lucini et al [ 20 ] evaluated Shiatsu for chronic stress; 70 volunteer patients chose either active relaxation and breathing training , passive Shiatsu or sham treatment stress management information.
Small sample, limited the validity of results. Although the design accounted for patient preference, results were confounded by more stressed patients choosing sham. Ingram [ 22 ] compared Shiatsu to no intervention for post-term pregnancy in women. Ballegaard et al [ 21 ] conducted a study of cost-effectiveness and efficacy of Shiatsu for angina pectoris. Sixty-nine consecutive patients were treated and compared with those from a separate trial of two invasive treatments for angina[ 23 ].
It also used a convenience and unpowered sample and no blinding. One study used a within-subjects repeated measures design, comparing Watsu water Shiatsu with Aix massage for fibromyalgia syndrome [ 24 ]. The repeated measures design with counterbalancing should reduce carryover effects although order effects may have occurred due to high dropout. In addition it used a volunteer sample. Three studies had no separate control group, using a single group pretest-posttest design[ 25 - 27 ], limiting the validity of results.
Lichtenberg et al's [ 27 ] pilot study of Shiatsu for schizophrenia showed significant improvements on scales relating to illness, psychopathy, anxiety, depression and others p values ranged from 0.
Brady et al [ 26 ] tested Shiatsu for lower back pain in 66 volunteers. Iida et al [ 25 ] investigated the relaxation effects of Shiatsu on anxiety and other side effects in 9 patients receiving cancer chemotherapy. The small and self-selected samples and lack of control group in these studies limits the quality and generalisablity of the results. In addition 13 of Brady et al's [ 26 ] participants had previously received Shiatsu. Long conducted a prospective observational study of patients of Shiatsu practitioners in 3 different countries[ 7 ].
Significant improvement in symptoms, especially for tension or stress and structural problems effect size 0. This study is of greater quality than other Shiatsu studies as the sample size was powered and it used a longitudinal and pragmatic study design. Recruitment of patients was through practitioners, who received a rigorous training and kept a recruitment log.
Confounding factors are reported and outcomes were accurately measured. However, data on non-respondents or those who refused to participate were not reported so evaluation of response bias is problematic.
Sundberg et al [ 19 ] and Ballegaard [ 21 ] used a pragmatic design - Shiatsu as part of an integrated model of healthcare or with other interventions acupuncture and lifestyle adjustment. This reflects normal practice but specific effects of Shiatsu cannot be isolated.
There was insufficient evidence both in quantity and quality on Shiatsu in order to provide consensus for any specific health condition or symptom. Of a total of 71 included studies described as giving acupressure as an intervention, 2 were meta-analyses, 6 systematic reviews, 39 RCTs, five crossover trials, 5 within-subjects trials, 5 controlled non-randomised, 7 uncontrolled trials and 1 prospective study.
These are summarised by health condition below. Pain was the most common issue addressed by acupressure studies and covered a range of topics. This included a systematic review, six RCTs with control groups and random assignment; 2 with non-randomised control groups or within-subject controls, and the remainder either did not have a control or random assignment.
Overall, the evidence for the efficacy of acupressure for pain is fairly strong and can be graded as category 1 evidence. Although some studies had methodological flaws, studies consistently show that acupressure is more effective than control for reducing pain, namely dysmenorrhoea acupressure at SP6 [ 9 , 28 - 30 ], lower back pain [ 31 - 33 ] and labour pain [ 34 , 35 ]. The evidence for minor trauma [ 36 , 37 ] and injection pain [ 38 , 39 ] is less conclusive and the evidence for headache is insufficient [ 40 ].
Each pain condition is discussed below. Of 4 papers for dysmenorrhoea, 1 was a systematic review 2 were RCTs, and one non equivalent control group. All studied school or university students, with sample sizes ranging from 30 to Two used acupressure on SP6, The other used a combination of points.
Both of the RCTs [ 28 , 30 ] compared acupressure to rest, which does not control for the placebo effect. Jun et al [ 29 ] compared acupressure to light touch, potentially controlling for non-specific effects but used sequential allocation which may create bias, although groups were homogenous in baseline demographics and dysmenorrhoea factors.
All studies found a significant reduction in pain. Studies were generally good quality, with low attrition rates and validated measures usually VAS. Only including students may limit generalisability and create Hawthorne bias. Two of the three studies of acupressure for labour pain were RCTs [ 34 , 35 ].
They both compared acupressure to touch, thus controlling for the effect of human touch; Chung et al [ 34 ] additionally had a conversation only control group. The third was a one group uncontrolled study [ 41 ]. All studies found acupressure significantly reduced pain,. Four studies on back or neck pain were identified, all RCTs and conducted by two groups of researchers, Hsieh et al [ 31 , 32 ] and Yip and Tse [ 33 , 42 ].
Hsieh et al unusually used a pragmatic design of four weeks of individualised acupressure compared to physical therapy. They also used powered samples, blinding where possible, valid outcome measures and intention to treat analysis to protect against attrition bias.
A no treatment group was not included, limiting assessment of specific effects. Yip and Tse also compared acupressure to usual care, although an acupressure protocol was used. They also had powered sample sizes but no blinding. Comparison groups of aromatherapy and electroacupuncture, limit specific effects of acupressure.
All four studies showed a significant reduction in pain. Two double-blind RCTs evaluated acupressure for minor trauma pain during ambulance transport [ 36 , 37 ]. Both used sham acupressure as a control, with Kober et al [ 36 ] additionally comparing to no treatment. Both studies showed significant reductions in pain, anxiety and heart rate. Limitations include fairly small sample and lack of no-treatment control.
Two studies evaluated acupressure for pain of injection [ 38 , 39 ]. Both studies showed reduction in pain but both were subject to limitations - Arai et al [ 39 ] only included 22 subjects although it was powered and randomised, with a sham treatment; Alavi et al's [ 38 ] trial was larger and randomised, but used a within-subjects crossover design which can create practice bias.
Only one study investigated headache [ 40 ], comparing a course of 8 sessions of acupressure to medication, which reduced pain. Although this used an RCT design, power calculation, intention-to-treat analysis, blinding and long follow up, there is very little detail on intervention only 7 STRICTA items , randomisation, recruitment or limitations. One RCT for dental pain [ 43 ] compared acupressure at LI4 to medication or sham acupressure, showing reduction in pain 4 and 24 hours after the first orthodontic treatment but not after second treatment.
Although an RCT and well reported, only 23 patients completed the study, despite a power calculation specifying a sample of The evidence was somewhat inconsistent and varied with type of nausea investigated.
Post-operative nausea had strongest evidence, graded as Category 1 evidence mainly due to a Cochrane systematic review and update [ 8 , 44 ] and a meta-analysis [ 45 ].
Little reliable evidence is added by the RCT [ 48 ]. The three studies of acupressure for nausea in pregnancy are of variable quality. Although one has a small sample and uncontrolled study design [ 49 ], a well conducted RCT [ 50 ]and meta analysis [ 51 ] provide Category 2 evidence for nausea in pregnancy. All the studies in the review and the majority in the meta-analysis used acupoint PC6. Both reviews were very high quality with comprehensive search terms and pooling of data.
Acustimulation, including acupressure, for nausea as a side-effect of chemotherapy also has been reported in a Cochrane review [ 46 ], as well as an RCT published subsequently [ 48 ] and a non-randomised trial [ 52 ]. The Cochrane review identified 11 trials and pooled data demonstrated significantly reduced vomiting but not nausea [ 46 ].
It was very good quality, with intention-to-treat analysis of pooled data and controlling for duplicate and language bias.
The main limitations are the lack of sample size calculation despite conducting a pilot study and patients breaking the blind. However, these results are limited by a small and convenience sample. All used acupressure on PC6 neiguan. As concluded by the meta-analysis [ 51 ], the RCT found improvements compared to sham or control.
Shin et al's RCT [ 50 ] is excellent quality with double-blinding, powered sample size, objective and subjective outcomes and good reporting. Markose et al [ 49 ] also found improvements in nausea, vomiting and retching, but due to lack of control group, small sample, high attrition and poor reporting the evidence is limited.
The meta-analysis included studies on all forms of acustimulation and was generally well conducted, although it did not attempt to find unpublished material and only 3 databases were used.
Five papers based on four RCTs investigated the use of acupressure for symptoms of renal disease. Due to limitations, repeated in all studies due to the common research team, evidence is category 2.
The studies used different points for different symptoms, including fatigue [ 55 , 57 ], depression [ 56 , 57 ] and sleep [ 54 , 56 ]. Sample sizes were between 62 powered and and had low attrition rates.
One study used blinding [ 54 ], the others may have been subject to placebo or observer bias. Five studies investigated acupressure for sleep in elderly long term care facilities [ 58 - 62 ], and one investigated alertness in the classroom [ 63 ].
Evidence for improving sleep quality in institutionalised elderly is consistent from a number of high quality studies and is category 1. Four of the sleep studies were RCTs [ 59 - 62 ], an additional single-group pilot study of only 13 people contributes little to the evidence base [ 29 ].
The four RCTs all used different acupoints. Two compared acupressure to sham points and control conversation [ 62 ]or routine care [ 60 ] but only one found significant improvements in sleep for acupressure compared to sham [ 62 ], giving limited evidence for specific effects. Three of the studies had powered and randomly selected samples between 44 and [ 60 , 62 ], validated procedure [ 62 ], intention-to-treat analysis or triple blinding [ 60 ].
The one study on alertness in the classroom [ 63 ]was a crossover study, randomly assigning 39 students to either stimulation-relaxation-relaxation or relaxation-stimulation-stimulation. Compared to relaxation, stimulation acupressure improved alertness. Although students were blinded, the majority correctly discerned the treatment. This did not significantly affect the results, although it raised p to 0.
Potential Hawthorne effect, small sample size 39 and low generalizability reduce the quality. Crossover design should reduce effects of retesting, carryover or time-related effects, although practise effect may be present especially with self-report.
Five studies investigated mental health, specifically dementia [ 64 , 65 ] and stress or anxiety [ 66 - 68 ]. The quality was very variable, with two pilot studies with sample sizes of 12 and 31 [ 64 , 68 ], a small one group study of 25 women [ 67 ] and two larger RCTs [ 65 , 69 ].
Category 2 evidence was present for anxiety related to surgery, although this was compared to sham only[ 69 ]. Fairly good evidence existed for agitation in dementia compared to control, although generalisability was limited by small sample size, lack of control and high attrition[ 65 ]. Evidence for reducing stress, anxiety and heart rate and thus enhancing spontaneous labour is promising, but limited by lack of control and a small, volunteer sample [ 67 ].
Six studies on respiratory conditions were identified, chronic obstructive pulmonary disease COPD [ 70 - 73 ], chronic obstructive asthma [ 74 ] and bronchiectasis [ 75 ]. Overall, the evidence is Category 2, as studies were well designed but had a number of methodological flaws.
Study designs included two controlled trials using randomised blocking design, matching groups for demographic and clinical factors [ 71 , 72 ]; one crossover design [ 70 ]; two pilot RCTs [ 74 , 75 ] and an RCT [ 73 ].
Results showed improvements in dyspnoea and decathexis compared to sham, although limited by high attrition, poor blinding and a small sample [ 70 ]. The pilot studies with the same authors showed improved quality of life for asthma patients [ 74 ] and sputum and respiratory scores for bronchiectasis compared to control [ 75 ], but are limited by small sample sizes, high dropout and lack of blinding.
Shiatsu regulates the automatic nervous system activity and stimulates the circulatory, lymphatic and hormonal systems. Poor posture, joint problems, sprains, arthritis, sciatica, acute and chronic neck and back pain, sinusitis, and bronchitis are treatable with Shiatsu.
More than 39 million Americans received a massage in the last year, according to an annual survey commissioned by the American Massage Therapy Association. More than half — 53 percent — who discussed massage with their healthcare providers say their doctor recommended they get massage therapy. Shiatsu is among the types, or modalities, of massage therapy to choose from. How is Shiatsu similar to or different from other techniques? While at-home massagers can help relieve tension, experts agree that a professional massage is a more enjoyable, thorough, and fulfilling experience.
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Call freephone 9 to 5 Monday to Friday or email us. Skip to main content. Home About cancer General cancer information Treatment for cancer Complementary and alternative therapies Individual therapies Shiatsu. Shiatsu is based on traditional Japanese massage therapy. Summary Shiatsu works with the body's energy flow, known as Ki or Qi pronounced chee. It uses acupressure to release tension and bring balance to the body.
It can help to lift your mood and make you feel relaxed. What is shiatsu? Why people with cancer use it One of the main reasons that people with cancer use shiatsu is that it makes them feel good. Some people with cancer say that it helps them cope better with their cancer and its treatment because it helps control symptoms and side effects such as: poor appetite sleep problems pain low mood After Shiatsu they feel very relaxed and have higher energy levels.
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