Avc, H.S., Ovayolu, N., & Ovayolu, O. (2016). Effect of acupressure on nausea-vomiting in patients with acute myeloblastic leukemia. Holistic Nursing Practice, 30, 257–262. 

To assess the effect of wristband acupressure applied at the P6 (Neiguan) acupuncture point on chemotherapy-induced nausea and vomiting (CINV) in patients with acute myeloblastic leukemia (AML)

Ninety patients with AML receiving the same chemotherapy regimen (high emetogenic chemotherapy, idarubicin and cytarabine) and who received at least the first cycle of chemotherapy were randomized to the control, pressure, or wristband (bilaterally) group for four days. All the patients received the same antiemetics regimen. The researcher applied pressure and instructed patients in the pressure and wristband groups on how to apply pressure on the P6 point (for 15 minutes on each arm) 30 minutes before chemotherapy; patients in the wristband group wore it 30 minutes before chemotherapy and were asked to wear it almost continuously.

• N = 90 (30 in each group; power analysis was conducted and achieved)   
• AGE: 17–62 years
• MALES: 55.6% (50 patients [15, 19, 16 in the three groups]), FEMALES: 44.4% (40 patients [15, 11, 14 in the three groups])
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Patients diagnosed with AML who did not have lymphedema, no communication, visual or hearing problems, and no psychiatric disorder
• OTHER KEY SAMPLE CHARACTERISTICS: Received the same chemotherapy regimen, had adequate understanding of and speaking skills in Turkish, received at least one chemotherapy cycle, and experienced nausea and vomiting in their previous chemotherapy cycles

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Turkey

PHASE OF CARE: Active antitumor treatment

Three-arm, randomized, controlled trial

• Face-to-face interviews to fill in the questionnaire (for demographical data, disease, chemotherapy protocol, antiemetics)
• Visual analog scale (VAS) to measure the severity of nausea and vomiting every 24 hours for four days

Severity of nausea was less in the wristband group on all study days (p = 0.001) as was severity of vomiting (p < 0.001) and the number of vomiting episodes (p = 0.001). The pressure group had the lowest number of nausea episodes (p = 0.002), and vomiting of that group was lower than in the controls (p = 0.006). Nausea and vomiting declined in all groups over the four study days.

The acupressure band was effective in reducing CINV, and direct pressure application prior to chemotherapy was better than no treatment.

• Small sample (< 100)
• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Measurement validity/reliability questionable
• Using the VAS to measure CINV
• Not measuring anticipatory nausea and vomiting
• No double blinding
• Not considering the cross-sectional research design to control the bias
• The baseline CINV was lowest in the wristband group.

Acupressure (using the wristband) is a complement antiemetic method to control CINV. It is an easy to apply, safe, and cost-efficient, with no side effects. It is also easily taught and learned.