Lee, E. J., & Frazier, S. K. (2011). The efficacy of acupressure for symptom management: a systematic review. Journal of Pain and Symptom Management, 42, 589–603.

To systematically review randomized, controlled trials that investigated the efficacy of acupressure for the management of symptoms.

Databases searched were CINAHL, MEDLINE, and PubMed.

Search keywords were acupressure, clinical trial, human, and/or randomized.

Studies were included in the review if

• They were randomized, controlled trials published from January 1, 2000 to January 31, 2010
• They were published in English
• They used acupressure as the sole intervention for one group
• There were four or more studies of the efficacy of acupressure for that particular symptom.

Studies were excluded from the review if they

• Had sample sizes of less than 30 patients
• Used auricular or hand pressure, reflexology, shiatsu, and electronic or magnetic devices
• Were unpublished studies and abstracts.

In total, 108 references were screened.

Each experimental study was evaluated for quality using the Cochrane risk of bias (RoB) tool. Articles were evaluated for the presence of each of the six domains, and one point was assigned for each domain present. Scores ranged from zero to six, with higher values indicating higher quality and less risk for bias. All trials were evaluated by two authors, and agreement between them was 100%. A significant likelihood of bias was found in the evaluation.  

Only six randomized, controlled trials included were performed to determine the efficacy of acupressure on the reduction of fatigue and improvement of sleep in adults in various populations. Fatigue and insomnia were grouped together because those investigations were typically studied simultaneously.  
 

• The final number of studies included was 43.
• The total sample size was 5,021 patients across all studies of all symptoms. For studies that specifically focused on fatigue and insomnia, the sample size was 211 patients.
• The sample range across all studies was 36 to 739 for all studies of all symptoms.
• Multiple diagnoses and symptoms were included:  nausea, pregnancy, chemotherapy, radiation, surgery, motion sickness, pain, dysmenorrhea, labor, back pain, fracture, trauma, dyspnea, asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, endstage renal disease (ESRD), and insomnia.

Patients were undergoing the active treatment phase of care.

Only three studies conducted included a measure of fatigue. Six studies concluded that acupressure was effective in improving fatigue and reducing insomnia. Multiple symptoms were discussed in topic areas; findings from other symptom reviews were not included in the summary.

The review did not provide rigorous support for the use of acupressure for the efficacy of symptom management.

• Significant bias existed according to the Cochrane RoB tool. 
• Lack of fidelity to the intervention confounded the results and may have added bias to the studies.

Well-designed randomized, controlled trials are needed to determine the utility and efficacy of acupressure to manage various symptoms in several patient populations. Issues exist when looking at fatigue and insomnia concurrently, such as determining whether fatigue is an intervening variable for insomnia or an outcome variable of insomnia or whether insomnia is an intervening variable for fatigue. A conceptual framework is needed to guide how concurrent or symptom clusters are studied.