Self-administered acupressure for symptom management among Chinese family caregivers with caregiver stress: a randomized, wait-list controlled trial

Agnes Tiwari, Lixing Lao, Amy Xiao-Min Wang, Denise Shuk Ting Cheung, Mike Ka Pui So, Doris Sau Fung Yu, Terry Yat Sang Lum, Helina Yin King Yuk Fung, Jerry Wing Fai Yeung, Zhang-Jin Zhang, Agnes Tiwari, Lixing Lao, Amy Xiao-Min Wang, Denise Shuk Ting Cheung, Mike Ka Pui So, Doris Sau Fung Yu, Terry Yat Sang Lum, Helina Yin King Yuk Fung, Jerry Wing Fai Yeung, Zhang-Jin Zhang

Abstract

Background: Caregiving can be stressful, potentially creating physical and psychological strain. Substantial evidence has shown that family caregivers suffer from significant health problems arising from the demands of caregiving. Although there are programs supporting caregivers, there is little evidence regarding their effectiveness. Acupressure is an ancient Chinese healing method designed to restore the flow of Qi (vital energy) by applying external pressure to acupoints. A randomized, wait-list controlled trial was developed to evaluate the effectiveness of a self-administered acupressure intervention on caregiver stress (primary objective) and stress-related symptoms of fatigue, insomnia, depression, and health-related quality of life (secondary objectives) in Chinese caregivers of older family members.

Methods: Two hundred Chinese participants, aged ≥ 21 years, who are the primary caregivers of an older family member and screen positive for caregiver stress and symptoms of fatigue/insomnia/depression will be recruited from a community setting in Hong Kong. Subjects will be randomized to receive either an immediate treatment condition (self-administered acupressure intervention) or a wait-list control condition. The self-administered acupressure intervention will include (i) an individual learning and practice session twice a week for 2 weeks, (ii) a home follow-up visit once a week for 2 weeks, and (iii) 15-min self-practice twice a day for 6 weeks. The wait-list control group will receive the same acupressure training after the intervention group has completed the intervention. We hypothesize that Chinese family caregivers in the intervention group will have lower levels of caregiver stress, fatigue, insomnia, depression, and higher health-related quality of life after completion of the intervention than participants in the wait-list control group.

Discussion: This study will provide evidence for the effectiveness of self-administered acupressure in reducing stress and improving symptoms of fatigue, insomnia, depression, and health-related quality of life in Chinese family caregivers. The findings will inform the design of interventions to relieve negative health effects of caregiving. Furthermore, the results can raise community awareness and serve as a basis for policymaking, planning, and allocation of resources regarding empowerment of family caregivers for self-care.

Trial registration: Current Controlled Trials NCT02526446 . Registered August 10, 2015.

Keywords: Acupressure; Caregiver stress; Chinese; Depression; Family caregivers; Fatigue; Health-related quality of life; Insomnia; Intervention; Randomized controlled trial (RCT); Self-administered acupressure.

Figures

Fig. 1
Fig. 1
Flow diagram of intervention/wait-list control and data collection points

References

    1. National Institute on Aging (NIA), National Institutes of Health (NIH). Global Health and Aging. . Accessed 24 Oct 2016.
    1. Family Caregiver Alliance. Impact of Caregiving on Caregiver Mental and Emotional Health. . Accessed 24 Oct 2016.
    1. Adelman RD, Tmanova LL, Delgado D, Dion S, Lachs MS. Caregiver burden: a clinical review. JAMA. 2014;311(10):1052–9. doi: 10.1001/jama.2014.304.
    1. Schulz R, Sherwood PR. Physical and mental health effects of family caregiving. Am J Nurs. 2008;108(9 Suppl):23–7. doi: 10.1097/01.NAJ.0000336406.45248.4c.
    1. Smith L, Onwumere J, Craig T, McManus S, Bebbington P, Kuipers E. Mental and physical illness in caregivers: results from an English national survey sample. Br J Psychiatry. 2014;205(3):197–203. doi: 10.1192/bjp.bp.112.125369.
    1. Choi J, Tate JA, Hoffman LA, Schulz R, Ren D, Donahoe MP, Given BA, Sherwood PR. Fatigue in family caregivers of adult intensive care unit survivors. J Pain Symptom Manage. 2014;48(3):353–63. doi: 10.1016/j.jpainsymman.2013.09.018.
    1. Chiu YC, Lee YN, Wang PC, Chang TH, Li CL, Hsu WC, Lee SH. Family caregivers’ sleep disturbance and its associations with multilevel stressors when caring for patients with dementia. Aging Ment Health. 2014;18(1):92–101. doi: 10.1080/13607863.2013.837141.
    1. Andrieu S, Rive B, Guilhaume C, Kurz X, Scuvee-Moreau J, Grand A, Dresse A. New assessment of dependency in demented patients: impact on the quality of life in informal caregivers. Psychiatry Clin Neurosci. 2007;61(3):234–42. doi: 10.1111/j.1440-1819.2007.01660.x.
    1. Jessup NM, Bakas T, McLennon SM, Weaver MT. Are there gender, racial or relationship differences in caregiver task difficulty, depressive symptoms and life changes among stroke family caregivers? Brain Inj. 2015;29(1):17–24. doi: 10.3109/02699052.2014.947631.
    1. Sant SV. China’s rapidly aging population strains resources. In: Voice of America. 2015. . Accessed 1 Mar 2016.
    1. Hua X. China to increase elderly bed numbers. In: China daily. 2016. . Accessed 1 Mar 2016.
    1. Chow C, Tiwari AF. Experience of family caregivers of community-dwelling stroke survivors and risk of elder absue: a qualitative study. J Adult Protection. 2014;16(5):276–93. doi: 10.1108/JAP-03-2014-0007.
    1. Yeung WF, Chung KF, Poon MM, Ho FY, Zhang SP, Zhang ZJ, Ziea ET, Wong VT. Acupressure, reflexology, and auricular acupressure for insomnia: a systematic review of randomized controlled trials. Sleep Med. 2012;13(8):971–84. doi: 10.1016/j.sleep.2012.06.003.
    1. Zhang Y, Shen CL, Peck K, Brismee JM, Doctolero S, Lo DF, Lim Y, Lao L. Training self-administered acupressure exercise among postmenopausal women with osteoarthritic knee pain: a feasibility study and lessons learned. Evid-Based Complement Alternat Med. 2012;2012:570431.
    1. Zhang ZJ, Chen HY, Yip KC, Ng R, Wong VT. The effectiveness and safety of acupuncture therapy in depressive disorders: systematic review and meta-analysis. J Affect Disord. 2010;124(1–2):9–21. doi: 10.1016/j.jad.2009.07.005.
    1. Zhang J, Zhao B, Lao LX, editors. Acupuncture and Moxibustion (International Standard Library of Chinese Medicine) Beijing China: People’s Medical Publishing House; 2014.
    1. Lee EJ, Frazier SK. The efficacy of acupressure for symptom management: a systematic review. J Pain Symptom Manage. 2011;42(4):589–603. doi: 10.1016/j.jpainsymman.2011.01.007.
    1. Song HJ, Seo HJ, Lee H, Son H, Choi SM, Lee S. Effect of self-acupressure for symptom management: a systematic review. Complement Ther Med. 2015;23(1):68–78. doi: 10.1016/j.ctim.2014.11.002.
    1. Harris RE, Jeter J, Chan P, Higgins P, Kong FM, Fazel R, Bramson C, Gillespie B. Using acupressure to modify alertness in the classroom: a single-blinded, randomized, cross-over trial. J Altern Complement Med (New York, N Y) 2005;11(4):673–9. doi: 10.1089/acm.2005.11.673.
    1. Hmwe NT, Subramanian P, Tan LP, Chong WK. The effects of acupressure on depression, anxiety and stress in patients with hemodialysis: a randomized controlled trial. Int J Nurs Stud. 2015;52(2):509–18. doi: 10.1016/j.ijnurstu.2014.11.002.
    1. Nordio M, Romanelli F. Efficacy of wrists overnight compression (HT 7 point) on insomniacs: possible role of melatonin? Minerva Med. 2008;99(6):539–47.
    1. Tsay SL, Cho YC, Chen ML. Acupressure and transcutaneous electrical acupoint stimulation in improving fatigue, sleep quality and depression in hemodialysis patients. Am J Chin Med. 2004;32(3):407–16. doi: 10.1142/S0192415X04002065.
    1. Molassiotis A, Sylt P, Diggins H. The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial. Complement Ther Med. 2007;15(4):228–37. doi: 10.1016/j.ctim.2006.09.009.
    1. Yu H, Wang X, He R, Liang R, Zhou L. Measuring the caregiver burden of caring for community-residing people with Alzheimer’s disease. PLoS One. 2015;10(7):e0132168. doi: 10.1371/journal.pone.0132168.
    1. Wang XM, Walitt B, Saligan L, Tiwari AF, Cheung CW, Zhang ZJ. Chemobrain: a critical review and causal hypothesis of link between cytokines and epigenetic reprogramming associated with chemotherapy. Cytokine. 2015;72(1):86–96. doi: 10.1016/j.cyto.2014.12.006.
    1. Social Analysis and Research Section (2), Census and Statistics Department, HKSAR. Population and Household Statistics Analysed by District Council District 2013. . Accessed 1 Mar 2016.
    1. Chou KR, Jiann-Chyun L, Chu H. The reliability and validity of the Chinese version of the caregiver burden inventory. Nurs Res. 2002;51(5):324–31. doi: 10.1097/00006199-200209000-00009.
    1. Cho YC, Tsay SL. The effect of acupressure with massage on fatigue and depression in patients with end-stage renal disease. J Nurs Res. 2004;12(1):51–9. doi: 10.1097/01.JNR.0000387488.63438.9a.
    1. Tsay SL, Chen ML. Acupressure and quality of sleep in patients with end-stage renal disease--a randomized controlled trial. Int J Nurs Stud. 2003;40(1):1–7. doi: 10.1016/S0020-7489(02)00019-6.
    1. Chen S, Chiu H, Xu B, Ma Y, Jin T, Wu M, Conwell Y. Reliability and validity of the PHQ-9 for screening late-life depression in Chinese primary care. Int J Geriatr Psychiatry. 2010;25(11):1127–33. doi: 10.1002/gps.2442.
    1. Lam ET, Lam CL, Fong DY, Huang WW. Is the SF-12 version 2 Health Survey a valid and equivalent substitute for the SF-36 version 2 Health Survey for the Chinese. J Eval Clin Pract. 2013;19(1):200–8. doi: 10.1111/j.1365-2753.2011.01800.x.
    1. Araujo CD, Veiga DF, Hochman B, Abla LE, Novo NF, Ferreira LM. Health economics and health preference concepts to orthopedics practitioners. Acta Ortopédica Brasileira. 2014;22:102–5. doi: 10.1590/1413-78522014220200456.
    1. McLennon SM, Bakas T, Jessup NM, Habermann B, Weaver MT. Task difficulty and life changes among stroke family caregivers: relationship to depressive symptoms. Arch Phys Med Rehabil. 2014;95(12):2484–90. doi: 10.1016/j.apmr.2014.04.028.
    1. Mosher CE, Bakas T, Champion VL. Physical health, mental health, and life changes among family caregivers of patients with lung cancer. Oncol Nurs Forum. 2013;40(1):53–61. doi: 10.1188/13.ONF.53-61.
    1. Gitlin LN, Belle SH, Burgio LD, Czaja SJ, Mahoney D, Gallagher-Thompson D, Burns R, Hauck WW, Zhang S, Schulz R, et al. Effect of multicomponent interventions on caregiver burden and depression: The REACH multisite initiative at 6-month follow-up. Psychol Aging. 2003;18(3):361–74. doi: 10.1037/0882-7974.18.3.361.
    1. Schulz R, Martire LM. Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry. 2004;12(3):240–9. doi: 10.1097/00019442-200405000-00002.
    1. Van’t Leven N, Prick AE, Groenewoud JG, Roelofs PD, de Lange J, Pot AM. Dyadic interventions for community-dwelling people with dementia and their family caregivers: a systematic review. Int Psychogeriatr. 2013;25(10):1581–603. doi: 10.1017/S1041610213000860.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe