Self-administered acupressure for treating adult psychiatric patients with constipation: a randomized controlled trial

Wai Kit Wong, Wai Tong Chien, Wai Ming Lee, Wai Kit Wong, Wai Tong Chien, Wai Ming Lee

Abstract

Background: Constipation has a high prevalence rate (>30 %) in psychiatric patients with psychotropic drugs. Common pharmacological and non-pharmacological interventions for constipation might have longer-term negative and adverse effects that would outweigh their short-term efficacy in symptom reduction. This randomized controlled trial aims to investigate the effect of self-administered acupressure for the management of constipation, in hospitalized psychiatric patients.

Methods: Seventy-eight patients were recruited in matched pairs in terms of gender, age and laxative use from five acute psychiatric wards in Hong Kong. Each of these matched pairs of patients was randomly assigned to either a self-administered acupressure (n = 39) or a sham group (n = 39), using computer-generated random numbers. After baseline measurement, the intervention and sham group received the same training in self-administered acupressure and supervised practice once per day for 10 days, except light pressure on non-acupoints was taught to the sham group. The acupoints chosen for acupressure included Zhongwan (RN12), right and left Tianshu (ST25), right and left Quchi (LI11). Participants' symptoms and quality of life regarding constipation were measured at baseline and immediately and 2 weeks after completion of the interventions with constipation assessment scale and patient assessment of constipation quality of life questionnaire, respectively.

Results: After 2 weeks follow-up, participants who had received self-administered acupressure indicated significantly greater improvements in both symptom severity (P = 0.0003) and quality of life (P = 0.0004) when compared with the sham group.

Conclusion: The psychiatric patients with constipation who practiced self-administered acupressure for 10 days improved their symptom severity and perceived quality of life immediately and 2 weeks after completion of the intervention in comparison with the sham group.

Trial registration: The trial was registered with the ClinicalTrials.gov (Reg. No: NCT02187640).

Figures

Fig. 1
Fig. 1
Recruitment, retention and group allocation of participants during the study

References

    1. Cheng C, Chan AOO, Hui WM, Lam SK. Coping strategies, illness perception, anxiety and depression of patients with idiopathic constipation: a population-based study. Aliment Pharmacol Ther. 2003;18(3):319–326. doi: 10.1046/j.1365-2036.2003.01663.x.
    1. Higgens PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol. 2004;99:750–759. doi: 10.1111/j.1572-0241.2004.04114.x.
    1. Dockx L, De Hert M. Antipsychotic and constipation: literature review. Psychiatric Nurs. 2009;3:141–151.
    1. Wilson L. Understanding bowel problems in older people: part 2. Nurs Older People. 2005;17:24–29. doi: 10.7748/nop2005.12.17.9.24.c2399.
    1. Bengtsson M, Ohlsson B. Psychological well-being and symptoms in women with chronic constipation treated with sodium picosulphate. Gastroenterol Nurs. 2005;28(1):3–12. doi: 10.1097/00001610-200501000-00002.
    1. Jay RT, Gail AC. Palliative care and pain: new strategies for managing opioid bowel dysfunction. Journal of Palliative Medicine. 2008;11(1):1–19. doi: 10.1089/jpm.2008.9999.
    1. Dennison C, Prasad M, Lloyd A, Bhattacharyya SK, Dhawan R, Coyne K. The health-related quality of life and economic burden of constipation. Pharmacoeconomics. 2005;23:461–476. doi: 10.2165/00019053-200523050-00006.
    1. Pekmazaris R, Aversa L, Walf-Klein G, Cedarbaum J, Reid-Durant M. The cost of chronic constipation. J Am Med Dir Assoc. 2002;3:224–228. doi: 10.1016/S1525-8610(04)70482-X.
    1. National Institute of Diabetes and Digestive and Kidney Disease Database. .
    1. Stanniland C, Taylor D. Tolerability of atypical antipsychotics. Drug Saf. 2000;22(3):195–214. doi: 10.2165/00002018-200022030-00004.
    1. De Hert M, Hudyana H, Dockx L, Bernagie C, Sweers K, Tack J, Leucht S, Peuskens J. Second generation antipsychotics and constipation: a review of the literature. Eur Psychiatry. 2011;26(1):34–44. doi: 10.1016/j.eurpsy.2010.03.003.
    1. Raepsaet J, Knapen J, Vancampfort D, Probst M. Motivation to physical activity in non-psychotic psychiatric inpatients. Int J Psychosoc Rehabil. 2010;15(11):51–60.
    1. McCreadie R. Diet, smoking and cardiovascular risk in people with schizophrenia. Br J Psychiatry. 2003;183:534–539. doi: 10.1192/bjp.183.6.534.
    1. De Hert M, Dockx L, Bernagie C, Peuskens B, Sweers K, Lecht S, Van de Straete S, Peuskens J. Prevalence and severity of antipsychotic-related constipation in patients with schizophrenia: a retrospective descriptive study. BMC Gastroenterol. 2011;11(17):1–4.
    1. Li MK, Lee TF, Suen KP. A review on the complementary effects of auriculotherapy in managing constipation. J Altern Complement Med. 2010;16(4):435–447. doi: 10.1089/acm.2009.0348.
    1. Marieke D, Marloes EJ, de Giel-Jan V, Martha A, Bob F, Marc A. Behavioral therapy for childhood constipation: a randomized controlled trial. J Am Acad Pediatrics. 2008;121(5):1334–1341.
    1. Marybetts S. Review: the use of abdominal massage to treat chronic constipation. J Bodyw Mov Ther. 2010;xx:1–10.
    1. Zhang W. Evaluation of therapeutic effect and safety of deep acupuncture at Tianshu (ST25) for treatment of slow transit constipation. J Tradit Chin Med. 2006;47:105–107.
    1. Wang LS, Chen YM. Effective observation of using the acupuncture on the kidney meridian of foot-shaoyin to treat constipation. Liaoning J Tradit Chin Med. 2006;33:881–882.
    1. Liu ZS, Zheng CZ, Zhang W. Observation on the short-term therapeutic effect of deep-needling Tianshu (ST25) on senile constipation. Chin Acupunct Moxibustion. 2004;24:155–156.
    1. Lai HM, Cheng W, Li P, Tan J, Wu LI. Wangbuliuxing therapy for constipation in fractured patients. Nurs J Chin People’s Liberation Army. 2000;17:9–10.
    1. Lamas K, Lindholm L, Stenlund H, Engstorm B, Jacobsson C. Effects of abdominal massage in management of constipation. Int J Nurs Stud. 2009;46:759–767. doi: 10.1016/j.ijnurstu.2009.01.007.
    1. Mains JA, Scoggins FR. The effectiveness of self-administered treatments: a practice-friendly review of the research. J Clin Psychol Sess. 2003;59:237–246. doi: 10.1002/jclp.10145.
    1. Liu Y. The essential book of traditional Chinese medicine. New York: Columbia University Press; 1988.
    1. Davis CL, Lewith GT, Broomfield J, Prescott P. A pilot project to assess the methodological issues in evaluating acupuncture as a treatment for disabling breathlessness. J Altern Complement Med. 2001;7(6):633–639. doi: 10.1089/10755530152755180.
    1. Stannard D. Pressure prevents nausea. Nurs Times. 1989;85(4):33–34.
    1. Dundee JW, Yang J. Prolongation of the antiemetic action of P6 acupuncture by acupressure in-patients having cancer chemotherapy. J R Soc Med. 1990;83:360–362.
    1. Wang HP, Horng HC, Lu CM, Chen MY, Chen HC, Chang CH, Lin CH. The effectiveness of acupressure on stroke patient with constipation. Chang Gung Nurs. 2006;17(4):418–427.
    1. Chen YT, Chang Y, Bai CH. The effectiveness of acupressure at relieving constipation in neurological patients. J Evid Based Nurs. 2006;2(4):301–310.
    1. Lin SF, Tang WR, Chang YC, Maa SH. Effectiveness of acupressure on elderly patients with constipation. J Nurs Healthc Res. 2011;7(3):175–187.
    1. Scogin F, Hanson A, Welsh D. Self-administered treatment in stepped-care models of depression treatment. J Clin Psychol. 2003;59:341–349. doi: 10.1002/jclp.10133.
    1. Watkins PL, Clum GA. Handbook of self-help therapy. New York: Taylor & Francis Group; 2008.
    1. Wong WK. Evaluation of the effect of acupressure protocol on adult psychiatric in-patients with constipation. DHSc thesis. The Hong Kong Polytechnic University, Faculty of Health and Social Sciences; 2014.
    1. McMillan SC, Williams FA. Validity and reliability of the Constipation Assessment Scale. Cancer Nurs. 1989;12(3):183–188. doi: 10.1097/00002820-198906000-00012.
    1. Marouis P, De La Loge C, Dubois D, Mcdermott A, Chassany O. Development and validation of the patient assessment of constipation quality of life questionnaire. Scand J Gastroenterol. 2005;40:540–551. doi: 10.1080/00365520510012208.
    1. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorder. Gastroenterology. 2006;130:1480–1491. doi: 10.1053/j.gastro.2005.11.061.
    1. Chen LJ, Chao ML. Effects of acupressure at relieving constipation in persistent vegetative state: a randomized control trial. J Integr Chin West Med. 2010;12(2):11–20.
    1. Yu D, Cao R, Wu J. Tui-Na of Chinese Medicine. Beijing: People’s Medical Publishing House; 1985.
    1. Yau ML, Cheung ST. Acupuncture. Shanghai: Shanghai Science and Technology; 1983.
    1. Preece J. Introducing abdominal massage in palliative care for the relief of constipation. Complement Ther Nurs Midwifery. 2002;8(2):101–105. doi: 10.1054/ctnm.2002.0610.
    1. McMillan SC, Williams FA. Validity and reliability of the Constipation Assessment Scale. Cancer Nurs. 1989;12(3):183–188. doi: 10.1097/00002820-198906000-00012.
    1. Broussard BS. The constipation assessment scale for pregnancy. J Obstet Gynecol Neonate Nurs. 1998;27(3):297–301. doi: 10.1111/j.1552-6909.1998.tb02652.x.
    1. World Health Organization: Healthy diet. .
    1. Tada H, Fujita M, Harris M, Tatewaki M, Nakagawa K, Yamamura T, Takahashi T. Neural mechanism of acupuncture-induced gastric relaxations in rats. Dig Discov Sci. 2003;45:59–68. doi: 10.1023/A:1021730314068.
    1. Zhu B, Rong PJ, Li YQ, Mei ZG, He W. Acupoints-stimulated effective regularity and its mechanisms. World J Acupunct Moxibustion. 2009;19(1):6–10.
    1. Stahl E, Lindberg A, Jansson SA, et al. Health-related quality of life is related to COPD disease severity. Health Qual Life Outcomes. 2005;3:56. doi: 10.1186/1477-7525-3-56.
    1. Wald A, Scarpignato C, Kamm MA, Mueller-lissners S, Helfrich I, Schuijt C, Petrini O. The burden of constipation on quality of life: results of a multinational survey. Aliment Pharmacol Ther. 2007;26(2):227–236. doi: 10.1111/j.1365-2036.2007.03376.x.
    1. Anderson L, Lewis G, Araya R, Elgie R, Harrison G, Proudfoot J, Williams C. Self-help books for depression: how can practitioners and patients make the right choice? Br J Gen Pract. 2005;55:387–392.
    1. Pantalon MV. Use of self-help books in the practice of clinical psychology. In: Bellack AS, Hersen M, Salkovskis P, editors. Comprehensive clinical psychology: volume 6. Adults: clinical formulation and treatment. New York: Elsevier Science; 1998. p. 265–276.
    1. Garvin V, Striegel-Moore RH, Kaplan A, Wonderlich SA. The potential of professionally developed self-help interventions for the treatment of eating disorders. In: Striegel-Moore RH, Smolak L, editors. Eating disorders: innovative directions in research and practice. Washington: American Psychological Association; 2001. pp. 153–172.
    1. Lev EL, Owen SV. A measure of self-care self-efficacy. Res Nurs Health. 1996;19:421–429. doi: 10.1002/(SICI)1098-240X(199610)19:5<421::AID-NUR6>;2-S.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren