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most of which stress that its concepts are similar to those of acupuncture. The main difference is that, instead of needle insertion, pressure is used for stimulation of acupuncture points. Normally this pressure is applied manually.
Although acupressure is often recommended as a symptomatic treatment for a wide range of conditions, for example, arthritis, claustrophobia, the common cold, gastrointestinal problems, gynecological complaints, insomnia, laryngitis, neuralgia, sciatica, renal disease, stuttering, sweating, tinnitus, and vertigo,
Many clinical trials have emerged, but their results are contradictory. Systematic reviews assessing the totality of this evidence might bring clarification, but several such articles have been published, and their conclusions also are contradictory.
This overview is aimed at summarizing and critically evaluating all systematic reviews of acupressure as a symptomatic treatment for any condition. Our ultimate goal is to provide clinicians with clearer guidance as to the value of this approach.
Electronic literature searches were carried out in April 2010 using Medline, Embase, Amed, CINAHL, the Cochrane Library, six Korean medical databases and Chinese databases, without restrictions as to time or language. The search terms were acupressure, shiatsu, acupuncture point stimulation, systematic review, and meta-analysis. In addition, our departmental files were hand-searched. Abstracts of reviews thus located were inspected by the authors, and those appearing to meet the inclusion criteria were retrieved and read in full by both authors. Reviews were defined as systematic if they included an explicit and repeatable methods section describing the search strategy and explicit inclusion/exclusion criteria.
To be included, a systematic review had to be concerned specifically with the effectiveness of acupressure and include evidence from at least two controlled clinical trials. Systematic reviews evaluating acupressure together with acupuncture, without evaluating the two approaches separately, were excluded. Reviews that were not systematic
Judgments about the quality of the primary studies were adopted from the respective systematic reviews. The Overview Quality Assessment Questionnaire was used to evaluate the methodological quality of all included systematic reviews.
The score ranges from 1 to 7; a score of three or less was considered as indicative of major flaws and a score of five or more as suggesting only minor flaws. Both authors did these assessments independently, and discrepancies were settled by discussion.
The systematic reviews had been published between 1996 and 2010. Most were published after 2000. They included between two and 71 sets of primary data, which, in many cases, were methodologically flawed. The majority related to the treatment of nausea and vomiting.
arrived at an inconclusive overall result, whereas most of the other systematic reviews drew positive conclusions about the effectiveness of acupressure (Table 2).
Our overview shows that several systematic reviews of acupressure have been published. The fact that most of them were recent indicates that the scientific interest in acupressure is growing. Most of the reviews are of poor quality, are based on few and often less than rigorous clinical trials, and arrive at overall positive conclusions.
For the treatment of nausea and vomiting, there are four reviews.
They are all positive but invariably of poor quality and based on mostly poor-quality primary studies. Thus, it might be wise to err on the safe side and consider acupressure not solidly evidence based for that indication.
For the prevention of nausea and vomiting, only one systematic review exists.
Both are of poor quality and both rely on a small number of flawed studies. It seems fair to say that the value of acupressure is not well documented for either of these conditions.
In essence, this means that the effectiveness of acupressure is currently not well documented for any condition. This is in sharp contrast to the many claims made by the proponents of this therapeutic modality.
The intriguing question arises: Does acupressure require a rigorous scientific evaluation at all? It is a safe and pleasant treatment and, if patients want it, appreciate it and pay for it, why not? This stance seems certainly reasonable, and we might agree with it. Yet, if proponents of any therapy make therapeutic claims that go beyond the notion of “a pleasant experience,” we need data to support these claims. In the case of acupressure, many such claims are being made (see above). We feel, therefore, that given the lack of sound evidence, such claims might not be responsible.
Our overview has several important limitations. Although our search strategy seemed thorough, we cannot totally exclude the notion that relevant articles were missed. By evaluating systematic reviews rather than clinical trials, important details of the primary studies may have been lost. Most crucially, the poor quality of the primary data and the systematic reviews is regrettable. Collectively, these limitations limit the conclusiveness of our findings.
In conclusion, although nine systematic reviews of acupressure are currently available, the effectiveness for this treatment has not been conclusively demonstrated for any condition.