臺灣博碩士論文加值系統

Acupressure is a non-invasive ancient healing practice, in which pressure is applied to the specific acupoints on the body. Following emerging public health concern with poor sleep quality and growing acceptance of alternative treatments, up-to-date systematic review and meta- analysis were designed to evaluate the effect of acupressure on quality of sleep. Ten English (PubMed, CENTRAL, CINAHL etc.) and five Chinese (CNKI, WANFANG etc.) databases were searched and the validity of the eligible studies was critically appraised by Jadad score and Cochrane risk of bias assessment tool. A total of 32 randomized controlled trials, using polysomnography, actigraphy or self-assessment tools to measure quality of sleep, were included in the review. Only three studies applied objective measurements of sleep quality, but all of the three favored the intervention. We used Pittsburgh sleep quality index (PSQI) as the primary outcome measure in the meta-analysis with random effects model for 13 trials (968 adult patients) investigating effect of acupressure compared to standard and sham treatments. We performed subgroup analyses to detect the source of heterogeneity, to identify the use of acupoints in different populations and to explore the contribution of sleep components to the total score change. The comparison of intervention to sham group (7 trials, 385 patients) yielded overall effect of 13% to 19% improvement in PSQI score (MD = -3.41, 95% CI -4.08, -2.75; I2 =12%), with sleep latency being the most affected component (MD = -0.77, 95% CI from -0.81 to -0.05; I2 = 0%). No adverse effects were reported. Subgroup analyses for modes of acupressure, acupoints selection and type of patients showed no significant difference with high heterogeneity. Despite clinical heterogeneity between the included studies, the results showed that even fragile populations, such as elderly and/or dialysis patients can benefit from acupressure and several standardized treatment protocols exist, involving 3 to 5 kg pressure to HT7 (Shenmen) acupoint delivered three to seven times a week for three to four weeks. Main methodological drawback for most studies was blinding of patients and personnel. This review has been registered in PROSPERO (registration number CRD42015025013).

Table of Contents
Table of contents i
Acknowledgements iii
Abstract iv
Keywords iv
Abbreviations v
List of tables vi
List of figures vi
Chapter 1. Background 1
1.1 Sleep quality 1
1.2 Sleep quality assessment 2
1.3 Treatments for sleep problems 4
1.4 Acupressure 5
1.5 Previous reviews conclusions 7
1.6 Purpose statement 8
Chapter 2. Methods 9
2.1 Search strategy 9
2.2 Study selection 10
2.3 Data extraction 10
2.4 Quality assessment 11
2.5 Data synthesis and statistical analysis 12
Chapter 3. Results 13
3.1 Study characteristics 13
3.2 Risk of bias 15
3.3 Publication bias 15
3.4 Synthesis of evidence 16
Chapter 4. Discussion 18
References 23
Tables 31
Table 1. Qualitative summary of eligible studies. 31
Table 2. Subgroup analyses summary. 35
Table 3. Pittsburgh sleep quality index domains contribution to the total score change after the intervention. 36
Figures 37
Figure 1. Systematic review flowchart. 37
Figure 2. Risk of bias across the studies included for meta-analysis 38
Figure 3. Funnel plot for publication bias 39
Figure 4. Forest plot of reduction in global Pittsburgh sleep quality index, comparing experimental groups to controls receiving sham acupressure. 40
Appendices 41
Appendix A. Search strategies 41
English search strategy based on MESH terms 41
Chinese search strategy based on TCM dictionary 42
Appendix B. List of databases and search results 43
Appendix C. List of eligible studies for the systematic review 44
Appendix D. Cochrane risk of bias assessment tool 45
Appendix E. Jadad score 47
Appendix F. Subgroup analyses and Forest plots 49
1. Controls treatment 49
1.1 Controls treatment Forest plot 50
2. Acupressure modes 51
2.1 Acupressure modes Forest plot 52
3. Countries of study 53
3.1 Countries of study Forest plot 54
4. Measured vs not measured weight 55
4.1 Measured vs. not measured weight Forest plot 55
5. Acupoints 56
5.1 Acupoints Forest plot 57
6. Age groups 58
6.1 Age groups Forest plot 58
7. Pittsburgh sleep quality index (PSQI) domains 59
7.1 Total PSQI score Forest plot 60
7.2 Sleep latency Forest plot 60
7.3 Duration of sleep Forest plot 60
7.4 Sleep efficiency Forest plot 61
7.5 Sleep disturbance Forest plot 61
7.6 Need meds to sleep Forest plot 61
7.7 Day dysfunction due to sleepiness Forest plot 62
7.8 Overall sleep quality Forest plot 62

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