No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
The Effectiveness of Shiatsu : Findings from a Cross-European, Prospective Observational Study
Abstract
The objective of this study was to explore client perceptions of the short-term and longer-term effects of shiatsu.
The study design was a prospective, 6-month observational, pragmatic study.
There were 85 shiatsu practitioners in three countries involved in the study: Austria, Spain, and the United Kingdom.
There were 948 clients receiving shiatsu from 1 of these practitioners.
Shiatsu as delivered by the practitioner in routine practice.
The outcomes measures were symptom severity, changes in health care use (baseline, 3 and 6 months), shiatsu-specific effects, uptake of advice (3 and 6 months), achieved expectations and occurrence of adverse events (4-6 days after first session, 3 and 6 months).
Six hundred and thirty-three (633) clients provided full follow-up data (a response rate of 67%). A typical shiatsu user was female, in her 40s, in paid employment, and had used shiatsu before. At "first-ever" use, the most typical reason for trying shiatsu was "out of curiosity." At "today's" session, the dominant reason was health maintenance. The most mentioned symptom groups were problems with "muscles, joints, or body structure," "tension/stress," and "low energy/fatigue." Symptom scores improved significantly over the 6 months (all symptom groups, Austria and the United Kingdom; two symptom groups, Spain), with moderate effect sizes (0.66-0.77) for "tension or stress" and "body structure problems" (Austria, the United Kingdom), and small effect sizes (0.32-0.47) for the other symptom groups (Spain, 0.28-0.43 for four groups). Previous users reported significant symptom improvement from "first ever" to baseline with moderate effect sizes. Across countries, substantial proportions (> or = 60%) agreed or agreed strongly with shiatsu-specific benefits. At 6 months, 77%-80% indicated that they had made changes to their lifestyle as a result of having shiatsu, and reductions in the use of conventional medicine (16%-22%) and medication (15%-34%). Ten (10) adverse events were reported by 9 clients (1.4%); none of these clients ceased shiatsu.
Clients receiving shiatsu reported improvements in symptom severity and changes in their health-related behaviour that they attributed to their treatment, suggestive of a role for shiatsu in maintaining and enhancing health.
... First, shiatsu is a holistic discipline that approaches treatment by considering the whole body, whereas acupressure, in most cases, chooses to treat a few points only. (5,6) Second, the pressure used in shiatsu is always stationary and sustained. (1) In acupressure, the pressure applied is often circular or may use a pumping action in which the thumb repeatedly presses and releases pressure quickly. ...
... And, there are others, including the authors of this article, who echo the statement by Teimoori et al. (12) that the two techniques are different. (5) These examples are but a few that illustrate the need to explore the differences between shiatsu and acupressure. ...
... Vi d e o 4 -h t t p s : / / w w w. y o u t u b e . c o m / watch?v=cOomHz6wEEU shows the difference between pumping pressure (defined, for example, as pressure at a frequency of 60 times per minute for 60 s) (5) and sustained pressure. It compares scenes from the following videos: "Acupressure: Acupressure for the foot" (https://www.youtube. ...
Background:
Although shiatsu has been taught in specialized schools in Japan since 1940, there is a limited amount of research for its practice. As a result, authors substitute shiatsu with acupressure to use available research on acupressure. It is the position of the authors that, while the two share common aspects, they are substantively different. This project was undertaken to describe technical differences and advocate for a clear distinction, especially in research studies and academic discussions.
Methods:
To understand whether it is appropriate to include acupressure studies in the evidence for shiatsu an analysis of the references included in a frequently cited systematic review was conducted to collect information about the protocols. In addition, a preliminary exploration of shiatsu practitioners' perceptions about the differences between shiatsu and acupressure is described. This exploration used videos of shiatsu and acupressure techniques and asked practitioners to comment on their perception of similarity.
Discussion:
The results identified several key technical differences between the two, including type of pressure applied, the positioning of the thumb, and the way in which body weight is used. Researchers should separate shiatsu and acupressure in their designs and purposively choose one or the other. To facilitate such clarification, we have proposed a definition for shiatsu that may facilitate the differentiation between these two techniques.
Conclusion:
The authors hope to stimulate discussion about the differences between shiatsu and acupressure, and to question the appropriateness of using acupressure studies as evidence of the efficacy of shiatsu. A true understanding of the efficacy of shiatsu cannot be determined until studies use a common definition of shiatsu and discontinue substituting acupressure research for evidence of shiatsu efficacy. When this happens, it is proposed that a clearer picture of the safety, efficacy, and mechanism of action of both shiatsu and acupressure will emerge.
... The second case study, undertaken in the modality of shiatsu, a body-based life-energy therapy developed in Japan and influenced by Western knowledge, casts light on the potential of a CAM to enhance critical health literacy. The case study is situated within a wider research study which aimed to provide cross-European insight into patientperceived experiences and effects of shiatsu [20]. The wider study used a longitudinal, observational study design. ...
... Over an eleven month period, 948 clients were recruited by 85 practitioners, and 633 clients completed all four questionnaires, a response rate of 67%. Full detail of the study methods can be found in [20] Long. ...
... Long's [20] longitudinal study provided cross-European evidence on client-reported effects, both positive and negative, of shiatsu over time, as delivered and received within routine practice for clients coming to shiatsu for whatever reason. The results demonstrated a set of interconnected and consistent evidence of client-perceived, beneficial effects in the short and longer term, as measured by changes in symptom severity, shiatsu-specific measures, the uptake of advice, primary care use, meeting expectations and satisfaction levels. ...
Healthcare services across Europe face increasing pressure on service provision within a context of tight resource constraints, population ageing, an ever-increasing burden of chronic illness and multiple co-morbidities. However, a very low, average of 3% of resources is spent on prevention. With the publication of Health 2020, a resurgence of public health, with its focus on promoting and protecting the health of communities, becomes a real possibility. This paper explores the potential of Complementary and Alternative Medicine (CAM) as an innovative practice to enhance health and well-being, and thus public health. Beginning with an overview of CAM’s core values and principles and evidence on its prevalence and user popularity, the paper focuses on the need to extend the notion of what counts as an outcome and the criticality of model validity in evaluating any CAM. Research evidence is presented on the potential value of CAM, with particular focus on findings from two case studies, one of traditional acupuncture, illustrating the importance of assessing outcome patterns, and the other of shiatsu illustrating the potential for enhancing critical health literacy. The set of emerging evidence points to CAM’s potential to develop clients’ critical health literacy, through enhancing awareness of the mind-body-lifestyle inter-connections and supporting enhanced control over their own lives. It argues that CAM has major potential to complement and add to individuals’ healing practices with a view to its provision within integrative healthcare practice.
... Health problems which may be amenable to treatment by Shiatsu include: headaches, migraine, stiff necks and shoulders, backaches, coughs, colds, menstrual problems, respiratory illnesses including asthma and bronchitis, sinus trouble and catarrh, insomnia, tension, anxiety and depression, fatigue and weakness, digestive disorders and bowel trouble, circulatory problems, rheumatic and arthritic complaints, sciatica and conditions following sprains and injuries [3]. Shiatsu is, however, a holistic therapy and often also impacts a patient's well-being, lifestyle, diet, body/mind awareness [7]. Shiatsu is commonly used by older (median age of 50 in the UK) females [7]. ...
... Shiatsu is, however, a holistic therapy and often also impacts a patient's well-being, lifestyle, diet, body/mind awareness [7]. Shiatsu is commonly used by older (median age of 50 in the UK) females [7]. ...
... The small and selfselected samples and lack of control group in these studies limits the quality and generalisablity of the results. In addition 13 of Brady et al's [26] participants had previously received Shiatsu Long (2008) conducted a prospective observational study of 948 patients of Shiatsu practitioners in 3 different countries [7]. Significant improvement in symptoms, especially for tension or stress and structural problems (effect size 0.66 to 0.77) were demonstrated. ...
Background: Shiatsu, similar to acupressure, uses finger pressure, manipulations and stretches, along Traditional Chinese Medicine meridians. Shiatsu is popular in Europe, but lacks reviews on its evidence-base.
... Health problems which may be amenable to treatment by Shiatsu include: headaches, migraine, stiff necks and shoulders, backaches, coughs, colds, menstrual problems, respiratory illnesses including asthma and bronchitis, sinus trouble and catarrh, insomnia, tension , anxiety and depression, fatigue and weakness, digestive disorders and bowel trouble, circulatory problems , rheumatic and arthritic complaints, sciatica and conditions following sprains and injuries [3]. Shiatsu is, however, a holistic therapy and often also impacts a patient's well-being, lifestyle, diet, body/mind awareness [7]. Shiatsu is commonly used by older (median age of 50 in the UK) females [7]. ...
... Shiatsu is, however, a holistic therapy and often also impacts a patient's well-being, lifestyle, diet, body/mind awareness [7]. Shiatsu is commonly used by older (median age of 50 in the UK) females [7]. This review aimed to identify the evidence base informing the practice of Shiatsu. ...
... The small and selfselected samples and lack of control group in these studies limits the quality and generalisablity of the results. In addition 13 of Brady et al's [26] participants had previously received Shiatsu Long (2008) conducted a prospective observational study of 948 patients of Shiatsu practitioners in 3 different countries[7]. Significant improvement in symptoms, especially for tension or stress and structural problems (effect size 0.66 to 0.77) were demonstrated. This study is of greater quality than other Shiatsu studies as the sample size was powered and it used a longitudinal and pragmatic study design. ...
Shiatsu, similar to acupressure, uses finger pressure, manipulations and stretches, along Traditional Chinese Medicine meridians. Shiatsu is popular in Europe, but lacks reviews on its evidence-base.
Acupressure and Shiatsu clinical trials were identified using the MeSH term 'acupressure' in: EBM reviews; AMED; BNI; CINAHL; EMBASE; MEDLINE; PsycARTICLES; Science Direct; Blackwell Synergy; Ingenta Select; Wiley Interscience; Index to Theses and ZETOC. References of articles were checked. Inclusion criteria were Shiatsu or acupressure administered manually/bodily, published after January 1990. Two reviewers performed independent study selection and evaluation of study design and reporting, using standardised checklists (CONSORT, TREND, CASP and STRICTA).
Searches identified 1714 publications. Final inclusions were 9 Shiatsu and 71 acupressure studies. A quarter were graded A (highest quality). Shiatsu studies comprised 1 RCT, three controlled non-randomised, one within-subjects, one observational and 3 uncontrolled studies investigating mental and physical health issues. Evidence was of insufficient quantity and quality. Acupressure studies included 2 meta-analyses, 6 systematic reviews and 39 RCTs. Strongest evidence was for pain (particularly dysmenorrhoea, lower back and labour), post-operative nausea and vomiting. Additionally quality evidence found improvements in sleep in institutionalised elderly. Variable/poor quality evidence existed for renal disease symptoms, dementia, stress, anxiety and respiratory conditions. Appraisal tools may be inappropriate for some study designs. Potential biases included focus on UK/USA databases, limited grey literature, and exclusion of qualitative and pre-1989 studies.
Evidence is improving in quantity, quality and reporting, but more research is needed, particularly for Shiatsu, where evidence is poor. Acupressure may be beneficial for pain, nausea and vomiting and sleep.
... It is a personalised treatment that recognises the interconnected physical, emotional and psychosocial aspects of the receiver [17]. People use shiatsu for various health complains and for health maintenance [5,18]. There is limited evidence for shiatsu's effects in various health conditions [5,19]. ...
... One of the conclusions of the biggest shiatsu study ever conducted, which included 948 participants in three European countries [18], was that when performed by qualified practitioners, shiatsu is a safe therapy with no enduring adverse effects [61]. Even so, there has been no published systematic review of its possible risks. ...
Introduction
People use shiatsu for health maintenance and help with illness. Shiatsu is often considered safe, but there has been no published systematic review of its possible risks. The review aims to assess the evidence of safety and risk of harm for shiatsu.
Methods
All types of studies, independent of control and with any style of shiatsu are eligible. Reports in any language will be included. Peer-reviewed studies and non-peer-reviewed literature will be handled in separate parts of the review. Electronic databases (including among others MEDLINE, AMED, Alt HealthWatch, Web of Science, CiNii) will be searched for identification of peer-reviewed publications. Hand-search will be used for non-peer-reviewed literature. Risk of bias will be assessed using RoB 2.0 in conjunction with McHarm (randomised trials), ROBINS:I in conjunction with McHarm (non-randomised studies), a modified PHARMA checklist (adverse reports). When appropriate, reporting bias will be assessed using ORBIT. The relevance of the described intervention to shiatsu will be based on clinical experience, using CARE for massage and bodywork and TIDieR. Root cause analysis of adverse events will consider Bradford Hill's criteria in the light of clinical experience.
Results
Meta-analysis is not planned. Results for each study will be presented in tables. Relationships within and between studies will be explored. A theory about the safety profile of shiatsu will be developed. Identified incidents will be presented in a narrative way and tabular categories.
Discussion
The discussion will highlight the relevance to various stakeholders and will explore issues that occurred from the review.
... The GPs were clearly satisfied with the shiatsu clinic, 'I've been really satisfied with it and I've been really pleased that patients were able to have it' (GP1). Patients also reported high satisfaction, supporting claims from users of shiatsu privately 18 ; 'It's more than met the expectations' (Julie), which sometimes contrasted with their comments about other treatments and referrals offered by their GPs. This could have been challenging for the practice, but with a positive outcome if it led to improved services. ...
... Complementary medicine is often used for chronic physical and psychological symptoms that seem resistant to orthodox medicine 5,36 and since chronic illnesses are most often presented in primary care, it seems logical to pilot complementary services within general practice. 6 Shiatsu has been associated with reported improvements in several chronic conditions, 17,18 suggesting the potential for clinical effectiveness studies on shiatsu in general practice. ...
... The study from which the data are drawn comprised a longitudinal , 6 months observational, pragmatic design of client experiences and effects of shiatsu as delivered and received in normal practice [42]. Following a pre-defined study protocol, clients were recruited by accredited and experienced shiatsu practitioners registered with one of three shiatsu national Societies: Österreichischen Dachverbands für Shiatsu (Austria); Asociación de Profesionales de Shiatsu de España (Spain); and the Shiatsu Society UK (UK). ...
... Indeed, for the one or two clients who indicated that they had experienced 'a potentially adverse event or effect', none ceased using shiatsu [39]. Moreover, the study findings were consistent across the three countries [42]. Nevertheless, a social desirability effect remains a possibility . ...
The potential contribution of complementary and alternative medicine (CAM) modalities to promote and support critical health literacy has not received substantial attention within either the health promotion or the CAM literature. This paper explores the potential of one CAM modality, shiatsu, in promoting well-being and critical health literacy.
Data are drawn from a longitudinal, 6 months observational, pragmatic study of the effects and experience of shiatsu within three European countries (Austria, Spain and the UK). Client postal questionnaires included: advice received, changes made 6 months later, clients 'hopes' from having shiatsu and features of the client-practitioner relationship.
At baseline, three-quarters of clients (n = 633) received advice, on exercise, diet, posture, points to work on at home or other ways of self-care. At 6 months follow-up, about four-fifths reported making changes to their lifestyle 'as a result of having shiatsu treatment', including taking more rest and relaxation or exercise, changing their diet, reducing time at work and other changes such as increased body/mind awareness and levels of confidence and resolve. Building on the findings, an explanatory model of possible ways that a CAM therapy could contribute to health promotion is presented to guide future research, both within and beyond CAM.
Supporting individuals to take control of their self-care requires advice-giving within a supportive treatment context and practitioner relationship, with clients who are open to change and committed to maintaining their health. CAM modalities may have an important role to play in this endeavour.
... Cancer treatments, especially chemotherapy, can increase anxiety in such patients [7,11]. Stress and anxiety in these patients can lead to the recurrence of the disease, lack of proper response to treatment, and longer hospital stays [12,13] Today, in addition to the employment of various pharmacological methods to relieve physical and mental problems of cancer patients, the use of complementary medicine approaches as a safe and inexpensive method has been suggested in various studies [14][15][16][17][18]. One of the methods adopted to reduce anxiety, reduce acute pain, improve symptoms, and make patients comfortable is the use of massage [19][20][21]. ...
Introduction
Patients with breast cancer are prone to numerous physical and mental complications due to their disease condition and the treatments they receive. Anxiety is one of the common psychological complications observed in such patients. This study aimed to investigate the effect of acupressure massage on anxiety during chemotherapy in patients with breast cancer.
Methods
This single-blind randomized clinical trial study was conducted on 70 cancer patients undergoing chemotherapy. The intervention group (n=35) received acupressure massage in three 5-minute periods with 2-minute breaks between them. However, in the control group (n=35), the same area was only touched for a while in a similar way that was performed in the intervention group. Patients' anxiety was measured before and after the intervention using the Spielberger State-Trait Anxiety Inventory. The collected data from both groups were analyzed in SPSS software (version20).
Results
The difference between patients' anxiety was significant after the intervention in the two groups. Accordingly, the level of anxiety among patients in the experimental group was significantly reduced after the intervention, compared to the control group (P=0.001).
Conclusion
Due to the simplicity and low cost of massage, it is recommended that this method be adopted to reduce patients' anxiety along with other treatments.
... CAM, including shiatsu, may be used in patient care, in addition to conventional medicine. 4,[14][15][16] They may complement patient care while respecting patient autonomy when disease management seems ineffective or not acceptable to the patient. 17 Users spoke little of using shiatsu with their GP. ...
Context: In 2014, the World Health Organization launched its second strategic plan on the development of complementary medicine. Shiatsu is one of eight alternative approaches worthy of interest. No study explored its users' health trajectories and the motives and experiences of their use of shiatsu. Aim: To explore motives and experiences of the use of shiatsu and its users' health care trajectories in France. Design and Setting: Qualitative study with shiatsu users. Methods: Semistructured telephone interviews with shiatsu users and audio recordings during shiatsu sessions. Shiatsu users were recruited across France by shiatsu practitioners who had no specific instructions on the profile of users to include. Descriptive then thematic analysis of data, with triangulation, according to a phenomenological approach, using MAXQDA© software. Results: Ten interviews and seven recordings were made to gather sufficient data. The major themes identified were the previous knowledge and representations of shiatsu, the symptoms leading to this use, the ineffectiveness of conventional medicine and the user's health trajectories. Users were looking for an alternative to conventional medicine and often resorted to other complementary medicines. They generally had no prior knowledge of shiatsu. They were advised to try shiatsu by those around them, never by a physician. Their main reasons for having recourse to shiatsu were pain, anxiety, and sleep disorders. Users initially tried conventional medicine. Some sought to modify or reduce their medicine intake. Shiatsu then became a regular practice. Users described derogatory reactions from their general practitioner (GP) to this complementary therapy. Conclusion: This study highlights a fluctuating and ambivalent relationship between complementary medicine and conventional medicine. Shiatsu users' health care trajectories include several phases: trust in conventional medicine then disappointment, rupture and risk taking for their health. To avoid this rupture, GP should be involved in the use of complementary therapies.
... (14) Three studies examining the effects of shiatsu have produced promising findings. (15)(16)(17) However, those studies were primarily carried out with older adults, and third-parties provided the shiatsu intervention. Reliance on a third party to deliver an NPSI presents issues of access, frequency, cost, and practicality of use. ...
Background:
Sleep problems exist for up to 30% of young people, and increase in the case of those with chronic pain. Because exclusive pharmacological management of sleep problems for children with pain is contraindicated, the development of appropriate non-pharmacological sleep interventions is a significant, largely unmet, need.
Purpose:
This study examined whether the application of a standardized hand self-shiatsu (HSS) intervention within a population of young people with chronic pain would be associated with improved objectively and subjectively measured sleep.
Setting:
The Pain Management Clinic of the Stollery Children's Hospital Hospital, a large tertiary care centre in Edmonton, Alberta and the University of Alberta.
Research design:
Sixteen young adults, aged 17 to 27, were recruited for a case series study. The intervention involved participants self-applying a standardized hand shiatsu protocol. Participants wore an actigraph for one week at baseline before learning the HSS technique, and then at four- and eight-week follow-up. At the same measurement points they completed validated self-report measures of their sleep quality and daytime fatigue. Each participant also completed a sleep log to supplement the actigraphy data and to collect their general impressions of the HSS experience. Data were analyzed with SPSS 23 software, using Freidman's test for analysis of variance.
Results:
The objective data did not support the hypothesis that this standardized HSS protocol improves objectively measured sleep. However, standardized self-report measures demonstrated statistically significant improvement in perceived sleep disturbance (chi-squared test [χ2] = 8.034, p = .02), sleep-related impairment (χ2 = 7.614, p = .02), and daytime fatigue as measured by the PROMIS Fatigue SF 8-a (χ2 = 12.035, p = .002), and the Flinder's Fatigue Scale (χ2 = 11.93, p = .003). Qualitative sleep log information indicated wide-spread endorsement of HSS for the management of sleep difficulties.
Conclusion:
Contrary to objective findings, self-report data support the technique of HSS to improve sleep. Participants' comments reflected an overall high level of acceptance and appreciation for the HSS technique. Results highlight the importance of expanding the theory and practice related to sleep measurement to better integrate the qualitative domain.
... My reading of Hadot focussed on three of his major books, one article, and an interview collection as primary literature sources (Hadot, 1995(Hadot, , 2002(Hadot, , 2006(Hadot, , 2009Hadot, Simmons, & Marshall, 2005). Secondary literature included the introductions to the latter books, as well as sections from other books, journal articles, blogposts, and publications that make no specific reference to his work, but appeared to resonate with it strongly (Bakewell, 2010;Chase, 2010aChase, , 2010bChase, Clark, & McGhee, 2013;Critchley, 2008;Davidson, 1997;Irrera, 2010;Lamb, 2011;Sharpe, 2011 (Kleinau, 2016;Long, 2008;Robinson, Lorenc, & Liao, 2011;Sedlin, 2013 (Chadwick, 1999;Deshimaru, 2012;Okumura, 2012;Uchiyama, Okumura, Leighton, 1997;Suzuki, 1988;Tenbreul, 2011). I also reviewed academic literature drawing on Zen and Buddhist theories and practices to explore issues related to healthcare, research, and related matters (Adam, 2006;Bentz & Shapiro, 1998;Gaskins, 1999;Krägeloh, 2013). ...
Physiotherapy and Fundamental Ethics engages the field of physiotherapy through a critique of its contemporary foundations from the perspective of the ethics philosophy of Emmannuel Levinas, in order to develop novel approaches to physiotherapy practice. Physiotherapy is a well-established healthcare profession, practiced in healthcare systems around the world. Despite its success, modern healthcare more generally faces a number of significant challenges, including increasing financial burdens, an increasingly ageing and chronically ill population, ongoing technological innovation, and diminishing trust in conventional healthcare. Ways in which physiotherapy could respond to these challenges and adapt to future needs are being explored. One approach entails a thorough reassessment of the profession's status quo and its subsequent development, drawing on hitherto unexamined philosophies, methodologies, and practices. This study seeks to contribute to these efforts by drawing on a range of traditions that have not yet been introduced to the profession, but appear to hold great potential for its critical reassessment and development.
... Although the most common indications are muscular-skeletal and psychological problems, Shiatsu is actually a holistic therapy and, as such, it also affects the patient's well-being, lifestyle, diet, sleep, and body-mind awareness. 5 The working mechanism of Shiatsu and similar techniques (such as acupressure) are not fully known, but they can be explained by different theories. Traditional Chinese medicine speculates that acupressure stimulates the acupoints to enhance energy flowing along the meridians, achieving therapeutic outcomes by improving the functions of the body systems. ...
Recently, there has been increasing interest toward nonpharmacological approaches for dementia and associated clinical manifestations, such as depression, with the common goal to improve health and quality of life of both patients and caregivers. In this scenario, the role of Shiatsu is of clinical and research interest, although to date a definitive recommendation on a systematic use in clinical practice cannot be made. To overcome the heterogeneity of the previous studies, we tested Shiatsu as an add-on treatment for late-life depression in a dedicated community of patients with mild-to-moderate Alzheimer’s disease. We found a significant adjuvant effect of Shiatsu for depression in these patients and hypothesized a neuroendocrine-mediated action on the neural circuits implicated in mood and affect regulation. However, this finding must be considered preliminary and requires confirmation in larger-scale controlled studies, possibly extending the range of outcome measures and including predictors of response. Future investigations should also include an objective assessment of the hypothalamus-pituitary-adrenocortical axis functioning. Nevertheless, starting from this pilot study, we suggest that a customized protocol applied for an adequate period in a controlled sample will represent a non-invasive and feasible advance for promoting patients’ mood and, possibly, slowing cognitive decline.
... This therapy can be used to reduce the stress and promote the overall health and well-being. [10,11] Shiatsu is a Japanese form of massage therapy, reinforces holistic healing and self-healing. Studies have shown that Shiatsu massage, self-administered or done by a professional Shiatsu practitioner used to stimulate the "sea of energy" point, help relieve the menstrual cramps. ...
Dysmenorrhea is one of the most common gynecological disorders, affects more than half of the reproductive aged women. Women experience periodic repeated discomforts associated with menstruation can affect their daily activities. A Quasi experimental study was conducted to evaluate the efficacy of using shiatsu therapy at "Sea of Energy" point on relieving primary dysmenorrhea. The study was conducted at College of Applied Medical Science, Shaqra University in the academic year 2015-2016. Eighty-two of nursing students at different academic levels was recruited for the study, allocated into two groups 'shiatsu group (46) and non-shiatsu group (36).Three tools for data collection were used; a structured interviewing questionnaire, visual-analogue scale and follow up chart. The results of the current study revealed that, the severity of pain and the associated symptoms was decreased in the shiatsu group compared to non-shiatsu group, with a highly statistically significant difference was found between groups after using the shiatsu massage therapy at "sea of energy" point. In conclusion, the present study concluded that using of shiatsu therapy at "Sea of Energy" point was effective for relieving primary dysmenorrhea pain and the associated symptoms for women. The study recommended that considering the shiatsu therapy as one of the effective therapeutic options for women suffering primary dysmenorrhea. Further studies are needed to investigate the effect of shiatsu points in a large population and on other health problems.
... However, as the distinction between Shiatsu and acupressure is one that needs highlighting to underline the unique character of Shiatsu, as distinct from acupressure [20,21], acupressure studies have not been considered in this paper. Long [22] also considers Shiatsu to be distinct from acupressure and states that acupressure 'focuses on symptomatic relief without necessary reference to the whole energy system or the person outside of the specific area being treated'. ...
Introduction: The study investigated the effectiveness of Shiatsu therapy in relation to the management of health and wellbeing concerns of cancer and palliative care patients in an out-patient clinic.
Method: Patients are referred to the Complementary Therapies Service for symptom management, particularly stress and anxiety, but also other symptoms such as nausea or insomnia. Data was collected following use of the Measure Yourself Concerns and Wellbeing (MYCaW) questionnaire, which was designed for evaluating supportive care interventions.
Results: Mean changes in post-intervention MYCaW scores were highly significant (p < 0.001), demonstrating
considerable improvements in both presenting symptoms and perceptions of wellbeing. Based on a significance level of 0.05, both the Wilcoxon signed-ranks test and the two-tailed t-test indicated that post-treatment ranks and means were statistically significantly lower than pre-treatment ranks and means in the categories.
Conclusion: Anxiety, stress management and pain scores were the most improved. Wellbeing scores also improved, on average, by two points on the Likert scale. Patients stated that ‘being listened to’ and ‘being heard’ were important factors when describing how Shiatsu had helped.
We suggest that a study using larger numbers is necessary in order to provide more robust evidence rather
than emerging trends.
... For this reason, these techniques are considered intrinsically safe and to be effective in a number of stress-related or painful conditions. [2][3][4][5][6][7][8][9] However, the effect of Shiatsu in patients with AD and geriatric depression has not been previously evaluated. ...
Objectives:
Among the complementary and alternative medicine, Shiatsu might represent a feasible option for depression in Alzheimer's disease (AD). We evaluated Shiatsu on mood, cognition, and functional independence in patients undergoing physical activity.
Design:
Single-blind randomized controlled study.
Setting:
Dedicated Community Center for patients with AD.
Interventions:
AD patients with depression were randomly assigned to the "active group" (Shiatsu + physical activity) or the "control group" (physical activity alone). Shiatsu was performed by the same therapist once a week for ten months.
Main outcome measures:
Global cognitive functioning (Mini Mental State Examination - MMSE), depressive symptoms (Geriatric Depression Scale - GDS), and functional status (Activity of Daily Living - ADL, Instrumental ADL - IADL) were assessed before and after the intervention.
Results:
We found a within-group improvement of MMSE, ADL, and GDS in the active group. However, the analysis of differences before and after the interventions showed a statistically significant decrease of GDS score only in the active group.
Conclusions:
The combination of Shiatsu and physical activity improved depression in AD patients compared to physical activity alone. The pathomechanism might involve neuroendocrine-mediated effects of Shiatsu on neural circuits implicated in mood and affect regulation.
... Long (115) planteó un estudio observacional con 633 personas de 3 países, con el concurso de sociedades de shiatsu, que mostró que las personas que practicaban habitualmente shiatsu obtenían efectos positivos en la calidad del sueño y el descanso. Revisiones sistemáticas, como la realizada por Robinson y cols. ...
... Long (115) set up an observational study with 633 people from 3 countries, through Shiatsu societies, which showed that the people who regularly practiced Shiatsu obtained positive effects in terms of the quality of sleep and rest. Systematic revisions, like that carried out by Robinson et al. (116) , in which 80 studies are included, 20 of which with level of evidence 1, reveal the benefi ts of Shiatsu for general health, however they conclude by affi rming that more well-designed experimental studies are needed. ...
... 10 It was developed in Japan based on the fundamentals of the traditional Chinese medicine (TCM) and also influenced by the Western medicine. 11 According to TCM, the vital energy flows throughout the body along pathways known as meridians, maintaining health. Several factors may lead to the blockage in the flow of the vital energy. ...
Background Fibromyalgia is a painful musculoskeletal disorder that compromises function and quality of life. Studies show that no single treatment is completely effective in all patients and many of them seek complementary and alternative medicine. However its evidence is still insufficient.
Objectives This clinical trial aimed to verify the effectiveness of Shiatsu (Japanese massage technique) in the improvement of pain, sleep quality and balance confidence of fibromyalgia patients.
Methods This study involved 34 women aged 33 to 62 years, divided into two groups: Shiatsu Group (SG; n=17), which received 16 sessions of Shiatsu lasting 50 minutes, twice a week, and Control Group (CG; n=17), who received educational guidance through a booklet. Both groups were evaluated before and after 8 weeks. The following instruments were used: Visual Analog Pain Scale, Dolorimeter, Pittsburgh Sleep Quality Index and Activities-Specific Balance Confidence Scale. Intergroup statistical analysis was performed using the t-test for data sets with normal distribution and the same variance and Mann-Whitney Rank Sum Test for data sets without normal distribution or equal variance. The significance level was α=0.05.
Results At baseline, both groups were similar for all variables. After eight weeks, SG showed statistically significant improvement in pain (p=0.015), tender point pain threshold (p<0,001) and sleep quality (p=0.018), when compared with the CG. There was no statistically significant difference for balance confidence between groups.
Conclusions The results indicate that the Shiatsu technique is effective in improving pain, tenderness and sleep quality in fibromyalgia patients.
Disclosure of Interest None Declared
... Long (115) va plantejar un estudi observacional amb 633 persones de 3 països, a través de les societats de xiatsu, que va mostrar que les persones que practicaven habitualment xiatsu obtenien efectes positius quant a la qualitat del son i el descans. Revisions sistemàtiques, com la realitzada per Robinson i col. ...
... It was during this time that I discovered and focussed on the philosophy of Emmanuel Levinas and Jewish philosophy in general. Further, about halfway through my undergraduate physiotherapy course I began a part-time course in "Shiatsu" (a Japanese acupressure treatment method based on traditional Chinese medicine and some Japanese Zen-Buddhist sentiments), completing the course six years later (Long, 2008;Masunaga & Ohashi, 1977). My study and practice of Aikido, Zazen and their philosophies began well before my physiotherapy training and has accompanied me ever since. ...
... 10 It was developed in Japan based on the fundamentals of the traditional Chinese medicine (TCM) and also influenced by the Western medicine. 11 According to TCM, the vital energy flows throughout the body along pathways known as meridians, maintaining health. Several factors may lead to the blockage in the flow of the vital energy. ...
This pilot study aimed to evaluate the potential effects of Shiatsu massage on the symptoms of adult patients with primary fibromyalgia, propose a Shiatsu treatment protocol, verify patient acceptability, and evaluate the feasibility for a larger study.
Thirty-four patients aged 33 to 62 years were divided into a Shiatsu group (SG; n = 17), who received full-body Shiatsu twice a week for 8 weeks, and a control group (n = 17), who received an educational booklet. The patients were assessed at baseline and after 8 weeks. Pain intensity was evaluated by the visual analog scale, pressure pain threshold by dolorimetry, anxiety by the State-Trait Anxiety Inventory, sleep by the Pittsburgh Sleep Quality Index, and symptoms impact on patient's health by the Fibromyalgia Impact Questionnaire. The SG was also questioned about adverse effects and level of satisfaction.
After treatment, the SG presented statistically significant differences (P < .05) for the change scores of all variables, except state anxiety, compared with the control group. Relative percentage changes were considered clinically relevant for visual analog scale (40.6%), pressure pain threshold (76.4%), Pittsburgh Sleep Quality Index (34.4%), and Fibromyalgia Impact Questionnaire (22.30%). No clinically relevant effects were observed for anxiety after treatment. No adverse effects were reported during the treatment, and about 94% of the patients demonstrated satisfaction with Shiatsu.
This pilot study showed the potential of Shiatsu in the improvement of pain intensity, pressure pain threshold, sleep quality, and symptoms impact on health of patients with fibromyalgia. The proposed Shiatsu treatment protocol was feasible and well accepted by the patients.
... Ce soin peut ainsi aider à appréhender les somatisations si fréquentes chez les aidants débordés. On note en effet que les troubles directement liés à un état de tensions musculaires (gorge serrée, estomac noué, etc.) semblent être nettement améliorés à la suite des séances de Shiatsu [9]. ...
Background
Estimates suggest that there are more than 700,000 adult caregivers of persons with dementia in this country, a large number of whom experience some form of sleep disturbance during the course of their caregiving career. Health care professionals are in the best position to detect and address this significant public health problem.Objectives
Prospective study of sleep with the main caregivers providing home-care for demented patients.Methods
This study was performed on elderly persons living at home. Two populations were concerned. The control group concerned 86 old persons living in the area of Limoges (France) and was contacted to join by the senior clubs of this city. The other group concerned caregivers to persons with dementia, living with them at home, and the assessments were done during the patient assessment. Each group had a cognitive evaluation by a Folstein's test and answered a questionnaire to describe their possible sleep difficulties.ResultsSixty-eight caregivers face sleep disturbance versus 25 non-caregiver controls. Caregiver sleep-problems are often linked to sleep disturbances in the care-recipient. Night-time awakenings by persons with dementia are a common precipitating cause of sleep/wake disturbances in vulnerable caregivers. Caregivers awake 2.3 times during the night versus 1.2 for control persons. Caregivers awake earlier (around 6:20) than non-caregivers (around 7:05) and their sleep time is shorter by one hour. Caregivers are more often depressed (28 in 98 versus 13 in 86) and have more often high blood pressure (56 in 98 versus 24 in 86). They received more medications and used more often self-medication.DiscussionThree major contributors to caregiver sleep-disturbance are pointed in this paper: the apparition of caregiver disrupted sleep routines, caregiver burden and depression and the caregiver's physical health status. Successful treatment of a caregiver's sleep disturbance requires careful consideration of each of these contributors. Non-pharmacological options are generally recommended as a first line of treatment for managing sleep disturbances in older adults, including caregivers of persons with dementia.
... Ce soin peut ainsi aider à appréhender les somatisations si fréquentes chez les aidants débordés. On note en effet que les troubles directement liés à un état de tensions musculaires (gorge serrée, estomac noué, etc.) semblent être nettement améliorés à la suite des séances de Shiatsu [9]. ...
Estimates suggest that there are more than 700,000 adult caregivers of persons with dementia in this country, a large number of whom experience some form of sleep disturbance during the course of their caregiving career. Health care professionals are in the best position to detect and address this significant public health problem.
Prospective study of sleep with the main caregivers providing home-care for demented patients.
This study was performed on elderly persons living at home. Two populations were concerned. The control group concerned 86 old persons living in the area of Limoges (France) and was contacted to join by the senior clubs of this city. The other group concerned caregivers to persons with dementia, living with them at home, and the assessments were done during the patient assessment. Each group had a cognitive evaluation by a Folstein's test and answered a questionnaire to describe their possible sleep difficulties.
Sixty-eight caregivers face sleep disturbance versus 25 non-caregiver controls. Caregiver sleep-problems are often linked to sleep disturbances in the care-recipient. Night-time awakenings by persons with dementia are a common precipitating cause of sleep/wake disturbances in vulnerable caregivers. Caregivers awake 2.3 times during the night versus 1.2 for control persons. Caregivers awake earlier (around 6:20) than non-caregivers (around 7:05) and their sleep time is shorter by one hour. Caregivers are more often depressed (28 in 98 versus 13 in 86) and have more often high blood pressure (56 in 98 versus 24 in 86). They received more medications and used more often self-medication.
Three major contributors to caregiver sleep-disturbance are pointed in this paper: the apparition of caregiver disrupted sleep routines, caregiver burden and depression and the caregiver's physical health status. Successful treatment of a caregiver's sleep disturbance requires careful consideration of each of these contributors. Non-pharmacological options are generally recommended as a first line of treatment for managing sleep disturbances in older adults, including caregivers of persons with dementia.
Numerous alternative treatments are physical by nature. They often require a hands-on approach of an alternative practitioner. In this chapter, I discuss treatments that fall into this category.
Presented as a collaborative reflexive account, this article has evolved through a series of discussions between the first author—who carried out an “insider” ethnography of Shiatsu practice—and her two supervisors. We highlight the challenges that she faced as an ethnographer in a field already familiar to the researcher and demonstrate how it was possible to use this tension to advantage in crafting an enhanced methodological approach. Drawing upon Bourdieu’s (1996, 24) notion of “forgetfulness of self,” we explore how the first author was able to harness and hone her key abilities, disposition, and innate knowledge as an experienced Shiatsu practitioner in order to forge a blended approach. Finally, the article suggests that this approach, based on sensitive skills involving “listening,” intuition, and touch—the essence of Shiatsu—can enhance ethnographic practice in general.
LAY SUMMARY
This study tested a no-cost, drug-free technique to promote sleep for Veterans and their family members. The technique, hand self-shiatsu (HSS), had promising outcomes in other studies with chronic pain patients and young athletes after concussion. HSS is easy to learn, takes only 10–15 minutes to perform before bed, requires no equipment, and is best done once in bed for the night. The sleep and daytime fatigue of 30 people who were taught HSS and 20 who were not were compared across a two-month period. The two groups were similar in age and gender. The self-report measures showed that people who did HSS reported less daytime fatigue and less sleep disturbance than those who did not. Also, in interviews at the end of the study, participants were very favorable about how easy and potentially useful HSS was. They also commented on the benefit of feeling more in control of their sleep. Although the study has limitations, the findings are promising. A HSS educational video, handouts, and app are available for free at https://cbotlabs.wixsite.com/handselfshiatsu .
Akupressur ist die Stimulation spezifischer Punkte, auf der Körperoberfläche durch Druck zu therapeutischen Zwecken. Der erforderliche Druck kann manuell oder mit einer Reihe von Instrumenten ausgeübt werden.
Acupressure is the stimulation of specific points, called acupoints, on the body surface by pressure for therapeutic purposes. The required pressure can be applied manually of by a range of devices. Acupressure is based on the same tradition and assumptions as acupuncture. Like acupuncture, it is often promoted as a panacea, a ‘cure all’.
Complementary alternative medicine, such as shiatsu, can represent a suitable treatment for primary headaches. However, evidence-based data about the effect of combining shiatsu and pharmacological treatments are still not available. Therefore, we tested the efficacy and safety of combining shiatsu and amitriptyline to treat refractory primary headaches in a single-blind, randomized, pilot study. Subjects with a diagnosis of primary headache and who experienced lack of response to ≥2 different prophylactic drugs were randomized in a 1:1:1 ratio to receive shiatsu plus amitriptyline, shiatsu alone, or amitriptyline alone for 3 months. Primary endpoint was the proportion of patients experiencing ≥50%-reduction in headache days. Secondary endpoints were days with headache per month, visual analogue scale, and number of pain killers taken per month. After randomization, 37 subjects were allocated to shiatsu plus amitriptyline (n = 11), shiatsu alone (n = 13), and amitriptyline alone (n = 13). Randomization ensured well-balanced demographic and clinical characteristics at baseline. Although all the three groups improved in terms of headache frequency, visual analogue scale score, and number of pain killers (p < 0.05), there was no between-group difference in primary endpoint (p = ns). Shiatsu (alone or in combination) was superior to amitriptyline in reducing the number of pain killers taken per month (p < 0.05). Seven (19%) subjects reported adverse events, all attributable to amitriptyline, while no side effects were related with shiatsu treatment. Shiatsu is a safe and potentially useful alternative approach for refractory headache. However, there is no evidence of an additive or synergistic effect of combining shiatsu and amitriptyline. These findings are only preliminary and should be interpreted cautiously due to the small sample size of the population included in our study.
The article is targeted to the abstract of available information about shiatsu technique, to get short review of shiatsu history, education of shiatsu technique and modern trend in the shiatsu education. We get overview of shiatsu lectors in CR, system of available education, professional companies, and position of shiatsu technique in Czech health care system. The article is based on master thesis of physiotherapist student defended on physiotherapy department FTVS UK.
To develop and apply a client-centred typology for classifying negative responses to a CAM therapy.
Prospective, 6 months cohort, pragmatic study of the effects and experience of shiatsu within three countries (Austria, Spain and the UK). Data collected via postal questionnaires, including on client-perceived negative responses. Classification of negative responses situated within a theoretical framework of Zen or Masunaga model of shiatsu.
Shiatsu as delivered by the practitioner in routine practice.
Prevalence of negative responses and response types.
633 clients provided full follow-up data, a response rate of 67%. A prevalence rate of 12-22 per 100 of client-perceived 'negative responses' was found across the three countries. Transitional effects accounted for 82% of all the client-described 'negative' responses. Nine clients (1.4% of the total), relating to 10 sets of written comments, reported a negative response that was classified as 'a potentially adverse event or effect' that might represent a risk to client safety. None of these clients ceased shiatsu.
A typology of negative responses has an important role for practitioners, clients and researchers in drawing up evidence on the safety of a therapy. For researchers and policy makers, use of such a typology informs insight into what might cause harm (that is, 'definite' adverse events). For clients, the typology takes seriously the clients' own view. For practitioners, the typology draws on the modality's guiding theory and suggests ways to improve the delivery of treatments. Applying the typology to a cross-European prospective study of shiatsu supports the argument of shiatsu being inherently a safe modality.
This paper aims to identify problems in estimating and the interpretation of the magnitude of intervention-related change over time or responsiveness assessed with health outcome measures. Responsiveness is a problematic construct and there is no consensus on how to quantify the appropriate index to estimate change over time between baseline and post-test designs. This paper gives an overview of several responsiveness indices. Thresholds for effect size (or responsiveness index) interpretation were introduced some thirty years ago by Cohen who standardised the difference-scores (d) with the pooled standard deviation (d/SDpooled). However, many effect sizes (ES) have been introduced since Cohen's original work and in the formula of one of these ES, the mean change scores are standardised with the SD of those change scores (d/SDchange). When health outcome questionnaires are used, this effect size is applied on a wide scale and is represented as the Standardized Response Mean (SRM). However, its interpretation is problematic when it is used as an estimate of magnitude of change over time and interpreted with the thresholds, set by Cohen for effect size (ES) which is based on SDpooled. Thus, in the case of using the SRM, application of these well-known cut-off points for pooled standard deviation units namely: ‘trivial’ (ES<0.20), ‘small’ (ES≥0.20<0.50), ‘moderate’ (ES≥0.50<0.80), or large (ES≥0.80), may lead to over- or underestimation of the magnitude of intervention-related change over time due to the correlation between baseline and outcome assessments.
Consequently, taking Cohen's thresholds for granted for every version of effect size indices as estimates of intervention-related magnitude of change, may lead to over- or underestimation of this magnitude of intervention-related change over time.
For those researchers who use Cohen's thresholds for SRM interpretation, this paper demonstrates a simple method to avoid over-or underestimation.
We provide a new perspective with which to understand what for a half century has been known as the "placebo effect." We argue that, as currently used, the concept includes much that has nothing to do with placebos, confusing the most interesting and important aspects of the phenomenon. We propose a new way to understand those aspects of medical care, plus a broad range of additional human experiences, by focusing on the idea of "meaning," to which people, when they are sick, often respond. We review several of the many areas in medicine in which meaning affects illness or healing and introduce the idea of the "meaning response." We suggest that use of this formulation, rather than the fixation on inert placebos, will probably lead to far greater insight into how treatment works and perhaps to real improvements in human well-being.
The primary purpose of revalidation is to certify fitness to practise. The Shipman inquiry made recommendations for improving the CMC's revalidation model. The GMC intends to develop explicit requirements for validation and quality assurance. The GMC will also continue to work with others to detect poorly performing doctors and ensure early action.
In the medical and scientific literature, there is a dearth of reports about how acupuncturists work and deliver care in practice. An informed characterization of the treatment process is needed to support the appropriate design of evaluative studies in acupuncture.
The design was that of a nested qualitative study within a pragmatic clinical trial. Six acupuncturists who treated up to 25 patients each were interviewed after the treatment phase of the trial to obtain an account of their experiences of providing acupuncture care to patients with low back pain referred by their GP. Using semistructured interviews and a topic guide, data were collected and analyzed for both a priori and emergent themes. This paper focuses on practitioners' accounts of the goals and processes of care, and describes the strategies employed in addition to needling and other hands-on treatments.
From the interview data, it is clear that a coherent body of theoretical knowledge informed clinical decisions and practice, and that the goals of treatment went beyond the alleviation of immediate pain-related symptoms. Acupuncturists in this study all described a pattern of patient-centered care based on a therapeutic partnership. Study participants confirmed the importance of three processes that characterized acupuncture care in this trial, each contributing to the goal of a positive long-term outcome; building a therapeutic relationship; individualizing care; and facilitating the active engagement of patients in their own recovery. Acupuncturists described elements of care that characterized these processes including establishing rapport, facilitating communication throughout the period of care, using an interactive diagnostic process, matching treatment to the individual patient, and the use of explanatory models from Chinese medicine to aid the development of a shared understanding of the patient's condition and to motivate lifestyle changes that reinforce the potential for a recovery of health. Acupuncturists did not view these therapeutic goals, processes, and strategies as a departure from their usual practice.
This study suggests that acupuncture care for patients with chronic conditions such as low back pain is likely to be a complex intervention that utilizes a number of patient-centered strategies to elicit longterm therapeutic benefits. Research designed to evaluate the effectiveness of acupuncture as it is practiced in the UK needs to accommodate the full range of therapeutic goals and related treatment processes.
In this paper we examine the reasons why the non-use of mail surveys is so prevalent in research in Spain when so many researchers have stressed the low economic costs of this information-gathering method. The two main reasons held by some experts is the low rate of response attained by the mail survey and the poor quality of the results obtained. Here we are concerned with how to obtain quality responses from mail surveys. We establish the hypothesis that 'the information gathered from mail surveys can achieve a high-quality response rate - indeed, a quality which varies little from that obtained from face-to-face or telephone surveys'.
In this paper, globalisation processes are examined through the prism of shiatsu, an originally Japanese, touch-based therapy, now practised in Europe, Japan, North America, and many other places. Examining this emergent plane of therapeutic practice provides an opportunity to reflect on categories of personhood, notably that of the individual, and its place within processes of globalisation. The article is divided into two parts. In the first part the holisms inherent to East Asian medical practice and underlying notions of personhood in Japan and Britain are critically examined. The seemingly reductionistic practice of 'bodily holism' in Japan is shown to reflect socio-centred notions of the person. The concept of holism animating shiatsu in a British school in London, far from being Japanese, 'ancient', or 'timeless', is shown to reflect individualism characteristic of the New Age movement. In the second part of the paper, using an auto-phenomenological approach, a description of practitioner (my own) and client's lived experience of shiatsu is given in case study form. This illustrates how 'holism' is felt within the context of a shiatsu treatment. The aesthetic form of the shiatsu touch described is shown to be implicitly individualising. This has, it is argued, profound implications for understanding the embodied dimensions of practitioner-patient encounters, the potential efficacy of treatment, and more generally the practice of globalised East Asian 'holistic' therapies in Britain and other settings.
Objective: The study aimed to survey the illness-conditions presenting for shiatsu treatment. Design: A nation-wide questionnaire survey was conducted of all qualified shiatsu practitioners registered with the Shiatsu Society UK. Methods: Client and practitioner questionnaires were piloted during a preliminary stage. In the main survey, all registered shiatsu practitioners in the UK (n = 397) were asked to complete structured questionnaires about themselves and three of their clients. Results: In the nation-wide survey, 288 practitioners (73%) completed at least one client questionnaire, giving a total of 792 client questionnaires for analysis. It was evident from both the preliminary stage and the main survey that musculoskeletal and psychological problems were the most common conditions presenting for shiatsu treatment. Conclusion: It was concluded that efficacy research in shiatsu should focus on musculoskeletal and psychological problems particularly neck/shoulder and lower back problems, arthritis, depression, stress and anxiety.
Dillman's Total Design Method (TDM), applied in mail surveys, has produced excellent results in several countries around the world, but as far as we can gather it has never been used in any southern European country. The results obtained from mail surveys in the United States, and some of the studies done by disciples of Dillman in several European countries, encouraged us to carry out the first investigation in Spain using the TDM for mail surveys. The scant use of mail surveys in Spain and the experience of various marketing firms made us expect that (1) a mail survey in Spain would not yield a response rate above 40 percent, and (2) that the use of TDM should notably increase the response rate, reaching a level similar to other countries. A mail survey in Navarra achived a response rate much higher than the expected lo percent, and TDM did indeed increase response.
Therapeutic landscapes are places, settings, situations, locales, and milieus that encompass both the physical and psychological environments associated with treatment or healing, and the maintenance of health and well-being. Practices from holistic medicine--also known as nonconventional, alternative, complementary or traditional medicine--are used to illustrate specific humanistic concepts in further examining therapeutic landscapes. In addition to contributing to a theoretically-informed health geography, this paper further develops the concept of therapeutic landscapes and the understanding of holistic medicine.
To develop and apply a client-centred typology for classifying negative responses to a CAM therapy.
Prospective, 6 months cohort, pragmatic study of the effects and experience of shiatsu within three countries (Austria, Spain and the UK). Data collected via postal questionnaires, including on client-perceived negative responses. Classification of negative responses situated within a theoretical framework of Zen or Masunaga model of shiatsu.
Shiatsu as delivered by the practitioner in routine practice.
Prevalence of negative responses and response types.
633 clients provided full follow-up data, a response rate of 67%. A prevalence rate of 12-22 per 100 of client-perceived 'negative responses' was found across the three countries. Transitional effects accounted for 82% of all the client-described 'negative' responses. Nine clients (1.4% of the total), relating to 10 sets of written comments, reported a negative response that was classified as 'a potentially adverse event or effect' that might represent a risk to client safety. None of these clients ceased shiatsu.
A typology of negative responses has an important role for practitioners, clients and researchers in drawing up evidence on the safety of a therapy. For researchers and policy makers, use of such a typology informs insight into what might cause harm (that is, 'definite' adverse events). For clients, the typology takes seriously the clients' own view. For practitioners, the typology draws on the modality's guiding theory and suggests ways to improve the delivery of treatments. Applying the typology to a cross-European prospective study of shiatsu supports the argument of shiatsu being inherently a safe modality.
Objectives: To identify the literature on primary total hip replacement (THR) surgery that is relevant to the question of whether prostheses differ in their medium to longer term outcomes, and to synthesise this evidence. To use evidence regarding both costs and outcomes of primary THR to model how much more effective newer prostheses must be to justify higher costs. Methods: Data sources: Electronic searches of MEDLINE and EMBASE (1980- 1995). Hand-searches (1980-1995) of the 11 journals with the highest yield of relevant articles in the electronic searches. Study selection: Randomised controlled trials (RCTs) of any kind that compared prostheses for primary THR. Observational cohort studies that included concurrent controls. Observational studies of single prostheses with at least 5 years of follow- up and reporting outcomes in terms of revision rate or semi-standardised clinical assessment. Data extraction and synthesis: It was not possible to carry out meta-analysis of the evidence from RCTs because each trial compared a unique pair of prostheses. A more informal form of meta-analysis was performed in which all data (randomised and observational) were combined for any prosthesis for which at least five independent studies reporting revision surgical rates were obtained. The meta-analysis was termed 'informal' because of the impossibility of controlling for numerous biases in the data and the poor quality of reporting of much of the evidence. Revision rates for eligible prostheses were calculated, adjusted for person-years at risk. Data were also combined for meta-analysis for other outcomes (i.e. hip scores, global ratings of success, and proportion of patients pain-free). However, studies lacked evidence of patient-based outcomes, and clinicians' views of outcome required substantial modification of diverse clinical ratings to produce a standardised score. Costs and benefits of primary THR were assessed using Markov modelling, and calculation of costs per quality adjusted life- year, with sensitivity analysis of the results. Outcomes data were taken from a prospective study of a series of patients followed up for 14 years after THR. Costs were estimated from cost-generating events for THR and unit costs from a single centre (Nuffield Orthopaedic Centre, Oxford). Results: Eleven RCTs were found that compared outcomes of prostheses. The trials followed up patients for short time periods (mean, 3.9 years) and had quite small sample sizes (mean, 168 patients). A significant difference between prostheses in terms of revision rate was observed in only one RCT. When results of all reports that included a revision rate were combined, ten prostheses met the criterion set for a meta-analysis that at least five independent studies should be available for a prosthesis to be included. Adjusted THR revision rates (revision rate per 100 person-years at risk) were calculated for each of the ten prostheses to take account of different lengths of observation. The most favourable adjusted revision rates were found for the Exeter, Lubinus and Charnley prostheses. Intermediate results were found for the Muller, McKee-Farrar and Stanmore prostheses. The least favourable adjusted revision rates were observed for the Ring, Harris-Galante, PCA and Charnley- Muller prostheses. Economic modelling indicated that to be cost-effective the following improvements in THR outcome and revision rates would be needed. For a new prosthesis costing three times more than the standard Charnley (i.e. typical cost of a new cementless prosthesis): ≥ 35-44% improvement in patients aged 50-70 years; ≥ 21-27% improvement in patients aged < 50 years. For a new prosthesis costing 1.5 times more than the standard Charnley (i.e. typical cost of a new cemented prosthesis): 9-12% improvement in patients aged 50-70 years; 6-7% improvement in patients aged < 50 years. From the available evidence, the extent of the improvement required of new and more expensive prostheses is particularly implausible for older patients. However the new cheaper prostheses may be cost-effective because the improvements required are more likely to be achievable. Conclusions: There is a striking paucity of clear and relevant evidence on which to make well-informed choices about prostheses for primary THR. Although basic scientific innovation continues in relation to THR, the knowledge base to inform selection of prostheses is unlikely to improve in the foreseeable future. Of prostheses commonly used in the NHS by far the greatest volume of evidence is available for the Charnley and on the basis of that evidence the Charnley appears to perform relatively well. However, the Charnley design has changed, and it is not clear how much of the evidence is relevant to the current design. Of other prostheses currently used in the NHS, positive evidence (but no data from RCTs) was found in support of the Exeter prosthesis, and some positive evidence was found for the Stanmore (for example, evidence that it performed as well as the Charnley in an RCT). Positive evidence for the Lubinus IP (less widely used in the NHS) was also found. The quality of the evidence for other prostheses was either poor or non-existent. No substantial evidence could be found for cementless prostheses in terms of independent observation of results from five or more studies. None of the analyses used in this review, such as meta-analysis of evidence, could overcome the fundamental weaknesses of the available evidence. The poor quality of evidence overall does not provide a basis clearly and authoritatively to identify prostheses that could be - or should not be recommended for use by the NHS. However, it is clear that the more expensive the prosthesis, the more difficult it is to provide justification for its selection on the basis of the current evidence. On the basis of the economic analysis it seems that the use of the more expensive (i.e. cementless) prostheses is hard to justify on current evidence. Recommendations for future research: As a substantial proportion of the evidence on outcomes of THR comes from healthcare systems quite different from the NHS (i.e. the Swedish and Norwegian national registers) it is recommended that the case for a UK register should be evaluated. Least biased assessments would be from RCTs, but to detect the small but important differences that may exist between prostheses such trials must be more adequately designed and powered than those carried out previously, and should involve multicentre participation and long-term follow-up. Economic modelling in this review indicates that such trials might identify differences in cost- effectiveness between cemented prostheses. Patient-based outcomes provide relevant and feasible methods to conduct large multicentre studies. To obtain unbiased assessments of outcome, the focus should be on outcomes of concern to patients, particularly pain and function, and not solely on revision surgery.
Shiatsu, a specific type of massage, was used as an intervention in this study of 66 individuals complaining of lower back pain. Each individual was measured on state/trait anxiety and pain level before and after four shiatsu treatments. Each subject was then called 2 days following each treatment and asked to quantify the level of pain. Both pain and anxiety decreased significantly over time. Extraneous variables such as gender, age, gender of therapist, length of history with lower back pain, and medications taken for lower back pain did not alter the significant results. These subjects would recommend shiatsu massage for others suffering from lower back pain and indicated the treatments decreased the major inconveniences they experienced with their lower back pain.
This qualitative study sought to evaluate the effects of shiatsu therapy on clients attending hospice day services. Eleven clients with advanced progressive disease received five therapy sessions each at weekly intervals. Data about the effects was collected through five unstructured interviews with each client. Four of these were conducted before, during, and shortly after the therapy regime, and the fifth was undertaken four weeks after treatment ended. All the interviews were tape-recorded, transcribed and subject to content analysis. The results of the analysis revealed significant improvements in energy levels, relaxation, confidence, symptom control, clarity of thought and mobility. These benefits were of variable duration - in some instances lasting a few hours but in others extending beyond the 5-week treatment regime. Action to ensure research trustworthiness included keeping research journals to provide an audit trail, conducting member checks and using peer debriefing. The study involved three overlapping cohorts of participants in a data collection period that took approximately 6 months.
To provide insight into client and practitioner perceptions of the effects of shiatsu, in the short and longer term, and positive and negative in nature.
A two-country, exploratory study was undertaken in the United Kingdom and Germany. In-depth interviews were undertaken with a purposive sample of 14 shiatsu practitioners and 15 clients. Client interviews focused on the experience of shiatsu and perceptions of its effects, both positive and negative. Practitioners were also asked about factors that enhanced or inhibited successful treatment. The taped and transcribed data were analyzed using grounded theory, assisted by NVivo (QSR, Markham, Ontario, Canada) software. To enhance generalizability, the findings from the alternative country data set were presented to a further set of practitioners in each country and as a whole to an international meeting of practitioners from seven European countries.
There was similarity in the perspectives of the clients and practitioners and participants from the United Kingdom and Germany. Both described a wide range of common, immediate and longer term effects. These included effects on initial symptoms, relaxation, sleeping, posture, and experiences of the body. A category of transitional effect arose, describing an effect that was not particularly positive and did not last long. Practitioners characterized this as being part of the healing response. Only a few negative effects were described by clients. One mentioned a negative physical reaction and two indicated difficulties coping with emotional reactions. While most practitioners conceived negative effects to be possible, these were more likely to be described as negative reactions.
This exploratory study has shed greater light on the effects of shiatsu. The sample findings provide a user and practitioner grounded base for the design of appropriate questions for exploration in a larger and more generalizable study of the effects of shiatsu.
Two distinct positive outcomes are possible with Classical Acupuncture; resolution of the "main complaint" for which the patient is seeking treatment and unexpected resolution of health concerns for which the patient is not seeking treatment. Two clinical cases are presented to illustrate this phenomenon clearly. In both cases, the unexpected outcomes follow logically from the central therapeutic imperative of Oriental medicine; treatment of both the patient's root and branch. Research designs focused on single health conditions do little to reflect this central clinical reality. To highlight this problem, the two cases presented here are repositioned within the framework of research designs focused on single health conditions. It becomes clear that any eventual "gold standard" of acupuncture-appropriate research designs would reflect the full health care service provided by Classical Acupuncture. This, in turn, would ensure that health care policies based on research results would be appropriate to the realities of clinical acupuncture.
Complementary and alternative medicine (CAM) often consists of whole systems of care (such as naturopathic medicine or traditional Chinese medicine (TCM)) that combine a wide range of modalities to provide individualised treatment. The complexity of these interventions and their potential synergistic effect requires innovative evaluative approaches. Model validity, which encompasses the need for research to adequately address the unique healing theory and therapeutic context of the intervention, is central to whole systems research (WSR). Classical randomised controlled trials (RCTs) are limited in their ability to address this need. Therefore, we propose a mixed methods approach that includes a range of relevant and holistic outcome measures. As the individual components of most whole systems are inseparable, complementary and synergistic, WSR must not focus only on the "active" ingredients of a system. An emerging WSR framework must be non-hierarchical, cyclical, flexible and adaptive, as knowledge creation is continuous, evolutionary and necessitates a continuous interplay between research methods and "phases" of knowledge. Finally, WSR must hold qualitative and quantitative research methods in equal esteem to realize their unique research contribution. Whole systems are complex and therefore no one method can adequately capture the meaning, process and outcomes of these interventions.
Healing can be both an intensely personal and a social and community event that often surprises us when it emerges from the landscape of everyday life. This observation raises at least three questions that serve as the focus for this paper's reflections about creating optimal healing places. Who are patients? What relationships and features of those relationships help patients toward healing? How do we understand and facilitate the emergence of healing over time and place? Using existing literature and our own past and current studies of patients, clinical encounters, and primary care practices, we explore each of these questions. We identify four different aspects or faces of patients: patients as human animals, patients as persons, patients as techno-consumers, and patients as patients. We highlight 10 lessons or observations about patients and their healing experiences. Key features of relational process are described, and nine interdependent relationship characteristics that appear to promote healing are discussed. The idea of healing landscapes as an emergent life space is introduced as a way of conceptualizing and further investigating these observations. A reflective action process for facilitating the emergence of healing landscapes and creating an ecology of hope is presented, and recommendations for future research are briefly shared.
To outline acupuncturists' perceptions of treating patients with rheumatoid arthritis (RA), exploring the impact of practitioner affiliation to a traditional or western theoretical base.
Qualitative study utilising Grounded Theory Method. Nineteen acupuncturists were chosen via theoretical sampling. In-depth semi-structured interviews were tape-recorded and transcribed. Field notes were also taken. Emerging categories and themes were identified.
Inter-affiliatory differences were identified in the treatments administered and the scope and emphasis of intended therapeutic effects. Limited divergence was found between acupuncturists' perceptions of treatment outcomes. Factors perceived as impacting on treatment outcomes were identified.
Clinical trials of acupuncture in RA may have failed to administer a treatment which reflects that administered in clinical practice. Outcome measures employed in clinical trials of acupuncture in RA, as well as established outcome indices for RA, may lack the necessary breadth to accurately assess acupuncture's efficacy. Acupuncturist affiliation has demonstrable implications for the practice and research of acupuncture.
The Collins Report, Resolution on the Status of Non-Conventional Medicine. Strasbourg: Euro-pean Parliament
- European Parliament
European Parliament. The Collins Report, Resolution on the Status of Non-Conventional Medicine. Strasbourg: Euro-pean Parliament, 1997.
Shiatsu Theory and Practice
- Beresford-Cooke
Beresford-Cooke C. Shiatsu Theory and Practice. Edinburgh: Churchill Livingstone, 1996.
Adequacy of Sample Size in Health Studies. Chichester: World Health Or-ganization
- S Lemeshow
- Hosmer Dw
- J Klar
- Lwanga
- Sk
Lemeshow S, Hosmer DW, Klar J, Lwanga SK. Adequacy of Sample Size in Health Studies. Chichester: World Health Or-ganization, John Wiley & Sons Ltd, 1990.
Shiatsu: A Review of the Evidence Online document at: www.shiatsuso-ciety.org Accessed
- Robinson N J Donaldson
- Lorenc
Robinson N, Donaldson J, Lorenc A. Shiatsu: A Review of the Evidence. London: Shiatsu Society UK and Thames Val-ley University, 2006. Online document at: www.shiatsuso-ciety.org Accessed January 8, 2007.