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The Efficacy of Shiatsu Therapy at "Sea of Energy" Point on Primary Dysmenorrhea in Nursing Students

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Abstract

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.
International Journal of Nursing Didactics, 7: 04 April (2017).
Contents lists available at www.innovativejournal.in
INTERNATIONAL JOURNAL OF NURSING DIDACTICS
homepage: http://innovativejournal.in/ijnd/index.php/ijnd
56
The Efficacy of Shiatsu Therapy at “Sea of Energy” Point on Primary Dysmenorrhea
in Nursing Students
Hanan F. Abbas Soliman1, Eman A. SolimanEl-Hosary2
1Lecturer of Maternity and Gynecological Nursing, Faculty of Nursing, Ain Shams University, Egypt
2Lecturer of Maternal and Newborn Health Nursing, Faculty of Nursing, Menoufiya University, Egypt.
DOI: http://dx.doi.org/10.15520/ijnd.2017.vol7.iss4.206.56-62
Abstract: 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.
Keywords: Primary Dysmenorrhea, Shiatsu.
INTRODUCTION
Dysmenorrhea is a common gynecological disorder affects
50% of menstruating women, it is classified into two types;
Primary dysmenorrhea is a painful menstruation with
normal anatomy of the pelvis, begins usually in the female
puberty. Its onset usually begins from six to twelve months
after menarche, with regular ovulatory cycles. Meanwhile,
secondary dysmenorrhea is defined as menstrual pain
associated with underlying pathology. These two forms of
dysmenorrhea are different at the time of menstrual cycle
manifestations in pain quality and other symptoms. Primary
dysmenorrhea (Spasmodic) is an acute pain which occurs in
the first two to three days of menstruation and is often
associated with gastrointestinal symptoms. Pain is confined
to the parts of the body which are innervated by the uterine
or ovarian nerves.[1]
Various bio-social and psychological causes were reported
as the cause of dysmenorrhea. During a period, the uterine
muscle contracts to shed the lining away, compressing the
blood vessels that line the uterus. Consequently, without
oxygen, the tissues in the uterus release pain-triggering
chemicals, along with prostaglandins that promote further
contractions, which worsen the pain. Obviously, it is
unknown why some women experience more severe
dysmenorrhea than others, but it may be due to excessive
production of prostaglandins causing stronger contractions;
it is considered the main cause of dysmenorrhea which
causes cramping and other symptoms.[2,3]
Primary dysmenorrhea is common in young women, can
reduce productivity and work performance and includes
symptoms as intermittent spasms of pain, usually centered in
the supra-pubic region, pain radiated to the lower back or
legs, nausea, vomiting, fatigue, fever, headache, diarrhea,
and vertigo.[4,5]Menstrual cramp is a very common
complaint, experienced by 45-95 % of female reproductive
age. Many women are suffering menstrual cramps just
before and during their menstrual periods. The discomfort is
merely annoying for some women, for others it could be
severe enough to interfere with everyday activities a few
days every month. [6]
A variety of complementary and alternative methods have
been used for the treatment of dysmenorrhea including;
herbal therapy, complementary medicine, acupressure,
biofeedback, trans-cutaneous electronic nerve stimulation,
and so on. Shiatsu treatment is one of the alternative
methods, which becomes more widely accepted. [7]
Shiatsu is a physical therapy means 'finger pressure'
originating from Japan that supports the body's natural
ability to self-heal, practice of a massage therapy, which
incorporates gentle manipulations, stretches combined with
pressure techniques by fingers, thumbs, elbows, knees and
feet. [8, 9]It is working on a holistic level, addresses
emotional, spiritual and physical aspects of health,
musculoskeletal and psychological problems are the most
common conditions presenting for treatment. This therapy
can be used to reduce the stress and promote the overall
health and well-being. [10,11]
Hanan F. Abbas Soliman et al, International Journal of Nursing Didactics, 7 (04) April, 2017,
57
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. Unlike
acupuncture, shiatsu therapy uses acupressure, applied by
hand to key areas on the body, to release discomfort, pain,
bloating and tension [1]. Also, it is effective to regulate the
menstrual cycle, improve energy, digestion, and can be used
to prevent or treat acute cramps, vaginal discharge,
constipation, headache and general weakness.[12,13]
"Sea of Energy" point is one of the most important points
for treating the dysmenorrhea, located by two fingers width
below the navel; stimulation of this point helps in treating
dysmenorrhea and associated symptoms. The practice uses
comfortable pressure, touch and manipulative techniques;
this balances the energy flow and adjusts the body's physical
structure elements[13].Shiatsu point is easy accessible, can
be simply found and massage with pressure can be exerted
on it without the help of medical staff, nurses have a crucial
role to encourage the women to cope with dysmenorrhea
through using safe alternative methods instead of medical
chemical drugs.
Significant of the study:
Primary dysmenorrhea with an estimated prevalence of 43%
to 90% is one of the most common health problems among
women younger than 25 years and one of the main reasons
for short-term school or work absence, resulting in a
significant economic loss. [1]The use of non-
pharmacological therapy is a time-honored approach in
modern investigation and research, to strengthening the
body and treating the disease without side- effects.
Therefore, using shiatsu therapy is effective for management
of primary dysmenorrhea. There are few studies indicate
that shiatsu therapy can reduce menstrual cramps and
associated symptoms; however, it is used in Europe to
relieve health problems[15].Improvement of research
evidence was found in quality, quantity and reporting, but
still more studies are needed, particularly for Shiatsu.
Shiatsu is a natural way to relieve menstrual pain and
symptoms. It is safe, non-invasive, economical and cost free
pain relieving technique. So the purpose of the present study
was to evaluate the efficacy of using shiatsu therapy at "Sea
of Energy" point on relieving primary dysmenorrhea.
Aim and Objectives of the Study: to study the efficacy of
using shiatsu therapy at "Sea of Energy" point on relieving
the primary dysmenorrhea through:
1. Identifying the severity of primary dysmenorrheal
cramps and the associated symptoms in nursing
students.
2. Evaluate the effectiveness of using shiatsu therapy at
"Sea of Energy" point on relieving primary
dysmenorrheal cramps and the associated symptoms.
Research question and hypothesis:
Is the using of shiatsu therapy at "Sea of Energy" point
effective in relieving the primary dysmenorrheal cramps and
the associated symptoms?
H1. The using of shiatsu therapy at "Sea of Energy" point
will be effective in relieving the primary dysmenorrheal
cramps and the associated symptoms.
SUBJECTS AND METHODS
1. Research Design, setting and timing: A Quasi-
experimental study design was conducted in college of
applied medical sciences, Shaqra University during the
academic year 2015-2016.
2 .Sampling size and technique:
A total of 82 nursing students was allocated into two groups;
shiatsu group (n= 46) and non-shiatsu group (n= 36) during
the academic year 2015-2016. They participated in the
current study by using the convenience sampling
technique. Note: Shaqra University system works by
academic levels with credit hours from level 3 to 8, so the
researchers selected the groups according to levels; shiatsu
group included the students in level 4, 6 and 8, while non-
shiatsu group included the students in level 3, 5 and 7.
Inclusion criteria: unmarried students have regular
menstrual cycles of 21-35 days and suffer from menstrual
pain and discomforts.
Exclusion criteria: included pelvic diseases, abdominal and
pelvic surgeries or having severe psychological stress
(parents’ divorce, death of close relatives, etc.) and taking
sedatives.
Tools for data collection: Three tools were used for data
collection. These consisted of students` structured
interviewing questionnaire sheet regarding to primary
dysmenorrhea, visual analogue scale and follow-up chart.
1) A Structure Interviewing Questionnaire; was developed
by the researchers to collect data after extensive literature
review related to: 1-a) demographic characteristics (age,
name, educational level...) and 1-b) menstrual
characteristics.
2) Visual Analogue Scale (VAS): was adopted from Gould
et al., 2001used to assess menstrual pain intensity. It
consists of a blank line anchored at each end of the line by
adjectives that describe the extremes of pain. The anchoring
adjectives commonly used are "no pain" (zero score) and
"severe pain" (the worst possible pain) the top score (ten).
The student was asked to place a mark on the line that best
indicates the pain being experienced. This tool takes 2 to 5
minutes to be completed; it was divided into three main
parts: the first part graded from 0-3.5 cm which reflects mild
pain, the second part graded from 4-7.5 cm for moderate
pain and the third part graded from 8-10 cm for severe pain.
These scores were recorded before and after intervention
[16].
3) Follow-up chart: It is a daily chart developed by the
researcher after extensive review of relevant and recent
literature. Students recorded the severity of dysmenorrhea
(pain) for two consecutive cycles (before and after using the
shiatsu therapy at different time intervals; at immediately,
1,2 then3 hours after intervention). Also, to prospective
record the impact and severity of menstrual symptoms.
Hanan F. Abbas Soliman et al, International Journal of Nursing Didactics, 7 (04) April, 2017,
58
Fieldwork:
Collection of data covered a period of 9 months from
October 2015 to June 2016. All of nursing students had been
fully informed about the research and consented to
participate in the research, followed by a baseline interview.
During the interview, data included student’s age, age of
menarche, length of menstrual cycle, duration of menstrual
flow, regularity of menstruation, amount of blood flow,
severity, onset and duration of pain were collected by the
students in shiatsu and non-shiatsu groups which were
selected according to levels, where the odd level numbers
were recruited as a non-shiatsu group and the even numbers
are recruited as a shiatsu group.
Shiatsu group: The researchers provided a personal
training of self-care shiatsu therapy to all the
participants in the shiatsu group. Additionally, they
provided information about shiatsu therapy through
(video, pictures, text)as follows: Stimulate the “sea of
energy” point located in the abdominal area by
measuring two fingers width below navel, then, light
pressure with manipulation or light massage is applied
to this area by fingers with deep breathing, for one to
two minutes. These steps applied three times daily
during the menstruation for two consecutive menstrual
cycles.
Non-shiatsu group: The researchers provided them
with health education about the usual care of
menstruation as (hygiene and diet)
Both groups were instructed to assess pain intensity and
severity of symptoms before and after the intervention
for two consecutive menstrual cycles.
Content validity and reliability:
Study tools were submitted to a panel of five experts in the
field of maternity nursing, to test the content validity.
Modifications were done according to the panel's judgment
on the clarity of sentences and content appropriateness.
Reliability analysis was conducted to investigate the
instrument internal consistency which used in the study.
Internal consistency describes the extent to which all the
questionnaire items measure the same concept or construct.
Cronbach alpha coefficients were calculated to examine the
measurement reliability with multipoint items. The accepted
values of Cronbach alpha coefficient range from 0.60 to
0.95.[17,18]The questionnaire items of the present study
were proven reliable where α = 0.91
Pilot Study:
It was conducted on 10% of the participants, were selected
randomly and excluded from the main study sample. Its aim
was to evaluate the simplicity and clarity of the tools. It also
helped in the estimation of the time needed to fill in the
forms. According to the pilot study results, simple
modifications were done as rephrasing or canceling some
questions.
Ethical consideration:
An official permission was granted from the dean of applied
medical sciences' college, Shaqra University. The
researchers introduced themselves to the students who met
the inclusion criteria and informed them about the purpose
of this study in order to obtain their acceptance to share in
this study. The researchers ensured that, the study posed no
risk or hazards to their health and their participation in the
study is voluntary. Nursing students who were willing to
participate in the study and met the inclusion criteria were
approached by the researchers and asked for verbal consent
to confirm their acceptance, and all events that occurred
during data collection were considered confidential.
Statistical design:
All statistical analyses were done using SPSS version 20.
Initially, the internal consistency coefficients were examined
to ensure the reliability of the used instrument for the
present samples. Frequencies, means and standard
deviations were calculated to describe the samples. T-test
and ANOVA were used to compare the means of two
different groups. Statistical significance was considered at
p-value <0.05.
RESULTS
Table (1) Showed that the mean ages of students in the
Shiatsu and Non-shiatsu groups was (22.4±4.5) and
(19.89±1.75), While the mean ages of menarche was (13.35
± 1.4) and (13.06±1.28) for both groups respectively. Also,
it was found that the mean duration of menstrual cycle for
shiatsu and non-shiatsu groups was (5.65±4.1) and (5.5±
3.0), meanwhile the mean length of the menstrual cycle was
(27.0 ± 3.4) and (28.3 ± 3.5) for both groups respectively.
Most of them had a moderate amount of blood flow in both
groups.
Table (2) illustrated that about half of the nursing students
(52.2 %) had moderate pain and (41.3%)of them had severe
pain in the shiatsu group compared to (27.8%) and (61.1%)
of the students had moderate and severe pain in the non-
shiatsu group respectively. Regarding to the onset and
duration of the menstrual pain among the students, it was
found that, more than half of the students had pain before
the beginning of the menstruation and up to 24-48 hours in
the shiatsu at (54.3%) and non shiatsu at (66.7%), while
37% and (33.3%) of the shiatsu and non shiatsu groups
respectively, had pain from the beginning of the
menstruation and up to 24-48 hours.
Figure (1) showed decreases of the menstrual pain mean
scores among the nursing students in the shiatsu group at the
initial assessment (pre-intervention), then at immediately, at
1, 2, and 3 hours after the intervention for two consecutive
menstrual cycles.
Table (3) revealed that there was no statistically significant
difference between the shiatsu and the non-shiatsu groups
related to pain scores before the intervention at (p=
0.29),while there were highly statistically significant
differences between groups at different time intervals for
two consecutive menstrual cycles after the intervention at (p
< 0.001).
Table (4) indicated that there was no statistically significant
difference between groups on mean scores of menstrual
symptoms at (t= -1.86, p-value 0.066) before the
intervention while there was highly statistically significant
differences between groups at (t= -7.29, p-value0.000*)
after the intervention.
Hanan F. Abbas Soliman et al, International Journal of Nursing Didactics, 7 (04) April, 2017,
59
Table (1): General and menstrual characteristics of the studied students.
Items
Shiatsu (N= 46)
No.
%
No.
%
Age:
≤ 20 years
21-25 years
>25 years
Mean ±SD
13
28
5
22.4±4.5
28.3
60.9
10.9
28
8
0
19.89±1.75
27.8
22.2
0
Age ofMenarche 9-12 years 13-16 years > 16 years
Mean ±SD
10
35
1
13.35 ± 1.4
21.7
76.1
2.2
10
26
0
13.06±1.28
27.8
72.2
0
Duration of menstrual cycle 1-3 days 4-6 days > 6 days
Mean ±SD
0
31
15
5.65±4.1
0
67.4
32.6
2
22
12
5.5± 3.0
5.6
61.1
33.3
Length of menstrual cycle 21-25 days 26-30 days 31-35 days
Mean ±SD
16
23
7
27.0 ± 3.4
34.8
50.0
15.2
10
14
12
28.3 ± 3.5
27.8
38.9
33.3
Amount of blood flow Mild
Moderate
Severe
3
40
3
6.5
87.0
6.5
0
32
4
0
88.9
11.1
Table (2): Characteristic of the menstrual pain among the students before the intervention.
Items
Shiatsu (N= 46)
Non-Shiatsu (N= 36)
No.
%
No.
%
Severity of pain:
- Mild (1-3)
- Moderate (4-7)
- S
evere (8-10)
3
24
19
6.5
52.2
41.3
4
10
22
11.1
27.8
61.1
Onset & duration of pain
- Before menstruation and up to 24-48 hours
- With onset of menstruation and up to 24-48 hours.
- A
fter 24 hours of menstruation and continue with it.
25
17
4
54.3
37.0
8.7
24
12
0
66.7
33.3
0
Figure (1). Mean menstrual pain Scores for the shiatsu Group.
0
0.5
1
1.5
2
2.5
First Cycle
Second Cycle
Hanan F. Abbas Soliman et al, International Journal of Nursing Didactics, 7 (04) April, 2017,
60
Table (3). Comparison of pain sever ityscores between groups during two menstrual cyclesat different time intervals.
Pain score at different time intervals
Shiatsu (N= 46)
Non-Shiatsu (N= 36)
F
P- value
Mean ± SD
Mean ± SD
Pre intervention pain score
2.34± .60
2.5± .697
1.12
.29
Post intervention pain score
At First Menstrual Cycle:
- Immediately after intervention.
- At 1 hour after intervention.
- At 2 hours after intervention.
- At 3 hours after intervention.
1.41 ±.88
1.0 ±.84
.61 ±.77
.33 ±.59
2.2±.66
1.7± .88
1.7± .66
1.3±.74
23.9
14.2
47.5
41.4
0.001* 0.001* 0.001* 0.001*
At Second Menstrual Cycle:
- Immediately after intervention.
- At 1 hour after intervention.
- At 2 hours after intervention.
- At 3 hours after intervention.
1.6±.93
1.1±.87
.72±.81
.48±.78
2.3±.65
1.7± .8
1.7± .65
1.2±.73
12.6
9.8
36.6
22.1
.001*
.002*
.000*
.000*
* Highly statistically significant at p< 0.001
Table (4).Comparison of symptoms severity scores between Shiatsu and Non-Shiatsu groups.
Non-Shiatsu (N= 36)
Shiatsu (N= 46)
Symptoms
After Mean ± SD
Before
Mean ± SD
After
Mean ± SD
Before
Mean ± SD
1.11 ±0.19
1.22 ± 1.19
0.39 ± 0.68
0.72 ± .86
Tension and Anxiety
1.11± 0.54
1.11 ± 1.16
0.09 ± 0.28
0.72 ± .93
Bowel Disturbances
1.08 ±.84
1.28 ± 1.05
0.30 ± .62
0.74 ± 0.83
Constipation
1.67 ± 1.12
1.28 ± 1.05
0.59 ± 0.90
1.70 ± 1.20
Abdominal Distension
1.06 ± 1.09
1.67 ± 1.12
0.46 ± 0.62
1.20 ± 1.31
Backache
1.28 ± 1.11
1.06 ± 1.09
0.30 ± 0.59
1.41 ± 1.34
Breast tenderness
0.97± 0.16
1.28 ± 1.11
0.48 ± 0.75
0.63 ± .92
Legs pain
1.28 ± 1.25
.83 ± .97
0.43 ± 0.68
1.35 ± 1.32
Nausea and vomiting
1.72 ± 1.21
1.28 ± 1.25
0.33 ± 0.59
1.07 ± 1.12
Anorexia
1.78 ± 1.37
1.72 ±1.21
0.41 ± 0.80
0.85 ± 1.13
Fatigue
1.22 ± 1.09
1.78 ± 1.37
0.17 ± 0.48
0.98 ± 1.20
Nervous
0.61± 0.49
1.22 ± 1.09
0.11 ± 0.37
0.54 ±. 80
Vertigo
15.1 ± 8.96
11.98±6.2
Pre intervention symptoms score
t= -1.86 p-value= .066
14.25±7.9
4.5±3.9
Post intervention symptoms score
t= -7.29 p-value.000 **
** Highly statistically significant at p< 0.001
DISCUSSION
Dysmenorrhea is the pain and discomfort experienced
during, or just before, a menstrual period. The intention of
this study was to study the efficacy of Shiatsu therapy at
“Sea of Energy” Point on Primary dysmenorrhea in nursing
students. The findings of the current study were discussed
within the following frame of references; identifying the
severity of pain and symptoms of primary dysmenorrhea
and evaluate the efficacy of using shiatsu massage therapy at
“Sea of Energy” Point on primary dysmenorrhea.
Regarding the severity of pain and symptoms of primary
dysmenorrhea, the present study illustrated a high
prevalence of dysmenorrhea among nursing students, most
of them had moderate and severe pain and very low rate had
mild pain in both groups (shiatsu and non-shiatsu groups).
On the same line with a study conducted by Mohamed and
Neaem, (2013) in Mansours, Egypt indicated a high
prevalence of dysmenorrhea (78.8%) among technical
secondary school girls. However, our finding was in
contrary to El-Gilany et al.,(2005) who studied primary
dysmenorrhea among664 secondary school students from
urban and rural areas in Mansoura, Egypt, reported that 75%
of the students' had dysmenorrhea, most of them had mild
and moderate pain; rated mild in (55.3%), moderate in
(30%) and severe in (14.7%). The differences could be
related to different culture, study population type and size.
Various menstrual symptoms were reported in the present
study included; tension, anxiety, bowel disturbances,
constipation, abdominal distension, backache, breast
tenderness, leg pain, nausea, vomiting, anorexia, fatigue,
nervousness and vertigo with mean symptom scores (11.98
± 6.24) and (15.1± 8.96) in the shiatsu and non-shiatsu
groups respectively. The finding of the present study was in
agreement with Peter, (2012) who found in his study that
dysmenorrhea varies from mild discomfort to severe pain;
with one fifth of women complaining that the pain prevents
everyday activity. Pain is usually localized to the lower
abdominal area, affect the lower back and thighs. Other
associated symptoms include nausea, vomiting, headache,
fatigue, dizziness or fainting and diarrhea were reported.
Regarding the efficacy of shiatsu therapy on primary
dysmenorrhea, the present study indicated that using the
Shiatsu therapy was safe and effective in relieving menstrual
pain and symptoms; this was supported by Long, (2009)
Hanan F. Abbas Soliman et al, International Journal of Nursing Didactics, 7 (04) April, 2017,
61
who reported that Shiatsu is an inherently safe treatment.
Also, our finding in accordance with Beresford-Cooke,
(2003)who reported that there are several health problems
may be amenable to treatment by Shiatsu include;
headaches, backaches, menstrual problems, insomnia,
tension, anxiety and depression, fatigue and weakness,
digestive disorders and bowel trouble, and others.
On the other hand, Robenson et al.,(2001) conducted a
study of the evidence for Shiatsu: a systematic review of
shiatsu and acupressure, reported that some evidence found
shiatsu was effective, but not safe as in neck massage, and
some others reported it is effective and safe in other
problems. This could be due to Shiatsu is practiced in many
countries, but varies in styles and points of practice. Also,
very little Shiatsu studies were conducted, suggesting well
designed studies are needed.
The current study revealed that, there were highly
statistically significant differences between the shiatsu and
the non-shiatsu groups regarding to menstrual pain at
different time intervals for two consecutive cycles after the
intervention and this congruent with a randomized control
trial study conducted by Wong et al.,(2010)who determined
the effect of alternative therapy as acupressure on relieving
primary dysmenorrhea and the study showed statistically
significant decrease in pain score using Visual Analogue
Scale. Also, a clinical trial conducted by Ggharlloghis et
al.,(2012) in which the results showed that the severity of
pain, decreased significantly for up to two hours following
intervention with acupressure technique.
In the same line with Mirbagher et al.,(2011) which
estimated that there were significant differences in Visual
Analogue Scale at immediately, one, two, and three hours
after intervention of acupressure technique. Furthermore,
this result congruent with Mohamed et al.,(2015)who
reported that using Femi-band acupressure on SP6 point for
one minute three times daily alleviated the primary
dysmenorrhea. This was explained by alternative therapies
are widely used in Asia and Europe to avoid the
pharmacological methods ' side-effects; Shiatsu therapy is
one of the alternative methods, which is considered a natural
way to relieve pain, safe, non-invasive, economical and cost
free. Also, it is self-administered technique for relieving
primary dysmenorrhea.
The current study illustrated that there was decreasing of the
menstrual symptom severity scores between the shiatsu and
non-shiatsu groups after using shiatsu massage therapy with
highly statistically significant differences between groups.
This finding was supported by Bipasha, (2015)who reported
that "Sea of Energy" point is one of the most important
points for treating dysmenorrhea, located below the navel by
two fingers width; stimulating this point helps in
normalizing irregular periods, menstrual cramps, treats
vaginal discharge and problems of constipation. Stimulation
of this point also helps in relieving digestive disorders such
as gas and irritable bowel syndrome, headache and general
weakness.
Tension and anxiety were reported symptoms in our study,
which improved after the intervention. This was congruent
with Long, (2008) who illustrated that shiatsu was a holistic
and natural therapy, can benefit most people. Many women
use it as a form of stress management or as part of a
preventative health care program. Help maintain balance;
the therapy can promote overall well-being, even if the
women are fit and healthy. Also, this result was congruent
with Beresford-Cooke, (2003) who reported that shiatsu
therapy was useful in the treatment of tension, anxiety and
depression. This also supported by Proctor et
al.,(2007)study, which illustrated that shiatsu therapy relived
tension and anxiety of primary and secondary
dysmenorrhea.
Furthermore, other symptoms were reported in the current
study, as headache, backache, nausea and vomiting, which
improved after the use of shiatsu therapy. This finding was
in the same line with Hsieh et al.,(2006)provided pragmatic
evidence for the long-term effects of acupressure/Shiatsu as
individualized treatment for low back pain, headache,
nausea and vomiting. This finding was also in agreement
with Shin and Song, (2005)who found that Shiatsu or
acupressure is considered an effective intervention for
reducing nausea and vomiting in pregnant women having
hyper emesis gravid arum than the placebo and the control
group at (F=8.259, p=.001).
CONCLUSION
Based on the findings of the present study, it was concluded
that the shiatsu group had a significant reduction in the
severity of primary dysmenorrhea pain and symptoms after
using the shiatsu therapy at "sea of energy" point.
RECOMMENDATIONS
Based on the findings of the current study, the following
was recommended: 1) Encouraging the use of shiatsu
therapy at" 'sea of energy" point during the first days of
menstruation to reduce the menstrual pain and symptoms.2)
The findings of the current study can be used as a guideline
for further research on effect of shiatsu therapy at" 'sea of
energy "point using a combination of different points. 3)
Further investigations are necessary to replicate the
beneficial findings of the present study on large populations.
4) Also, further studies are needed to investigate the effect
of other shiatsu points in relieving other health problems.
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Thesis
Les Interventions Non-Médicamenteuses (INM), et autres procédures qui peuvent leur être associées (Médecine Traditionnelle, Médecines Complémentaires et Alternatives), sont aujourd’hui d’une prépondérance à ne pas sous-estimer dans l’optique d’une santé intégrative. Une évaluation scientifique robuste est nécessaire afin de trier les pratiques néfastes ou inefficaces, de celles attestant de réels bénéfices. Dans ce domaine, les essais randomisés contrôlés (ERC) font loi, à un titre discutable du fait de leurs limites intrinsèques. Par le biais d’une revue systématique de littérature centrée sur les pratiques de manipulation corporelles comme soins de support proposés en oncologie, nous confirmons la difficulté qu’ont les ERCs de tirer des conclusions fermes et bien appuyées. Nous présentons alors une méthode interventionnelle différente et peu enseignée, les protocoles expérimentaux à cas unique, et proposons leur illustration à travers quatre études. Celles-ci portent sur l’évaluation de différentes interventions dans des contextes de maladies chroniques ou de problèmes de santé variables : 1) Jeu vidéo thérapeutique dans le cadre de la réadaptation physique de la maladie de Parkinson, 2) Intervention musicale en Soins Palliatifs, 3) Hypnose face aux restrictions hydriques de patients sous hémodialyse et 4) Séances de shiatsu face à la dysménorrhée primaire. Ces études rendent compte de résultats intéressants, et permettent de discuter des forces et faiblesses de cette méthode. Nous plaidons alors en sa faveur du fait de ses principes expérimentaux légitimes ainsi que son adéquation avec la pratique fondée sur la preuve. Nous profitons enfin de la faible qualité des études que nous avons menées pour dresser une liste de recommandations et d’écueils à considérer afin de les employer de façon optimale.
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