Content uploaded by Andrea Kleinau
Author content
All content in this area was uploaded by Andrea Kleinau on Mar 21, 2019
Content may be subject to copyright.
A preview of the PDF is not available
A review of Shiatsu and an endpoint analysis (meta-analysis) of controlled studies on the efficacy of Shiatsu
Abstract
The objective of this review of research on Shiatsu was to determine its specific efficacy in medical care and therapeutic safety. The results show that Shiatsu is an effective and safe treatment method for the indications that were investigated. Shiatsu is used for physiological, psychosomatic, neurological, psychophysiological or psychosocial impairments and to generally support health and well-being. This review is a clear, differentiated analysis of studies since 1946 that are available worldwide and is divided into monocausal efficacy (part A) and the multifactorial effect of Shiatsu (part B). A total of 15 studies are compared, with 7 controlled studies and 9 uncontrolled studies on Shiatsu being included in the study analysis (parts A and B) (see page 17, Tab. 2). Compared to conventional medicine, which was used in controlled studies as a method of comparison, on average, Shiatsu shows a slight advantage over the studies included.
Shiatsu, Acupressure, Metaanalysis
... 22 In contrast, some studies show varying results depending on the method and population studied. [31][32][33][34] Another study showed that the Shiatsu technique was a safe complementary method for induction of labour in post-term pregnancies, which provides another perspective on the use of Shiatsu massage during labour. 20 Additionally, Shiatsu massage during labour is thought to have few adverse effects and is a simple procedure to perform on expectant mothers. ...
... 33,34,37 Alternating massages and Shiatsu treatment can reduce blood levels of stress hormones such as cortisol, adrenaline, and norepinephrine. 31,38 Although the effectiveness of Shiatsu massage in lowering labour pain and anxiety was unknown earlier, it was claimed that massage enhanced parasympathetic nervous system activity, decreasing labour time, and enhancing delivery pleasure. 1 In line with our findings, the results of the aforementioned investigations revealed that shiatsu massage had a good influence on the health concerns of many patients. ...
... 1 In line with our findings, the results of the aforementioned investigations revealed that shiatsu massage had a good influence on the health concerns of many patients. 31,32,34 Numerous studies have demonstrated the beneficial effects of Shiatsu massage on several health issues. For example, a study conducted on the impact of Shiatsu massage on patients suffering from chronic lower back pain indicated a significant reduction in pain intensity and improvement in functional mobility after a series of Shiatsu massage sessions. ...
Background
Labour pain experienced by women during childbirth can significantly affect the mother’s psychological condition and birthing process. This study aimed to determine the effect of shiatsu massage on pain and anxiety during labour.
Method
This randomized controlled trial was conducted on 80 nulliparous pregnant women who gave birth in four low-risk maternity clinics in Samarinda, Indonesia, from February to May 2022. The women were randomized into intervention (N=40) and control (N=40) groups based on random allocation. Certified midwives performed shiatsu massages following standard protocols. Pain was assessed using the Numeric Rating Scale, and anxiety was assessed using the Hamilton Anxiety Rating Score at three times including before the intervention (T0), the latent phase (T1), and at transition phase (T2). The impact of the intervention was analyzed using repeated measures analysis of variance by SPSS 26. A p-value less than 0.05 was considered statistically significant.
Results
The intervention group showed a significant reduction in labour pain scores from 6.85±1.00 (T0) to 6.13±0.88 (T1) and 4.78±0.83 (T2) (P<0.001), while the control group showed an increase from 6.85±1.00 (T0) to 8.05±0.64 (T1) and 8.85±0.48 (T2) (P<0.001). Anxiety scores in the intervention group decreased from 28.53±4.41 (T0) to 26.15±3.59 (T1) and 20.65±2.69 (T2) (P<0.001), whereas the control group experienced an increase from 25.55±3.16 (T0) to 27.05±3.36 (T1) and 31.73±3.27 (T2) (P<0.001). The between-subject effects in time levels for labour pain and anxiety in the two study groups had a significant impact (P<0.001).
Conclusion
Findings showed that shiatsu massage was effective and safe for relieving pain and reducing anxiety during childbirth of nulliparous women. This research suggests that shiatsu massage can be used as an effective alternative method to relieve pain and anxiety during labour in low risk pregnancies, particularly in settings with limited access to pharmaceutical analgesics.
Trial Registration Number: IRCT20220317054316N1
... Scientific studies have been carried out on shiatsu and showed its benefits. 3,4 It has been named ''one of the eight alternative approaches of interest'' by European Parliament. 5 Faced with the growing use of CAM and the development of shiatsu, the aim of this work was to explore motives and experiences of shiatsu use, the health trajectories of its users, and the place of general practitioners (GP) in the decision to have recourse to this complementary therapy. ...
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.
Introduction: Integrative medicine (IM), the integration of complementary therapies (CTs) and conventional care, is common despite a scarce evidence base of cost-effectiveness. This study explored the cost-effectiveness of IM from a healthcare perspective comparing conventional primary care to a comprehensive IM model in the management of patients with chronic non-specific back/neck pain. Methods: Data on clinical management (planning and delivering IM), resource use (conventional care, CTs, prescription and non-prescription analgesics) and outcome effectiveness (SF-6D) were derived alongside a pragmatic randomized clinical pilot trial (n = 80) with 16 weeks follow-up. Costs and effects, i.e. quality-adjusted life years (QALYs), were estimated over different time periods and willingness-to-pay thresholds. Net monetary benefit and bootstrapping methods were used to address uncertainty in the cost-effectiveness analyses. Results: The IM model, on average integrating 7 CT sessions with conventional primary care over 10 weeks, resulted in increased QALYs, somewhat higher cost of health care provision but a reduced cost of using health care resources, including less use of analgesics compared to conventional primary care. The costs/QALY ranged between D 24,000 and 41,000. Conclusion: Given the threshold value of D 50,000 per QALY gained, and a remaining effect of one year, it is indicated that IM might be cost-effective compared with conventional primary care. Future cost-effectiveness studies of IM should be carried out from a societal perspective and should be based on large scale pragmatic randomized clinical trials.
Studies have suggested a possible role for shiatsu in treating a variety of mental and physical ailments.
To determine if shiatsu can provide clinical benefit to individuals diagnosed with schizophrenia.
An open-label pilot study.
An inpatient psychiatric ward at Herzog Memorial Hospital, Jerusalem, Israel.
Twelve hospitalized patients with chronic schizophrenia.
Shiatsu treatment provided in a course of eight 40-minute biweekly sessions over 4 weeks.
All subjects were evaluated at baseline, 2 weeks, 4 weeks (end of treatment), and 12 weeks (followup). The tools used for assessment included the Clinical Global Impression (CGI), the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS), the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). Side effects were measured using the Simpson-Angus Scale for Extrapyramidal Symptoms (SAS) and the Abnormal Involuntary Movement Scale (AIMS).
On all scales of psychopathology and side effects, the subjects showed a statistically and clinically significant improvement by the end of treatment. This improvement was maintained at the 12-week follow-up. These findings, while encouraging, must be considered preliminary and require confirmation and cross-validation in larger-scale controlled studies.
A model for integrative medicine (IM) adapted to Swedish primary care was previously developed. The aim of this study was to explore the feasibility of a pragmatic randomised clinical trial to investigate the effectiveness of the IM model versus conventional primary care in the management of patients with non-specific back/neck pain. Specific objectives included the exploration of recruitment and retention rates, patient and care characteristics, clinical differences and effect sizes between groups, selected outcome measures and power calculations to inform the basis of a full-scale trial.
Eighty patients with back/neck pain of at least two weeks duration were randomised to the two types of care. Outcome measures were standardised health related quality of life (the eight domains of SF-36) complemented by a set of exploratory "IM tailored" outcomes targeting self-rated disability, stress and well-being (0-10 scales); days in pain (0-14); and the use of analgesics and health care over the last two weeks (yes/no). Data on clinical management were derived from medical records. Outcome changes from baseline to follow-up after 16 weeks were used to explore the differences between the groups.
Seventy-five percent (80/107) of screened patients in general practice were eligible and feasible to enroll into the trial. Eighty-two percent (36/44) of the integrative and 75% (27/36) of the conventional care group completed follow-up after 16 weeks. Most patients had back/neck pain of at least three months duration. Conventional care typically comprised advice and prescription of analgesics, occasionally complemented with sick leave or a written referral to physiotherapy. IM care generally integrated seven treatment sessions from two different types of complementary therapies with conventional care over ten weeks. The study was underpowered to detect any statistically significant differences between the groups. One SF-36 domain showed a clinically relevant difference between groups that was also supported by a small distribution based effect size, i.e. vitality (-7.3 points, Cohen's d -0.34) which was in favour of IM. There was a clinical trend between groups showing that IM contributed to less use of prescription and non-prescription analgesics (-11.7 and - 9.7 percent units respectively) compared to conventional care. Exploring clinically relevant differences and the SF-36 as the basis for a main outcome measure showed that the sample sizes needed per arm to adequately power a full-scale trial depended on the target domain, i.e. ranging from 60 (vitality) to 339 (role emotion).
This pilot study investigated the implementation of IM in the primary care management of non-specific back and neck pain. Recruiting patients and implementing IM in routine clinical practice was feasible. The results warrant further exploration into different perspectives and relevant combinations of outcome measures including the use of health resources, drugs and cost-effectiveness to help understand the relevance of IM in primary care. Future research should prioritize larger scale studies considering variability, pain duration and small to moderate treatment effects.
Clinical trials NCT00565942.
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.
The authors resume that the results from this retrospective study by evaluation of treatment protocols give evidence to the absence of prohibited acupuncture points during pregnancy.
There was no evidence of the existence of prohibited points in clinical tests of all points during all stages of pregnancy and the indications for use under scrutiny.
The elevated number of patients (n = 5.885) as well as the results lead to conclude without doubt that there is no evidence to support the traditional doctrine of prohibited points during pregnancy.
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.
The purpose of this study was to examine the psychophysiological effects of shiatsu and massage while in the prone position. Twenty-four healthy women gave informed written consent to participate. After resting in the prone position for 50 min, each subject was massaged and given shiatsu for 15 min and again rested for 15 min in the prone position. Every 5 min, skin temperature was measured along the neck and back. Blood pressure and pulse rate also were measured every 5 min throughout the procedure. A visual analog scale was used to assess the severity of pain experienced before the massage and shiatsu as well as at completion of the procedure. The subject's favorite sleeping posture and previous physical pain experienced during massage and shiatsu were assessed. The findings revealed that significant differences were found in skin temperatures (elevated 0.5 degrees) along the back after the procedure. Systolic blood pressure was found to be significantly lower after the massage and shiatsu when compared with systolic blood pressure prior to the procedure. No significant differences before and after the procedures were found in either the diastolic blood pressure or pulse rate. The procedure was found to give the subjects relief from pain. No significant differences were noted in the subject's favorite sleeping posture, the experience of previous physical pain, or the experience of the massage and shiatsu.
Recent epidemiological data indicate that chronic stress is an important component of cardiovascular risk, implicitly suggesting that stress management might offer a useful complement to orthodox medical treatment and prevention of hypertension. In this context, information on mechanisms, such as subclinical increases in arterial pressure and sympathetic drive, is well documented. Conversely, evidence on methodologies and comparative efficacy needs to be improved. Accordingly, this study was planned to test the autonomic and subjective effects of two popular modalities of stress management.
We studied 70 patients complaining of stress-related symptoms, avoiding any potential autonomic confounder, such as established hypertension or drug treatment. Patients were divided in three groups: group I (n = 30) followed a breathing-guided relaxation training (active); group II (n = 15) an oriental massage, shiatsu (passive); and group III (n = 25) followed a sham intervention. Subjective effects of stress were assessed by validated questionnaires and autonomic nervous system regulation by spectral analysis of RR interval variability. Factor analysis was used to extract information simultaneously embedded in subjective and functional data.
Although the problem of a greater quantity of treatment procedure in the active group than in the passive group existed, results showed that active relaxation, further to slightly reducing arterial pressure, might be more effective in relieving symptoms of stress and inducing an improved profile of autonomic cardiovascular regulation, as compared with passive massage or sham intervention.
This active technique seems capable of beneficially addressing simultaneously the individual psychological and physiopathological dimensions of stress in clinical settings, with potentially beneficial effects on cardiovascular risk profile.