Effect of acupressure on women with urodynamic stress incontinence

xix, 216 leaves : ill. ; 30 cm.PolyU Library Call No.: [THS] LG51 .H577P SN 2011 ChangObjective: To assess the effectiveness of a standardized protocol of acupressure for women aged between 18 and 60 years with urodynamic stress incontinence (USI). Design: A randomized, single-blinded, placebo-controlled trial using a computer-generated table to allocate the interventions was employed. All of the participants were recruited in an urogynecology clinic in a local acute hospital. Participants: Eighty-one women were randomly assigned to an intervention (acupressure) group (n = 27), sham (sham acupressure) group (n = 27), or control (usual care) group (n = 27). All of the participants were required to undergo pelvic floor training. The participants in the intervention group underwent a course of acupressure based on a validated standardized protocol. Intervention: A validated standardized protocol of acupressure was developed. The intervention comprised three half-hour sessions per week for a total of thirty sessions. Outcome measures: Outcome measures included pelvic floor muscle strength, one-hour pad test, number of episodes of urine leakage over four days, self-reported severity of urine leakage and quality of life as measured by the Chinese version of the King’s Health Questionnaire (CKHQ). Data was collected at baseline before intervention and at three months after intervention. Five percent (n = 4) of the participants dropped out of the study. All of the analyzed data was randomized, and thus the condition of the withdrawing participants was assumed to be unchanged at the end point of the intervention.Results: A Kruskal-Wallis test was used to conduct a three-group comparison, and a Mann-Whitney U test was used for an inter-group comparison. A Chi-square test of independence for the categorical variables was employed. The level of statistical significance was set at 0.05. The level of statistical significance gives no indication as to whether the intervention has clinical implications, and thus the relative change in the outcome measures was calculated. There was a significant difference in pelvic floor muscle strength across the three groups (H = 7.05, p = 0.03), and between the intervention and sham groups (Z = -2.31, p = 0.02) and the intervention and control groups (Z = - 2.25, p = 0.02). There was a significant difference in self-reported severity of urine leakage between the intervention and control groups (Z = - 2.48, p = 0.01) after intervention. Ancillary analyses were conducted to compare the relative change and mean difference in pelvic floor muscle strength, number of episodes of urine leakage, and CKHQ scores among the three groups from baseline to the end of the intervention. In the intervention group, all of the selected outcome measures were found to have undergone a significant relative improvement after intervention. In contrast, there was relatively less improvement in pelvic floor muscle strength and number of episodes of urine leakage in the sham group and control group. A negative change was observed in four out of the eight CKHQ domains in the control group. There was a significant mean paired difference among the three groups in pelvic floor muscle strength (H = 9.92, p = 0.01) and number of episodes of urine leakage (H = 6.03, p = 0.01) before and after intervention. Similarly, there was a significant mean paired difference in all of the domains of the CKHQ among all three groups before and after intervention, with positive improvements in the group undergoing acupressure. Conclusion: Acupressure is a simple and non-invasive intervention that appears to have positive physiological and psychological effects on women with USI. Nurses are in the best position to identify the needs of women with this distressing health problem. The findings point to the possibility of including acupressure as an intervention option for managing USI in women. As acupressure is non-invasive in nature, nurses should consider extending its therapeutic use in existing healthcare services. The physiological mechanisms of acupressure remain unknown, and the anatomical and electrophysiological changes induced by this intervention need to be further explored. As this study was conducted in a local clinic, the results require further validation from multicenter studies.School of NursingPh.D., School of Nursing, The Hong Kong Polytechnic University, 201