Evaluation the effect of acupressure protocol on adult psychiatric in-patients with constipation

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Evaluation the effect of acupressure protocol on adult psychiatric in-patients with constipation

 

Author: Wong, Wai Kit
Title: Evaluation the effect of acupressure protocol on adult psychiatric in-patients with constipation
Degree: D.H.Sc.
Year: 2014
Subject: Constipation.
Acupressure.
Psychotherapy patients.
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xiii, 237 leaves : color illustrations ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2760486
URI: http://theses.lib.polyu.edu.hk/handle/200/7621
Abstract: Background: Constipation is common among psychiatric patients. Its symptoms not only enhance patients' suffering and reduce quality of life but also increase the treatment costs. However, pharmacological treatment only relieves its symptom severity in short term and the longer-term side-effects of drugs may far outweigh its therapeutic effects. Therefore, non-pharmacological alternative approaches (e.g., acupressure) in managing constipation of psychiatric patients may be considered. Aims: This study was to test the effectiveness of a self-administered acupressure protocol on reducing adult psychiatric patients' symptoms of constipation and enhancing their quality of life over a period of 2 weeks follow-up, when compared with sham control. It also explored how these patients' perceived benefits and limitations of self-administration of this acupressure intervention in managing their constipation. Methods: This proposed study adopted a mixed research methods design. For outcome analysis, a double-blinded randomized control trial with repeated-measures, sham group design was used. In addition, a formative evaluation of this intervention was conducted using focus group interviews to explore the participants' perceived benefits and limitations of the acupressure intervention used. Participants: A total of 78 patients who met the study criteria between April and October 2013 were recruited from five wards of an adult psychiatric team in a 1,000-bed regional psychiatric hospital in Hong Kong. After matched in pairs in terms of gender, age, and laxatives used, each patient in the matched pairs was randomly assigned into either the intervention (self-administered acupressure program) or sham (placebo) group. Intervention: The treatment group received training in self-administered acupressure, while the sham (control) group was also trained with similar technique, except using the non-acupoints with light pressure applied, and gentle rubbing on the abdomen with very minimal pressure. Both groups of participants implemented their interventions once a day for 10 days under the supervision of a research nurse in their wards.
Outcome measures: Main outcomes of this study included Constipation Assessment Scale (CAS), Patient Assessment Constipation Quality of Life Questionnaire (PAC-QoL), and socio-demographic and clinical data collected by a trained assessor who was blinded to the intervention assignment. These data were measured at recruitment and immediately (Post-test 1) and two weeks (Post-test 2) after completion of the 10-day interventions. Qualitative focus group data were collected after the post-test 2 measurement. Results: The result of Mann-Whitney U test indicated there were no significant differences between the intervention (n=33) and sham group (n=35) on the baseline mean scores of CAS (U=-0.614, p=0.539). However, there was significant difference of PAC-QoL mean scores between the two groups at baseline (U=-3.495, p<0.0005). The results of Generalized Equation Estimation (GEE) test indicated the participants in the acupressure program had significant greater improvements in the mean scores of both CAS (p< 0.0005) and PAC-QOL (p< 0.0005) than that of the sham group over the 2-week follow-up. From the focus group interview data, this acupressure intervention could improve not only patients' symptoms of constipation, but also, their physical and psychosocial health conditions, as well as their job performance. The perceived obstacles to their implementation of this intervention after their discharge included social stigma embarrassment, reduced motivation for practices, and lack of essential equipments for practices. There were also rooms for improvement of this self-help acupressure program suggested included integrating physical exercise in this program and providing a guidebook and essential equipment to the participants for self-help after hospital discharge. Conclusion: The self-administered acupressure programme for adult psychiatric in-patients facilitated by trained mental health nurses in Hong Kong with a validated protocol was found effective in reducing their symptoms severity of constipation and improving their quality of life. Future research is recommended to test the effects of this self-help protocol in diverse groups of psychiatric patients with constipation across Chinese and Asian populations.

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