The effect of acupressure for managing agitation in nursing home residents with dementia : randomized controlled trial

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The effect of acupressure for managing agitation in nursing home residents with dementia : randomized controlled trial


Author: Kwan, Yiu Cho
Title: The effect of acupressure for managing agitation in nursing home residents with dementia : randomized controlled trial
Degree: Ph.D.
Year: 2016
Subject: Acupressure.
Dementia -- Patients
Hong Kong Polytechnic University -- Dissertations
Department: School of Nursing
Pages: 1 online resource (370 pages) : color illustrations
370 pages) : color illustrations
Language: English
InnoPac Record:
Abstract: Introduction: Agitation is commonly observed in people with dementia (PWD). It has many negative impacts on the PWD themselves, their caregivers, and society. Acupressure is a therapeutic modality which originates from traditional Chinese medicine (TCM). Preliminary evidence supports its effectiveness and feasibility. However, there are many issues related to the effects of acupressure which are still unknown. This study aimed at examining the effects of acupressure on agitation and stress, the mediating effects of acupressure on agitation by stress, and the sustainability of the effects of acupressure. Methods: To develop the intervention protocol and research design through evidence-based procedures, this study followed the Medical Research Council 2008 guideline for developing and evaluating complex interventions. This study used three methods sequentially to develop the study: literature review, Delphi process, and pilot study. A randomized controlled trial (RCT) was then used to answer the research question. The RCT blinded both assessors and participants, and used parallel groups. The participants were allocated to three groups in a 1:1:1 ratio by permuted block randomization. The intervention was acupressure, which was compared with two controlled conditions: sham and usual care. In the acupressure group, participants received acupressure at five acupoints: Fengchi (GB20), Baihui (GV20), Shenmen (HT7), Niguan (PC6), and Yingtang (EX-HN3). A course of acupressure lasted for two weeks and was implemented twice a day on five days per week. Each session lasted for 10 minutes. In the sham group, participants received the sham protocol, which was the same as the acupressure protocol except that five non-acupoints were used. In the usual care group, participants received no active interventions. The primary outcome was agitation as measured by the Cohen-Mansfield Agitation Inventory (CMAI). The secondary outcome was stress as measured by salivary cortisol. Outcome variables were measured at the baseline (T0) and the 3rd (T1), 5th (T2), and 8th weeks (T3) after the baseline. The general estimating equation (GEE) and structured equation modeling (SEM) were employed for statistical analysis.
Results: The study recruited 119 eligible subjects from 12 residential care homes in Hong Kong. In the GEE analysis, a significant interaction effect (i.e. group by time) was only observed on the outcome of stress (X2=14.811, p=0.022); none was observed on agitation. In the pair-wise analysis between time points in the acupressure group, there was significant agitation reduction in T2 (MD=-6.84, p<0.001) and stress reduction in T1 (MD=-0.27μg/dL, p<0.001) and T2 (MD=-0.21 μg/dL, p=0.001) compared with the baseline. The agitation and stress levels in the acupressure group were not observed to be significantly different at T3 compared with the baseline. In the SEM mediation analysis, stress was not observed to play a significant mediating role leading acupressure to reduce agitation. Conclusion: This study confirmed that acupressure significantly reduces cortisol levels in agitated PWD, but does not reduce their agitation. Although significant effect on cortisol reduction was observed, the hypothesis that stress is a cause of agitation in PWD nor there is a sustained effect of acupressure on both stress and agitation cannot be confirmed.

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