Is ear acupressure or massage therapy effective in improving pain, anxiety and depression among dementia patients?
Date of publication of randomized controlled trial: July 2015
Design
Randomized controlled trial (RCT).
Participants
120 elderly people diagnosed with dementia who were institutionalized in residential homes in Spain (age range: 67 to 91 years, male %: 28.3%).
Intervention
Intervention 1: Ear acupressure was performed by a qualified acupuncturist. The seeds were placed with adhesive tape, and were replaced by new ones every 15 days. Duration of intervention was 3 months.
Intervention 2: Massage therapy was performed by a qualified physiotherapist. The massage was applied on the lower limbs and back, and it lasted for 20 minutes per session. The frequency of massage was 5 times per week. Duration of the intervention was 3 months.
Comparator
Comparison 1: Ear acupressure versus no intervention;
Comparison 2: Massage therapy versus no intervention.
Major Outcomes
Outcome 1: Change in pain score as measured by the DOLOPLUS2 scale at the end of intervention. The scale ranged from 0 to 30, a higher score indicated more severe pain.
Outcome 2: Change in anxiety score as measured by the Campbell scale at the end of the intervention. A higher score indicated more severe anxiety.
Outcome 3: Change in depression scores as measured by the Cornell Scale at the end of intervention. A higher score indicated more severe depression.
Settings
The trial was conducted in outpatient settings.
Comparison    Ear acupressure versus no intervention
Main Results
In ear acupressure group, pain score decreased by 8.55, anxiety score decreased by 3.05 and depression score decreased by 9.63. In no intervention group, pain score increased by 3.78, anxiety score increased by 1.69 and depression score increased by 5.72.
Comparison 1: Ear acupressure versus no intervention among dementia patients
Outcomes No. of studies (Total number of participants) Mean (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 1(75) -8.55 (4.39)/ 40 3.78 (1.42)/ 35 Not applicable as there is only 1 trial Not reported Low
2 (NA) 1(75) -3.05 (1.65)/ 40 1.69 (0.79)/ 35 Not applicable as there is only 1 trial Not reported Low
3 (NA) 1(75) -9.63 (5.00)/ 40 5.72 (2.28)/ 35 Not applicable as there is only 1 trial Not reported Low
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Massage therapy versus no intervention
Main Results
In massage therapy group, pain score decreased by 5.89, anxiety score decreased by 2.40 and depression score decreased by 6.94. In no intervention group, pain score increased by 3.78, anxiety score increased by 1.69 and depression score increased by 5.72.
Comparison 2: Massage therapy versus no intervention among dementia patients
Outcomes No. of studies (Total number of participants) Mean (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) Overall quality of evidence*
Mean (SD)/ No. of participants Mean (SD)/ No. of participants
1 (NA) 1(70) -5.89 (3.64)/ 35 3.78 (1.42)/ 35 Not applicable as there is only 1 trial Not reported Low
2 (NA) 1(70) -2.40 (1.65)/ 35 1.69 (0.79)/ 35 Not applicable as there is only 1 trial Not reported Low
3 (NA) 1(70) -6.94 (4.02)/ 35 5.72 (2.28)/ 35 Not applicable as there is only 1 trial Not reported Low
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Ear acupressure versus no intervention
Main Results
In ear acupressure group, pain score decreased by 8.55, anxiety score decreased by 3.05 and depression score decreased by 9.63. In no intervention group, pain score increased by 3.78, anxiety score increased by 1.69 and depression score increased by 5.72.
Comparison 1: Ear acupressure versus no intervention among dementia patients
Outcomes 1 (NA) 2 (NA) 3 (NA)
No. of studies (Total number of participants) 1(75) 1(75) 1(75)
Mean (SD)/ No. of participants Intervention -8.55 (4.39)/ 40 -3.05 (1.65)/ 40 -9.63 (5.00)/ 40
Comparator 3.78 (1.42)/ 35 1.69 (0.79)/ 35 5.72 (2.28)/ 35
MD (95% CI) Not reported Not reported Not reported
Overall quality of evidence* Low Low Low
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Massage therapy versus no intervention
Main Results
In massage therapy group, pain score decreased by 5.89, anxiety score decreased by 2.40 and depression score decreased by 6.94. In no intervention group, pain score increased by 3.78, anxiety score increased by 1.69 and depression score increased by 5.72.
Comparison 2: Massage therapy versus no intervention among dementia patients
Outcomes 1 (NA) 2 (NA) 3 (NA)
No. of studies (Total number of participants) 1(70) 1(70) 1(70)
Mean (SD)/ No. of participants Mean (SD)/ No. of participants -5.89 (3.64)/ 35 -2.40 (1.65)/ 35 -6.94 (4.02)/ 35
Mean (SD)/ No. of participants 3.78 (1.42)/ 35 1.69 (0.79)/ 35 5.72 (2.28)/ 35
MD (95% CI) Not reported Not reported Not reported
Overall quality of evidence* Low Low Low
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Conclusion
Benefits
Patients receiving ear acupressure or massage therapy showed improvement in pain, anxiety and depression from baseline to the end of intervention. Meanwhile, patients in the no intervention group did not show any improvement. For all outcomes, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported in this trial.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/25322869
The synopsis is based on the following article:
Rodríguez-Mansilla J, González López-Arza MV, Varela-Donoso E, Montanero-Fernández J, González Sánchez B, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clinical rehabilitation. 2015 Jul;29(7):683-93.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.