Complementary Therapies in Clinical Practice最新文献

Objectives

Functional fitness is essential for healthy living in older adults. Specially targeted fitness programs might be the most beneficial. This intervention study aimed to assess the efficacy of a specific 16-week exercise program in improving functions as measured by the Fullerton Functional Fitness Test (FFFT), also known as the Senior Test, in older adults.

Participants

Thirty-eight participants (66 % women, M_age = 80.15, SD = 7.21) were randomized into an exercise group (n = 24) and a waiting list control group (n = 14). The exercise group trained three times a week for 1 h.

Methods

Objective tests (FFFT and handgrip power) and subjective psychological measures (life satisfaction, resilience, happiness, perceived stress, and well-being) were obtained at baseline, after eight weeks, and after 16 weeks. The data were analyzed using mixed-effect regression models.

Results

The results yielded statistically significant group-by-time interactions in all models, indicating improvements in physical and psychological measures over time in the treatment group compared to the control group. Significant differences between the groups in the estimated marginal means (with adjusted 95 % confidence intervals) emerged after 16 weeks in happiness (−3.5 [-6.5, −0.4]), resilience (−5.5 [-9.9, −1.2]), perceived stress (2.2 [0.2, 4.2]), well-being (−5.8 [-7.9, −3.6]), upper limb strength (−5.7 [-9.0, −2.4]), upper body flexibility (−8.7 [-16.4, −1.0]), and agility and balance (4.6 [1.2, 8.1]). Except for happiness and resilience, these differences surfaced already after eight weeks.

Conclusion

The here-employed 16-week exercise program, targeting the test elements of the FFFT, efficiently induced physical and mental improvements in older adults.

Introduction

To investigate the effect of physical exercise alone and in combination with cognitive stimulation on cognition, physical function, and quality of life in patients with Alzheimer's Disease (PwAD).

Methods

The study was a randomized controlled, single-blinded trial with pre-and post-treatment and follow-up assessments conducted at the private hospital and home environment in PwAD. Seventy-five (N = 75) participants diagnosed with AD were enrolled, but sixty (N = 60) participants (mean age 77.8 years, standard deviation (SD) 6.7) were randomized as physical exercise group (PEG) (n = 20), physical exercise and cognitive stimulation group (PE + CSG) (n = 20) and control group (CG) (n = 20). Participants in PEG and PE + CSG performed an online supervised physical exercise program (SPEP) given biweekly for 12 weeks. Additionally, the cognitive stimulation (CS) program was offered for at least three or five days for 12 weeks for PE + CSG. No treatment was given for the CG. The primary outcome measures were cognition, balance, functional mobility (FM), upper extremity muscle strength (UEMS) and lower extremity muscle strength (LEMS), and quality of life (QoL). Furthermore, depression, basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were measured secondarily.

Results

PE + CSG demonstrated significant improvement in cognition, balance, FM, UEMS, IADL and reduction in depression compared to the CG (p < 0.05). Besides, participants in the PE + CSG had statistically superior QoL and IADL than the PEG (p < 0.05).

Conclusions

The addition of CS to the SPEP was a safe and effective method to gain statistically significant improvements in cognition, balance, FM, UEMS, IADL, and reduction in depression in PwAD.

Spa therapy is recommended to manage symptoms of fibromyalgia, but the physiological mechanisms underlying this improvement have been poorly studied. In an original study, we explored the effect of a 3-week rheumatology spa treatment for fibromyalgia patients on quality of life and with a symptom severity questionnaire. We present here the results of an ancillary study which explored three secondary criteria using objective measurement methods: diurnal actimetry for physical activity analysis, nocturnal actimetry for sleep analysis and heart rate variability. Eighty-three fibromyalgia patients were randomized to participate in an immediate 3-week rheumatological spa therapy, either a start within 6 weeks after inclusion (interventional group, n = 39) or a delayed, start 6 months after inclusion (control group, n = 44). Patients were asked to wear an actimeter (n = 56) to assess diurnal physical activity and sleep quality and a 24-h Holter ECG (n = 60) to assess nocturnal heart rate variability at baseline, 3 months and 6 months after inclusion. Time spent in sedentary and light physical activity was reduced to ∼30 min at 6 months in the interventional group (P = 0.027). Sleep quality and heart rate variability were not improved. Spa therapy made it possible to reduce sedentary activities in patients’ daily life for up to 6 months afterwards, concomitant with the improvement in quality of life, pain and fatigue as highlighted in the original Thermalgi study.

Background

Researchers have investigated the physical and psychosocial advantages of Taekwondo for older adults. However, prior studies of Taekwondo's impact on physical function and psychological well-being in this demographic have produced inconsistent findings. Thus, this systematic review aimed to assess how Taekwondo practice affects the physical function and psychological well-being of older adults.

Methods

We systematically searched PubMed, EMBASE, CINAHL, SPORTDiscus, Scopus, Korea Education and Research Information Service, Korean Studies Information Service System, Korean National Assembly Library, Research Information Sharing Service, National Digital Science Library, and China National Knowledge Infrastructure from their inception to December 2023. Two reviewers independently selected and extracted data from each study. We calculated effect sizes using a random-effects model with a 95 % confidence interval (CI) and evaluated study quality using the Physiotherapy Evidence Database scale.

Results

This review included ten studies with 227 participants aged 66.1–73.6 years. The meta-analysis revealed significant enhancements in cognitive function [Korean Version of Mini-Mental State Examination, standard mean difference (SMD) = 0.700, 95 % CI (0.364–1.037), I² = 0 %, p < .001], blood indicators [β-amyloid, SMD = 0.613, 95 % CI (0.103–1.123), I² = 34.920 %, p < .05; brain-derived neurotrophic factor, SMD = 0.566, 95 % CI (0.166–0.966), I² = 0 %, p < .01; high-density lipoprotein cholesterol, SMD = 0.677, 95 % CI (0.357–0.966), I² = 0 %, p < .001; low-density lipoprotein cholesterol, SMD = 0.809, 95 % CI (0.376–1.242), I² = 42.621 %, p < .001; and total cholesterol, SMD = 0.979, 95 % CI (0.603–1.356), I² = 22.221 %, p < .001], and physical function [lean body mass, SMD = 0.465, 95 % CI (0.109–0.821), I² = 0 %, p < .05, and handgrip strength, SMD = 0.929, 95 % CI (0.194–1.663), I² = 48.217 %, p < .05].

Conclusions

This meta-analysis indicates that Taekwondo training is a beneficial therapy with protective effects on cognitive function, physical function, and body composition in older adults. These findings highlight its potential significance in cognitive rehabilitation and physiological health promotion among this demographic population.

Background and purpose

Sleep disturbance is a very common problem among breast cancer patients, and auricular acupressure is a non-pharmacologic intervention to improve the sleep quality. This study aimed to investigate the effectiveness and safety of auricular acupressure to improve sleep quality in breast cancer patients.

Methods

Overall, 8 electronic databases in English and Chinese were systematically searched from inception to August 12, 2023 to identify eligible randomized controlled trials (RCTs). The risk of bias was assessed by version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2.0).

Results

A total of 16 studies with 1199 participants were included. The synthesized results showed that compared with the control group, auricular acupressure had a significant effect on improving the effective rate of sleep quality improvement in patients with breast cancer (risk ratio [RR] 1.56, 95 % confidence interval [CI] 1.14 to 2.14; P < 0.001), and that significantly reduced the Pittsburgh Sleep Quality Index (PSQI) global score (mean difference [MD] −3.47, 95 % CI -4.37 to −2.58; P < 0.001). Subgroup analysis of effective rate and PSQI score showed similar significant effects. Additionally, the improvement of sleep quality was better when auricular acupressure was performed by nurses using Vaccaria seeds. Furthermore, the optimal intervention program was performed 1–2 times a day, 3–5 min each time, and lasted for 2–4 weeks.

Conclusion

Auricular acupressure may effectively improve the sleep quality of patients with breast cancer. However, more rigorously designed, large-sample, multi-center RCTs are required to further validate the results.

Introduction

The Complementary Health and Wellbeing service has been offering integrative therapies to cancer patients at The Christie Hospital NHS Trust since 1997 and has not undergone an external service evaluation in that time. It is considered a pioneering service.

Method

An external academic was invited to undertake a service evaluation based on information and experiences since the implementation of services changes as the result of the COVID 19 pandemic. Service users and therapists were interviewed along with review of quality control data and documentation.

Results

Eighteen staff and eight patients were interviewed showing a high functioning and valuable service, offering a range of services to meet the needs of both inoutpatient and outpatient services. All staff are qualified and passionate, with a significant number of research outputs. However, the service is at capacity, and must rethink some delivery to ensure long term sustainability. Services offered include acupuncture, aromatherapy, massage, talking therapies and motivational behavioural changes. There is a high degree of patient satisfaction as the therapies help them manage their life affecting side effects, however accessing or being aware of the service before treatment commenced was a concern for patients.

Discussion

The Complementary Health and Wellbeing Service is well resourced, with all staff paid employees of the NHS trust funded via a charitable part of the trust. There is a self-funding education unit to provide staff training with participants coming from around the world. The therapists are expert practitioners who have undergone specialist training to work in this unique environment, however capacity to meet the needs of the service is limited, and there are gaps in the way patient evaluations are collected, which needs to be addressed for long term viability and future benchmarking. The changes to service to adapt to COVID-19 have become embedded within the service.

Background

Healthcare providers have faced challenges for patients with moderate and severe chronic obstructive pulmonary disease (COPD) in conducting their pulmonary rehabilitation due to dyspnea and exercise intolerance. Neuromuscular electrical stimulation (NMES) has been used to improve the muscle group's power and endurance without adding pulmonary workload, which might be used as a potential adjuvant rehabilitation method and thus to improve patients' pulmonary functions.

Methods

This was a systematic review and meta-analysis of randomized controlled trials. Data were retrieved from PubMed, CINAHL, Academic Search Complete, Cochrane Library, and Airiti Library databases from the inception of the database to December 2022. The Cochrane Collaboration tool was used to assess the risk of bias. Two reviewers independently assessed, extracted, and appraised the included studies. Then, the grading of recommendations, assessment, development, and evaluation (GRADE) methodology was used for assessing the certainty of evidence. The pooled estimates were calculated using a random-effects model.

Results

In total, 19 studies involving 589 moderate to severe COPD patients were analyzed. Compared with controls, adding NMES to pulmonary rehabilitation could significantly increase exercise capacity, physical activity function, and health-related quality of life (HRQoL) (all p < 0.05). The GRADE results showed low to very low certainty of evidence levels.

Conclusion

NMES could improve exercise capacity and reduce the perceived sensation of dyspnea during exercise and is recommended as an effective adjuvant training modality in the rehabilitation for moderate to severe COPD patients.

Background

Acupuncture is a promising modality in clinical practice, where the participants' experiences are crucial to acupuncture's use and effects. However, a comprehensive review synthesising participant experiences throughout treatment sessions is lacking. This study aims to explore the qualitative literature regarding participants' experiences of acupuncture as a potential treatment modality.

Methods

A qualitative systematic review of existing literature was conducted through AMED, MEDLINE, Scopus, Embase, and Web of Science. The Joanna Briggs Institute (JBI) critical appraisal checklist was employed to evaluate research quality. Subsequently, the data were extracted and synthesised utilising the JBI Qualitative Assessment and Review Instrument (QARI) tool and data synthesis was carried out through meta-aggregation.

Results

A total of twenty-eight articles were incorporated into the analysis. Four synthesised findings were identified: (1) Before acupuncture: last trust and hope; (2) During acupuncture: relaxing and calming; (3) After acupuncture: mind-body effects; and (4) Practitioner-participant relationship.

Conclusion

The findings highlight the changes participants experienced before and after acupuncture sessions. Implementing additional promotional initiatives for acupuncture can increase public awareness and encourage individuals to consider it an early symptom management option.

Review registration

This review was registered in PROSPERO (No. CRD42023475373).

Background

Postoperative shoulder-tip pain (STP) is a common complication following laparoscopic cholecystectomy (LC). The study seeks to determine whether acupressure can be used as an alternative to medication for pain relief, as medications often come with side effects. This study aims to evaluate the effect of acupressure on pain levels and physiological indicators in patients undergoing LC.

Materials and methods

This double-blind, randomized clinical trial was conducted on 81 patients who underwent LC at Al-Zahra Hospital of Isfahan University of Medical Sciences, Isfahan, Iran, in 2022. The patients were divided into two groups: the intervention group, which received acupressure (42 participants), and the control group (39 participants). The selected pressure points were LI11, LI4, SJ5, HT7, P6, and K1. Demographic and clinical data were collected, and the pain level was evaluated using the visual analogue score (VAS). The data was analyzed using SPSS version 16 software with a significance level of p < 0.05.

Results

The intervention and control groups were homogeneous in terms of age, gender, duration of surgery, and pethidine consumption (p > 0.05). The average VAS significantly decreased in both the intervention and control groups (p < 0.001). The intervention group had a significantly higher reduced score compared to the control group, 30 min and 72 h after applying acupressure (p < 0.001). Significant differences were observed between the two groups in terms of changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and breath rate (BR) (p < 0.05).

Conclusions

acupressure can effectively improve STP and physiological indicators in patients undergoing LC.

Trial registration no

IRCT20150715023216N14 (Registration date: 2023-01-22, https://irct.behdasht.gov.ir/user/trial/68111/view).

Background

Yoga practice can increase blood flow in the genital area, increase muscular strength, and improve body perception, which is related to sexual function. This study aimed to summarize the available evidence about the effects of yoga on sexual function in adults.

Methods

Systematic searches of five databases were conducted from inception to April 28, with the last update on September 28, 2023. Randomized clinical trials (RCTs) that compared yoga with nonintervention control groups on sexual function in adults. Risk of bias and certainty of evidence were assessed by the Cochrane risk of bias tool 2, and the GRADE approach, respectively. Summary effect size measures were calculated using a random-effects model estimation and are reported as standardized mean differences and 95% confidence intervals. Reporting followed the PRISMA guidelines.

Results

Ten RCTs that comprised 730 adults (range mean age, 26.64–68.2 years; 680 [93.2 %] women) were included. For the primary outcome, yoga intervention was associated with a significant small improvement in sexual function (−0.31; −0.47 to −0.15, p = 0.0002), with some concerns about risk of bias in nine RCTs (90%) and low-certainty evidence. Subgroup analyses revealed that yoga interventions performed by women (−0.36; −0.52 to −0.21, p < 0.00001), healthy individuals (−0.38; −0.59 to −0.16, p = 0.0006), or middle-aged individuals (−0.44; −0.63 to −0.25, p < 00001) significantly improved sexual function compared with control groups.

Conclusion

Yoga was associated with a small improvement in sexual function compared with nonintervention control groups in adults. However, high-quality, larger RCTs are required to draw more definitive conclusions.