穴位指壓應用於緩解癌因性疲憊之效果－－系統性文獻回顧及統合分析

The Effectiveness of Acupressure in Reducing Cancer-Related Fatigue: A Systematic Review and Meta-Analysis

背景穴位指壓為美國國家癌症資訊網建議之癌因性疲憊非藥物治療方式之一。目前國內外少有探討穴位指壓緩解癌因性疲憊之系統性回顧及統合分析研究。
目的本文欲檢驗穴位指壓介入對於癌因性疲憊緩解之效果量，及不同指壓部位之建議穴位點、頻次。
方法本研究依PRISMA 2009進行文獻篩選，收錄2020年10月前文獻，採用Cochrane Library、Embase、CINAHL、MEDLINE、Google學術引擎資料庫進行搜尋。評讀工具為RoB 2.0（risk of bias 2.0）及ROBINS-I（risk of bias in non-randomised studies of interventions），並使用RevMan 5.4軟體進行資料分析。
結果經篩選341篇文獻後，最終收錄12篇文獻（15組數據），研究對象共960位。整體穴位指壓效果量為SMD = -0.77，95% CI [-0.90, -0.65]。在次群組分析中，耳穴指壓組SMD = -0.98，95% CI [-1.25,-0.71]、身體穴位指壓SMD = -0.70，95% CI [-0.84, -0.56]。
結論／實務應用穴位指壓能有效緩解癌因性疲憊，建議穴位點為合谷穴（LI4）、足三里穴（ST36）、三陰交穴（SP6），常見介入頻次為一天一次、每次一分鐘至三分鐘；耳神門穴和耳皮質下穴，各按壓一天一次，每次三分鐘。藉此結論，期望未來提供臨床端對癌因性疲憊照護措施參考建議。

Background: Acupressure is one of the recommended non-pharmacologic treatments for cancer-related fatigue (CRF) according to the National Comprehensive Cancer Network guidelines. However, few systematic review or meta-analysis studies have focused on the effect of acupressure on CRF.
Purpose: The purpose of this study was to examine the effectiveness of acupressure in reducing CRF and to identify the effective acupoints and frequencies of acupressure treatments.
Methods: The search and screening procedures were conducted in accordance with PRISMA 2009 guidelines. The search database included Embase, CINAHL, Cochrane Library, MEDLINE and Google Scholar. RoB 2.0 and ROBINS-I were used as appraisal tools. The statistical analysis, including effect size estimation, was computed using RevMan 5.4.
Results: Twelve studies (15 sets of data) were included in the review and analysis. Nine hundred sixty patients with cancer who were currently undergoing or had completed treatment were enrolled as participants and received different levels of acupressure. The result showed the overall effect size of CRF in reducing acupressure to be SMD= -0.77, 95% CI [-0.90, -0.65]. In the subgroup analysis, the effect size of auricular acupressure was SMD= -0.98, 95% CI [-1.25, -0.71] and the body acupressure effect size was SMD= -0.70, 95% CI [-0.84, -0.56].
Conclusion/Implications for Practice: Based on the results of this systematic review, acupressure may be applied to the body acupoints Hegu (LI4), Zusanli (ST36), and Sanyinjiao (SP6) once daily for 1-3 minutes each and to the auricular acupoints shenmen and subcortex once daily for 3 minutes each to effectively reduce cancer-related fatigue.