Standardization of an acupressure protocol for managing agitation in nursing home residents with dementia: a pilot study

2.50
Hdl Handle:
http://hdl.handle.net/10755/324016
Category:
Abstract
Type:
Research Study
Level of Evidence:
Quasi-Experimental Study, Other
Research Approach:
Pilot/Exploratory Study
Title:
Standardization of an acupressure protocol for managing agitation in nursing home residents with dementia: a pilot study
Author(s):
Kwan, Rick Yiu Cho; Lai, Claudia Kam Yuk
Lead Author STTI Affiliation:
Pi Iota
Author Details:
Rick Kwan, RN, MSc, PhD student, Hong Kong, email: rick.kwan@polyu.edu.hk
Abstract:

Introduction

Acupressure is a non-pharmacological intervention whose effectiveness in reducing agitation is supported by preliminary studies and theories. It is hypothesized that acupressure can reduce agitation through modifying the Qi flow along the meridian and moderating stress levels. The Medical Research Council guideline on developing and evaluating complex interventions was adopted to develop a standardized protocol and further evaluate the effect of acupressure in managing agitation for nursing home residents with dementia.

 

Aims

This pilot study addressed the following issues in the development and evaluation of the effect of acupressure: (1) identification of the feasibility of saliva sample collection and acupressure delivery on people with dementia (PWD) who are agitated, (2) identification of the changes in effect (i.e. agitation and stress) over time, and (3) comparison of the efficacy of acupressure when delivered in different dosages.

 

Methods

The time series factorial design was used. Two factors – frequency and duration – in the ‘dosage’ intervention were tested. The two frequencies were once and twice a day. The four durations were one, two, three and four weeks. The two factors formed eight combinations, ranging from once daily for one week to twice daily for four weeks. Agitation was measured by the Cohen-Mansfield Agitation Inventory (CMAI) as the primary outcome. Stress was measured by salivary cortisol and was a secondary outcome. The outcomes were measured weekly from one week prior to commencement of the intervention to four weeks after completion of the intervention for each group. Dropouts (e.g. death), withdrawals, undelivered interventions (e.g. participant refused or was unavailable) and uncollected data (e.g. because of hospitalization) were documented.

 

Results/discussion

Twenty-four subjects were recruited and assigned to groups of three. In terms of the feasibility of data collection, a relatively low return rate of valid saliva samples was noted (53.33%), due mainly to subjects’ refusal to give saliva samples and subjects’ dry mouth. Proper hydration and clear explanations to both potential participants and their families are crucial to enhancing the saliva sample return rate. The intervention implementation proved feasible, with 396 out of 450 acupressure sessions (88%) completed and 19 out of 24 participants (79.17%) completing more than 80% of the expected sessions. The acupressure protocol can therefore be implemented on agitated PWD. In this study, the effect size (Cohen’s d) ranged from 0.58 to 1.03 and attrition was 4%. These figures provide an important reference for sample size estimation in subsequent trials.

For effect change over time, both agitation and stress were significantly reduced in the first week, followed by a slight rebound in weeks 2 and 3. The effect surged again in the second wave, peaked in weeks 4 and 5, then gradually tailed off. This finding reveals that the ideal times to capture the peak effect are at weeks 4 and 5.

To compare the efficacy of the intervention on the primary outcome (agitation) at different dosages (frequency and duration), dosages were compared at week 5 when the peak effect was observed. Comparing the frequencies, both the twice- (mean difference: -9.0, p=0.005) and once-a-day (mean difference: -12.0, p=0.019) groups showed significant reductions in agitation. Comparing the durations, only the one- (mean difference: -11.5, p=0.046) and two-week groups (mean difference: -14.0, p=0.026) showed significant reductions in agitation. The two-week and twice-a-day groups revealed more significant differences by smaller p-values. To evaluate the efficacy of the intervention on the secondary outcome (stress) at different dosages (frequency and duration), different dosages were compared at week 4 when the peak effect was observed. Comparing the frequencies, only the twice-a-day group (mean difference: -0.37μg/dL, p=0.015) showed a significant reduction of salivary cortisol concentration (SCC). As for duration, none of the four groups showed a significant change in SCC. Therefore it is recommended that the intervention be delivered twice daily for two weeks in the main study.

 

Conclusion

This pilot study represents pioneering work examining the feasibility of an acupressure intervention protocol for PWD with agitation. The findings provide information on the change of effects over time and demonstrate the efficacy of acupressure at various dosages. They will thus help to inform researchers in the design of subsequent trials.

Keywords:
Acupressure; dementia; agitation
MeSH:
Acupressure; Dementia--therapy
Repository Posting Date:
30-Jul-2014
Date of Publication:
30-Jul-2014
Sponsors:
Sigma Theta Tau International
Note:
The Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.; This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryAbstracten
dc.typeResearch Studyen
dc.evidence.levelQuasi-Experimental Study, Otheren
dc.research.approachPilot/Exploratory Studyen
dc.titleStandardization of an acupressure protocol for managing agitation in nursing home residents with dementia: a pilot studyen_US
dc.contributor.authorKwan, Rick Yiu Cho-
dc.contributor.authorLai, Claudia Kam Yuk-
dc.contributor.departmentPi Iotaen
dc.author.detailsRick Kwan, RN, MSc, PhD student, Hong Kong, email: rick.kwan@polyu.edu.hken_GB
dc.identifier.urihttp://hdl.handle.net/10755/324016-
dc.description.abstract<p><span style="text-decoration: underline;">Introduction</span></p> <p>Acupressure is a non-pharmacological intervention whose effectiveness in reducing agitation is supported by preliminary studies and theories. It is hypothesized that acupressure can reduce agitation through modifying the Qi flow along the meridian and moderating stress levels. The Medical Research Council guideline on developing and evaluating complex interventions was adopted to develop a standardized protocol and further evaluate the effect of acupressure in managing agitation for nursing home residents with dementia.</p> <p> </p> <p><span style="text-decoration: underline;">Aims</span></p> <p>This pilot study addressed the following issues in the development and evaluation of the effect of acupressure: (1) identification of the feasibility of saliva sample collection and acupressure delivery on people with dementia (PWD) who are agitated, (2) identification of the changes in effect (i.e. agitation and stress) over time, and (3) comparison of the efficacy of acupressure when delivered in different dosages.</p> <p> </p> <p><span style="text-decoration: underline;">Methods</span></p> <p>The time series factorial design was used. Two factors – frequency and duration – in the ‘dosage’ intervention were tested. The two frequencies were once and twice a day. The four durations were one, two, three and four weeks. The two factors formed eight combinations, ranging from once daily for one week to twice daily for four weeks. Agitation was measured by the Cohen-Mansfield Agitation Inventory (CMAI) as the primary outcome. Stress was measured by salivary cortisol and was a secondary outcome. The outcomes were measured weekly from one week prior to commencement of the intervention to four weeks after completion of the intervention for each group. Dropouts (e.g. death), withdrawals, undelivered interventions (e.g. participant refused or was unavailable) and uncollected data (e.g. because of hospitalization) were documented.</p> <p> </p> <p><span style="text-decoration: underline;">Results/discussion</span></p> <p>Twenty-four subjects were recruited and assigned to groups of three. In terms of the feasibility of data collection, a relatively low return rate of valid saliva samples was noted (53.33%), due mainly to subjects’ refusal to give saliva samples and subjects’ dry mouth. Proper hydration and clear explanations to both potential participants and their families are crucial to enhancing the saliva sample return rate. The intervention implementation proved feasible, with 396 out of 450 acupressure sessions (88%) completed and 19 out of 24 participants (79.17%) completing more than 80% of the expected sessions. The acupressure protocol can therefore be implemented on agitated PWD. In this study, the effect size (Cohen’s d) ranged from 0.58 to 1.03 and attrition was 4%. These figures provide an important reference for sample size estimation in subsequent trials.</p> <p>For effect change over time, both agitation and stress were significantly reduced in the first week, followed by a slight rebound in weeks 2 and 3. The effect surged again in the second wave, peaked in weeks 4 and 5, then gradually tailed off. This finding reveals that the ideal times to capture the peak effect are at weeks 4 and 5.</p> <p>To compare the efficacy of the intervention on the primary outcome (agitation) at different dosages (frequency and duration), dosages were compared at week 5 when the peak effect was observed. Comparing the frequencies, both the twice- (mean difference: -9.0, p=0.005) and once-a-day (mean difference: -12.0, p=0.019) groups showed significant reductions in agitation. Comparing the durations, only the one- (mean difference: -11.5, p=0.046) and two-week groups (mean difference: -14.0, p=0.026) showed significant reductions in agitation. The two-week and twice-a-day groups revealed more significant differences by smaller p-values. To evaluate the efficacy of the intervention on the secondary outcome (stress) at different dosages (frequency and duration), different dosages were compared at week 4 when the peak effect was observed. Comparing the frequencies, only the twice-a-day group (mean difference: -0.37μg/dL, p=0.015) showed a significant reduction of salivary cortisol concentration (SCC). As for duration, none of the four groups showed a significant change in SCC. Therefore it is recommended that the intervention be delivered twice daily for two weeks in the main study.</p> <p> </p> <p><span style="text-decoration: underline;">Conclusion<em></em></span></p> <p>This pilot study represents pioneering work examining the feasibility of an acupressure intervention protocol for PWD with agitation. The findings provide information on the change of effects over time and demonstrate the efficacy of acupressure at various dosages. They will thus help to inform researchers in the design of subsequent trials.</p>en_GB
dc.subjectAcupressureen_GB
dc.subjectdementiaen_GB
dc.subjectagitationen_GB
dc.subject.meshAcupressureen_US
dc.subject.meshDementia--therapyen_US
dc.date.available2014-07-30T17:19:12Z-
dc.date.issued2014-07-30-
dc.date.accessioned2014-07-30T17:19:12Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
dc.description.noteThe Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.en
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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