title: Using acupressure to modify alertness in the classroom: a single-blinded, randomized, cross-over trial.
abstract: BACKGROUND
  Previous reports have suggested that acupressure is effective in reducing pain and improving sleep quality; however, its effects on alertness have not been characterized.
  
  
  OBJECTIVE
  The aim of this study was to determine whether two different acupressure treatments have opposing effects on alertness in a full-day classroom setting.
  
  
  METHODS
  This was a cross-over (two-treatments; three periods), single-blinded, randomized trial.
  
  
  METHODS
  The University of Michigan School of Public Health was the setting.
  
  
  METHODS
  Students attending a course in clinical research design and statistical analysis at the University of Michigan participated in the study.
  
  
  METHODS
  Blinded subjects were randomized to two acupressure treatment sequences: stimulation-relaxation-relaxation or relaxation-stimulation-stimulation. Acupressure treatments were self administered over 3 consecutive days. Pre- and post-treatment alertness scores were assessed each day using the Stanford Sleepiness Scale (SSS). Changes in the SSS score (afternoon-morning) were analyzed using a mixed regression model of fixed and random effects. Important factors that were expected to affect alertness, such as caffeine and previous night's sleep, were also assessed.
  
  
  RESULTS
  Baseline characteristics and protocol compliance were similar between the two sequences. Stimulation acupressure treatment yielded a 0.56-point greater difference in score on the SSS, corresponding to less fatigue, compared to the relaxation acupressure treatment (p = 0.019). Day of study (p = 0.004) and hours of overnight sleep (p = 0.042) also significantly affected the change in SSS scores. Incorporating participants' beliefs as to which treatment they received did not significantly alter the observed treatment effect.
  
  
  CONCLUSIONS
  Acupressure at stimulation and relaxation points has differential effects on alertness in a classroom setting. Further research is necessary to confirm these findings and to determine whether stimulation and relaxation acupressure are equally effective in influencing alertness.
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI 48106, USA. reharris@med.umich.edu
authors.forename: Richard E
authors.initials: RE
authors.lastname: Harris
authors.forename: Joanne
authors.initials: J
authors.lastname: Jeter
authors.forename: Paul
authors.initials: P
authors.lastname: Chan
authors.forename: Peter
authors.initials: P
authors.lastname: Higgins
authors.forename: Feng-Ming
authors.initials: FM
authors.lastname: Kong
authors.forename: Reza
authors.initials: R
authors.lastname: Fazel
authors.forename: Candace
authors.initials: C
authors.lastname: Bramson
authors.forename: Brenda
authors.initials: B
authors.lastname: Gillespie
mesh_terms: D019050:Acupressure / Q000379:methods; D015669:Acupuncture Points; D000328:Adult; D001143:Arousal / Q000502:physiology; D002940:Circadian Rhythm / Q000502:physiology; D018592:Cross-Over Studies; D005221:Fatigue / Q000517:prevention & control*; D006801:Humans; D012044:Regression Analysis; D016037:Single-Blind Method; D013334:Students; D016896:Treatment Outcome; D014851:Wakefulness / Q000502:physiology