title: Hand self-Shiatsu for sleep problems in persons with chronic pain: a pilot study.
abstract: OBJECTIVE
  Difficulty falling asleep (sleep latency) and staying asleep (sleep maintenance) are common problems for persons living with pain. Research demonstrates that sleep problems are, in turn, related to exacerbation of chronic pain. There is a growing body of evidence for a range of pragmatic, non-pharmacological sleep interventions that can potentially be incorporated into pain management programs. This study looks at the outcome of teaching patients with musculoskeletal pain standardized pre-bedtime hand self-Shiatsu (HSS) to reduce sleep latency.
  
  
  METHODS
  A case series design, with participants acting as their own controls, was selected to facilitate hypothesis generation for this novel, under-researched intervention. Sleep efficiency, latency and maintenance, sleep beliefs, pain intensity and basic participant demographics were collected at baseline with actigraphy and standardized self-report questionnaires. After one week of baseline data collection, the HSS intervention was taught to participants. Follow-up data were collected at 2 and 8 weeks post-intervention.
  
  
  RESULTS
  Data collected at baseline and the two follow-up periods revealed no apparent changes in the objective actigraphy data. However a trend toward improved self-reported sleep latency (time to fall asleep) and sleep duration (time spent asleep) emerged. A number of participants reported they were more concerned with increasing their period of unbroken sleep as opposed to their total sleep time and it is possible that HSS may be useful to be applied during nighttime awakenings as well as before bed. None of the participants reported adverse effects of the intervention.
  
  
  CONCLUSIONS
  These preliminary findings are promising and future studies exploring the mechanism of action and with stronger control of treatment fidelity are indicated.
authors.affiliation: Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2G4; E-mail: cary.brown@ualberta.ca.
authors.forename: Cary A
authors.initials: CA
authors.lastname: Brown
authors.affiliation: Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2G4.
authors.forename: Geoff
authors.initials: G
authors.lastname: Bostick
authors.affiliation: Shiatsu Therapist, Artists' Health Centre, Toronto Western Hospital, Toronto, Ontario, Canada M5T 2S8.
authors.forename: Leisa
authors.initials: L
authors.lastname: Bellmore
authors.affiliation: Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2G4.
authors.forename: Dilesha
authors.initials: D
authors.lastname: Kumanayaka
mesh_terms: D056044:Actigraphy; D019050:Acupressure / Q000379:methods*; D000368:Aged; D059350:Chronic Pain / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010865:Pilot Projects; D012648:Self Care; D012893:Sleep Wake Disorders / Q000209:etiology / Q000628:therapy*; D011795:Surveys and Questionnaires