The effect of daily self-measurement of pressure pain sensitivity followed by acupressure on depression and quality of life versus treatment as usual in ischemic heart disease: a randomized clinical trial.
BACKGROUND
Depressive symptoms and reduced quality of life (QOL) are parts of the chronic stress syndrome and predictive of adverse outcome in patients with ischemic heart disease (IHD). Chronic stress is associated with increased sensitivity for pain, which can be measured by algometry as Pressure Pain Sensitivity (PPS) on the sternum.


OBJECTIVE
To evaluate if stress focus by self-measurement of PPS, followed by stress reducing actions including acupressure, can decrease depressive symptoms and increase psychological well-being in people with stable IHD.


METHODS
Observer blinded randomized clinical trial over 3 months of either intervention or treatment as usual (TAU).


METHODS
Intention to treat.


METHODS
Two hundred and thirteen participants with IHD were included: 106 to active treatment and 107 to TAU. Drop-out: 20 and 12, respectively. The active intervention included self-measurement of PPS twice daily followed by acupressure as mandatory action, aiming at a reduction in PPS. Primary endpoint: change in depressive symptoms as measured by Major depression inventory (MDI). Other endpoints: changes in PPS, Well-being (WHO-5) and mental and physical QOL (SF-36).


RESULTS
At 3 months PPS decreased 28%, to 58, in active and 11%, to 72, in TAU, p<0.001. MDI decreased 22%, to 6.5, in active group vs. 12%, to 8.3 in TAU, p = 0.040. WHO-5 increased to 71.0 and 64.8, active group and TAU, p = 0.015. SF-36 mental score sum increased to 55.3 and 53.3, active and TAU, p = 0.08.


CONCLUSIONS
PPS measurements followed by acupressure reduce PPS, depressive symptoms and increase QOL in patients with stable IHD.


BACKGROUND
ClinicalTrials.gov NCT01513824.
Herlev University Hospital, Department of Endocrinology, Herlev, Denmark.
Natasha
N
Bergmann
Ull Care A/S, Hellerup, Denmark.
Søren
S
Ballegaard
Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark.
Per
P
Bech
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Ake
A
Hjalmarson
Herlev University Hospital, Department of Endocrinology, Herlev, Denmark.
Jesper
J
Krogh
The National Research Centre for the Working Environment, Copenhagen, Denmark.
Finn
F
Gyntelberg
Herlev University Hospital, Department of Endocrinology, Herlev, Denmark; Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.
Jens
J
Faber
D000203:Activities of Daily Living / Q000523:psychology; D019050:Acupressure; D000368:Aged; D003865:Major Depressive Disorder / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D010146:Pain / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology*; D058748:Pain Perception; D011788:Quality of Life / Q000523:psychology*; D012648:Self Care; D013312:Stress, Physiological