title: Effects of acupressure on chemotherapy-induced nausea and vomiting-a systematic review with meta-analyses and trial sequential analysis of randomized controlled trials.
abstract: BACKGROUND
  Acupressure has been used as an effective way in treating with stomach upset. However the efficacy of acupressure in preventing chemotherapy-induced nausea and vomiting is uncertain.
  
  
  OBJECTIVE
  To assess the effectiveness of acupressure on three categories of chemotherapy-induced nausea and vomiting.
  
  
  METHODS
  Databases had been retrieved from inception through February 2016 for the randomized controlled trials in accordance with the inclusion criteria, including PubMed, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, Science Direct, CINAHL, China Biology Medicine, Chinese National Knowledge infrastructure, Wan Fang and Database for Chinese Technical Periodicals. Additional studies were identified through hand searches of bibliographies and Internet searches.
  
  
  METHODS
  Systematic review with meta-analyses and trial sequential analysis of randomized controlled trials.
  
  
  METHODS
  Two reviewers selected relevant eligible articles, critical appraisal of the methodological quality was conducted on the basis of using Cochrane Handbook. A standardized Excel form was used to extract information. Meta-analysis and trial sequential analysis was performed using software RevMan 5.3 and TSA 0.9.
  
  
  RESULTS
  Twelve studies with 1419 patients were included. Only three studies were assessed as high quality, one study was evaluated as moderate, and eight studies were evaluated as poor. The meta-analysis showed that acupressure reduced the severity of acute (SMD=-0.18, 95% CI -0.31 to -0.05, p<0.01) and delayed (SMD=-0.33, 95% CI -0.64 to -0.01, p=0.04) nausea. However, there was no benefit effect on the incidence or frequency of vomiting. No definitive conclusions were drawn from the trial sequential analysis.
  
  
  CONCLUSIONS
  This systematic review suggested a protective effect of acupressure on chemotherapy-induced nausea and vomiting, while more well-designed clinical trials with larger sample size were needed to draw a definitive conclusion.
authors.affiliation: School of Nursing, Nanjing Medical University, Jiangsu, China. Electronic address: 495831256@qq.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Miao
authors.affiliation: Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: 542443843@qq.com.
authors.forename: Xinyou
authors.initials: X
authors.lastname: Liu
authors.affiliation: School of Nursing, Nanjing Medical University, Jiangsu, China. Electronic address: 1328475487@qq.com.
authors.forename: Chaojun
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Respiration, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China. Electronic address: konghui@njmu.edu.cn.
authors.forename: Hui
authors.initials: H
authors.lastname: Kong
authors.affiliation: Department of Respiration, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China. Electronic address: wpxie@njmu.edu.cn.
authors.forename: Weiping
authors.initials: W
authors.lastname: Xie
authors.affiliation: School of Nursing, Nanjing Medical University, Jiangsu, China; Department of Respiration, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China. Electronic address: liuky188@126.com.
authors.forename: Kouying
authors.initials: K
authors.lastname: Liu
mesh_terms: D019050:Acupressure; D000970:Antineoplastic Agents / Q000009:adverse effects*; D006801:Humans; D009325:Nausea / Q000139:chemically induced / Q000628:therapy*; D014839:Vomiting / Q000139:chemically induced / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents
keywords: Acupressure; Meta-analysis; Nausea; Vomiting