Summary of findings 6. Acupressure compared to usual care for pain management in labour.

Acupressure compared to usual care for pain management in labour
Patient or population: pain management in labour Setting: hospital Intervention: acupressure Comparison: usual care
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with usual care	Risk with acupressure
Pain intensity as measured by numeric rating scale (NRS) and visual analogue scale (VAS). Lower scores indicate less pain.	The mean pain intensity was 8.44	The mean pain intensity score in the intervention group was 1.07 standard deviations lower (1.45 lower to 0.69 lower).		620 (8 RCTs)	⊕⊝⊝⊝ VERY LOW 1 2	The use of acupressure would result in a pain score approximately 2 cm lower on a 10 cm VAS or 2 points on a numeric rating scale compared to usual care.
Satisfaction with pain relief assessed with: higher score indicate greater satisfaction with pain relief. Scale from: 0 to 3	The mean satisfaction score with pain relief in the control group was 1.6	The mean satisfaction with pain relief score was 1.05 higher (0.75 higher to 1.35 higher)		105 (1 RCT)	⊕⊝⊝⊝ VERY LOW 3 4
Sense of control in labour ‐ not reported	‐	‐	‐	‐	‐
Satisfaction with childbirth experience ‐ not reported	‐	‐	‐	‐	‐
Use of pharmacological pain relief ‐ not reported	‐	‐	‐	‐	‐
Assisted vaginal birth ‐ not reported	‐	‐	‐	‐	‐
Caesarean section	Study population		RR 0.82 (0.54 to 1.23)	391 (4 RCTs)	⊕⊕⊝⊝ LOW 5 6
	241 per 1000	198 per 1000 (130 to 296)
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; NRS: numeric rating scale; VAS: visual analogue scale
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

¹ Downgraded one level due to serious risk of bias: majority of included studies have high or unclear risk of bias relating to performance and detection bias

² Downgraded two levels due to very serious inconsistency: considerable heterogeneity (I² = 75%)

³ Downgraded two levels due to very serious risk of bias: single study at high risk of bias for selection, performance and detection bias. Very likely to have influenced the outcome

⁴ Downgraded one level due to serious imprecision: small sample size (105)

⁵ Downgraded one level due to serious risk of bias: two of the four studies included were at high risk of performance and detection bias, two studies were at high or unclear risk of selection bias and three at high or unclear risk of incomplete outcome data

⁶ Downgraded one level due to serious imprecision: wide confidence intervals incorporating both benefit and harm