Summary of findings 7. Acupressure compared to combined control for pain management in labour.
| Acupressure compared to combined control for pain management in labour | ||||||
| Patient or population: pain management in labour Setting: hospital Intervention: acupressure Comparison: combined control | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with combined control | Risk with acupressure | |||||
| Pain intensity One study used VAS pain score on scale 1 ‐ 100 mm One study used VAS pain score on scale 1 ‐ 10 mm ‐ the mean score of pre‐ and post‐intervention difference in pain perception measured by VAS was taken in three phases, latent, active and transitional |
The mean pain intensity score in the intervention group was 0.42 standard deviations lower (0.65 lower to 0.18 lower) | 322 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | |||
| Satisfaction with pain relief ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | |
| Sense of control in labour ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | |
| Satisfaction with childbirth assessed with: greater score indicates greater satisfaction Scale from: 0 to 100 | The mean satisfaction score with childbirth in the control group was 80.2 | The mean satisfaction score in the intervention group was 4.8 higher (2.29 lower to 11.89 higher) | ‐ | 212 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 2 3 | |
| Use of pharmacological analgesia | Study population | RR 0.94 (0.71 to 1.25) | 212 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 2 4 | ||
| 525 per 1000 | 493 per 1000 (373 to 656) | |||||
| Assisted vaginal birth | Study population | RR 0.81 (0.39 to 1.67) | 212 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 2 4 | ||
| 156 per 1000 | 126 per 1000 (61 to 261) | |||||
| Caesarean section | Study population | RR 0.48 (0.22 to 1.04) | 212 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 2 4 | ||
| 206 per 1000 | 99 per 1000 (45 to 214) | |||||
| *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; 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: both studies have unclear risk of bias for performance bias, possible effect on this outcome
2 Downgraded one level due to serious risk of bias: single study has unclear risk of performance bias, likely to effect this outcome
3 Downgraded two levels due to very serious imprecision: wide confidence interval greater than 0.25 on either side of the line of no effect and small sample size
4 Downgraded two levels for very serious imprecision: wide confidence interval encompassing both benefit and harm and small sample size