Ahmadi 2011.

Methods	Randomised controlled trial.
Participants	70 ˝lactating women with breast engorgement˝ who were referred to Gha'em Hospital in Fars, Iran. Exclusion criteria: mothers with a breast abscess, fever (defined as T > 38°C), sore/cracked nipples, heart disease, fracture in the shoulder region, history of breast surgery, use of traditional herbal remedies for breast engorgement and mothers who did not want to take part in the study.
Interventions	Intervention group (35 participants): acupressure, using hand massage, was applied simultaneously to both breasts for 2 min, followed by a 30‐second rest. This was repeated for a total of 20 min and performed twice a day, on 2 consecutive days (a total of 4 times over 2 days). Control group (35 participants): hot (43‐46°C) and cold (10‐18° C) compresses were applied intermittently (2 min each) to both breasts simultaneously for 20 min, twice a day, on 2 consecutive days (a total of 4 times over 2 days).
Outcomes	Breast engorgement severity index based on degree of breast tension, erythema and pain.
Notes	The study uses individual breasts as the unit of analysis.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	The paper only states that the 70 women were randomly assigned to 1 intervention or the other in a way that would create 2 intervention groups of 35 each but method of sequence generation is not specified.
Allocation concealment (selection bias)	Unclear risk	Allocation concealment is not described.
Blinding (performance bias and detection bias) Women	High risk	The type of intervention did not allow blinding of women.
Blinding (performance bias and detection bias) Clinical staff	High risk	The type of intervention did not allow blinding of clinical staff.
Blinding of outcome assessment (detection bias)	High risk	The outcome assessor based results on a "breast engorgement checklist", but no blinding was done.
Incomplete outcome data (attrition bias) All outcomes	Low risk	No missing outcome data ‐ all patients were followed up.
Selective reporting (reporting bias)	Low risk	The results are strictly based on the authors' pre‐made checklist.
Other bias	Low risk	No other bias identified. Baseline characteristics (education, career, parity, type of birth) of intervention and control groups very similar.