Unveiling the latest evidence: an updated systematic review and meta-analysis and GRADE assessment on the effectiveness of acupressure in managing labor pain

Abstract

Background

Labor pain is a significant challenge during childbirth, highlighting the necessity for effective pain management strategies. Acupressure has been recognized as a non-pharmacological method; however, its efficacy requires comprehensive evaluation. This updated systematic review and meta-analysis seeks to consolidate the most recent evidence regarding the effectiveness of Acupressure in alleviating labor pain and to evaluate the quality of this evidence using the GRADE framework.

Methods

An updated systematic review was conducted by querying multiple databases for randomized controlled trials (RCTs) that evaluated the impact of Acupressure on labor pain. Studies were included based on predefined eligibility criteria. The risk of bias was assessed using the Cochrane risk-of-bias method for randomized trials (RoB). Meta-analyses were performed to determine the overall effect size, and the GRADE approach was applied to assess the certainty of the evidence. Meta-analyses of all the data were done using RevMan 5.4.

Results

A total of 37 studies met the inclusion criteria. The meta-analysis revealed that Acupressure significantly reduces labor pain compared to touch (MD = -1.19, 95% CI -1.66 to -0.72, p < 0.00001), Sham (MD = -1.41, 95% CI -2.55 to -0.27, p = 0.01), and no intervention group (MD = -2.32, 95% CI -2.87 to -1.76, p < 0.00001). Although both SP6 and LI4 Acupressure points reduced pain, SP6 had more of an impact compared to previous reviews. The funnel plot comparing the effect of Acupressure with a touch on labor pain intensity suggested a possible publication bias. The GRADE assessment indicated a moderate to low level of certainty regarding these results.

Conclusions

Acupressure seems to be a viable method for alleviating labor pain, supported by moderate to low-quality evidence. Additionally, it is advisable to conduct well-designed RCTs to enhance the validity of these findings and investigate the underlying mechanisms that contribute to the effectiveness of Acupressure in this setting.