Reply to: acupressure and quality of recovery after surgery.

Abstract

Editor, We thank Dr. Fassoulaki for her interest in our study1 and her valuable comments.2 We agree that checklists are important tools for study designing and reporting. For this reason, our study protocol publication3 referred to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT). We agree that patients in our study were not blinded, which is why we did not report the study as double blinded. However, individuals who assessed patient quality of recovery (i.e. the primary endpoint) were blinded to the study arm. We did not include an acupuncture group, as our study focused on noninvasive acupoint stimulation. We chose a sham-intervention based on light touch on the same acupoints as used in the acupressure group because this design has been successfully utilised in prior studies demonstrating positive results.4–9 The order of acupressure in the study was always consistent: PC6 followed by LI4 and finally by HT7. We selected a 2-min acupressure application per acupoint, as this duration of pressure has been successfully utilised in other positive acupressure studies.10–13 However, we agree that our results may not be generalisable to other durations and frequencies of acupressure applications. Indeed, this is one reason why clinical trials are challenging in this field (i.e. there are a large number of permutations of point location, duration of pressure and number of acupressure sessions per day that could be employed). As we stated in the Discussion section of our manuscript, we agree that postoperative multimodal analgesic treatment, which is increasingly routine care, may have limited observing a putative beneficial impact of postoperative acupressure therapy. The results presented for primary and secondary outcomes in Figure 3 and Table 3 are from the modified intention-to-treat analysis (i.e. n = 161, excluding two patients with consent withdrawal). Finally, we do agree that the difference in patient satisfaction was minimal in magnitude and therefore may have limited clinical relevance.