Effects of shiatsu on the health-related quality of life of a person with secondary progressive multiple sclerosis: A mixed methods N-of-1 trial within a whole systems research case study

European Journal of Integrative Medicine, Volume 32, December 2019, 101006



Introduction: Multiple Sclerosis (MS) is a chronic neurological disorder with high prevalence in Finland. Most people with MS will develop Secondary-Progressive MS (SPMS) over time. People with MS report lower than the average Health-Related Quality of Life (HRQoL) and use Complementary and Alternative Medicine (CAM) for their symptoms. Personalised interventions such as shiatsu have an insufficient evidence base. The n-of-1 trial is a promising study design for personalised interventions in chronic conditions but has not little used in CAM research. The aim was to investigate if shiatsu affects the HRQoL of a person with SPMS.

Methods: Six-periods counterbalanced mixed-methods n-of-1 trial within a Whole Systems Research (WSR) case study was used. The short version of the MSQLI, data collected from a semi-structured interview and case notes were used to assess the effect of the treatment. The collected data analysed quantitatively and qualitatively and synthesised as a descriptive case study.

Results: The study was able to document improvements in spasticity, bowel function, fatigue, pain, sleep and relaxation. No adverse events occurred. Preliminary estimations of the onset and wash-out of shiatsu effects were inferred. Advantages and drawbacks of the design are discussed to improve future applicability.

Conclusions: Shiatsu was able to improve some domains of the HRQoL of the specific person with SPMS. It was a safe treatment with no adverse events. Mixed methods n-of-1 trial within a WSR case study was an appropriate design for the study.

Accepted Manuscript (available under the CC-BY-NC-ND 4.0 license)