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
Background: MS is a chronic neurological disorder with high prevalence in Finland. Most people with MS will develop Secondary Progressive MS (SPMS) over the years. People with MS report lower than the average Health-Related Quality of Life (HRQoL) and use CAM for their symptoms. Interventions of personalised nature like shiatsu have an insufficient evidence base. The n-of-1 trial is a promising study design for personalised interventions in chronic conditions yet it has not been used a lot in CAM research.
Aims and Objectives: The aim was to investigate if shiatsu affects the HRQoL of a person with SPMS. Objectives were to design and implement a mixed methods n-of-1 trial within a whole systems research case study and to reflect on the implementation and the appropriateness of the design.
Methodology: Six-periods counterbalanced mixed methods n-of-1 trial within a whole systems research case study was used. The short version of the MSQLI, data collected from the semi-structured interview and case notes were used to assess the effect of the treatment. Structured personal reflection was included. The collected data analysed quantitatively and qualitatively and synthesised as a descriptive case study.
Findings: The study was able to document improvements in spasticity, bowel function, sleep and relaxation, fatigue and pain. 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.
Conclusion: Shiatsu was able to improve some domains of the HRQoL of a person with SPMS. It was a safe treatment with no adverse events. Mixed methods n-of-1 trial within a whole systems research case study was an appropriate design for the study.
Manuscript (available under the CC-BY-NC-ND 4.0 license)