Ask an answerable question (PICO)：
Primary dysmenorrhea is the most common disease in gynecology clinics. Dysmenorrhea typically occurs in young women and presents as lower abdominal pain before, during, or after menstruation. Such pain is often accompanied by other physical discomforts. It can also restrict physical and daily activities, such as work or school, and may even lead to emotional changes, thereby affecting the quality of life. Many women of childbearing age seek treatment at traditional Chinese medicine (TCM) clinics due to the discomfort of dysmenorrhea. Acupressure, a commonly used and easy-to-perform technique in clinical practice, is believed to unblock meridians, promote blood circulation, and alleviate discomfort. This has prompted the author to search the literature to determine whether acupressure can relieve primary dysmenorrhea.
The Method and Analysis of Literature Review：
A clinical care question was formulated first: Can acupressure relieve primary dysmenorrhea? In this study, PICO (patient – intervention - comparison - outcome) framework was used to address the clinical question based on three keywords: Primary dysmenorrhea (P), Acupressure (I), and Menstrual Pain intensity (O). These keywords were connected in literature search using Boolean logic (i.e., “and” or “or”) on six databases: PubMed, Cochrane Library, EMBASE, CINAHL Plus with Full Text, Airiti Library (Chinese Electronic Periodical Services) and National Digital Library of Theses and Dissertations in Taiwan. The search criteria included Meta-analysis (MA), Systematic Review (SR), and Randomized Controlled Trial (RCT) articles. The following screening criteria were applied: the title and abstract meeting the PICO framework, full text available in Traditional Chinese or English, and the article belonging to MA, SR, or RCT. Finally, three articles were included for critical appraisal: two randomized controlled trials, and one systematic review.
Critical Appraisal：
The critical appraisal was conducted using the Critical Appraisal Skills Programme (CASP) to evaluate the validity, importance and applicability of the literature. The 2018 CASP Systematic Review Checklist was used for MA and SR articles. Among the included SR articles, only one did not clearly explain the precision of the results, while other items were clearly described. For RCT articles, the 2020 CASP RCT Checklist was used for critical appraisal. Only one article did not clearly describe whether all the participants were accounted for and whether there was blinding, while the other nine items were clearly described. The evidence levels were based on the 2011 Oxford Centre for Evidence-Based Medicine (CEBM) criteria. One article used an SR design and was classified as Level 1, while two articles used an RCT design and were classified as Level 2.
Results, Conclusions and Recommendations：
According to the results of the critical appraisal, acupressure during the menstrual cycle can improve dysmenorrhea discomfort in women. However, the effect appeared somewhat limited. The limited effect may be due to the duration of acupressure and the selection of acupressure points. In clinical care, in addition to combining traditional Chinese and Western medicine treatments, it is recommended that women with dysmenorrhea receive acupressure on the Sanyinjiao point during the 1st to 3rd days of the menstrual cycle for the first, second, and third months. The suggested method is to press the acupoint for 5 seconds and relax for 1 second, or press and rub in a circular motion 10 times and then relax for 2 seconds, for 3 minutes on each foot, totaling 6 minutes for both feet, twice a day (morning and evening).
