Trends in Korean intervention studies on complementary and alternative therapies in rehabilitation nursing

Article information

J Exerc Rehabil Vol. 20, No. 5, 158-163, October, 2024

Publication date (electronic) : 2024 October 25

doi : https://doi.org/10.12965/jer.2448548.274

Da-Jung Kim

Department of Nursing, Cheju Halla University, Jeju, Korea

^*Corresponding author: Da-Jung Kim, Department of Nursing, Cheju Halla University, 38 Halladaehak-ro, Jeju 63092, Korea, Email: jung-321@hanmail.net

Received 2024 August 10; Revised 2024 September 9; Accepted 2024 September 12.

Abstract

INTRODUCTION

The U.S. National Center for Complementary and Alternative Medicine defines complementary and alternative medicine (CAM) as “diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.” It classifies CAM practices into five groups: (1) Biologically based practices including herbs and vitamins; (2) Energy medicine involving practices, such as magnet therapy, meridian therapy, and acupuncture; (3) Manipulative and body-based practices, such as massage and aromatherapy; (4) Mind-body medicine including meditation and relaxation techniques; and (5) Whole medical system, such as Traditional Chinese Medicine and Ayurveda (Oh et al., 2006). Additionally, CAM aims to harmonize treatment by considering the holistic aspects of mental, social, and environmental components, not limited to only addressing the patient’s illness (Corbin Winslow and Shapiro, 2002). CAM practices have the advantage of being offered either complementarily or independently of conventional medical treatment models to maximize therapeutic effects and enhance patient satisfaction (DeKeyser et al., 2001).

Patients undergoing rehabilitation therapies often face challenges owing to a decline in physical functionality and psychological difficulties secondary to disabilities. Over time, they experience various disabilities caused by illness, going through cycles of exacerbations and remissions, and they make efforts to cope with their conditions independently (Prvu Bettger et al., 2015). Therefore, for rehabilitation patients to receive assistance in overcoming disabilities, managing the worsening of their conditions, addressing risk factors in daily life, and recovering lost or weakened functions to the greatest extent possible to adapt to their environment is crucial. Providing nursing care that supports functional recovery and adaptation is also necessary to enable them to perform activities of daily living (ADLs) postdischarge and address major health concerns (Duncan et al., 2002).

CATs in nursing can be provided in conjunction with or as alternatives to conventional medical treatments to enhance therapeutic outcomes for rehabilitation patients and improve their satisfaction. Therefore, establishing the correct knowledge and attitude toward CATs is crucial not only for the theoretical development of nursing but also for the expansion of CAM practices (DeKeyser et al., 2001). CATs can support rehabilitation patients in therapeutic, psychological, social, and environmental aspects.

However, a review of previous studies indicates that the research trends on CATs in rehabilitation nursing have primarily been explored through integrative reviews. These studies have limitations in understanding how CAT research has progressed and what knowledge has been accumulated (Oh et al., 2006). This makes it challenging to comprehensively understand recent domestic (South Korean) research trends. Additionally, little research is dedicated to analyzing how CATs are currently being integrated into rehabilitation nursing and how new roles are being adapted. To address this research gap, this study systematically analyzed the trends of different types of Korean CAT-related intervention studies in rehabilitation nursing through an integrative review, aiming to gain a comprehensive understanding of recent domestic research trends.

This study aims to understand research trends in CATs by conducting an integrative review of CAT-related intervention studies in the field of rehabilitation nursing published in South Korea over the past decade. By employing an integrative review methodology, which synthesizes findings from diverse study designs and methodologies, the goal is to provide a comprehensive overview that can inform the restructuring of CATs for rehabilitation patients. Additionally, this approach will help identify gaps in the existing literature and explore appropriate research directions for the future application of CATs in rehabilitation nursing.

MATERIALS AND METHODS

Target articles and literature search

The literature search focused on papers published in the field of rehabilitation nursing in Korean academic journals over the past 10 years (2014–2023). The search was conducted using databases such as the National Assembly Library, the Korean Studies Information Service System, DBPIA, and RISS4U, with the search terms “complementary and alternative therapies,” “rehabilitation nursing,” and “intervention study.” Unpublished papers, conference proceedings, studies involving non-human subjects, review articles, and papers without accessible full texts were excluded. A total of 14 papers that met the eligibility criteria were selected for analysis (Fig. 1).

Fig. 1

Study flow diagram. KISS, Korean Studies Information Service System.

RESULTS

General characteristics of the studies

The characteristics of the reviewed papers are as follows: examining the distribution of papers by publication period, eight (57.1%), two (14.3%), and four (28.6%) were published in 2014 and 2015, between 2016 and 2019, and between 2020 and 2023, respectively. Regarding participant groups, nine (64.3%) targeted older adults, while five (35.7%) targeted nonolder adults. The total sample sizes were categorized as follows: fewer than 30, 30–39, 40–49, and 50–59, and 60 or more participants in two (14.3%), five (35.7%), three (21.4%), and two papers (14.3%) each, respectively (Table 1).

Table 1

General characteristics of the studies (n=14)

CAT intervention methods

The CAT intervention methods used in the 14 papers reviewed are as follows: seven papers (50.0%) applied manipulative and body-based therapies (e.g., auricular acupressure, massage, and hand acupuncture), two (14.3%) applied mind-body therapies (e.g., Tai Chi exercise), four (28.6%) applied energy therapies (e.g., acupressure, moxibustion, finger pressure pellet therapy), and the remaining paper (7.1%) applied another, unspecified therapy (Fig. 2).

Fig. 2

Distribution of the 14 papers reviewed by intervention method.

Content analysis (outcome measures and efficacy analysis)

Table 2 summarizes the content analysis of the 14 papers included in the review. The efficacy analysis revealed that CATs yielded different effects depending on participant characteristics and outcome measures.

Table 2

General characteristics of the studies (n=14)

The efficacy analysis of the studies on older adults (No. 1–9) can be summarized as follows: aromatherapy and foot reflexology massage reduced dementia-related sleep disorders and wandering behavior. Auricular acupressure improved sleep duration, sleep satisfaction, and nocturia. Moxibustion significantly reduced the severity of low back pain and disability in performing ADLs in the experimental group compared to the control group. Tai Chi exercise administered to older adult women led to a statistically significant improvement in right upper limb and lower limb flexibility, but no significant difference in lower limb strength, left upper limb flexibility, bilateral static balance, agility, or dynamic balance. Tai Chi exercise administered to rural older adults at risk of dementia significantly improved their attention span compared to the control group. Auricular acupressure applied to older adult workers exhibited a pain reduction effect but no difference in joint range of motion or sleep quality.

The efficacy analysis of the four studies on nonolder adults (No. 10–14) can be summarized as follows: auricular acupressure on home-based stroke patients displayed no significant difference in upper limb function or perceived health status. Aromatherapy hand massage applied to dialysis patients was more effective in reducing pulse rate than in reducing anxiety. Self-lymphatic drainage applied to breast cancer survivors exhibited only partial improvement in quality of life and no difference in subjective symptoms of edema.

DISCUSSION

This study examines trends in domestic intervention studies on CATs in rehabilitation nursing and aims to identify potential areas for restructuring CAT programs and explore future research directions. A total of 14 research papers were analyzed, with a focus on participant characteristics, CAT intervention methods, outcome measures, and efficacy analysis. This study concludes with a presentation of trends and recommendations for domestic CAT intervention research in rehabilitation nursing.

First, among the 14 papers, nine (64.3%) focused on older adult patients, which is consistent with previous research suggesting increased use of CATs among older adults for disease management (Suen et al., 2016). Owing to physiological changes and potential interactions with underlying diseases and existing treatments, older patients require greater caution in medication and surgical considerations (Knopp-Sihota et al., 2022). Therefore, safe and effective nonpharmacological interventions are needed. In this context, CATs offer a relatively safe, noninvasive, and cost-effective alternative to treatments involving expensive medical equipment, thereby reducing healthcare costs. They are especially advantageous for home-bound older adult patients because of the availability of visiting care. Therefore, CATs may be preferred among older age groups. Their potential to improve pain management, physical functionality, psychological health, and quality of life in older adults (Nawai, 2019) warrants further development and active utilization.

Second, among the CAT intervention methods reviewed, auricular acupressure was the most used form of manipulative and body-based therapy in nursing care. Auricular acupressure involves placing small objects, such as seeds, magnets, or stones, on reflex points on the ear using tape and applying pressure with the fingers. Its low pain, minimal side effects, affordability, and ease of application make it a suitable CAT for many patients (Lee and Frazier, 2011; Kim and Park, 2023). Given that CATs have traditionally been employed for health maintenance rather than disease treatment (Kim et al., 2013), their application within the nursing care field needs to be broadened. This underscores the importance of nurse education and program development to integrate CATs into clinical practice and community settings for rehabilitation patients who require noninvasive and affordable interventions.

Third, the efficacy analysis revealed that the effects of CATs varied depending on participant characteristics and outcome measures. Previous research (Kılıç Akça and Taşcı, 2016; Lee and Hur, 2022) has confirmed differences in effect sizes based on intervention methods, timing of measurement, and participant characteristics, which limits the applicability and sustained efficacy of CATs in rehabilitation nursing. To enhance the generalizability of CATs, standardized methods need to be established, scientific knowledge accumulated, and repeated studies conducted. This is also essential for defining their academic identity and direction.

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