The efficacy of acupressure in managing opioid-induced constipation: Single-blind a randomized controlled study

The efficacy of acupressure in managing opioid-induced constipation: Single-blind a randomized controlled study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The efficacy of acupressure in managing opioid-induced constipation: Single-blind a randomized controlled study DİLEK YILDIRIM, Vildan KOCATEPE, Gül KÖKNEL TALU This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-717911/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Purpose Opioid-induced constipation is one of the heath problems with a negative impact on the quality of life. This randomized-controlled trial aimed to investigate the effects of acupressure therapy on the management of opioid-induced constipation. Methods The trial was conducted on 140 patients, who were assigned to the acupressure (n = 70) and the control groups (n = 70). In addition to routine care, patients in the acupressure group received 8-min acupressure from the Zhongwan (CV12), Guanyuan (CV4) and Tianshu (ST25) acupoints once a day for 4 weeks. The outcomes included Defacationa Diary (DD), Visual Analog Scale Questionnaire (VASQ) and Patient assessment of constipation quality of life questionnaire (PAC-QOL). Results DD scores obtained by the acupressure and the control groups. There was a statistically significant difference between the acupressure and control groups in terms of stool consistency (2.22 ± .49 vs 1.80 ± .55) (p = 0.001), straining (1.98 ± .71 vs 2.91 ± .37) (p = 0.001), incomplete evacuation (0.37 ± .29 vs 0.61 ± .43) (p = 0.001), stool amount (0.93 ± .14 vs .95 ± .20) (p = 0.001) and the number of defecations (0.70 ± .22 vs 0.46 ± .29), (p = 0.001) measured at the fifth week. Besides, with the exception of stool amount, there was a statistically significant increase in the DD scores obtained by the acupressure group between the first and the fifth weeks. Inter-group comparison of the pre-test and post-test scores showed that acupressure group obtained statistically significantly higher scores from the PAC-QOL (p = .0001). Conclusions Findings of this trial suggested that 4-week acupressure was an effective way to improve the quality of life and reduce both subjective and objective constipation symptoms in patients with opioid-induced constipations. Cancer Biology Oncology Nursing Acupressure opioid-induced constipation cancer complementary medicine Figures Figure 1 Figure 2 Introduction Opioid-induced constipation, which occurs as a result of a decrease in intestinal motility after the initiation of opioid therapy, increase in rectal sphincter tone or indifference to the stimulations of rectum related with defecation reflex is one of the important health problems with a negative impact on the quality of life [ 1 , 2 ]. It may require medication change or decrease in opioid dose, which, in turn, may influence the effectiveness of therapy. The prevalence of opioid-related constipation is 39.4% [ 3 ]. Although, informing the patients about constipation, and the suggestions to increase the consumption of fibrous food, water intake, physical exercise and abdominal massage have all been suggested, none of the existing studies proposed an effective method to manage opioid-induced constipation [ 4 ]. Costs of pharmacological drugs such as laxatives and the consequences of inappropriate use of laxatives, including, fluid imbalances, loss of electrolytes and disturbances of acid-base metabolism, bring the need for non-pharmacological methods [ 5 ]. One of the methods to prevent constipation is acupressure. Acupressure is the application of pressure or localized massage to specific sites on the body to reduce pain, maintain relief and avoid nausea or constipation [ 6 ]. Proper acupressure massage promotes gastrointestinal motility and digestive juice secretion via conduction reflex of nerves and meridians [ 7 ]. The effectiveness of acupressure has been reported by various studies [ 8 – 12 ]. Randomized-controlled trial of Shin and Park (2018) on patients with breast cancer found that auricular acupressure, which was received once a week for 6 consecutive weeks, resulted with significant improvements in stool form and the quality of life and reduced the constipation-assessment scores [ 8 ]. Patients with advanced cancer in the study of Wang et al. (2019) received an 8 minutes acupressure treatment for 3 consecutive days from 3 acupoints, namely, Zhongwan (CV12), Guanyuan (CV4) and Tianshu (ST25). Significant improvements in the symptoms of constipation, including colonic motility, straining during defecation, hard stools, sensation of incomplete evacuation and anorectal obstruction were observed for the intervention group (9). Despite the existence of various studies on the effectiveness of acupressure on the management of constipation in different patient groups [ 8 – 12 ], no study on the management of opioid-induced constipation has been conducted yet. Consequently, this study aims to evaluate the effectiveness of acupressure on the management of opioid-induced constipation. Methods Study design and participants This randomized-controlled trial was conducted in the algology clinic of a university hospital in Istanbul between August 2020 and June 2021. Registered to the Clinical Trials with the number ‘NCT 04876508’, the study conformed fully with the guidelines of the Consolidated Standards of Reporting Trials (CONSORT) Checklist (Fig. 1 ). Patients diagnosed with constipation, who were at the age of 18 years and above, agreed to participate, received opioid treatment for at least two weeks, and could receive oral feeding were included to the study. Patients with communication or cooperation problems, severe thrombocytopenia (< 50.000/µl), gastrointestinal tumor, intraabdominal infection, irritable bowel syndrome, intestinal obstruction, inflammatory bowel disease, history of abdominal hernia, bowel cancer or abdominal surgery, and psychiatric problems, including delirium, anxiety, depression or panic attack, were excluded from the study. Sample size was calculated with G Power (version 3.1.9). Sample size for 0.5 effect size and 0.05 error level was 57 participants for each group. Sample size calculation was conducted in accordance with one of the existing studies in the literature [ 9 ]. The power for the sample size was 95.1%. Given the possibility of defection, we assigned 70 participants for each group. Data Collection Tools Patient Information Form Comprised of 15 questions, this form included questions on socio-demographic characteristics, diagnosis, medications, laxative consumption, daily fluid consumption, daily physical exercise, opioid usage, weekly nutrition diary, movement/activity level, fiber intake and defecation. Defecation Diary Prepared by Pamuk et al. (2003), Defecation Diary (DD) measured the weekly levels of straining, incomplete evacuation, < 3 defecation/week and stool consistency for five weeks [ 13 ]. For each patient, the number of weekly defecations was obtained from the diary, and for each symptom, total score in one week was divided to the number of defecations in one week, the results of which provided the mean score for each symptom for each defecation. Visual Scale Analog Questionnaire Prepared by Pamuk et al. (2003), Visual Analog Scale Questionnaire (VASQ) had six items on the symptoms of constipation, including the frequency of stools, stool consistency, straining and incomplete evacuation. Participants were asked to daily respond the same items by marking a score between 0 and 10. A symptom was defined to be present when it was scored a 3 on the VASQ. Daily scores obtained from the VASQ were summed for each item to calculate the weekly mean VASQ score. Patient Assessment of Constipation Quality of Life Questionnaire Patient assessment of constipation quality of life questionnaire (PAC-QOL) was developed by Marquis et al. (2005) to measure the effects of opioid-induced constipation on daily activities and the quality of life [ 14 ]. Validity and reliability of the Turkish version of the PAC-QOL was determined by Bengi et al. (2015). The scale had four subscales, namely, physical discomfort, psychosocial discomfort, worries and concerns and satisfaction. Higher scores obtained from the scale indicated the lower quality of life [ 15 ]. Cronbach’s alpha of the PAC-QOL during the first and the fifth weeks of our study were 0.91 and 0.94, respectively. Procedures A total of 140 patients participated in the study. Patients were assigned to the acupressure (n = 70) or the control group (n = 70) using a computer-generated randomization list prepared by the researcher. During the first meeting, which took about 25–30 minutes, we obtained information about fiber intake, daily fluid consumption, diet restrictions and constipation by using the patient information form. We used the PAC-QOL to evaluate the responses on the quality of life related with constipation. Medical information, including diagnosis of disease and treatment plan, was obtained via patient records. All participants were followed by the researcher for one week without any intervention. During the first week, all participants were asked to consume normal food and beverages and continue stool softeners, such as laxatives. All participants were asked to complete the DD and the VASQ after each defecation during the first week. Following the first week, we conducted face-to-face interviews with the patients visiting the clinic. At the beginning of the second week, participants in the acupressure (i.e. intervention) group underwent a 15-min acupressure training session administered by the researchers. To standardize and calibrate the process, one of the researchers taught the participants of the acupressure group to self-administer the acupressure methods and asked the participants to roll each acupuncture points for two minutes. Application of acupressure started with the application of Zhongwan (CV12), Guanyuan (CV4) and Tianshu (ST25) acupressure points. CV12 was on the midline, 4 cun superior to the umbilicus. CV4 was on the midline, 3 cun inferior to the umbilicus. ST25 was 2 cun lateral to the midline at the level of the umbilicus (16]. We applied 3–5 kg firm pressure with the fingertips in a circular motion at a speed of two circles per second for a duration of two minutes per acupoint. A one-minute rest was applied before moving to the next acupoint. Acupressure treatment lasted for 8 minutes. A weighing scale was used to measure the correct amount of finger pressure necessary for the acupressure treatment. Participants in the acupressure group received acupressure at home, work, or the clinic. Following the training, participants were instructed to perform 8-min acupressure once a day for four weeks. Participants in the control group received routine treatment and were asked to complete the DD and the VASQ on a weekly basis over a course of four weeks. Assessments lasting 20–25 min were held with the patients once a week, either face-to-face or via telephone. Once the study was completed, all participants were asked to complete the PAC-QOL again. Each patient was evaluated at least 5 times during the trial. During these evaluations, participants were asked to report and bring the results of the evaluation forms requested to be completed at home to the clinic. Data Analysis Number, percentage, mean and standard deviation were used for descriptive statistical analysis. To compare descriptive characteristics of the control and acupressure groups, we used Pearson’s Chi-square and Fischer’s Exact test for categorical variables and independent samples T-test and Mann-Whitney U test for numerical variables. Frequency of constipation in the control and acupressure groups was analyzed with Pearson’s Chi-square analysis. Difference between the groups in terms of the scores obtained from the DD, VASQ and PAC-QOL was analyzed using independent T-test and Mann-Whitney U test. Mean scores obtained during the first and the fifth weeks were compared with dependent sample t-test and Wilcoxon signed-rank test. Mean scores obtained from the DD were analyzed with independent samples T-test, one-way analysis of variance and Kruskal-Wallis test. Skewness and Kurtosis values and Kolmogorov-Smirnov test were used to evaluate whether the variables followed a normal distribution. Statistical significance was set at p < .05. Results The trial started with 292 participants and concluded with 140 participants due to the exclusion of some of the participants for various reasons mentioned in Fig. 1 . No negative events related with acupressure were observed. Sociodemographic and clinical characteristics of the participants in the acupressure and the control groups were similar (Table 1 ). Table 1 Sociodemographic and clinical characteristics of the groups. Acupressure (n = 70) Control (n = 70) Min.- Max. ± SD Min.- Max. ± SD test p Age 18–90 60.93 ± 14.05 21–90 60.22 ± 12.81 t: 0.30 0.75 n % n % χ 2 p Gender Female 20 28.6 32 45.7 4.406 0.54 Male 50 71.4 38 54.3 Marital Status Single 13 18.6 10 14.3 0.468 0.649 Married 57 81.4 60 95.7 Education Illiterate 9 12.9 10 14.3 8.126 .149 Literate 7 10 8 11.4 Primary school graduate 32 45.7 35 50.0 Secondary school graduate 12 17.1 6 8.6 High school graduate 8 11.4 3 4.3 University graduate 2 2.9 8 11.4 Working status Employed 7 10.0 29 41.4 2.146 0.59 Unemployed 63 90.0 41 58.6 Last day of defecation Day 0 (Same day) 13 18.6 15 21.4 2.541 .637 1 day ago 19 27.1 16 22.9 2 days ago 30 42.9 32 45.7 8–10 days ago 8 11.4 7 10.0 Diet restriction Yes 17 24.3 19 27.1 .150 .699 No 53 75.7 51 72.9 Fiber intake Yes 33 47.1 37 52.9 1.884 .170 No 37 52.9 33 47.1 Daily fluid consumption 10 glasses and over 21 30.0 22 31.4 .291 .865 6–9 glasses 35 50.0 32 45.7 ≤ 5 glasses 14 20.0 16 22.9 SD SD t p ECOG Performans Skoru 3.63 1.01 3.58 .91 .437 .662 Medical Diagnosis Lung cancer 39 55.7 35 50.0 Genitourinary System Cancers 13 18.6 14 20.0 Breast Cancer 4 5.7 6 8.6 Bone Cancer 5 7.1 5 7.1 Hematological Cancers 3 4.3 7 10.0 The sarcoma of soft tissue 6 8.6 3 4.3 Table 2 showed the findings on the DD scores obtained by the acupressure and the control groups. There was a statistically significant difference between the acupressure and control groups in terms of stool consistency (2.22 ± .49 vs 1.80 ± .55) (p = 0.001), straining (1.98 ± .71 vs 2.91 ± .37) (p = 0.001), incomplete evacuation (0.37 ± .29 vs 0.61 ± .43) (p = 0.001), stool amount (0.93 ± .14 vs .95 ± .20) (p = 0.001) and the number of defecations (0.70 ± .22 vs 0.46 ± .29), (p = 0.001) measured at the fifth week. Besides, with the exception of stool amount, there was a statistically significant increase in the DD scores obtained by the acupressure group between the first and the fifth weeks. Table 2 Defecation diary scores between the acupressure and control group. Weekly defecation diary score Acupressure (n = 70) Control (n = 70) ±SD ±SD t* / U p Stool amount 1st week .96 ± .13 .91 ± .21 U: 2113.5 .036 2 nd week .94 ± .22 .99 ± .30 U: 2078.5 .016 3rd week .90 ± .21 .98 ± .35 U: 2117.0 .028 4th week .95 ± .16 .96 ± .26 U: 2062.0 .014 5th week .93 ± .14 .95 ± .20 U: 2000.5 .006 1st vs. 5th week Z − .115 1.820 p .909 .089 Stool consistency 1st week 1.40 ± .55 1.45 ± .61 t: 4.991 .667 2 nd week 1.41 ± .56 1.54 ± .60 t: .778 .796 3rd week 1.67 ± .68 1.61 ± .67 t: − .340 .734 4th week 2.24 ± .50 1.79 ± .58 t: 5.670 .000 5th week 2.22 ± .49 1.80 ± .55 t: 5.444 .000 1st vs. 5th week t** -10.762 2.735 p .000 .325 Straining 1st week 3.16 ± .73 2.90 ± .95 t: 1.846 .067 2 nd week 3.15 ± .72 2.88 ± .90 t: 1.801 .074 3rd week 2.76 ± .81 2.94 ± .88 t: − .926 .356 4th week 2.04 ± .73 2.89 ± .98 t: -6.018 .000 5th week 1.98 ± .71 2.91 ± .37 t: -6.559 .000 1st vs. 5th week t** 11.460 1.428 p .000 .756 Incomplete evacuation 1st week .79 ± .28 .72 ± .40 t: 1.332 .185 2 nd week .78 ± .27 .74 ± .38 t: 1.271 .206 3rd week .63 ± .33 .53 ± .38 t: -1.397 .165 4th week .39 ± .30 .54 ± .32 t: -5.607 .000 5th week .37 ± .29 .61 ± .43 t: -5.903 .000 1st vs. 5th week t** 9.139 .721 p .000 .453 Number of defecations 1st week .45 ± .13 .46 ± .27 U: 2273.5 .416 2 nd week .44 ± .12 .45 ± .22 U: 2332.0 .587 3rd week .54 ± .17 .51 ± .26 U: 1672.0 .001 4th week .67 ± .20 .45 ± .19 U: 698.5 .000 5th week .70 ± .22 .46 ± .29 U: 697.0 .000 1st vs. 5th week t** -6.414 2.000 p .000 .069 t*: t-test in dependent groups; t **: t -test in independent groups, Z: Wilcoxon test, U: Mann Whitney U test Figure 2 demonstrated the comparison of the weekly mean scores obtained from the VASQ and inter-group comparison for the first and the fifth weeks. Compared to the control group, there was a statistically significant decrease in constipation (5.52 ± 1.82 vs 7.62 ± 2.04) (p < 0.001), straining (5.14 ± 1.82 vs 7.17 ± 2.31) (p < 0.001), pain (3.12 ± 1.97 vs 5.01 ± 2.81) (p < 0.001), feeling of fullness in the rectum (3.31 ± 1.60 vs 3.95 ± 2.14) (p = 0.047), and the severity of gas (4.34 ± 1.76 vs. 7.91 ± 1.75) (p < 0.001) in the acupressure group in the fifth week. However, there was no statistically significant difference between the two groups in terms of the severity of incomplete evacuation (4.15 ± 1.80 vs. 4.48 ± 2.49) (p = 0.484). Comparison of the PAC-QOL scores obtained by the acupressure and control groups in Table 3 revealed that pre-test scores were similar but post-test scores of the acupressure group were statistically significant than the control group (60.65 ± 9.68 vs 82.00 ± 14.00) (p = 0.001). (Table 3 ). Inter-group comparison of the pre-test and post-test scores showed that acupressure group obtained statistically significantly higher scores from the PAC-QOL (p = .0001). However, no significant improvement was observed in the control group. Finally, we did not observe any adverse events during the study. Table 3 PACQLQ scores between the acupressure and control group. PACQLQ Subscales Pre-test Post-test Groups ± SD ± SD t* p The Patient Assessment of Constipation Quality of Life (PACQLQ) Acupressure 76.14 ± 10.62 60.65 ± 9.68 19.03 .0001 Control 74.81 ± 12.77 82.00 ± 14.00 -11.93 .0001 t** .134 -10.486 p .524 .0001 Subscales Physical Discomfort Acupressure 11.83 ± 2.24 8.77 ± 2.03 20.67 .0001 Control 11.40 ± 2.20 12.55 ± 2.15 -6.76 .0001 t** .639 -10.691 p .241 .0001 Psychosocial Discomfort Acupressure 21.32 ± 4.35 15.91 ± 4.08 16.88 .0001 Control 21.14 ± 5.06 25.08 ± 4.82 -14.06 .0001 t** .233 -12.131 p .816 .0001 Anxiety Acupressure 29.64 ± 5.35 21.97 ± 5.32 14.98 .0001 Control 28.67 ± 6.43 31.28 ± 6.12 -12.24 .0001 t** .971 -10.368 p .333 .0001 Satisfaction Acupressure 13.32 ± 3.35 12.05 ± 3.12 -3.83 .0001 Control 13.60 ± 2.97 13.14 ± 2.83 1.46 .267 t** − .506 4.136 p .613 .0001 t*: t-test in dependent groups; t **: t -test in independent groups. Discussion Based on our literature review, we may suggest that this study was the first randomized-controlled trial with the highest sample size on the effectiveness of acupressure on opioid-induced constipation. We found that acupressure was an effective method to manage opioid-induced constipation and improve the quality of life. Five-week DD records of the participants using opioid in our study revealed a significant improvement in terms of stool amount and consistency, straining, incomplete evacuation and the number of defecations. Similarly, the VASQ scores obtained by the acupressure group indicated a significant improvement in the symptoms of constipation in the fifth week. Besides, acupressure therapy improved the quality of life, which was measured by the PAC-QOL. Despite the limited number of studies in the literature, existing studies reported the positive effects of acupressure therapy on the management of constipation. Similar to our findings, the study of Wang et al. (2019) on the effects of acupressure on constipation in patients with advanced cancer reported that a 8-minutes acupressure therapy for 3 consecutive days on Zhongwan (CV12), Guanyuan (CV4), and Tianshu (ST25) acupoints alleviated the symptoms of constipation [ 9 ]. In another randomized control trial on patients with breast cancer, auricular acupressure was applied to seven auricular acupoints for six weeks. The study found that auricular acupressure was an effective method to relieve constipation in patients with breast cancer receiving chemotherapy [ 8 ]. Meta-analysis of Lee et al. (2010) on chronic functional constipation in 15 randomized-controlled trials found that moxibustion was as effective as medical therapy to change intestinal motility and improve the quality of life [ 17 ]. Wong et al. (2015) studied the effects of SP6 acupressure on pain and menstrual distress in young women with dysmenorrhea and found that SP6 acupressure had an immediate pain-relieving effect for dysmenorrhea and was effective in relieving both the pain and menstrual distress resulting from dysmenorrhea [ 18 ]. Studies on acupuncture suggest that contractility of distal colon and vagal and sympathetic stimuli may stimulate colonic motility [ 19 , 20 ]. Given the fact that acupressure is based on the stimulation of basic acupuncture points and some of the patients are unconformable with acupuncture pins, we may conclude that acupressure is a more comfortable method of constipation management. Besides, we observed that the application of acupressure was easy to be learned and applied by the participants in different environments. Conclusion Findings of this trial suggested that 4-week acupressure was an effective way to reduce both subjective and objective constipation symptoms in patients with opioid-induced constipation. Besides, acupressure improved the quality of life in the participants. Therefore, we suggest that acupressure may be used as a non-invasive method to manage constipation patients with opioid-induced constipation. Declarations Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflicts of interest: The authors declare that they have no conflict of interest. Availability of data and material: Data are available upon request from the corresponding author. Code availability: N/A Authors' contributions: D.Y.: Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Validation, Visualization,Writing - review & editing. V.K.: Conceptualization, Data curation, Methodology, Validation, Visualization, Writing - review & editing. G.K.T.: Data curation, Methodology, Visualization, Writing - review & editing. All authors have read and approved the final manuscript. Ethics approval: We obtained approval from University Ethics Committee (Number 2020/16). All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Constent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: N/A References Turan N, Aşt TA (2016) The effect of abdominal massage on constipation and quality of life. Gastroenterol Nurs 39:48–59. doi: 10.1097/SGA.0000000000000202 Nafziger AN, Barkin RL (2018) Opioid therapy in acute and chronic pain. J Clin Pharmacol 58:1111–1122. doi: 10.1002/jcph.1276 McClurg D, Hagen S, Hawkins S, Lowe-Strong A (2011) Abdominal massage for the alleviation of constipation symptoms ın people with multiple sclerosis: a randomized controlled feasibility study. Multiple Sclerosis Journal 17:223–233 Eyigör C (2015) Opioidlerin kullanım ilkeleri, yan etki yönetimi ve yeni opioidler. Ege üniversitesi tıp fakültesi algoloji bilim dalı, ağrı bülteni. Türk Algoloji Derneği Yayınları 1:1–6 Stommel P, Holschneider AM (2006) Anorectal malformations in children (dietary prevention of constipation). Springe, London Synder M, Tracy MF (2014) Complementary and alternative therapies in nursing 7th edition. New York: Springer, 556 pages, softcover, ISBN: 978-0-8261-9612-5 Ren K, Qiu J, Wang X, Niu F, Jiang T (2012) The effect of a sweet potato, footbath, and acupressure intervention in preventing constipation in hospitalized patients with acute coronary syndromes. Gastroenterol Nurs 35:271–277 Shin J, Park H (2018) Effects of auricular acupressure on constipation in patients with breast cancer receiving chemotherapy: a randomized control trial. West J Nurs Res 40:67–83 Wang PM, Hsu CW, Liu CT, Lai TY, Tzeng FL, Huang CF (2019) Effect of acupressure on constipation in patients with advanced cancer. Support Care Cancer 27:3473–3478 Abbott R, Ayres I, Hui E, Hui KK (2015) Effect of perineal self-acupressure on constipation: a randomized controlled trial. J Gen Intern Med 30:434–439 Jing X, Liu J, Wang C, Ji M, Chen X, Mei Y, Zhu QR (2018) Auricular acupressure is an alternative in treating constipation in leukemia patients undergoing chemotherapy: a systematic review and meta-analysis. Complement Ther Clin Pract 31:282–289 Abbasi P, Mojalli M, Kianmehr M, Zamani S (2019) Effect of acupressure on constipation in patients undergoing hemodialysis: A randomized double-blind controlled clinical trial. Avicenna J Phytomed 9:84–91 Pamuk ÖN, Pamuk GE, Çelik AF (2003) Revalidation of description of constipation in terms of recall bias and visual scale analog questionnaire. J Gastroenterol Hepatol 8:1417–1422 Bengi G, Yalçın M, Akpınar H, Keskinoğlu P, Ellidokuz H (2015) Validity and reliability of the patient assessment of constipation quality of life questionnaire for the Turkish population. Turk J Gastroenterol 26:309–314 Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O (2005) Development and validation of the patient assessment of constipation quality of life questionnaire. Scand J Gastroenterol 40:540–551 World Health Organization (2008) WHO standard acupuncture point locations in the Western Pacific region. World Health Organization, Manila Lee MS, Kang JW, Ernst E (2010) Does moxibustion work? An overview of systematic reviews. BMC Res Notes 3:284 Wong CL, Lai KY, Tse HM (2010) Effects of SP6 acupressure on pain and menstrual distress in young women with dysmenorrhea. Complement Ther Clin Pract 16:64–69 Luo D, Liu S, Xie X, Hou X (2008) Electroacupuncture at acupoint ST-36 promotes contractility of distal colon via a cholinergic pathway in conscious rats. Dig Dis Sci 53:689–693 Hróbjartsson A, Emanuelsson F, Skou Thomsen AS, Hilden J, Brorson S (2014) Bias due to lack of patient blinding in clinical trials. A systematic review of trials randomizing patients to blind and nonblind sub-studies. Int J Epidemiol 43:1272–1283 Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 24 Sep, 2021 Reviewers invited by journal 23 Sep, 2021 Editor invited by journal 10 Aug, 2021 Editor assigned by journal 16 Jul, 2021 First submitted to journal 14 Jul, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-717911","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":52997841,"identity":"e5a4c86b-5de3-417a-b8c2-a2da2c25d95d","order_by":0,"name":"DİLEK YILDIRIM","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-6228-0007","institution":"Istanbul Aydin University: Istanbul Aydin Universitesi","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"DİLEK","middleName":"","lastName":"YILDIRIM","suffix":""},{"id":52997842,"identity":"6106bebc-65e6-446b-b445-b149ae4f11fc","order_by":1,"name":"Vildan KOCATEPE","email":"","orcid":"","institution":"Acıbadem Üniversitesi: Acibadem Universitesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Vildan","middleName":"","lastName":"KOCATEPE","suffix":""},{"id":52997843,"identity":"aac45114-fe2c-41bf-8838-505999a03dd1","order_by":2,"name":"Gül KÖKNEL TALU","email":"","orcid":"","institution":"Istanbul University: Istanbul Universitesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gül","middleName":"KÖKNEL","lastName":"TALU","suffix":""}],"badges":[],"createdAt":"2021-07-14 19:29:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-717911/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-717911/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13824430,"identity":"b764ba3b-e53f-4a41-9c37-97cfe14b4214","added_by":"auto","created_at":"2021-09-21 14:35:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28303,"visible":true,"origin":"","legend":"Consort flow diagram","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-717911/v1/58183086c79e127490cdc9c3.png"},{"id":13824431,"identity":"f30149fb-1206-4a68-8552-e805ffb90a3f","added_by":"auto","created_at":"2021-09-21 14:35:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":45175,"visible":true,"origin":"","legend":"Mean VAS score.","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-717911/v1/85ef5dd31cb39809f21c55f4.png"},{"id":13824432,"identity":"c3abe4ed-a9f5-403a-81db-e079539da694","added_by":"auto","created_at":"2021-09-21 14:35:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":449963,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-717911/v1/9c3b4bac-1257-4893-9074-60f9903d20f9.pdf"}],"financialInterests":"","formattedTitle":"The efficacy of acupressure in managing opioid-induced constipation: Single-blind a randomized controlled study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOpioid-induced constipation, which occurs as a result of a decrease in intestinal motility after the initiation of opioid therapy, increase in rectal sphincter tone or indifference to the stimulations of rectum related with defecation reflex is one of the important health problems with a negative impact on the quality of life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It may require medication change or decrease in opioid dose, which, in turn, may influence the effectiveness of therapy. The prevalence of opioid-related constipation is 39.4% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although, informing the patients about constipation, and the suggestions to increase the consumption of fibrous food, water intake, physical exercise and abdominal massage have all been suggested, none of the existing studies proposed an effective method to manage opioid-induced constipation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Costs of pharmacological drugs such as laxatives and the consequences of inappropriate use of laxatives, including, fluid imbalances, loss of electrolytes and disturbances of acid-base metabolism, bring the need for non-pharmacological methods [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. One of the methods to prevent constipation is acupressure.\u003c/p\u003e \u003cp\u003eAcupressure is the application of pressure or localized massage to specific sites on the body to reduce pain, maintain relief and avoid nausea or constipation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Proper acupressure massage promotes gastrointestinal motility and digestive juice secretion via conduction reflex of nerves and meridians [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The effectiveness of acupressure has been reported by various studies [\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Randomized-controlled trial of Shin and Park (2018) on patients with breast cancer found that auricular acupressure, which was received once a week for 6 consecutive weeks, resulted with significant improvements in stool form and the quality of life and reduced the constipation-assessment scores [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Patients with advanced cancer in the study of Wang et al. (2019) received an 8 minutes acupressure treatment for 3 consecutive days from 3 acupoints, namely, Zhongwan (CV12), Guanyuan (CV4) and Tianshu (ST25). Significant improvements in the symptoms of constipation, including colonic motility, straining during defecation, hard stools, sensation of incomplete evacuation and anorectal obstruction were observed for the intervention group (9).\u003c/p\u003e \u003cp\u003eDespite the existence of various studies on the effectiveness of acupressure on the management of constipation in different patient groups [\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], no study on the management of opioid-induced constipation has been conducted yet. Consequently, this study aims to evaluate the effectiveness of acupressure on the management of opioid-induced constipation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participants\u003c/h2\u003e \u003cp\u003eThis randomized-controlled trial was conducted in the algology clinic of a university hospital in Istanbul between August 2020 and June 2021. Registered to the Clinical Trials with the number \u0026lsquo;NCT 04876508\u0026rsquo;, the study conformed fully with the guidelines of the Consolidated Standards of Reporting Trials (CONSORT) Checklist (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePatients diagnosed with constipation, who were at the age of 18 years and above, agreed to participate, received opioid treatment for at least two weeks, and could receive oral feeding were included to the study. Patients with communication or cooperation problems, severe thrombocytopenia (\u0026lt;\u0026thinsp;50.000/\u0026micro;l), gastrointestinal tumor, intraabdominal infection, irritable bowel syndrome, intestinal obstruction, inflammatory bowel disease, history of abdominal hernia, bowel cancer or abdominal surgery, and psychiatric problems, including delirium, anxiety, depression or panic attack, were excluded from the study.\u003c/p\u003e \u003cp\u003eSample size was calculated with G Power (version 3.1.9). Sample size for 0.5 effect size and 0.05 error level was 57 participants for each group. Sample size calculation was conducted in accordance with one of the existing studies in the literature [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The power for the sample size was 95.1%. Given the possibility of defection, we assigned 70 participants for each group.\u003c/p\u003e \u003c/div\u003e\u003ch2\u003eData Collection Tools\u003c/h2\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePatient Information Form\u003c/h2\u003e \u003cp\u003eComprised of 15 questions, this form included questions on socio-demographic characteristics, diagnosis, medications, laxative consumption, daily fluid consumption, daily physical exercise, opioid usage, weekly nutrition diary, movement/activity level, fiber intake and defecation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDefecation Diary\u003c/h2\u003e \u003cp\u003ePrepared by Pamuk et al. (2003), Defecation Diary (DD) measured the weekly levels of straining, incomplete evacuation, \u0026lt;\u0026thinsp;3 defecation/week and stool consistency for five weeks [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For each patient, the number of weekly defecations was obtained from the diary, and for each symptom, total score in one week was divided to the number of defecations in one week, the results of which provided the mean score for each symptom for each defecation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eVisual Scale Analog Questionnaire\u003c/h2\u003e \u003cp\u003ePrepared by Pamuk et al. (2003), Visual Analog Scale Questionnaire (VASQ) had six items on the symptoms of constipation, including the frequency of stools, stool consistency, straining and incomplete evacuation. Participants were asked to daily respond the same items by marking a score between 0 and 10. A symptom was defined to be present when it was scored a 3 on the VASQ. Daily scores obtained from the VASQ were summed for each item to calculate the weekly mean VASQ score.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePatient Assessment of Constipation Quality of Life Questionnaire\u003c/h2\u003e \u003cp\u003ePatient assessment of constipation quality of life questionnaire (PAC-QOL) was developed by Marquis et al. (2005) to measure the effects of opioid-induced constipation on daily activities and the quality of life [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Validity and reliability of the Turkish version of the PAC-QOL was determined by Bengi et al. (2015). The scale had four subscales, namely, physical discomfort, psychosocial discomfort, worries and concerns and satisfaction. Higher scores obtained from the scale indicated the lower quality of life [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Cronbach\u0026rsquo;s alpha of the PAC-QOL during the first and the fifth weeks of our study were 0.91 and 0.94, respectively.\u003c/p\u003e \u003c/div\u003e\u003ch2\u003eProcedures\u003c/h2\u003e\u003cp\u003eA total of 140 patients participated in the study. Patients were assigned to the acupressure (n\u0026thinsp;=\u0026thinsp;70) or the control group (n\u0026thinsp;=\u0026thinsp;70) using a computer-generated randomization list prepared by the researcher.\u003c/p\u003e \u003cp\u003e During the first meeting, which took about 25\u0026ndash;30 minutes, we obtained information about fiber intake, daily fluid consumption, diet restrictions and constipation by using the patient information form. We used the PAC-QOL to evaluate the responses on the quality of life related with constipation. Medical information, including diagnosis of disease and treatment plan, was obtained via patient records.\u003c/p\u003e \u003cp\u003eAll participants were followed by the researcher for one week without any intervention. During the first week, all participants were asked to consume normal food and beverages and continue stool softeners, such as laxatives. All participants were asked to complete the DD and the VASQ after each defecation during the first week. Following the first week, we conducted face-to-face interviews with the patients visiting the clinic.\u003c/p\u003e \u003cp\u003eAt the beginning of the second week, participants in the acupressure (i.e. intervention) group underwent a 15-min acupressure training session administered by the researchers. To standardize and calibrate the process, one of the researchers taught the participants of the acupressure group to self-administer the acupressure methods and asked the participants to roll each acupuncture points for two minutes. Application of acupressure started with the application of Zhongwan (CV12), Guanyuan (CV4) and Tianshu (ST25) acupressure points. CV12 was on the midline, 4 cun superior to the umbilicus. CV4 was on the midline, 3 cun inferior to the umbilicus. ST25 was 2 cun lateral to the midline at the level of the umbilicus (16]. We applied 3\u0026ndash;5 kg firm pressure with the fingertips in a circular motion at a speed of two circles per second for a duration of two minutes per acupoint. A one-minute rest was applied before moving to the next acupoint. Acupressure treatment lasted for 8 minutes. A weighing scale was used to measure the correct amount of finger pressure necessary for the acupressure treatment. Participants in the acupressure group received acupressure at home, work, or the clinic. Following the training, participants were instructed to perform 8-min acupressure once a day for four weeks.\u003c/p\u003e \u003cp\u003eParticipants in the control group received routine treatment and were asked to complete the DD and the VASQ on a weekly basis over a course of four weeks. Assessments lasting 20\u0026ndash;25 min were held with the patients once a week, either face-to-face or via telephone. Once the study was completed, all participants were asked to complete the PAC-QOL again. Each patient was evaluated at least 5 times during the trial. During these evaluations, participants were asked to report and bring the results of the evaluation forms requested to be completed at home to the clinic.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eNumber, percentage, mean and standard deviation were used for descriptive statistical analysis. To compare descriptive characteristics of the control and acupressure groups, we used Pearson\u0026rsquo;s Chi-square and Fischer\u0026rsquo;s Exact test for categorical variables and independent samples T-test and Mann-Whitney U test for numerical variables. Frequency of constipation in the control and acupressure groups was analyzed with Pearson\u0026rsquo;s Chi-square analysis. Difference between the groups in terms of the scores obtained from the DD, VASQ and PAC-QOL was analyzed using independent T-test and Mann-Whitney U test. Mean scores obtained during the first and the fifth weeks were compared with dependent sample t-test and Wilcoxon signed-rank test. Mean scores obtained from the DD were analyzed with independent samples T-test, one-way analysis of variance and Kruskal-Wallis test. Skewness and Kurtosis values and Kolmogorov-Smirnov test were used to evaluate whether the variables followed a normal distribution. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe trial started with 292 participants and concluded with 140 participants due to the exclusion of some of the participants for various reasons mentioned in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. No negative events related with acupressure were observed. Sociodemographic and clinical characteristics of the participants in the acupressure and the control groups were similar (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and clinical characteristics of the groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAcupressure (n\u0026thinsp;=\u0026thinsp;70)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;70)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMin.- Max.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u003cb\u003e\u0026plusmn; SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMin.- Max.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u003cb\u003e\u0026plusmn; 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colname=\"c7\"\u003e \u003cp\u003et: 0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eχ\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.649\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e.149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLast day of defecation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay 0 (Same day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e.637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 day ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 days ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u0026ndash;10 days ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiet restriction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e.699\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e72.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFiber intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDaily fluid consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 glasses and over\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e.865\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;9 glasses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;5 glasses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003et\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECOG Performans Skoru\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e.662\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical Diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGenitourinary System Cancers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBreast Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBone Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHematological Cancers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eThe sarcoma of soft tissue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e showed the findings on the DD scores obtained by the acupressure and the control groups. There was a statistically significant difference between the acupressure and control groups in terms of stool consistency (2.22\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;.49 vs 1.80\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;.55) (p\u0026thinsp;=\u0026thinsp;0.001), straining (1.98\u0026thinsp;\u0026plusmn;\u0026thinsp;.71 vs 2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;.37) (p\u0026thinsp;=\u0026thinsp;0.001), incomplete evacuation (0.37\u0026thinsp;\u0026plusmn;\u0026thinsp;.29 vs 0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;.43) (p\u0026thinsp;=\u0026thinsp;0.001), stool amount (0.93\u0026thinsp;\u0026plusmn;\u0026thinsp;.14 vs .95\u0026thinsp;\u0026plusmn;\u0026thinsp;.20) (p\u0026thinsp;=\u0026thinsp;0.001) and the number of defecations (0.70\u0026thinsp;\u0026plusmn;\u0026thinsp;.22 vs 0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;.29), (p\u0026thinsp;=\u0026thinsp;0.001) measured at the fifth week. Besides, with the exception of stool amount, there was a statistically significant increase in the DD scores obtained by the acupressure group between the first and the fifth weeks.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDefecation diary scores between the acupressure and control group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eWeekly defecation diary score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcupressure\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u003cb\u003e\u0026plusmn;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u003cb\u003e\u0026plusmn;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003et* / U\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eStool amount\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1st week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.96\u0026thinsp;\u0026plusmn;\u0026thinsp;.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.91\u0026thinsp;\u0026plusmn;\u0026thinsp;.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU: 2113.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 nd week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.94\u0026thinsp;\u0026plusmn;\u0026thinsp;.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.99\u0026thinsp;\u0026plusmn;\u0026thinsp;.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU: 2078.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.90\u0026thinsp;\u0026plusmn;\u0026thinsp;.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.98\u0026thinsp;\u0026plusmn;\u0026thinsp;.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU: 2117.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.95\u0026thinsp;\u0026plusmn;\u0026thinsp;.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.96\u0026thinsp;\u0026plusmn;\u0026thinsp;.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU: 2062.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.93\u0026thinsp;\u0026plusmn;\u0026thinsp;.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.95\u0026thinsp;\u0026plusmn;\u0026thinsp;.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU: 2000.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1st vs. 5th week Z\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026minus;\u0026thinsp;.115\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e1.820\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e.909\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.089\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eStool consistency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1st week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.40\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.45\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: 4.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.667\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 nd week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.41\u0026thinsp;\u0026plusmn;\u0026thinsp;.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.54\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: .778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.796\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.61\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: \u0026minus;\u0026thinsp;.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.734\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.24\u0026thinsp;\u0026plusmn;\u0026thinsp;.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.79\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: 5.670\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.80\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: 5.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1st vs. 5th week t**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e-10.762\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e2.735\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.325\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eStraining\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1st week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.90\u0026thinsp;\u0026plusmn;\u0026thinsp;.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: 1.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 nd week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.15\u0026thinsp;\u0026plusmn;\u0026thinsp;.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.88\u0026thinsp;\u0026plusmn;\u0026thinsp;.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: 1.801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.76\u0026thinsp;\u0026plusmn;\u0026thinsp;.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.94\u0026thinsp;\u0026plusmn;\u0026thinsp;.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: \u0026minus;\u0026thinsp;.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.04\u0026thinsp;\u0026plusmn;\u0026thinsp;.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.89\u0026thinsp;\u0026plusmn;\u0026thinsp;.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: -6.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.98\u0026thinsp;\u0026plusmn;\u0026thinsp;.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: -6.559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1st vs. 5th week t**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e11.460\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e1.428\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.756\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eIncomplete\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eevacuation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1st week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.79\u0026thinsp;\u0026plusmn;\u0026thinsp;.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.72\u0026thinsp;\u0026plusmn;\u0026thinsp;.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: 1.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 nd week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.78\u0026thinsp;\u0026plusmn;\u0026thinsp;.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.74\u0026thinsp;\u0026plusmn;\u0026thinsp;.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: 1.271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.63\u0026thinsp;\u0026plusmn;\u0026thinsp;.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.53\u0026thinsp;\u0026plusmn;\u0026thinsp;.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: -1.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.39\u0026thinsp;\u0026plusmn;\u0026thinsp;.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.54\u0026thinsp;\u0026plusmn;\u0026thinsp;.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: -5.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.37\u0026thinsp;\u0026plusmn;\u0026thinsp;.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.61\u0026thinsp;\u0026plusmn;\u0026thinsp;.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: -5.903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1st vs. 5th week t**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e9.139\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.721\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.453\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eNumber of\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003edefecations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1st week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.45\u0026thinsp;\u0026plusmn;\u0026thinsp;.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.46\u0026thinsp;\u0026plusmn;\u0026thinsp;.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU: 2273.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 nd week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.44\u0026thinsp;\u0026plusmn;\u0026thinsp;.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.45\u0026thinsp;\u0026plusmn;\u0026thinsp;.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU: 2332.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.587\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.54\u0026thinsp;\u0026plusmn;\u0026thinsp;.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.51\u0026thinsp;\u0026plusmn;\u0026thinsp;.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU: 1672.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.67\u0026thinsp;\u0026plusmn;\u0026thinsp;.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.45\u0026thinsp;\u0026plusmn;\u0026thinsp;.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU: 698.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5th week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.70\u0026thinsp;\u0026plusmn;\u0026thinsp;.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.46\u0026thinsp;\u0026plusmn;\u0026thinsp;.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU: 697.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1st vs. 5th week t**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e-6.414\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e2.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.069\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003et*: t-test in dependent groups; t **: t -test in independent groups, Z: Wilcoxon test, U: Mann Whitney U test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrated the comparison of the weekly mean scores obtained from the VASQ and inter-group comparison for the first and the fifth weeks. Compared to the control group, there was a statistically significant decrease in constipation (5.52\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;1.82 vs 7.62\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;2.04) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), straining (5.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82 vs 7.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), pain (3.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97 vs 5.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.81) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), feeling of fullness in the rectum (3.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60 vs 3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14) (p\u0026thinsp;=\u0026thinsp;0.047), and the severity of gas (4.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76 vs. 7.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the acupressure group in the fifth week. However, there was no statistically significant difference between the two groups in terms of the severity of incomplete evacuation (4.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80 vs. 4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49) (p\u0026thinsp;=\u0026thinsp;0.484).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eComparison of the PAC-QOL scores obtained by the acupressure and control groups in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e revealed that pre-test scores were similar but post-test scores of the acupressure group were statistically significant than the control group (60.65\u0026thinsp;\u0026plusmn;\u0026thinsp;9.68 vs 82.00\u0026thinsp;\u0026plusmn;\u0026thinsp;14.00) (p\u0026thinsp;=\u0026thinsp;0.001). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Inter-group comparison of the pre-test and post-test scores showed that acupressure group obtained statistically significantly higher scores from the PAC-QOL (p\u0026thinsp;=\u0026thinsp;.0001). However, no significant improvement was observed in the control group. Finally, we did not observe any adverse events during the study.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePACQLQ scores between the acupressure and control group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003ePACQLQ Subscales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eGroups\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e \u003cb\u003e\u0026plusmn; SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e \u003cb\u003e\u0026plusmn; SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003et*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c2\" namest=\"c1\" rowspan=\"4\"\u003e \u003cp\u003eThe Patient Assessment of Constipation Quality of Life (PACQLQ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcupressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.14\u0026thinsp;\u0026plusmn;\u0026thinsp;10.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60.65\u0026thinsp;\u0026plusmn;\u0026thinsp;9.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.81\u0026thinsp;\u0026plusmn;\u0026thinsp;12.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82.00\u0026thinsp;\u0026plusmn;\u0026thinsp;14.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-11.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003et**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.134\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e-10.486\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.524\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e.0001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"15\" rowspan=\"16\"\u003e \u003cp\u003e\u003cb\u003eSubscales\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePhysical Discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcupressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-6.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003et**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.639\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e-10.691\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.241\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e.0001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePsychosocial Discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcupressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.32\u0026thinsp;\u0026plusmn;\u0026thinsp;4.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.14\u0026thinsp;\u0026plusmn;\u0026thinsp;5.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.08\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-14.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003et**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.233\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e-12.131\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.816\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e.0001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcupressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.64\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.97\u0026thinsp;\u0026plusmn;\u0026thinsp;5.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.28\u0026thinsp;\u0026plusmn;\u0026thinsp;6.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-12.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003et**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.971\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e-10.368\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.333\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e.0001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcupressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.267\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003et**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026minus;\u0026thinsp;.506\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e4.136\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e.613\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e.0001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003et*: t-test in dependent groups; t **: t -test in independent groups.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBased on our literature review, we may suggest that this study was the first randomized-controlled trial with the highest sample size on the effectiveness of acupressure on opioid-induced constipation. We found that acupressure was an effective method to manage opioid-induced constipation and improve the quality of life.\u003c/p\u003e \u003cp\u003eFive-week DD records of the participants using opioid in our study revealed a significant improvement in terms of stool amount and consistency, straining, incomplete evacuation and the number of defecations. Similarly, the VASQ scores obtained by the acupressure group indicated a significant improvement in the symptoms of constipation in the fifth week. Besides, acupressure therapy improved the quality of life, which was measured by the PAC-QOL.\u003c/p\u003e \u003cp\u003eDespite the limited number of studies in the literature, existing studies reported the positive effects of acupressure therapy on the management of constipation. Similar to our findings, the study of Wang et al. (2019) on the effects of acupressure on constipation in patients with advanced cancer reported that a 8-minutes acupressure therapy for 3 consecutive days on Zhongwan (CV12), Guanyuan (CV4), and Tianshu (ST25) acupoints alleviated the symptoms of constipation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In another randomized control trial on patients with breast cancer, auricular acupressure was applied to seven auricular acupoints for six weeks. The study found that auricular acupressure was an effective method to relieve constipation in patients with breast cancer receiving chemotherapy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Meta-analysis of Lee et al. (2010) on chronic functional constipation in 15 randomized-controlled trials found that moxibustion was as effective as medical therapy to change intestinal motility and improve the quality of life [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Wong et al. (2015) studied the effects of SP6 acupressure on pain and menstrual distress in young women with dysmenorrhea and found that SP6 acupressure had an immediate pain-relieving effect for dysmenorrhea and was effective in relieving both the pain and menstrual distress resulting from dysmenorrhea [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies on acupuncture suggest that contractility of distal colon and vagal and sympathetic stimuli may stimulate colonic motility [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Given the fact that acupressure is based on the stimulation of basic acupuncture points and some of the patients are unconformable with acupuncture pins, we may conclude that acupressure is a more comfortable method of constipation management. Besides, we observed that the application of acupressure was easy to be learned and applied by the participants in different environments.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFindings of this trial suggested that 4-week acupressure was an effective way to reduce both subjective and objective constipation symptoms in patients with opioid-induced constipation. Besides, acupressure improved the quality of life in the participants. Therefore, we suggest that acupressure may be used as a non-invasive method to manage constipation patients with opioid-induced constipation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e The authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e Data are available upon request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability:\u003c/strong\u003e N/A \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eD.Y.: Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Validation, Visualization,Writing - review \u0026amp; editing. V.K.: Conceptualization, Data curation, Methodology, Validation, Visualization, Writing - review \u0026amp; editing. G.K.T.: Data curation, Methodology, Visualization, Writing - review \u0026amp; editing. All authors have read and approved the final manuscript. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e We obtained approval from University Ethics Committee (Number 2020/16). All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConstent to participate:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eN/A \u0026nbsp; \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTuran N, Aşt TA (2016) The effect of abdominal massage on constipation and quality of life. Gastroenterol Nurs 39:48\u0026ndash;59. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/SGA.0000000000000202\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNafziger AN, Barkin RL (2018) Opioid therapy in acute and chronic pain. J Clin Pharmacol 58:1111\u0026ndash;1122. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jcph.1276\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcClurg D, Hagen S, Hawkins S, Lowe-Strong A (2011) Abdominal massage for the alleviation of constipation symptoms ın people with multiple sclerosis: a randomized controlled feasibility study. Multiple Sclerosis Journal 17:223\u0026ndash;233\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEyig\u0026ouml;r C (2015) Opioidlerin kullanım ilkeleri, yan etki y\u0026ouml;netimi ve yeni opioidler. Ege \u0026uuml;niversitesi tıp fak\u0026uuml;ltesi algoloji bilim dalı, ağrı b\u0026uuml;lteni. T\u0026uuml;rk Algoloji Derneği Yayınları 1:1\u0026ndash;6\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStommel P, Holschneider AM (2006) Anorectal malformations in children (dietary prevention of constipation). Springe, London\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSynder M, Tracy MF (2014) Complementary and alternative therapies in nursing 7th edition. New York: Springer, 556 pages, softcover, ISBN: 978-0-8261-9612-5\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRen K, Qiu J, Wang X, Niu F, Jiang T (2012) The effect of a sweet potato, footbath, and acupressure intervention in preventing constipation in hospitalized patients with acute coronary syndromes. Gastroenterol Nurs 35:271\u0026ndash;277\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShin J, Park H (2018) Effects of auricular acupressure on constipation in patients with breast cancer receiving chemotherapy: a randomized control trial. West J Nurs Res 40:67\u0026ndash;83\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang PM, Hsu CW, Liu CT, Lai TY, Tzeng FL, Huang CF (2019) Effect of acupressure on constipation in patients with advanced cancer. Support Care Cancer 27:3473\u0026ndash;3478\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbbott R, Ayres I, Hui E, Hui KK (2015) Effect of perineal self-acupressure on constipation: a randomized controlled trial. J Gen Intern Med 30:434\u0026ndash;439\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJing X, Liu J, Wang C, Ji M, Chen X, Mei Y, Zhu QR (2018) Auricular acupressure is an alternative in treating constipation in leukemia patients undergoing chemotherapy: a systematic review and meta-analysis. Complement Ther Clin Pract 31:282\u0026ndash;289\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbbasi P, Mojalli M, Kianmehr M, Zamani S (2019) Effect of acupressure on constipation in patients undergoing hemodialysis: A randomized double-blind controlled clinical trial. Avicenna J Phytomed 9:84\u0026ndash;91\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePamuk \u0026Ouml;N, Pamuk GE, \u0026Ccedil;elik AF (2003) Revalidation of description of constipation in terms of recall bias and visual scale analog questionnaire. J Gastroenterol Hepatol 8:1417\u0026ndash;1422\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBengi G, Yal\u0026ccedil;ın M, Akpınar H, Keskinoğlu P, Ellidokuz H (2015) Validity and reliability of the patient assessment of constipation quality of life questionnaire for the Turkish population. Turk J Gastroenterol 26:309\u0026ndash;314\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarquis P, De La Loge C, Dubois D, McDermott A, Chassany O (2005) Development and validation of the patient assessment of constipation quality of life questionnaire. Scand J Gastroenterol 40:540\u0026ndash;551\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (2008) WHO standard acupuncture point locations in the Western Pacific region. World Health Organization, Manila\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee MS, Kang JW, Ernst E (2010) Does moxibustion work? An overview of systematic reviews. BMC Res Notes 3:284\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong CL, Lai KY, Tse HM (2010) Effects of SP6 acupressure on pain and menstrual distress in young women with dysmenorrhea. Complement Ther Clin Pract 16:64\u0026ndash;69\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo D, Liu S, Xie X, Hou X (2008) Electroacupuncture at acupoint ST-36 promotes contractility of distal colon via a cholinergic pathway in conscious rats. Dig Dis Sci 53:689\u0026ndash;693\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHr\u0026oacute;bjartsson A, Emanuelsson F, Skou Thomsen AS, Hilden J, Brorson S (2014) Bias due to lack of patient blinding in clinical trials. A systematic review of trials randomizing patients to blind and nonblind sub-studies. Int J Epidemiol 43:1272\u0026ndash;1283\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Acupressure, opioid-induced constipation, cancer, complementary medicine","lastPublishedDoi":"10.21203/rs.3.rs-717911/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-717911/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eOpioid-induced constipation is one of the heath problems with a negative impact on the quality of life. This randomized-controlled trial aimed to investigate the effects of acupressure therapy on the management of opioid-induced constipation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe trial was conducted on 140 patients, who were assigned to the acupressure (n\u0026thinsp;=\u0026thinsp;70) and the control groups (n\u0026thinsp;=\u0026thinsp;70). In addition to routine care, patients in the acupressure group received 8-min acupressure from the Zhongwan (CV12), Guanyuan (CV4) and Tianshu (ST25) acupoints once a day for 4 weeks. The outcomes included Defacationa Diary (DD), Visual Analog Scale Questionnaire (VASQ) and Patient assessment of constipation quality of life questionnaire (PAC-QOL).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDD scores obtained by the acupressure and the control groups. There was a statistically significant difference between the acupressure and control groups in terms of stool consistency (2.22\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;.49 vs 1.80\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;.55) (p\u0026thinsp;=\u0026thinsp;0.001), straining (1.98\u0026thinsp;\u0026plusmn;\u0026thinsp;.71 vs 2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;.37) (p\u0026thinsp;=\u0026thinsp;0.001), incomplete evacuation (0.37\u0026thinsp;\u0026plusmn;\u0026thinsp;.29 vs 0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;.43) (p\u0026thinsp;=\u0026thinsp;0.001), stool amount (0.93\u0026thinsp;\u0026plusmn;\u0026thinsp;.14 vs .95\u0026thinsp;\u0026plusmn;\u0026thinsp;.20) (p\u0026thinsp;=\u0026thinsp;0.001) and the number of defecations (0.70\u0026thinsp;\u0026plusmn;\u0026thinsp;.22 vs 0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;.29), (p\u0026thinsp;=\u0026thinsp;0.001) measured at the fifth week. Besides, with the exception of stool amount, there was a statistically significant increase in the DD scores obtained by the acupressure group between the first and the fifth weeks. Inter-group comparison of the pre-test and post-test scores showed that acupressure group obtained statistically significantly higher scores from the PAC-QOL (p\u0026thinsp;=\u0026thinsp;.0001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eFindings of this trial suggested that 4-week acupressure was an effective way to improve the quality of life and reduce both subjective and objective constipation symptoms in patients with opioid-induced constipations.\u003c/p\u003e","manuscriptTitle":"The efficacy of acupressure in managing opioid-induced constipation: Single-blind a randomized controlled study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-09-21 14:35:52","doi":"10.21203/rs.3.rs-717911/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2021-09-24T14:17:27+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-09-23T14:00:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"Supportive Care in Cancer","date":"2021-08-10T13:41:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-07-16T08:54:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2021-07-14T06:35:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"cafd7e61-36e3-49d4-b036-8409a2cd46dc","owner":[],"postedDate":"September 21st, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":7327471,"name":"Cancer Biology"},{"id":7327472,"name":"Oncology"},{"id":7327473,"name":"Nursing"}],"tags":[],"updatedAt":"2022-03-01T15:52:27+00:00","versionOfRecord":[],"versionCreatedAt":"2021-09-21 14:35:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-717911","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-717911","identity":"rs-717911","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}