College of Nursing, Michigan State University, East Lansing, Michigan, USA.
Department of Statistics and Probability, Michigan State University, East Lansing, Michigan, USA.
Res Nurs Health. 2021 Oct;44(5):796-810. doi: 10.1002/nur.22169. Epub 2021 Jul 19.
Optimal sequencing of complementary therapies can help improve symptom management through nonpharmacological approaches. A 12-week sequential multiple assignment randomized trial comparing home-based reflexology and meditative practices on severity of fatigue and other symptoms was conducted among patients with cancer and their informal caregivers. Dyads were initially randomized to reflexology (N = 150), meditative practices (N = 150), or control (N = 47). If patient's fatigue did not improve (nonresponse) after 4 weeks of reflexology or meditative practices, the dyad was rerandomized to either add the other therapy or continue with the original therapy for weeks 5-8. Four decision rules (DRs) were compared: (1) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, continue with reflexology for another 4 weeks, thus providing a higher dose; (2) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, add meditative practices for the next 4 weeks; (3) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, continue meditative practices for another 4 weeks, thus providing a higher dose; and (4) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, add reflexology for the next 4 weeks. Symptoms were evaluated weekly using the M.D. Anderson Symptom Inventory (MDASI). Clinically, nurses can recommend either therapy since no differences were found among the 4 DRs, with the exception of lower severity for summed MDASI symptoms at week 8 for the use of reflexology only (DR-1) versus DR-2 (sequencing reflexology to meditative practices). Adding the other therapy for nonresponders after 4 weeks may not be warranted.
最佳的补充治疗顺序可以通过非药物方法帮助改善症状管理。一项为期 12 周的序贯多项分配随机试验比较了家庭反射疗法和冥想练习对癌症患者及其非专业照护者疲劳和其他症状严重程度的影响。在这项试验中，将患者-照护者对初始随机分为反射疗法组（N=150）、冥想练习组（N=150）或对照组（N=47）。如果患者在接受反射疗法或冥想练习 4 周后疲劳症状没有改善（无反应），则将对患者-照护者对重新随机分为以下两种情况之一：（1）继续接受反射疗法或冥想练习 4 周；（2）更换另一种疗法。试验比较了 4 种决策规则（DR）：（1）开始接受反射疗法，如果在 4 周后疲劳无反应，则继续接受反射疗法 4 周，以提供更高剂量；（2）开始接受反射疗法，如果在 4 周后疲劳无反应，则在接下来的 4 周内添加冥想练习；（3）开始接受冥想练习，如果在 4 周后疲劳无反应，则继续接受冥想练习 4 周，以提供更高剂量；（4）开始接受冥想练习，如果在 4 周后疲劳无反应，则在接下来的 4 周内添加反射疗法。每周使用 MD 安德森症状评估量表（MDASI）评估症状。从临床角度来看，由于在 4 种 DR 之间没有发现差异，护士可以推荐使用任何一种疗法，除了在第 8 周时，仅使用反射疗法（DR-1）的 MDASI 症状总和严重程度低于 DR-2（将反射疗法顺序调整为冥想练习）。对于 4 周后无反应的患者，增加另一种治疗方法可能没有必要。
