Department of Medical Surgical Nursing, Pushpagiri College of Nursing, Thiruvalla, Kerala, India.
Pushpagiri Centre for Evidence-based Practice (PCEBP): A JBI Affiliated Group, Thiruvilla, Kerala, India.
JBI Evid Synth. 2023 Feb 1;21(2):373-400. doi: 10.11124/JBIES-20-00590.
The objective of this review was to synthesize the best available research evidence regarding the effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections.
Pain associated with intramuscular injections continues to be a challenge for nurses. Various physical stimulation methods to alleviate pain and improve satisfaction for patients receiving intramuscular injections have been reported; however, the evidence surrounding the effectiveness of these methods remains inconclusive.
This systematic review considered randomized and quasi-experimental studies that used any physical stimulation strategies (eg, skin tapping, manual pressure, massage, pinch, traction) for adults aged 18 years and over receiving intramuscular injections. Studies that evaluated pain using validated instruments were considered for inclusion.
A three-step search strategy was conducted. MEDLINE, Embase, CINAHL, the Cochrane Library (Cochrane CENTRAL), Google Scholar, Dissertation Abstracts International, ProQuest Dissertations and Theses, and MedNar were searched from inception until 2020. We restricted the inclusion of studies to trials published in English. Two independent reviewers conducted the critical appraisal of eligible studies using the JBI checklists for randomized controlled and quasi-experimental trials. Data were extracted using the JBI data extraction tool, and meta-analysis and subgroup analysis were undertaken, where appropriate.
Twenty-five studies were included with a total sample size of 1956 patients. Pooled results demonstrated that pain was significantly less with the use of the Helfer skin tap technique compared to no intervention (two studies; RR 0.73; 95% CI 0.66, 0.81; P <0.00001) or standard intervention (three studies; SMD -2.25; 95% CI -3.65, -0.85; P =0.002). Intervention with acupressure using standard treatment as control showed significant reduction in pain intensity (MD -4.78; 95% CI -5.32, -4.24; P <0.00001). Similarly, pain was significantly lower with manual pressure (two studies; SMD -0.42; 95% CI -0.69, 0.15; P =0.002) when compared to standard treatment. Pain scores were significantly lower in patients who received pinch technique, ShotBlocker, massage, or combination intervention (skin traction, pressure, and rapid muscle release) compared with no intervention, standard treatment, or placebo control.
The evidence from this review demonstrates that physical stimulation - particularly the Helfer skin tap technique, acupressure, manual pressure, pinch technique, ShotBlocker, massage, and combination - can significantly lower intramuscular injection pain; however, this is based on low or very low certainty of evidence.
PROSPERO CRD42020168586.
本综述的目的是综合现有最佳研究证据，评估物理刺激在减轻成人肌肉注射疼痛方面的有效性。
肌肉注射引起的疼痛仍然是护士面临的挑战。已经报道了各种物理刺激方法来减轻疼痛和提高接受肌肉注射的患者的满意度；然而，这些方法的有效性证据仍然存在争议。
本系统综述考虑了使用任何物理刺激策略（例如，皮肤拍打、手动按压、按摩、捏压、牵引）的随机和准实验研究，纳入对象为年龄在 18 岁及以上接受肌肉注射的成年人。评估疼痛时使用验证工具的研究被认为符合纳入标准。
采用三步搜索策略。从开始到 2020 年，检索了 MEDLINE、Embase、CINAHL、Cochrane 图书馆（Cochrane 中心）、Google Scholar、 Dissertation Abstracts International、ProQuest Dissertations and Theses 和 MedNar。我们将研究的纳入范围限制为发表在英语中的试验。两名独立的评审员使用 JBI 清单对合格研究进行了批判性评估，这些清单适用于随机对照和准实验研究。使用 JBI 数据提取工具提取数据，如果合适，进行荟萃分析和亚组分析。
共纳入 25 项研究，总样本量为 1956 名患者。汇总结果表明，与无干预（两项研究；RR 0.73；95%CI 0.66,0.81；P<0.00001）或标准干预（三项研究；SMD-2.25；95%CI-3.65,-0.85；P=0.002）相比，使用 Helfer 皮肤拍打技术干预时疼痛明显减轻。与标准治疗相比，使用穴位按压干预时疼痛强度显著降低（MD-4.78；95%CI-5.32,-4.24；P<0.00001）。同样，与标准治疗相比，手动按压时疼痛也明显减轻（两项研究；SMD-0.42；95%CI-0.69,0.15；P=0.002）。与无干预、标准治疗或安慰剂对照相比，接受捏压技术、ShotBlocker、按摩或联合干预（皮肤牵引、压力和快速肌肉松解）的患者疼痛评分显著降低。
本综述的证据表明，物理刺激——特别是 Helfer 皮肤拍打技术、穴位按压、手动按压、捏压技术、ShotBlocker、按摩和联合干预——可以显著减轻肌肉注射疼痛；然而，这是基于低或非常低确定性的证据。
PROSPERO CRD42020168586。
