Intervention
pain, itching, constipation
SIDE EFFECT, COMPLICATIONS
Before applying AA, the surface of the ears was examined; if a foreign substance and/or oil were found in the ears, they were removed using alcohol swabs. At the beginning of the study, the amount and type of laxative use, the levels of physical activity, and the number of fruits and vegetables consumed by the patient were recorded. Participants should maintain usual dietary habits and levels of physical activity and laxative use.The intervention was performed by one care provider who had passed the AA training course under the supervision of a specialist (research consultant) in traditional medicine and acupressure in a traditional medicine clinic. Course training included selecting the seven acupoints and taping the auricular plasters with vaccaria seeds. In order to investigate and increase the care provider adherence, the implementation of the intervention was reviewed daily by an acupressure specialist (research consultant) and other researchers. The intervention included treatment with AA on seven acupoints (large intestine, rectum, San Jiao, spleen, lung, sympathetic, and subcortex), and these points were effective in alleviating constipation symptoms (see Fig. Seven auricular acupointsIn the intervention group, to apply continuous AA, auricular plasters with vaccaria seeds were used and the researcher manually stimulated seeds three to four times a day until the participant felt a slight pain. To prevent interference between the intervention and control groups, as well as blinding the participants, seedless auricular plasters were used for the control group in the seven acupoints as sham acupressure and weren't actually caused the stimulation. In a systematic review and meta-analysis of randomized controlled trials regarding the efficacy of auriculotherapy for constipation in adults conducted by Yang et al. (2014), the duration of AA varied from 3 to 60 days [To prevent undue pressure on the two ears, auricular plasters (with seeds) were placed on one ear every five days, 5 days on the right ear, and after 5 days, Auricular plasters (with seed) were directly removed from the ear and in the second 5 days, new auricular plasters (with seeds) were placed on the left ear. If the auricular plasters were removed from the ear earlier than five days, the researcher again used the new auricular plasters. All participants were evaluated for side effects and no serious complications occurred among the participants. The only side effect was local itching, which was reported by 9 participants. Local itching was described as mild, transient and tolerable and only one participant dropped out in the intervention group due to local itching and unwillingness to continue the study.