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Background and Rationale

Wider Context

There would appear to be no end to the interest in complementary therapies. Concurrent with the widespread use of complementary and alternative medicine (CAM) is a public demand and right for guarantees of safety and effectiveness. While each discipline is keen to follow a route of self-regulation and develop their own codes of ethics and professional practice, national and European Union policy makers need guidance on ways to assess the quality of CAM professional practices, safety and benefits for its citizens.

In May 1997, the European Parliament adopted a resolution on the Status of Non-Conventional Medicine (the Collins Report, Resolution on the Status of Non-Conventional Medicine). Inter alia, this called on the Commission to:

It is important to note the focus on recognition of a right to practise and the need for research to provide an accepted base for practice. It leaves open what the form, content and detail of that evidence base is, in particular, what counts as 'good science' or 'appropriate knowledge' within CAM (Vincent and Furnham, 1998; Long and Mercer, 1999).

Shiatsu

Shiatsu has its roots in Chinese philosophy and medicine as an autonomous healing art. Its aim is to restore and maintain the energetic balance in human beings through the application of pressure to the body’s energy channels and points. It is an integrated part of the health care system in Japan and has been practised in the West for the last 25 years. It treats the individual from a holistic perspective and promotes the adoption of healthy lifestyle practises in relation to nutrition, diagnosed health conditions, immunity enhancement, protection of health and prevention of illness.

Shiatsu is one of the eight non-conventional medicine disciplines named in the Collins Report. Professional training courses exist in 10 EU member states and in Switzerland, with about 10,000 students in professional training at this time, and over 2,500 practitioners in professional practice. Each country has a National Professional Association, providing a Practitioner Register, regulation of training programmes and standards, codes of ethics and of professional practice, complaint procedures, insurance schemes, educational exchange, publications, and representation to official bodies and the State. Finally, created in 1993, the European Shiatsu Federation (ESF), comprising ten national professional associations, aims to promote a European standard of professional practice and to establish the legal recognition of shiatsu throughout the European Union.

The research base of shiatsu is at an early stage of development. For example, in a search commissioned by the University of Salford from the Research Council on Complementary Medicine (London, UK) on shiatsu and the associated area of acupressure, only 38 English language studies were identified. Only a tiny minority focused on shiatsu. Further, musculo-skeletal and psychological problems were the most common conditions presenting for shiatsu treatment, as indicated in a recent UK survey (Harris and Pooley, 1998).

In summary, the wider context of professional recognition and the need for practice to be based on sound research evidence suggest the need for a foundational study which explores the effects of shiatsu from a user and practitioner perspective. A second and subsequent set of questions relates to any comparison of its relative effectiveness to other forms of CAM or conventional medical approaches.