Pilot Study

Manobala V R et al. (2026) · Bioinformation

This single-arm pilot trial with 30 participants explored whether a 90-day Siddhar yogam programme could reduce the symptom burden of varicose veins, which are dilated, twisted veins of 3 mm or more in the legs. Siddhar yogam belongs to the Siddha system of medicine, a South Indian tradition that explains illness through three humors, Vatham (air), Pitham (fire) and Kabham (water), and counts Siddhar yogam among its Kayakarpam (rejuvenation science) methods. The practice combines yoga postures, controlled breathing and meditation. The authors note that no standardized, non-invasive therapy exists for varicose veins, a condition they say affects about 5% of people in India. The 30 patients (10 men and 20 women, aged 30 to 55) were recruited at the National Institute of Siddha's Ayothidoss Pandithar Hospital. All practised the same 35-minute routine for 90 days: a few minutes of relaxation, 21 minutes of postures such as raised-leg pose, half plough, inverted pose and cycling pose, and 5 minutes of Thirumoolar breathing practice. Symptoms and quality of life were scored with the Aberdeen Varicose Vein Questionnaire (AVVQ), where a lower score means less impact, before and after the programme. There was no comparison group. Average AVVQ scores dropped from 16.2 to 12.0 (a fall of 4.2 points; reported as significant at p < 0.05 by Wilcoxon signed rank test). Most participants (over 85%) reported long periods of standing, and the Siddha assessments, which grade humors, body constituents and an eight-fold examination, showed derangement mainly in Vatham and Pitham before treatment and a reduction in these findings afterwards, though the paper gives no figures for that change. The authors suggest the postures lower pressure in the leg veins and help blood return to the heart by working the calf muscles, but they did not measure this. Because the trial had one arm, no follow-up and only one outcome measure, and excluded severe cases, the authors say the efficacy of the regimen cannot be established. They recommend larger randomized trials.

Hazel J Jenkins et al. (2026) · Chiropractic & manual therapies

This pilot randomised trial with 20 patients and 11 chiropractors explored whether it is practical to run a large study asking a simple question: does taking spinal x-rays change outcomes for people receiving chiropractic care for back or neck pain? In medical settings, trials have found routine imaging does not improve non-specific low back pain, yet chiropractors use x-rays at widely varying rates (8% to 84%), partly to screen for reasons spinal manipulation might be unsuitable. No randomised trial had tested imaging where manipulation is also part of care, so the authors first tested whether such a trial could work. Chiropractors in Sydney, Australia, invited adults with a new episode of spinal pain, where the chiropractor was unsure whether an x-ray was needed. A computer randomly assigned each consenting patient to get spinal radiographs or not, and everything else, including manipulation, was decided between chiropractor and patient. Pain, disability (Roland Morris Disability Questionnaire for the back, Neck Disability Index), satisfaction and side effects were collected at 2, 6 and 12 weeks, and chiropractors were interviewed about the experience. Recruitment was the main difficulty: 135 patients were screened, 33 (24%) were eligible and 20 took part, short of the 50 planned. Three of 10 patients assigned to imaging did not get it, and 2 of 10 assigned to no imaging did, always after a clinical change. Follow-up fell from 90% of patients at 2 weeks to 75% at 12 weeks. Pain and disability fell in both groups, but differences between groups were small and the trial was too small to compare them. Mild, short-lived side effects such as muscle soreness affected 4 of 20 participants (1 imaging, 3 no imaging). The authors judged that most criteria for a larger trial were met but recruitment and cross-over would need strategies, since COVID-19, time pressure and discomfort explaining diagnostic uncertainty to patients limited enrolment. Limitations include a self-selected group of chiropractors, probably non-consecutive recruitment and mostly young, low-disability participants.

Jonathan Greenberg et al. (2025) · JAMA network open

This feasibility randomized clinical trial with 92 sedentary adults experiencing chronic musculoskeletal pain explored whether a mind-body walking program could be delivered successfully across three geographically and racially diverse U.S. academic medical centers, compared with a health education program. The mind-body walking program combined quota-based pacing — increasing step-count goals gradually based on what participants could sustain, rather than tying goals to whether pain was present — with mind-body skills such as breathing exercises and body scans, and cognitive skills aimed at identifying and reframing unhelpful pain-related thoughts. The trial measured physical function in three complementary ways (self-reported, performance-based, and step-count-based), addressing a gap identified in pain-trial reporting guidelines. Participants were randomized 1:1 to the 10-week, 60-minute weekly group mind-body walking program (47 participants) or a matched health-education control (45 participants), recruited between April 2023 and January 2024. The mind-body group received a Fitbit Inspire 3 tracker with individualized weekly step goals. Physical function was measured with the 6-Minute Walk Test, a wrist-worn accelerometer worn for one week, and the World Health Organization Disability Assessment Schedule. Pain, mood, and psychological mechanisms — pain catastrophizing, fear of movement, adaptive coping, and mindfulness — were measured with validated questionnaires before and after the program. Both programs met most feasibility benchmarks, including attendance (95.7% mind-body walking vs 82.2% health education), delivery fidelity, and participant retention (93.6% vs 86.7%). Racial and ethnic diversity exceeded its target (54.3% of participants from minority groups, against a 38% benchmark), though overall recruitment fell short (69.7% of eligible patients enrolled, against an 80% target). Within the mind-body walking group, participants showed large pre-to-post improvements in walking distance (48.6 meters over six minutes, P<.001), self-reported physical function (P<.001), and pain catastrophizing (P<.001), plus medium improvements in pain intensity (P=.002) and fear of movement (P<.001), and smaller but significant improvements in adaptive coping and mindfulness (both P<.05). The health education group improved only on walking distance and pain intensity. Because the trial was not statistically powered to compare the two programs against each other, these within-group changes describe what happened in each arm rather than a demonstrated advantage of one program over the other. The trial establishes that a mind-body walking program can be delivered with strong attendance and participant satisfaction across diverse academic medical centers, supporting a future, fully powered efficacy trial. The findings do not establish that the mind-body walking program produces greater benefit than health education, since the study was designed to test feasibility rather than comparative outcomes. The gap between eligible and enrolled participants (69.7% versus an 80% target) points to recruitment timing as an area for refinement in future trial designs.

Jing-Yu Tan et al. (2022) · BMC complementary medicine and therapies

This preliminary randomized controlled trial with 114 breast cancer patients starting their first round of chemotherapy explored whether auricular acupressure -- pressing small seeds against specific points on the outer ear -- could ease chemotherapy-induced nausea and vomiting (CINV), a side effect that standard anti-nausea drugs do not fully control. The study is grounded in the idea, borrowed from Traditional Chinese Medicine, that stimulating certain ear points can influence nausea pathways elsewhere in the body. To find out how much of any benefit was real versus expectation, researchers compared a "true" acupressure group against a look-alike "sham" version and against standard care alone. Women scheduled for chemotherapy known to cause significant nausea were split into three groups of 38: true acupressure (firm seeds pressed on seven ear points three times a day for five days), sham acupressure (soft, non-stimulating seeds at the same points and schedule), and standard antiemetic care alone. Everyone received standard anti-nausea medication regardless of group. Nausea and vomiting were tracked using the MASCC Antiemesis Tool, a validated eight-item scale, on the second and sixth days of the chemotherapy cycle, and quality of life was measured separately. Both acupressure groups did better than standard care alone for CINV occurring in the first 24 hours (acute CINV). More than half of the true acupressure group (52.6%) had no nausea or vomiting at all in that window, compared to under a quarter (23.7%) on standard care alone (a meaningful and statistically significant difference, p=0.01). Total symptom scores were also meaningfully lower with true acupressure across several measures (p-values from 0.001 to 0.004, with effect sizes edging toward "large"). The catch: the sham acupressure group did almost as well as the true group on nearly every measure, meaning much of the benefit looks like a placebo effect rather than something unique to real acupressure -- though the researchers note that a placebo effect big enough to meaningfully reduce nausea is still clinically useful. Neither approach measurably helped with nausea that showed up later (days 2-5) or with quality of life. Practically, this suggests auricular acupressure is a safe, low-cost option worth adding alongside standard anti-nausea medication for the first day of chemotherapy, with only mild, temporary ear discomfort reported by about 1 in 7 participants. The main limitation is that the study was small and not designed to definitively prove acupressure's own mechanism works beyond expectation -- a larger, more rigorously powered trial is needed to confirm whether the benefit holds up and how much is truly attributable to acupressure itself versus the ritual of treatment.