Inclusion criteria

Types of participants

Studies involving chronic disease/mental health patients of all age groups and backgrounds will be considered. This review will consider studies that involve people suffering from a mental or physical health condition, such as fibromyalgia, obesity, anxiety, depression and PTSD.

The Department of Health of the Commonwealth Government of Australia defines chronic health as a prolonged illness that cannot usually be resolved spontaneously or cured completely.11 Chronic diseases are usually complex and varied in both causality and impacts on patients. They may cause premature death or lead to long-term disability.11 Other common features of chronic diseases are as follows:

- Multiple complex causal factors;

- A long developmental period without any symptoms;

- Prolonged course of illness often characterized by other health complications; and

- Functional impairment or disability.11

Studies which clearly state that subjects are receiving other treatments apart from just EFT, i.e. EFT is used as a supportive care method, will be excluded. This will enable better insight into EFT's effectiveness as a treatment method for health conditions.

Types of intervention(s)/phenomena of interest

The intervention of interest is Emotional Freedom Techniques (tapping). Studies involving Thought Field Therapy, which is considered the predecessor of EFT, will be excluded from this review. Similarly, studies on traditional acupuncture and other forms of acupoint stimulation will also be excluded from this review.

EFT is a technique that can be self-administered by patients. However, for the purpose of this review, only studies which involve a minimum of four hours of intervention/training by a practitioner will be considered. Self-administered EFT has been excluded to reduce variability in the review. Four hours of minimum intervention time has been chosen because literature on other comparable interventions, such as Brief Interventions suggest four short counselling sessions by a trained interventionist.12 Currently, there is no literature suggesting minimum intervention time for EFT. Studies involving both individual and group therapy will be considered for this review.

The intervention will be compared to standard/conventional care methods for given health conditions; for example, Eye Movement Desensitization and Reprocessing (EDMR) for PTSD and Cognitive Behavioural Therapy for anxiety and depression.

Types of outcomes

The primary outcomes that will be considered are listed in the table below.

Types of studies

This systematic review will focus only on RCTs and cohort studies, with or without a control group, to ensure that studies ranking high in the hierarchy of evidence are included. This will ensure that the review is robust and of good quality. Other literature such as clinical demonstrations, case studies and expert opinion articles will be excluded from this review.

Search strategy

This review will incorporate published and unpublished studies written in the English language. The search will encompass electronic databases, direct contact with researchers, research listed on eftuniverse.com (research, training and certification body for EFT), as well as the Association for Comprehensive Energy Psychology (ACEP) website. Studies published between January 2000 and the present will be considered for this review. EFT emerged in the early 1990s.10 The starting date (2000) has been chosen arbitrarily to ensure a degree of currency in the chosen literature.

The following steps in the search strategy will be employed:

1. An initial search on the electronic database Medline, with the key word 'Emotional Freedom Technique*'. The results generated by this search will be scanned for additional key words.

2. Using those key words identified, a number of electronic databases will be searched.

3. Reference lists of identified papers will be scanned to search for additional studies.

4. Eftuniverse.com and the ACEP websites will be searched for research.

5. Personal contact will be made with researchers to gain access to additional unpublished studies, as well as those studies whose full text is not found on the web.

6. Some journals publishing information on energy psychology are not yet indexed with major databases. One such journal which has a large amount of published literature on this topic is Energy Psychology.This journal will be hand searched separately.

The databases that will be searched include:

- Medline

- PsychINFO

- CINAHL

- Embase

- Compendex

- Web of Science

Below is a list of the key words selected for the search. This list is not exhaustive and will be refined in the course of the search. The key words have been chosen using the PICO search method.

P: anxiety, stress, mental illness*, disease*, chronic disease*, psychosomatic disease*

I: Emotional freedom technique*, acupoint*, energy psychology, meridian-based, energy medicine

Assessment of methodological quality

Two reviewers will independently assess methodological quality prior to inclusion in the review using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix I). Disagreements will be resolved through discussion and consultation with a third reviewer, if required.

Data collection

The data extracted from the studies will pertain to participants, intervention logistics and implementation, and outcomes. Data that will be extracted includes, but is not necessarily limited to:

* Sample size

* Demographic distribution of participants

* Other personal attributes or qualifying characteristics of chosen participants

* Medical condition of participants

* Process of randomization

* Intervention details (e.g. duration, one-on-one or group session, year, qualification of facilitator, other logistic or descriptive details related to implementation)

* Findings from accompanying questionnaires/interviews, where applicable

* Results (Statistics, changes in subjective units of distress, reported perceived benefits, measured changes in health parameters, etc.)

* Comparison between results from EFT and other techniques/modalities, where applicable.

The standardized data extraction tool from JBI MASTARI will be used for data extraction (Appendix II).

Data synthesis

With quantitative data results, the overall effect of similar single studies can be combined to calculate a summary of effect of the intervention, which may have statistical significance. Where possible, data will be pooled in statistical meta-analysis using JBI-MAStARI.

Effect sizes may be expressed as odds ratios (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed statistically using the standard Chi-square and also explored using subgroup analyses based on the different study designs included in this review. Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate.

Conflicts of interest

None to declare.

Acknowledgements

This systematic review is part of a PhD research project, currently underway at Monash University's School of Rural Health, supported by the Australian Post-Graduate Award scholarship. The project is supported and supervised by Dr Anske Robinson, Dr Hanan Khalil and Dr Peta Stapleton (Bond University).

References