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Complement Ther Med. 2009 Jun;17(3):168-75. doi: 10.1016/j.ctim.2008.09.004. Epub 2008 Nov 17.

A typology of negative responses: a case study of shiatsu.

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University of Leeds, School of Healthcare, Leeds, UK.



To develop and apply a client-centred typology for classifying negative responses to a CAM therapy.


Prospective, 6 months cohort, pragmatic study of the effects and experience of shiatsu within three countries (Austria, Spain and the UK). Data collected via postal questionnaires, including on client-perceived negative responses. Classification of negative responses situated within a theoretical framework of Zen or Masunaga model of shiatsu.


Shiatsu as delivered by the practitioner in routine practice.


Prevalence of negative responses and response types.


633 clients provided full follow-up data, a response rate of 67%. A prevalence rate of 12-22 per 100 of client-perceived 'negative responses' was found across the three countries. Transitional effects accounted for 82% of all the client-described 'negative' responses. Nine clients (1.4% of the total), relating to 10 sets of written comments, reported a negative response that was classified as 'a potentially adverse event or effect' that might represent a risk to client safety. None of these clients ceased shiatsu.


A typology of negative responses has an important role for practitioners, clients and researchers in drawing up evidence on the safety of a therapy. For researchers and policy makers, use of such a typology informs insight into what might cause harm (that is, 'definite' adverse events). For clients, the typology takes seriously the clients' own view. For practitioners, the typology draws on the modality's guiding theory and suggests ways to improve the delivery of treatments. Applying the typology to a cross-European prospective study of shiatsu supports the argument of shiatsu being inherently a safe modality.

[Indexed for MEDLINE]

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