The effects of slow-stroke back massage on anxiety and shoulder pain in elderly stroke patients

Assessment approaches for hemiplegic shoulder pain in people living with stroke - A scoping review

PURPOSE

Hemiplegic shoulder pain (HSP) is reported in up to 40% of people with stroke. Causes of HSP are often multifactorial. To inform appropriate treatment, reliable/valid assessments are critical. The aim of this scoping review was to collate assessment approaches used in studies where the primary outcome was HSP, and to identify how frequently each assessment approach was used.

METHODS

A systematic search, including studies from 2000-2023 was conducted of the MEDLINE, EMBASE, CINAHL, AMED, Biomed Central, and Cochrane Library databases, with four key terms used: "assess", "stroke", "pain" and "shoulder". All primary studies published in English language fulfilling the reviews inclusion criteria were included. Six reviewers extracted the data.

RESULTS

A total of 29 assessment methods for HSP were identified from 124 studies. The common assessments were: Visual Analogue Scale (n = 75, 60%), Passive Range of Movement (n = 65, 52%), Fugl-Meyer Assessment (n = 32, 26%), glenohumeral subluxation (n = 30, 24%) and Numerical Rating Scale (n = 27, 22%).

CONCLUSION

A wide range of assessment approaches was identified for HSP, and some are used more than others. A fully comprehensive assessment that considers different aspects of pain including severity and timing, functioning, and the psychological burden, is needed in this area of practice to be able to guide appropriate treatment.

A systematic review and multivariate meta-analysis of the physical and mental health benefits of touch interventions

Receiving touch is of critical importance, as many studies have shown that touch promotes mental and physical well-being. We conducted a pre-registered (PROSPERO: CRD42022304281) systematic review and multilevel meta-analysis encompassing 137 studies in the meta-analysis and 75 additional studies in the systematic review (n = 12,966 individuals, search via Google Scholar, PubMed and Web of Science until 1 October 2022) to identify critical factors moderating touch intervention efficacy. Included studies always featured a touch versus no touch control intervention with diverse health outcomes as dependent variables. Risk of bias was assessed via small study, randomization, sequencing, performance and attrition bias. Touch interventions were especially effective in regulating cortisol levels (Hedges' g = 0.78, 95% confidence interval (CI) 0.24 to 1.31) and increasing weight (0.65, 95% CI 0.37 to 0.94) in newborns as well as in reducing pain (0.69, 95% CI 0.48 to 0.89), feelings of depression (0.59, 95% CI 0.40 to 0.78) and state (0.64, 95% CI 0.44 to 0.84) or trait anxiety (0.59, 95% CI 0.40 to 0.77) for adults. Comparing touch interventions involving objects or robots resulted in similar physical (0.56, 95% CI 0.24 to 0.88 versus 0.51, 95% CI 0.38 to 0.64) but lower mental health benefits (0.34, 95% CI 0.19 to 0.49 versus 0.58, 95% CI 0.43 to 0.73). Adult clinical cohorts profited more strongly in mental health domains compared with healthy individuals (0.63, 95% CI 0.46 to 0.80 versus 0.37, 95% CI 0.20 to 0.55). We found no difference in health benefits in adults when comparing touch applied by a familiar person or a health care professional (0.51, 95% CI 0.29 to 0.73 versus 0.50, 95% CI 0.38 to 0.61), but parental touch was more beneficial in newborns (0.69, 95% CI 0.50 to 0.88 versus 0.39, 95% CI 0.18 to 0.61). Small but significant small study bias and the impossibility to blind experimental conditions need to be considered. Leveraging factors that influence touch intervention efficacy will help maximize the benefits of future interventions and focus research in this field.

The Effects of Aromatherapy on Anxiety and Depression in People With Cancer: A Systematic Review and Meta-Analysis

Background

Anxiety and depression are highly prevalent in people with cancer. Medical therapies are usually prescribed to alleviate anxiety and depression, but they are associated with a variety of adverse effects. Recently, aromatherapy showed potential as a complementary medicine to improve psychological health and wellbeing. However, its effectiveness on relieving anxiety and depression has not been established.

Objective

This study explored the beneficial effects of aromatherapy on psychological symptoms such as anxiety and depression in people with cancer.

Methods

We searched international databases including PubMed, Web of Science, Cochrane Library, Embase, Medline, Ebscohost, ProQuest and Scopus from inception to 31 May 2021. The risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias. The systematic review and meta-analysis were performed according to the PRISMA guidelines. Quantitative analysis was performed on the studies that met our inclusion criteria, and Meta-analysis was performed on the studies with available data by RevMan software.

Results

The quality of the literatures were assessed carefully by two researchers, a total of 17 studies were included in the systematic review and 10 articles were conducted in meta-analysis. The aromatherapy was effective in relieving anxiety (SMD = -0.49, p < 0.05) in people with cancer. Subgroup analysis suggested that most effective methods were aromatic massage (SMD = -0.70, p < 0.005), aromatherapy with lavender essential oils (SMD = -1.12, p < 0.01), short-time interventions (duration < 4weeks) (SMD = -0.87, p < 0.05) and studies in Asia (SMD = -0.83, p < 0.05). Regarding depression and psychological wellbeing, there were no difference between aromatherapy and control groups.

Conclusion

In cancer patients, the aromatherapy was effective for relieving anxiety. However, there was no beneficial effect on depression and psychological wellbeing.

Systematic Review Registration

PROSPERO, identifier: CRD42021272465.

Effectiveness and functional magnetic resonance imaging outcomes of Tuina therapy in patients with post-stroke depression: A randomized controlled trial

OBJECTIVE

To investigate the effectiveness and functional magnetic resonance imaging (fMRI) outcomes of Tuina therapy in patients with post-stroke depression (PSD).

METHODS

This was a single-center, randomized, two-armed, controlled trial. Eighty-four patients with PSD were selected and randomly assigned to a Tuina therapy group or a routine rehabilitation control group. The patients underwent five 20-min treatment sessions per week over a period of 2 weeks. The primary outcome measure was change in Hamilton Depression Rating Scale (HAMD) score over the 2 weeks of intervention, whereas the secondary outcome measures were changes in Fugl-Meyer Assessment (FMA) score, Modified Barthel index (MBI), and Mini Mental State Examination (MMSE) score.

RESULTS

The Tuina group showed significantly improved HAMD scores compared to the routine rehabilitation control group (5.85, [2.54, 9.16]). For the secondary outcomes, the Tuina group showed better MMSE scores than the routine rehabilitation group (1.97, [1.19, 2.76]); however, there were no significant differences between the other secondary outcomes of both groups (P > 0.05). After 2 weeks, both groups showed a significant decrease in HAMD score compared to baseline. In addition, the Tuina group showed a significant decrease in MMSE score compared to baseline (2.35, [1.8, 2.9]); however, there were no significant differences in the MBI and FMA scores of the two group after the intervention (P > 0.05). Regarding fMRI results, the zALFF values of the right caudate nucleus, right putamen, right insula, left superior temporal gyrus, right parahippocampal gyrus, right hippocampus, left middle temporal gyrus, left angular gyrus, and left thalamus were higher in the Tuina group. In the Tuina group, the functional connectivity between the hippocampus and thalamus, and the thalamus and caudate nucleus, were significantly different (P <0.01). In addition, the zALFF value of the hippocampus was significantly negatively correlated with HAMD score. No serious adverse events were observed in both groups.

CONCLUSION

Tuina therapy administered 10 times within 2 weeks is safe and can effectively relieve depression and improve cognitive function in patients with PSD. This finding may be closely related to the effect of Tuina therapy on the activation and functional connectivity of the hippocampus.

CLINICAL TRIAL REGISTRATION

http://www.chictr.org.cn/showproj.aspx?proj=55151, identifier ChiCTR200003388.

The effect of slow-stroke back massage on chemotherapy-related fatigue in women with breast cancer: An assessor blinded, parallel group, randomized control trial

OBJECTIVE

This randomized controlled parallel-group trial was conducted to investigate the effect of slow-stroke back massage (SSBM) on the level of fatigue in women with breast cancer undergoing chemotherapy.

METHODS

Sixty-four women with breast cancer receiving chemotherapy were randomly assigned to SSBMG (n:32), who received SSBM, and CG (n:32), who received routine treatment only. Women with breast cancer in the intervention group received SSBM for a total of 20 min, 10 min before and after each chemotherapy infusion (2nd, 3rd, and 4th cycle). The Brief Fatigue Inventory (BFI) was completed before and after three cycles of chemotherapy (2nd, 3rd, and 4th) to assess the level of fatigue in women with breast cancer.

RESULTS

After using SSBM, the BFI score was significantly lower in SSBMG than in CG (p 0.001) at all three-time points (1st, 2nd, and 3rd-time points). While the within-group change (Δ) in SSBMG differed significantly between time points (p = 0.018, η2 = 0.14), in contrast, the within-group change (Δ) in CG was found not to differ between time points.

CONCLUSION

This study has shown that SSBM, one of the non-pharmacological methods, has a positive effect on the level of fatigue in women with breast cancer.

Slow-Stroke Back Massage Compared With Music Therapy for Leukemia-Related Pain and Fatigue: A Randomized Controlled Trial

PURPOSE

Comparison of two safe complementary medicine methods to treat cancer-related pain and fatigue in adult patients with acute leukemia during active treatment with chemotherapy.

METHODS

A randomized trial with three groups (light massage, music therapy, and standard care) in Ahvaz, Iran, between 2018 and 2019. A total of 104 participants of the massage and music therapy groups received 15-minute intervention sessions, thrice weekly for 4 weeks, and participants of the control group received standard care. Cancer-related pain and fatigue intensity were measured by numeric self-report rating scales. During the 4 weeks of the interventions, pain and fatigue intensity were measured weekly. All the groups were followed up for 2 weeks after the end of the intervention.

RESULTS

Pain and fatigue intensity decreased significantly over time between the intervention groups compared with the standard care group. In the massage and music therapy groups, a progressive reduction of pain and fatigue intensity over time (from the baseline to the fourth week) was observed. Fatigue intensity did not differ between the two intervention groups. Pain intensity decreased more in the massage group compared with the music therapy group. The durable effects of the massage therapy were greater compared with the music therapy 2 weeks after the intervention was completed.

CONCLUSION

Light massage was more effective and persisted longer than the music therapy for controlling leukemia-related pain and fatigue in adult patients with acute leukemia.

A Strategic Program for Risk Assessment and Intervention to Mitigate Environmental Stressor-Related Adverse Pregnancy Outcomes in the Indian Population

The Problem: Global environmental stressors of human health include, but are not limited to, conflict, migration, war, natural disasters, climate change, pollution, trauma, and pandemics. In combination with other factors, these stressors influence physical and mental as well as reproductive health. Maternal stress is a known factor for adverse pregnancy outcomes such as preterm birth (PTB); however, environmental stressors are less well-understood in this context and the problem is relatively under-researched. According to the WHO, major Indian cities including New Delhi are among the world's 20 most polluted cities. It is known that maternal exposure to environmental pollution increases the risk of premature births and other adverse pregnancy outcomes which is evident in this population.

Response to the Problem: Considering the seriousness of this problem, an international and interdisciplinary group of researchers, physicians, and organizations dedicated to the welfare of women at risk of adverse pregnancy outcomes launched an international program named Optimal Pregnancy Environment Risk Assessment (OPERA). The program aims to discover and disseminate inexpensive, accessible tools to diagnose women at risk for PTB and other adverse pregnancy outcomes due to risky environmental factors as early as possible and to promote effective interventions to mitigate these risks. OPERA has been supported by the Worldwide Universities Network, World Health Organization (WHO) and March of Dimes USA.

Addressing the Problem: This review article addresses the influence of environmental stressors on maternal-fetal health focusing on India as a model population and describes the role of OPERA in helping local practitioners by sharing with them the latest risk prediction and mitigation tools. The consequences of these environmental stressors can be partially mitigated by experience-based interventions that build resilience and break the cycle of inter- and-transgenerational transmission. The shared knowledge and experience from this collaboration are intended to guide and facilitate efforts at the local level in India and other LMIC to develop strategies appropriate for the jurisdiction for improving pregnancy outcomes in vulnerable populations.

Ischemic stroke-induced polyaxonal innervation at the neuromuscular junction is attenuated by robot-assisted mechanical therapy

Ischemic stroke is a leading cause of disability world-wide. Mounting evidence supports neuromuscular pathology following stroke, yet mechanisms of dysfunction and therapeutic action remain undefined. The objectives of our study were to investigate neuromuscular pathophysiology following ischemic stroke and to evaluate the therapeutic effect of Robot-Assisted Mechanical massage Therapy (RAMT) on neuromuscular junction (NMJ) morphology. Using an ischemic stroke model in male rats, we demonstrated longitudinal losses of muscle contractility and electrophysiological estimates of motor unit number in paretic hindlimb muscles within 21 days of stroke. Histological characterization demonstrated striking pre- and postsynaptic alterations at the NMJ. Stroke prompted enlargement of motor axon terminals, acetylcholine receptor (AChR) area, and motor endplate size. Paretic muscle AChRs were also more homogenously distributed across motor endplates, exhibiting fewer clusters and less fragmentation. Most interestingly, NMJs in paretic muscle exhibited increased frequency of polyaxonal innervation. This finding of increased polyaxonal innervation in stroke-affected skeletal muscle suggests that reduction of motor unit number following stroke may be a spurious artifact due to overlapping of motor units rather than losses. Furthermore, we tested the effects of RAMT - which we recently showed to improve motor function and protect against subacute myokine disturbance - and found significant attenuation of stroke-induced NMJ alterations. RAMT not only normalized the post-stroke presentation of polyaxonal innervation but also mitigated postsynaptic expansion. These findings confirm complex neuromuscular pathophysiology after stroke, provide mechanistic direction for ongoing research, and inform development of future therapeutic strategies. SIGNIFICANCE: Ischemic stroke is a leading contributor to chronic disability, and there is growing evidence that neuromuscular pathology may contribute to the impact of stroke on physical function. Following ischemic stroke in a rat model, there are progressive declines of motor unit number estimates and muscle contractility. These changes are paralleled by striking pre- and postsynaptic maladaptive changes at the neuromuscular junction, including polyaxonal innervation. When administered to paretic hindlimb muscle, Robot-Assisted Mechanical massage Therapy - previously shown to improve motor function and protect against subacute myokine disturbance - prevents stroke-induced neuromuscular junction alterations. These novel observations provide insight into the neuromuscular response to cerebral ischemia, identify peripheral mechanisms of functional disability, and present a therapeutic rehabilitation strategy with clinical relevance.

The Effectiveness of Massage Therapy for Improving Sequelae in Post-Stroke Survivors. A Systematic Review and Meta-Analysis

Objective: To assess the effect of therapeutic massage for improving sequelae in stroke survivors. Methods: A systematic review of the nine medical databases from January 1961 to December 2020 was carried out. The bibliography was screened to identify randomized controlled clinical trials (RCTs). Two reviewers independently screened references, selected relevant studies, extracted data and assessed the risk of bias using the PEDro scale. The primary outcome was upper and lower limb motor function and spasticity. Results: A total of 3196 studies were identified and 18 RCT were finally included (1989 individuals). A meta-analysis of RCTs in the comparison of Chinese massage (Tuina) plus conventional physiotherapy versus conventional physiotherapy was performed. The mean difference (MD) in the subacute stage on upper limb motor-function using the Fugl Meyer Assessment was 2.75; (95% confidence interval (CI) from 0.97 to 4.53, p = 0.002, I² = 36%). The MD on upper limb spasticity using modified Ashworth scale was −0.15; (95% CI from −0.24 to −0.06, p < 0.02, I² = 0%).The MD on lower limb spasticity was −0.59; (95% CI from −0.78 to −0.40, p < 0.001, I² = 0%) in the endpoint. Conclusions: Therapeutic massage, especially Tuina, in addition to conventional therapy is effective for improving motor function and for reducing spasticity in stroke survivors.

Characteristics and treatment of geriatric patients in an osteopathic neuromusculoskeletal medicine clinic

CONTEXT

Osteopathic manipulative medicine (OMM) is an adjunctive treatment approach available to geriatric patients, but few studies provide details about presenting conditions, treatments, and response to osteopathic manipulative treatment (OMT) in that patient population.

OBJECTIVES

To provide descriptive data on the presentation and management of geriatric patients receiving OMT at an outpatient osteopathic neuromusculoskeletal medicine (ONMM) clinic.

METHODS

Data were retrospectively collected from electronic health records (EHR) at a single outpatient clinic for clinical encounters with patients over 60 years of age who were treated with OMT between July 1, 2016, and June 30, 2019. Records were reviewed for demographic information, insurance type, presenting concerns, assessments, regions treated, OMT techniques used, and treatment response.

RESULTS

There were 9,155 total clinical encounters with 1,238 unique patients found during the study period. More women than men were represented for overall encounters (6,910 [75.4%] vs. 2,254 [24.6%]) and unique patients (850 [68.7%] vs. 388 [31.3%]; both p<0.001). The mean (standard deviation, SD) number of encounters per patient per year was 4.5 (4.0) and increased with increasing age by decade (p<0.001). Medicare was the most common primary insurance (7,246 [79.2%]), with private insurance the most common secondary insurance (8,440 [92.2%]). The total number of presenting concerns was 12,020, and back concerns were most common (6,406 [53.3%]). The total number of assessments was 18,290; most were neuromusculoskeletal (17,271 [94.5%]) and in the thoracolumbar region (7,109 [38.9%]). The mean (SD) number of somatic dysfunction assessments per encounter was 5 (1.7); the thoracic region was the most documented and treated (7,263 [15.8%]). With up to 19 technique types per encounter, the total number of OMT techniques documented across all encounters was 43,862, and muscle energy (7,203 [16.4%]) was the most documented. The use of high-velocity, low-amplitude (HVLA) declined as age increased (p<0.001). The overall treatment response was documented in 7,316 (79.9%) encounters, and most indicated improvement (7,290 [99.6%]).

CONCLUSIONS

Our results showed that geriatric patients receiving OMT at our clinic were predominately presenting for neuromusculoskeletal concerns associated with back, neck, and extremity conditions, consistent with national epidemiological data for this population. The most common OMT techniques were also consistent with those used nationally by osteopathic medical students and practicing physicians. Future longitudinal studies are needed to determine the length of time improvement persists and the overall health impact experienced by geriatric patients receiving OMT.

Interventions for Post-Stroke Shoulder Pain: An Overview of Systematic Reviews

Background

Shoulder pain following stroke leads to poorer quality of life and daily functioning. Whilst many treatment approaches exist, there is currently no systematic overview of the evidence base for these. This review addressed the question “What is the evidence for interventions for treating hemiplegic shoulder pain?”

Methods

An overview of systematic reviews was performed according to PROSPERO protocol (CRD42020140521). Five electronic databases including Cochrane, MEDLINE, Embase and EmCare were searched to June 2019. Included systematic reviews were those of comparative trials of interventions for hemiplegic shoulder pain in adults, reporting pain outcomes using a validated pain scale. Review quality was assessed with AMSTAR2 and those considered at high risk of bias for four or more items were excluded. The most recent, comprehensive review for each intervention category was included. Outcomes of function and quality of life were also extracted.

Results

Seven systematic reviews of 11 interventions were included, with varied quality. Reviews showed significant benefits in terms of pain reduction for many interventions including acupuncture (conventional 19 trials, electroacupuncture 5 trials, fire needle 2 trials, warm needle 1 trial and bee venom 3 trials), orthoses (1 trial), botulinum toxin injection (4 trials), electrical stimulation (6 trials) and aromatherapy (1 trial). However, the majority of trials were small, leading to imprecise estimates of effect. Findings were often inconsistent across outcome measures or follow-up times. Outcomes from trials of acupuncture were heterogenous with likely publication bias.

Conclusion

A number of systematic reviews indicate significant reductions in pain, with a wide range of treatments appearing promising. However, significant limitations mean the clinical importance of these findings are uncertain. Due to complex etiology, practitioners and health systems must consider the range of potential interventions and tailor their approach to individual presentation, guided by their local circumstances, expert opinion and the growing literature base.

The effect of aromatherapy massage with lavender and chamomile oil on anxiety and sleep quality of patients with burns

INTRODUCTION

Regarding the importance of anxiety management and improvement of the quality of sleep in patients with burn injuries, this study aimed to determine the effect of aromatherapy massage (using aromatic oils of lavender and chamomile) on the anxiety and sleep quality of the patients with burn injuries.

METHOD

In a quasi-experimental study, 105 patients with burns were recruited by convenience sampling method and then assigned into three groups (control, placebo massage, and combined aromatic oil massage). The study intervention was performed 20min before bedtime in three sessions, within a week. The control group was only under daily routine care. The study data were collected using the Persian version of Spielberg's anxiety scale and the Pittsburgh Sleep Quality Inventory. Descriptive and inferential statistical tests were used to analyze the data in SPSS version 20.

RESULTS

The results showed a significant difference among the three groups in terms of anxiety score (P<0.001) and in terms of sleep quality after the intervention (P=0.027).

CONCLUSION

Since the aromatherapy massage as a non-pharmacological and simple method can improve the anxiety and quality of sleep in patients with burns, it is suggested that nurses and burn medical care team apply it to reduce burn patients' anxiety and promote their sleep quality. Applying massage alone also reduces anxiety in burn survivors.

Management of acute pain in dementia: a feasibility study of a robot-assisted intervention

Background: The management of pain is particularly challenging in patients with moderate to severe dementia owing to the loss of communication ability or underlying causes such as behavioral symptoms. It is often associated with health care professionals’ frustration and feeling of helplessness. The present study determined a framework and examined the feasibility of an innovative intervention using the PARO^® robot for the management of acute pain in dementia.

Method: A mixed-methods research design combining qualitative (five focus groups) and quantitative (questionnaire survey) approaches was used to define the intervention framework. We recruited 57 health care professionals from various medical and paramedical specialties (eg, nursing auxiliaries, nurses, physicians, psychologists) and with expertise in gerontology. The feasibility of the intervention was subsequently assessed with 12 patients suffering from dementia in painful situations to validate the procedure.

Results: Four main issues have been addressed: 1) the identification of a core group of painful situations associated with care (washing, dressing/change, transfer/mobilization), currently considered as inefficiently managed; 2) the selection of an appropriate assessment methodology including criteria and tools for pain evaluation; 3) the definition of health professionals' training needs and organizational requirements for their implementation; and 4) the perceived usefulness of a robot-assisted intervention for the management of pain in dementia in daily practice. The feasibility study showed that the predefined intervention framework was applicable and acceptable for the majority of professionals and patients.

Conclusion: A consistent and feasible intervention framework for the management of painful situations associated with care in dementia using the PARO robot was defined. Understanding of professionals’ needs, opinions and perceived obstacles regarding the intervention was a useful step in the preparation of the forthcoming clinical trial.

Effect of Hand and Foot Massage Therapy on Psychological Factors and EEG Activity in Elderly People Requiring Long-Term Care: A Randomized Cross-Over Study

Massage therapy is widely used as a complementary therapy in the elderly. Here, we investigate the effect of hand and foot massage therapy on psychological factors and electroencephalographic (EEG) activity in elderly people requiring long-term care. We included 12 elderly people requiring long-term care, who were randomly divided into two groups (A and B). Group A received hand massage and group B received foot massage, both for 15 min each. After 1 week, group A received foot massage and group B received hand massage, both for 15 min each. We assessed emotions and mood states with a Likert scale after each massage and resting-state EEG activity was measured before and after each massage. Our results showed that both hand and foot massage led to a high degree of pleasant, relaxed, and refreshed feelings. Moreover, resting-state alpha activity significantly increased in the left insular cortex after hand massage (p < 0.05), and in the right and left posterior cingulate cortex after foot massage (p < 0.05). This study suggests that hand and foot massage therapy modulate psychological factors and EEG activity in elderly people requiring long-term care.

Effect of foot reflexology and slow stroke back massage on the severity of fatigue in patients undergoing hemodialysis: A semi-experimental study

Background Fatigue is one of the most disturbing and the most common symptoms reported by patients dialyzed. There are methods available on complementary and alternative medicine, through which nurses can help patients to promote their health. Reflexology is a treatment which has a long history and is considered as one of the most popular and the most widespread methods of alternative medicine. In this study, the effects of foot reflexology and slow stroke back massage on the severity of fatigue in patients treated with hemodialysis were measured. Methods This is a quasi-experimental study that performed on 52 patients chosen from Imam Khomeini dialysis center in Zabol and divided into control and intervention groups by randomize allocation method. Required information collected from a demographic and fatigue severity questionnaire. After completing questionnaires by the study subjects, foot massage and slow stroke back massage was performed during three weeks, two sessions each week (5 sessions in total). At the end of intervention data of two groups was collected. Data was analyzed using independent sample t-Test, Chi-squared test, Fisher exact test, oneway ANOVA with repeated measures and Bonferroni test by SPSS software version 21. Results The mean [±SD] fatigue in patients with foot reflexology massage and slow stroke back massage reflect on the 53.61[±10.12] and 52.20 [±10.37], and the differences were not significant, but after the intervention, fatigue in the group receiving foot reflexology massage was reduced significantly compared to slow stroke back massage group (p<0.0001). Conclusions The result of this study showed that reflexology massage is a safe and economical nursing intervention for decreasing fatigue in hemodialysis patients.

Massage therapy for home care patients using the health insurance system in Japan

OBJECTIVES

To clarify the status of home care massage services provided to patients. This will help in understanding how many patients utilize this service and the circumstances under which treatment is provided.

DESIGN

A retrospective study.

SETTING

Fifty-four acupuncture, moxibustion, and massage clinics. Participants were patients who had received home care massage for six months or more. We collected a total of 1587 responses from these 54 massage clinics; of these, 1415 responses (mean age = 79.1 ± 11.5 years) were valid (valid response rate 89.2%).

MAIN OUTCOME MEASURES

Actual patients and actual care services.

RESULTS

The most common disorder observed among patients who utilized home care massage services was cerebrovascular disease (at approximately 36%), while the second most common were arthropathy-related disorders (16.3%). Although most patients received massage, approximately 30% received manual therapy (e.g. manual correction) and hot fomentation as part of thermotherapy. Notably, only around 10% of patients received massage alone; the majority received treatment in combination with range of motion and muscle-strengthening exercises.

CONCLUSIONS

This study helped to clarify the actual state of patients receiving home care massage and the details of the massage services provided. This study clearly showed the treatment effectiveness of massage, which can be used by home medical care stakeholders to develop more effective interventions.

Interventions for treating anxiety after stroke

BACKGROUND

Approximately 20% of stroke patients experience clinically significant levels of anxiety at some point after stroke. Physicians can treat these patients with antidepressants or other anxiety-reducing drugs, or both, or they can provide psychological therapy. This review looks at available evidence for these interventions. This is an update of the review first published in October 2011.

OBJECTIVES

The primary objective was to assess the effectiveness of pharmaceutical, psychological, complementary, or alternative therapeutic interventions in treating stroke patients with anxiety disorders or symptoms. The secondary objective was to identify whether any of these interventions for anxiety had an effect on quality of life, disability, depression, social participation, caregiver burden, or risk of death.

SEARCH METHODS

We searched the trials register of the Cochrane Stroke Group (January 2017). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2017, Issue 1: searched January 2017); MEDLINE (1966 to January 2017) in Ovid; Embase (1980 to January 2017) in Ovid; the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1937 to January 2017) in EBSCO; and PsycINFO (1800 to January 2017) in Ovid. We conducted backward citation searches of reviews identified through database searches and forward citation searches of included studies. We contacted researchers known to be involved in related trials, and we searched clinical trials registers for ongoing studies.

SELECTION CRITERIA

We included randomised trials including participants with a diagnosis of both stroke and anxiety for which treatment was intended to reduce anxiety. Two review authors independently screened and selected titles and abstracts for inclusion.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed risk of bias. We performed a narrative review. We planned to do a meta-analysis but were unable to do so as included studies were not sufficiently comparable.

MAIN RESULTS

We included three trials (four interventions) involving 196 participants with stroke and co-morbid anxiety. One trial (described as a 'pilot study') randomised 21 community-dwelling stroke survivors to four-week use of a relaxation CD or to wait list control. This trial assessed anxiety using the Hospital Anxiety and Depression Scale and reported a reduction in anxiety at three months among participants who had used the relaxation CD (mean (standard deviation (SD) 6.9 (± 4.9) and 11.0 (± 3.9)), Cohen's d = 0.926, P value = 0.001; 19 participants analysed).The second trial randomised 81 participants with co-morbid anxiety and depression to paroxetine, paroxetine plus psychotherapy, or standard care. Mean levels of anxiety severity scores based on the Hamilton Anxiety Scale (HAM-A) at follow-up were 5.4 (SD ± 1.7), 3.8 (SD ± 1.8), and 12.8 (SD ± 1.9), respectively (P value < 0.01).The third trial randomised 94 stroke patients, also with co-morbid anxiety and depression, to receive buspirone hydrochloride or standard care. At follow-up, the mean levels of anxiety based on the HAM-A were 6.5 (SD ± 3.1) and 12.6 (SD ± 3.4) in the two groups, respectively, which represents a significant difference (P value < 0.01). Half of the participants receiving paroxetine experienced adverse events that included nausea, vomiting, or dizziness; however, only 14% of those receiving buspirone experienced nausea or palpitations. Trial authors provided no information about the duration of symptoms associated with adverse events. The trial of relaxation therapy reported no adverse events.The quality of the evidence was very low. Each study included a small number of participants, particularly the study of relaxation therapy. Studies of pharmacological agents presented details too limited to allow judgement of selection, performance, and detection bias and lack of placebo treatment in control groups. Although the study of relaxation therapy had allocated participants to treatment using an adequate method of randomisation, study recruitment methods might have introduced bias, and drop-outs in the intervention group may have influenced results.

AUTHORS' CONCLUSIONS

Evidence is insufficient to guide the treatment of anxiety after stroke. Further well-conducted randomised controlled trials (using placebo or attention controls) are required to assess pharmacological agents and psychological therapies.

The Effect of Slow-Stroke Back Massage on the Anxiety Levels of Iranian Women on the First Postpartum Day

Background

Anxiety disorder is common during the postpartum period. Back massage relaxation techniques are one of the most important nonpharmacological interventions to prevent and control postpartum-related anxiety.

Objectives

To determine the effectiveness of slow-stroke back massage on the anxiety levels of primiparous mothers in the first days after delivery.

Materials and Methods

This single-blind controlled clinical trial consisted of 100 primiparous mothers with normal deliveries. The mothers were randomly allocated to interventional (n = 50) or control (n = 50) groups using binary blocks. Both groups were followed up just before, immediately after, and the morning after the intervention. Data were collected using a demographic questionnaire and Spielberger’s state anxiety inventory (STAI) questionnaire.

Results

The mean age of the mothers was 22 years. There were no significant between-group differences in age (P = 0.333), education (P = 0.427), and medication during labor and the postpartum period (P = 0.412). There was no statistically significant difference between the mean anxiety scores of the experimental (6.66 ± 35.48) and control groups (9.05 ± 37.42) before the intervention (P = 0.268). Immediately after the massage and the next morning, there was a significant between-group difference in the anxiety scores (P < 0.001).

Conclusions

The findings demonstrate that slow-stroke back massage is a simple, inexpensive, noninvasive, and effective method to reduce the anxiety levels of primiparous women during the first postpartum day.

Comparing the effects of two Swedish massage techniques on the vital signs and anxiety of healthy women

Background:

Anxiety is an inseparable part of our lives and a serious threat to health. Therefore, it is necessary to use certain strategies to prevent disorders caused by anxiety and adjust the vital signs of people. Swedish massage is one of the most recognized techniques for reducing anxiety. This study aims to compare the effects of two massage techniques on the vital signs and anxiety of healthy women.

Materials and Methods:

This quasi-experimental study with a two-group, crossover design was conducted on 20 healthy women who were selected by simple sampling method and were randomly assigned to BNC (Back, Neck, and Chest) or LAF (Leg, Arm, and Face) groups. Massage therapy was carried out for a 14-week period (two 4-week massage therapy sessions and 6 weeks washout stage). Gathered data were analyzed using paired t-test with a significance level of P < 0.05.

Results:

Both BNC and LAF methods caused a significant decrease in systolic BP in the first stage (P = 0.02, 0.00); however, diastolic BP showed significant decrease only in BNC group (P = 0.01). The mean average of body temperature of LAF group showed a significant decrease in the first stage (P = 0.0.3), and pulse and respiratory rate showed significant decrease in both groups during the second stage (P = 0.00). In addition, anxiety scores showed no significant difference before and after massage therapy (P < 0.05).

Conclusions:

Massage therapy caused a decrease in systolic BP, pulse, and respiratory rate. It can be concluded that massage therapy was useful for decreasing the vital signs associated with anxiety in healthy women.

The Impact of Massage Therapy on Function in Pain Populations-A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population

PURPOSE

Pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life outcomes across all pain populations.

METHODS

Key databases were searched from inception through February 2014. Eligible randomized controlled trials were assessed for methodological quality using SIGN 50 Checklist. Meta-analysis was applied at the outcome level. A diverse steering committee interpreted the results to develop recommendations.

RESULTS

Sixty high quality and seven low quality studies were included in the review. Results demonstrate massage therapy effectively treats pain compared to sham [standardized mean difference (SMD) = -.44], no treatment (SMD = -1.14), and active (SMD = -0.26) comparators. Compared to active comparators, massage therapy was also beneficial for treating anxiety (SMD = -0.57) and health-related quality of life (SMD = 0.14).

CONCLUSION

Based on the evidence, massage therapy, compared to no treatment, should be strongly recommended as a pain management option. Massage therapy is weakly recommended for reducing pain, compared to other sham or active comparators, and improving mood and health-related quality of life, compared to other active comparators. Massage therapy safety, research challenges, how to address identified research gaps, and necessary next steps for implementing massage therapy as a viable pain management option are discussed.

Massage, a complementary therapy effectively promoting the health and well-being of older people in residential care settings: a review of the literature

AIMS

To explore the potential benefits of massage within daily routine care of the older person in residential care settings.

BACKGROUND

Globally, the proportion of people over 65 years is rapidly rising. Increased longevity means older people may experience a rise in physiological and psychological health problems. These issues potentially place an increased demand for quality long-term care for the older person. Complementary approaches such as massage appear to be needed in quality residential care.

DESIGN

A critical literature review was undertaken.

METHODS

A literature review pertaining to massage in the older resident was conducted using a range of online databases. Fourteen studies dated 1993-2012 met the inclusion criteria and were critically evaluated as suitable resources for this review.

RESULTS

Evidence suggests massage may be advantageous from client and nursing perspectives. Clients' perceive massage to positively influence factors such as pain, sleep, emotional status and psychosocial health. Evidence also demonstrates massage to benefit the client and organisation by reducing the necessity for restraint and pharmacological intervention. Massage may be incorporated into care provision and adopted by care providers and family members as an additional strategy to enhance quality of life for older people.

CONCLUSION

Massage offers a practical activity that can be used to enhance the health and well-being of the older person in residential care.

IMPLICATIONS FOR PRACTICE

Massage offers benefit for promoting health and well-being of the older person along with potential increased engagement of family in care provision. Integration of massage into daily care activities of the older person requires ongoing promotion and implementation.

Does touch massage facilitate recovery after stroke? A study protocol of a randomized controlled trial

BACKGROUND

Despite high quality stroke care, decreased sensorimotor function, anxiety and pain often remain one year after stroke which can lead to impaired health and dependence, as well as higher healthcare costs. Touch massage (TM) has been proven to decrease anxiety and pain, and improve quality of health in other conditions of reduced health, where reduced anxiety seems to be the most pronounced benefit. Thus there are reasons to believe that TM may also reduce anxiety and pain, and improve quality of life after stroke. Further, several studies indicate that somatosensory stimulation can increase sensorimotor function, and it seems feasible to believe that TM could increase independence after stroke. In this study we will evaluate effects of TM after stroke compared to sham treatment.

METHODS

This is a prospective randomized open-labelled control trial with blinded evaluation (PROBE-design). Fifty patients with stroke admitted to stroke units will be randomized (1:1) to either a TM intervention or a non-active transcutaneous electrical nerve stimulation (non-TENS) control group. Ten sessions of 30 min treatments (TM or control) will be administered during two weeks. Assessment of status according to the International Classification of Functioning, Disability and Health (ICF), including body function, activity, and participation. Assessment of body function will include anxiety, pain, and stress response (heart rate variability and salivary cortisol), where anxiety is the primary outcome. Activity will be assessed by means of sensorimotor function and disability, and participation by means of health-related quality of life. Assessments will be made at baseline, after one week of treatment, after two weeks of treatment, and finally a follow-up after two months. The trial has been approved by the Regional Ethical Review Board.

DISCUSSION

TM seems to decrease anxiety and pain, increase health-related quality of life, and improve sensorimotor functions after stroke, but the field is largely unexplored. Considering the documented pleasant effects of massage in general, absence of reported adverse effects, and potential effects in relation to stroke, it is essential to evaluate effects of TM during the sub-acute phase after stroke. The results of this project will hopefully provide important knowledge for evidence-based care.

TRIAL REGISTRATION

ClinicalTrials.gov: NTC01883947.

Masoterapia en las alteraciones conductuales de ancianos con demencia

Objetivo

Diseño

Fuente de datos

Selección de los estudios

Extracción de datos

Resultados

Conclusiones

Acute effects of traditional Thai massage on cortisol levels, arterial blood pressure and stress perception in academic stress condition: A single blind randomised controlled trial

Traditional Thai massage (TTM) has been applied widely to promote relaxation. However, there is little evidence to support its efficacy on academic stress. A randomised controlled trial was performed to examine the acute effects of TTM on cortisol level, blood pressure, heart rate and stress perception in academic stress. This prospective trial included 36 physiotherapy students with a self perceived stress score of between 3 and 5. They were randomly allocated into the TTM (18 people) group or the control group (18 people). Saliva cortisol level, blood pressure, heart rate and stress perception rating were measured before and after the intervention. Both groups showed a significant reduction in cortisol level and heart rate when compared with baseline (p < 0.001). There were no significant differences in cortisol level between the two groups. The results suggest the need for further study into other possible physiological effects on stress of TTM.

The effectiveness of therapeutic massage in painful shoulder syndrome

Introduction: The chronic painful shoulder syndrome comprises the set of symptoms located in the area of the shoulder girdle and all the structures which make this complex, namely, the scapula, the clavicle and the arm. The complexity of the structures, which make up for the shoulder girdle, results in frequent dysfunctions as the abnormality in functioning of only one element can lead to the problems with the whole structure. Pain and limited joint mobility are the most frequent symptoms. The dysfunctions of the shoulder girdle limit the patient’s independence and evoke mental and physical discomfort which decrease the quality of life. The syndrome often occurs as a main disorder but in many cases its symptoms coexist with other diseases. The purposeof the work was to present the possibility of application of therapeutic (tensegrity) massage in the chronic pain shoulder syndrome.Material and methods: This article presents the process of massage application to different muscles of the shoulder in the appropriate order, which is called the therapeutic (tensegrity) massage. The purpose of the massage is to decrease the tonus of the muscle and increase the blood flow which ought to result in restoring the shoulder function. Six 45–minute-long massage sessions were performed and repeated every three days.Results: After the therapy, the decrease of painful shoulder was observed along with the vanish of the shoulder and the arm lifting habit. After this massage period, when the pain was smaller, the patient immediately wanted to continue physiotherapy.Conclusions: Massage is one of the forms of therapy, which can be used in the painful shoulder syndrome. It might often constitute the introductory stage to the rehabilitation aimed at mobilization of the patient.

Lifetime stress cumulatively programs brain transcriptome and impedes stroke recovery: benefit of sensory stimulation

Prenatal stress (PS) represents a critical variable affecting lifetime health trajectories, metabolic and vascular functions. Beneficial experiences may attenuate the effects of PS and its programming of health outcomes in later life. Here we investigated in a rat model (1) if PS modulates recovery following cortical ischemia in adulthood; (2) if a second hit by adult stress (AS) exaggerates stress responses and ischemic damage; and (3) if tactile stimulation (TS) attenuates the cumulative effects of PS and AS. Prenatally stressed and non-stressed adult male rats underwent focal ischemic motor cortex lesion and were tested in skilled reaching and skilled walking tasks. Two groups of rats experienced recurrent restraint stress in adulthood and one of these groups also underwent daily TS therapy. Animals that experienced both PS and AS displayed the most severe motor disabilities after lesion. By contrast, TS promoted recovery from ischemic lesion and reduced hypothalamic-pituitary-adrenal axis activity. The data also showed that cumulative effects of adverse and beneficial lifespan experiences interact with disease outcomes and brain plasticity through the modulation of gene expression. Microarray analysis of the lesion motor cortex revealed that cumulative PS and AS interact with genes related to growth factors and transcription factors, which were not affected by PS or lesion alone. TS in PS+AS animals reverted these changes, suggesting a critical role for these factors in activity-dependent motor cortical reorganization after ischemic lesion. These findings suggest that beneficial experience later in life can moderate adverse consequences of early programming to improve cerebrovascular health.

Guidance on the management of pain in older people

This guidance document reviews the epidemiology and management of pain in older people via a literature review of published research. The aim of this document is to inform health professionals in any care setting who work with older adults on best practice for the management of pain and to identify where there are gaps in the evidence that require further research. The assessment of pain in older people has not been covered within this guidance and can be found in a separate document (http://www.britishpainsociety.org/pub_professional.htm#assessmentpop). Substantial differences in the population, methods and definitions used in published research makes it difficult to compare across studies and impossible to determine the definitive prevalence of pain in older people. There are inconsistencies within the literature as to whether or not pain increases or decreases in this age group, and whether this is influenced by gender. There is, however, some evidence that the prevalence of pain is higher within residential care settings. The three most common sites of pain in older people are the back; leg/knee or hip and 'other' joints. In common with the working-age population, the attitudes and beliefs of older people influence all aspects of their pain experience. Stoicism is particularly evident within this cohort of people. Evidence from the literature search suggests that paracetamol should be considered as first-line treatment for the management of both acute and persistent pain, particularly that which is of musculoskeletal origin, due to its demonstrated efficacy and good safety profile. There are few absolute contraindications and relative cautions to prescribing paracetamol. It is, however, important that the maximum daily dose (4 g/24 h) is not exceeded. Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in older people after other safer treatments have not provided sufficient pain relief. The lowest dose should be provided, for the shortest duration. For older adults, an NSAID or cyclooxygenase-2 (COX-2) selective inhibitor should be co-prescribed with a proton pump inhibitor (PPI), and the one with the lowest acquisition cost should be chosen. All older people taking NSAIDs should be routinely monitored for gastrointestinal, renal and cardiovascular side effects, and drug–drug and drug–disease interactions. Opioid therapy may be considered for patients with moderate or severe pain, particularly if the pain is causing functional impairment or is reducing their quality of life. However, this must be individualised and carefully monitored. Opioid side effects including nausea and vomiting should be anticipated and suitable prophylaxis considered. Appropriate laxative therapy, such as the combination of a stool softener and a stimulant laxative, should be prescribed throughout treatment for all older people who are prescribed opioid therapy. Tricyclic antidepressants and anti-epileptic drugs have demonstrated efficacy in several types of neuropathic pain. But, tolerability and adverse effects limit their use in an older population. Intra-articular corticosteroid injections in osteoarthritis of the knee are effective in relieving pain in the short term, with little risk of complications and/or joint damage. Intra-articular hyaluronic acid is effective and free of systemic adverse effects. It should be considered in patients who are intolerant to systemic therapy. Intra-articular hyaluronic acid appears to have a slower onset of action than intra-articular steroids, but the effects seem to last longer. The current evidence for the use of epidural steroid injections in the management of sciatica is conflicting and, until further larger studies become available, no firm recommendations can be made. There is, however, a limited body of evidence to support the use of epidural injections in spinal stenosis. The literature review suggests that assistive devices are widely used and that the ownership of devices increases with age. Such devices enable older people with chronic pain to live in the community. However, they do not necessarily reduce pain and can increase pain if used incorrectly. Increasing activity by way of exercise should be considered. This should involve strengthening, flexibility, endurance and balance, along with a programme of education. Patient preference should be given serious consideration. A number of complementary therapies have been found to have some efficacy among the older population, including acupuncture, transcutaneous electrical nerve stimulation (TENS) and massage. Such approaches can affect pain and anxiety and are worth further investigation. Some psychological approaches have been found to be useful for the older population, including guided imagery, biofeedback training and relaxation. There is also some evidence supporting the use of cognitive behavioural therapy (CBT) among nursing home populations, but of course these approaches require training and time. There are many areas that require further research, including pharmacological management where approaches are often tested in younger populations and then translated across. Prevalence studies need consistency in terms of age, diagnosis and terminology, and further work needs to be done on evaluating non-pharmacological approaches.

Massage therapy for neck and shoulder pain: a systematic review and meta-analysis

Objective. To evaluate the effectiveness of massage therapy (MT) for neck and shoulder pain. Methods. Seven English and Chinese databases were searched until December 2011 for randomized controlled trials (RCTs) of MT for neck and shoulder pain. The methodological quality of RCTs was assessed based on PEDro scale. The meta-analyses of MT for neck and shoulder pain were performed. Results. Twelve high-quality studies were included. In immediate effects, the meta-analyses showed significant effects of MT for neck pain (standardised mean difference, SMD, 1.79; 95% confidence intervals, CI, 1.01 to 2.57; P < 0.00001) and shoulder pain (SMD, 1.50; 95% CI, 0.55 to 2.45; P = 0.002) versus inactive therapies. And MT showed short-term effects for shoulder pain (SMD, 1.51; 95% CI, 0.53 to 2.49; P = 0.003). But MT did not show better effects for neck pain (SMD, 0.13; 95% CI, −0.38 to 0.63; P = 0.63) or shoulder pain (SMD, 0.88; 95% CI, −0.74 to 2.51; P = 0.29) than active therapies. In addition, functional status of the shoulder was not significantly affected by MT. Conclusion. MT may provide immediate effects for neck and shoulder pain. However, MT does not show better effects on pain than other active therapies. No evidence suggests that MT is effective in functional status.

Evidence for therapeutic interventions for hemiplegic shoulder pain during the chronic stage of stroke: a review

OBJECTIVE

To determine the effectiveness of therapeutic interventions targeting hemiplegic shoulder pain (HSP) more than 6 months post stroke.

METHODS

A literature search of multiple databases (PubMed, CINAHL, Ovid, and EMBASE) was conducted to identify articles published in the English language from 1980 to April 2012. Studies were included if (1) all participants were adults who had sustained a stroke; (2) research design was a randomized controlled trial (RCT) that examined the effectiveness of any treatment for HSP; (3) all participants had experienced stroke at least 6 months previously; and (4) an assessment of pain had been conducted before and after treatment using a standardized method. The following data were extracted: patient characteristics (ie, age, gender, time since stroke), sample size, study design, measurement of pain pre and post treatment, and adverse events.

RESULTS

Ten RCTs (PEDro scores 4-9) met inclusion criteria and included a total sample size of 388 individuals with a mean age of 53.2 years (range, 43.6-73.2). Mean time post stroke was 18.4 months. Three studies addressed the use of botulinum toxin type A (BTx-A); 2 studies examined electrical stimulation; 3 studies focused on intraarticular glenohumeral corticosteroid injections; 1 studied subacromial corticosteroid injections; and 1 study looked at massage therapy.

CONCLUSIONS

Positive outcomes were noted with the use of corticosteroid injections and electrical stimulation and conflicting results were seen regarding the use of BTx-A. Overall, these targeted therapies provide benefit in the treatment of HSP in individuals who are more than 6 months post stroke.

[Nursing interventions for stroke patients: an integrative literature review]

The objective of this study was to analyze the knowledge on nursing interventions for hospitalized stroke patients. An integrative literature review was performed by accessing five online databases, in September 2009. The descriptors used in the search were nursing care and stoke, in Portuguese, English and Spanish. A total 223 articles were found, and 12 were selected. It was found in the articles that there was a greater number of clinical nursing interventions, followed by educational, managerial and research interventions. Clinical interventions are more related to the biological aspects of patients. As to the educational interventions, the articles point at the fundamental role of nurses, as well as that of relatives and caregivers. The main managerial intervention was the coordination of health care. As for research interventions, only one was identified and described as the development and improvement of health care practice through clinical evidence.

Interventions for treating anxiety after stroke

BACKGROUND

Approximately 20% of stroke patients experience anxiety at some point after stroke.

OBJECTIVES

To determine if any treatment for anxiety after stroke decreases the proportion of patients with anxiety disorders or symptoms, and to determine the effect of treatment on quality of life, disability, depression, social participation, risk of death or caregiver burden.

SEARCH METHODS

We searched the trials register of the Cochrane Stroke Group (October 2010), CENTRAL (The Cochrane Library 2010, Issue 4), MEDLINE (1950 to October 2010), EMBASE (1947 to October 2010), PsycINFO (1806 to October 2010), Allied and Complementary Medicine database (AMED) (1985 to October 2010), Cumulative Index to Nursing and Allied Health (CINAHL) (1982 to October 2010), Proquest Digital Dissertations (1861 to October 2010), and Psychological Database for Brain Impairment Treatment Efficacy (PsycBITE) (2004 to October 2010). In an effort to identify further published, unpublished and ongoing trials, we searched trial registries and major international stroke conference proceedings, scanned reference lists, and contacted select individuals known to the review team who are actively involved in psychological aspects of stroke research, and the Association of the British Pharmaceutical Industry.

SELECTION CRITERIA

Two review authors independently screened and selected titles and abstracts for inclusion in the review. Randomised trials of any intervention in patients with stroke where the treatment of anxiety was an outcome were eligible.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data for analysis. We performed a narrative review. A meta-analysis was planned but not carried out as studies were not of sufficient quality to warrant doing so.

MAIN RESULTS

We included two trials (three interventions) involving 175 participants with co-morbid anxiety and depression in the review. Both trials used the Hamilton Anxiety Scale (HAM-A) to assess anxiety, and neither included a placebo control group. One trial randomised 81 patients to paroxetine, paroxetine plus psychotherapy or standard care. Mean level of anxiety severity scores were 58% and 71% lower in the paroxetine, and paroxetine plus psychotherapy groups respectively compared with those in standard care at follow-up (P < 0.01). The second trial randomised 94 stroke patients, also with co-morbid anxiety and depression, to receive buspirone hydrochloride or standard care. At follow-up, the mean level of anxiety was significantly lower for those receiving buspirone relative to controls (P < 0.01). Half of the participants receiving paroxetine experienced adverse events that included nausea, vomiting or dizziness; however, only 14% of those receiving buspirone experienced nausea or palpitations. No information was provided about the duration of symptoms associated with adverse events.

AUTHORS' CONCLUSIONS

There is insufficient evidence to guide the treatment of anxiety after stroke. The data available suggest that pharmaceutical therapy (paroxetine and buspirone) may be effective in reducing anxiety symptoms in stroke patients with co-morbid anxiety and depression. No information was available for stroke patients with anxiety only. Randomised placebo controlled trials are needed.

Complementary therapies in rehabilitation: nurses' narratives. Part 1

AIMS AND OBJECTIVES

To document the narratives of nursing staff in a Thai rehabilitation centre where complementary therapies are used and to discuss perceived progress of these complementary therapies on stroke patients. Specific complementary therapies used at this rehabilitation centre include Thai massage and herbal therapies.

BACKGROUND

In Thailand, there is cultural acknowledgement of a range of traditional therapies (including complementary therapies) widely used in Thai health care. For example, meditation enjoys wide acceptance in Thai culture and attracts strong participation from visitors to Thai Buddhist centres because of growing interest in developing a personal health regime for future preventative health problems.

DESIGN

Qualitative study using narrative inquiry and discourse analysis framed by poststructural theory.

METHOD

Six nursing staff and six stroke patients were interviewed about their involvement in complementary therapy practice and treatments and their experiences of these therapies in rehabilitation. This paper reports the six nurses' narratives of their involvement with patients and complementary therapies.

RESULTS

The overall findings revealed two strong themes: nurses' professional landscape and changes in stroke patients' embodiment. These two themes were interwoven in a main discourse of nurses attending to and enabling holistic care.

CONCLUSION

The contexts of temporality, spatiality and other people influencing the progress of patients' recovery are significant in this study. In particular, the findings illustrate the importance of the nurses' discourse in preparing stroke patients for a state of readiness to heal.

RELEVANCE TO CLINICAL PRACTICE

The nurses' role becomes much more significant in health care as demonstrated through these stories. Their part in establishing a holistic approach through motivating, advising, educating, calming and imparting a sense of family enables a strong connection with mind, body and spirit potentiating recovery for stroke patients.

Interventions for anxiety in the critically ill: a guide for nurses and families

Anxiety is a common feeling for patients and families during the critical care experience. As anxiety for critically ill patients presents increased risks for morbidity and mortality, it is imperative that nurses strive to identify unrelieved anxiety early to prevent adverse events. Alleviating anxiety experienced by families as a result of the critical care experience involves providing assurance, allowing them to remain near the patient, providing accurate and current information, providing for their comfort, and projecting a supportive attitude. As constant care providers, nurses can have the greatest impact on creating an environment that is safe, healing, and humane for critically ill patients and their families.

Complementary therapies in healthcare: design, implementation and evaluation of an elective course for undergraduate students

Complementary therapies are making a significant and cost effective contribution to the health of the community, especially in relation to chronic disease management and prevention of disease. Because of the increased use of complementary therapies, nurses, and other health professionals need to be familiar with specific practices so that they can assist clients to make informed decisions in the use of these therapies. Importantly, with the increased interest in complementary therapies, there is a need to ensure these practices are safe, cause no harm and are used to enhance the well-being of patients. This paper reports on the design, implementation and evaluation of a complementary therapies course and a linked Thai cultural studies tour. The course was implemented at The University of Newcastle for the first time in 2009 with an enrollment of 200 students. It is an elective course for both nursing students and those from other disciplines. In this paper we describe the reasons for the introduction of this course and its value in nursing education. We then provide an overview of the course and report on evaluation results from both the course and the Thai cultural studies tour.

Massage therapy reduces physical discomfort and improves mood disturbances in women with breast cancer

BACKGROUND. A randomized controlled trial was conducted to investigate the efficacy of classical massage treatment in reducing breast cancer-related symptoms and in improving mood disturbances. METHODS. Women diagnosed with primary breast cancer were randomized into an intervention group and a control group. For a period of 5 weeks, the intervention group received bi-weekly 30-min classical massages in the back and head-neck areas. The control group received no additional treatment to their routine healthcare. To evaluate treatment efficacy, the following validated questionnaires were administrated at baseline (T1), at the end of the intervention (T2), and at a followup at 11 weeks (T3): the Short Form-8 Health Survey, the European Organization of Research and Treatment of Cancer quality of life questionnaire breast module (EORTC QLQ-BR23), the Giessen Complaints Inventory (GBB), and the Berlin Mood Questionnaire (BSF). RESULTS. Eighty-six eligible women (mean age: 59 years) were enrolled in the study. A significantly higher reduction of physical discomfort was found in the intervention group compared with the control group at T2 (p=0.001) and at T3 (p=0.038). A decrease in fatigue was also observed. Women in the intervention group reported significantly lower mood disturbances at T2 (p<0.01) but not at T3. The effect of treatment on mood disturbances was significantly higher if a patient was treated continuously by the same masseur. CONCLUSION. Classical massage seems to be an effective adjuvant treatment for reducing physical discomfort and fatigue, and improving mood disturbances in women with early stage breast cancer.

The Psychologic Consequences of Chronic Dyspnea in Chronic Pulmonary Obstruction Disease: The Effects of Acupressure on Depression

OBJECTIVES

The onset of depression is often triggered by breathlessness in persons with chronic obstructive pulmonary disease (COPD). It is hypothesized that these are the psychologic consequences of chronic dyspnea. Lessening dyspnea might alleviate depressive symptoms. Acupressure has been shown in other studies to produce relaxation. The aim of this study was to determine if it would lessen dyspnea and reduce depression in patients with COPD.

SUBJECTS AND DESIGN

Subjects diagnosed with COPD were chosen from one medical center and three regional hospitals in Taipei, Taiwan. A randomized, block experimental design was used, with subjects and the data collector blinded. Using age, gender, pulmonary function, smoking, and steroid use as matching factors, 44 subjects were randomly assigned to either the true acupressure or the sham acupressure groups. The true acupressure group received a program of acupressure using appropriate acupoints that promote relaxation and relieve dyspnea. The sham acupressure group received acupressure using sham acupoints different from the meridians and ganglionic sections of the true acupressure group. Both acupressure programs lasted 4 weeks, with five sessions per week that lasted 16 minutes per session.

OUTCOME MEASURES

The Geriatric Depression Scale (GDS) and Dyspnea Visual Analogue Scale (DVAS) were administered prior to the program as a baseline, and again following the completion of the 4-week program. Oxygen saturation and other physiological indicators were measured before and after each session.

RESULTS

The results of this study showed that the GDS scores, DVAS scores, oxygen saturation, and physiological indicators of the true acupressure group were significantly improved, compared to those of the sham acupressure group.

CONCLUSIONS

These findings provide health professionals with an evidence-based intervention to use with persons with COPD. Applying this acupressure program in clinical practice, communities, and long-term care units may lessen chronic dyspnea and depression in persons with COPD.

Effectiveness of massage therapy for chronic, non-malignant pain: a review

Previous reviews of massage therapy for chronic, non-malignant pain have focused on discrete pain conditions. This article aims to provide a broad overview of the literature on the effectiveness of massage for a variety of chronic, non-malignant pain complaints to identify gaps in the research and to inform future clinical trials. Computerized databases were searched for relevant studies including prior reviews and primary trials of massage therapy for chronic, non-malignant pain. Existing research provides fairly robust support for the analgesic effects of massage for non-specific low back pain, but only moderate support for such effects on shoulder pain and headache pain. There is only modest, preliminary support for massage in the treatment of fibromyalgia, mixed chronic pain conditions, neck pain and carpal tunnel syndrome. Thus, research to date provides varying levels of evidence for the benefits of massage therapy for different chronic pain conditions. Future studies should employ rigorous study designs and include follow-up assessments for additional quantification of the longer-term effects of massage on chronic pain.