Does the experimental design capture the effects of complementary therapy? A study using reflexology for patients undergoing coronary artery bypass graft surgery

Comprehensive insights into herbal P-glycoprotein inhibitors and nanoformulations for improving anti-retroviral therapy efficacy

The worldwide HIV cases were 39.0 million (33.1-45.7 million) in 2022. Due to genetic variations, HIV-1 is more easily transmitted than HIV-2 and favours CD4 + T cells and macrophages, producing AIDS. Conventional HIV drug therapy has many drawbacks, including adherence issues leading to resistance, side effects that lower life quality, drug interactions, high costs limiting global access, inability to eliminate viral reservoirs, chronicity requiring lifelong treatment, emerging toxicities, and a focus on managing infections. Conventional dosage forms have bioavailability issues due to intestinal P-glycoprotein (P-gp) efflux, which can reduce anti-retroviral drug efficacy and lead to resistance. Use of phyto-constituents with P-gp regulating actions has great benefits for semi-synthetic modification to create formulations with greater bioavailability and reduced toxicity, which improves drug effectiveness. Lipid-based nanocarriers, solid lipid nanoparticles, nanostructured lipid carriers, polymer-based nanocarriers, and inorganic nanoparticles may inhibit P-gp efflux. Employing potent P-gp inhibitors within nanocarriers as a Trojan horse approach can enhance the intracellular accumulation of anti-retroviral drugs (ARDs), which are substrates for efflux transporters. This technique increases oral bioavailability and offers lower-dose options, boosting HIV patient compliance and lowering costs. Molecular docking of the inhibitor with P-gp may anticipate optimum binding and function, allowing drug efflux to be minimised.

The effect of Shiatsu massage on agitation in mechanically ventilated patients: A randomized controlled trial

BACKGROUND

Patients admitted to the intensive care units encounter many complications due to the nature of the disease and invasive medical procedures such as intubation and mechanical ventilation. Among these complications, agitation is a frequently-observed and serious problem.

OBJECTIVES

This study aimed to investigate the effect of Shiatsu massage on agitation in mechanically ventilated patients.

METHODS

In this randomized controlled trial, a total of 68 mechanically ventilated patients were selected and then randomly assigned to two groups of intervention and control. Patients in the intervention group received three 5-minute periods of Shiatsu massage with a 2-minute break between them, while patients in the control group only received a touch on the area considered for the message. Data were collected before and after the intervention using the Richmond Agitation-Sedation Scale (RASS) and then analyzed using IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, N.Y., USA).

RESULTS

The results showed that the level of agitation significantly decreased in the intervention group compared to the control group (p=.001).

CONCLUSION

Application of shiatsu massage seems to be effective in managing agitation in mechanically ventilated patients. Further studies with greater sample size and longer follow-up period are needed to confirm the current findings.

Effect of foot reflexology on chest pain and anxiety in patients with acute myocardial infarction: A double blind randomized clinical trial

BACKGROUND AND PURPOSE

The aim of this study was to determine the effect of foot reflexology on chest pain and anxiety in patients with AMI.

MATERIALS AND METHODS

This study was a double blind randomized clinical trial. Stratified random sampling was carried out on 90 patients with AMI in the three groups of treatment, placebo and control. Foot reflexology was done for three consecutive days, each time for 20 min. Chest pain and anxiety were evaluated with Visual Analogue Scale before, immediately and 20 min later.

RESULTS

20 min after the intervention, severity of chest pain in treatment group was significantly lower than control group (p < 0.001) and placebo group (p = 0.002). Severity of anxiety between groups and at different times was not significant.

CONCLUSIONS

Foot reflexology was effective in attenuating chest pain, had the most effect in 20 min after intervention, and can be used to relieve chest pain in patients with AMI.

The effectiveness of massage on peri-operative anxiety in adults: A meta-analysis of randomized controlled trials and controlled clinical trials

BACKGROUND AND PURPOSE

and purpose: Massage has gained increasing attention for reducing peri-operative anxiety. We aimed to investigate the effectiveness of massage for peri-operative anxiety in adults.

METHODS

Six English electronic databases were comprehensively searched from their inception to February 2020. Subgroup analysis, quality assessment, sensitivity analysis, meta-regression and publication bias assessment were performed.

RESULTS

Twenty-five controlled trials comprising 2494 participants were included. The meta-analysis indicated that massage could significantly reduce peri-operative anxiety for most types of surgical patients. Specifically, it was effective for pre-, intra- and post-operative anxiety. Acupoint or specific body reflex area massage showed a larger effect than general massage did. Massage delivered by professionals and non-professionals were both effective. Massage lasting 10-20 min per session was the most worthy of recommendation. Massage was concomitant with the improvement of peri-operative vital signs and post-operative pain.

CONCLUSION

Massage is a promising complementary therapy for ameliorating peri-operative anxiety in adults.

Effect of pre-cesarean foot reflexology massage on anxiety of primiparous women

Introduction Anxiety is a common feeling in cesarean section and lack of attention to it is associated with negative consequences for health of mother and child. Reflexology is a way to reduce anxiety. So far, the effect of reflexology on pre-cesarean anxiety has not been evaluated. Therefore, we aimed to evaluate the effect of pre-cesarean foot reflexology massage on the anxiety of women during their first pregnancy. Materials and Methods This study is a three-group clinical trial that was conducted in 2019. The study sample consisted of 90 pregnant women hospitalized for cesarean section in Zahedan who were randomly divided into three groups of 30 women. The subjects completed the state section of Spielberger anxiety questionnaire. The control group did not receive any intervention. For two groups, 1 h before surgery, a group received reflexive massage, and the another group simple massage. Duration of massage for each group was 30 min. After 30 min, the subjects completed the state section of Spielberger questionnaire again. Statistical analysis was performed by SPSS software program, version 21.0. ANOVA and ANCOVA tests were used to compare between groups and paired t-test was used for intra-group comparisons. Results The results showed that the level of anxiety was significantly reduced in the reflexology massage group (from 55 ± 8 to 40 ± 7) as well as simple massage group (from 51 ± 10 to 47 ± 7) (p<0.001). In the control group, anxiety was increased (from 49 ± 9 to 56 ± 9) (p<0.001). Comparison between the three groups by ANCOVA indicated that reflexology massage and simple massage significantly decreased anxiety scores (p>0.001 and p>0.001,respectively). Reflexive massage significantly reduced anxiety scores (p>0.001) as compared to simple massage. Conclusion The results of this study revealed the positive effect of reflexology massage on pre-cesarean anxiety. Because reflexology massage is an inexpensive, simple, and easy approach, the use of this non-pharmaceutical method is recommended to reduce pre-cesarean anxiety.

Randomized controlled trial of the foot reflexology on pain and anxiety severity during dressing change in burn patients

BACKGROUND

One of the most important problems in burn patients was pain, especially in dressing changes. This pain can lead to anxiety in the patient. The aim of this study was to determine the effect of foot reflexology on pain and anxiety severity in burn patients.

METHODS

This study was a randomized controlled trial, in which 66 patients with burn injuries referred to Vali-e-asr Hospital, Arak, Iran participated. After obtaining written consent, patients were enrolled to study according to inclusion criteria and then, divided into intervention (n = 33) and control (n = 33) groups using simple random allocation. In the intervention group, in addition to standard care, reflexology was performed for one week on Saturday, Monday and Wednesday (three times in a week). The intervention was done one hour before dressing change in a separate room for 30 min. The control group received only standard care during this time (both intervention and control groups were the same in the type of treatment, and reflexology was considered as an extra care in the intervention group). Severity of pain and anxiety in both groups was measured using visual analog scale twice a day (5-10 min before dressing change and 5-10 min after dressing change) for six days. SPSS software ver. 15 was used for statistical analysis. Mean and standard deviation were used for quantitative variables and qualitative variables were reported as frequency and percentage. Data were analyzed using Chi‑square, Mann-Whitney, Fisher's exact tests, and paired t-test. The Kolmogorov-Smirnov test was used to check the normality of data.

RESULTS

The results showed no significant difference in severity of pain (p = 0.25) and anxiety (p = 0.37) between the two groups on the first day, before the intervention. In the following days, the results showed no significant difference between the two groups in the second and third treatments after intervention . However, the mean pain scores showed a significant difference between the two groups in the forth (p = 0.005), fifth (p = 0.001), and sixth (p = 0.001) days after intervention. Anxiety scores also showed a significant difference between the two groups on the fourth (p = 0.01), fifth (p = 0.001), and sixth (p = 0.001) days.

CONCLUSIONS

Our results showed foot reflexology is an appropriate and safe intervention for management of pain and anxiety of burn patients. Therefore, it can be used as a complementary method alongside other methods.

The Effect of Foot Reflexology Applied Before Coronary Angiography and Percutaneous Transluminal Coronary Angioplasty on Anxiety, Stress, and Cortisol Levels of Individuals: A Randomized Controlled Trial

BACKGROUND

Coronary angiography and percutaneous transluminal coronary angioplasty procedures cause anxiety and stress in individuals.

OBJECTIVE

The aim of this study was to determine the effect of foot reflexology applied before coronary angiography and percutaneous transluminal coronary angioplasty on the anxiety, stress, and cortisol levels of individuals.

METHODS

A simple randomized trial design was used. The patients who met the inclusion criteria were divided into 4 groups including experimental and control groups of coronary angiography patients (30 patients in each group) and percutaneous transluminal coronary angioplasty (26 patients in each group) by randomization method. Data were collected with the State-Trait Anxiety Inventory and Distress Thermometer 90 minutes before coronary angiography and percutaneous transluminal coronary angioplasty and the laboratory samples were taken. After these procedures, foot reflexology was applied to both feet of the patients in the experimental group for 30 minutes, and the control group received only standard care. The inventories were reapplied 30 minutes after the reflexology application and after coronary angiography and percutaneous transluminal coronary angioplasty.

RESULTS

Whereas there was no statistically significant difference (P > .05) between the coronary angiography and percutaneous transluminal coronary angioplasty experimental and control groups in Anxiety Inventory and stress median scores before reflexology, a significant difference was found (P < .001) 30 minutes after reflexology application and after coronary angiography and percutaneous transluminal coronary angioplasty. After the reflexology, anxiety and stress scores were significantly lower in the experimental group compared with the control group (P < .001). Whereas there was a significant difference (P < .001) in the within-group cortisol values of both reflexology groups, no significant difference was found in the control groups (P > .05).

CONCLUSIONS

The application of reflexology before coronary angiography and percutaneous transluminal coronary angioplasty reduces the levels of anxiety, stress, and cortisol without any side effects.

The effects of foot reflexology on depression during menopause: A randomized controlled clinical trial

OBJECTIVE

The purpose of this study was to determine the effects of foot reflexology on depression during menopause.

DESIGN

Randomized controlled clinical trial.

SETTING

Gynecology outpatient clinic.

INTERVENTIONS

We enrolled 90 menopausal women with depression. Participants were assigned to the intervention (n = 45) and control (n = 45) groups by block randomization. Participants in the intervention group received 15 min of foot reflexology on each foot for a total of 30 min in evenings, twice a week for six weeks. Participants in the control group received only the routine care for menopause patients.

MAIN OUTCOME MEASURES

The Beck Depression questionnaire was completed by all participants at the beginning of the trial and the end of the intervention and two months after completion of the intervention.

RESULTS

A total of 121 patients were assessed for eligibility to participate in the study. One-hundred patients met the criteria to participate, and 90 participants-45 participants in each group-completed the study. In the intervention group, the mean scores of depression before, immediately after, and two months after the study were 26.97 ± 4.47 (95% CI = 25.3-28.3), 22.55 ± 5.18 (95% CI = 20.9-24.1), and 21.20 ± 5.74 (95% CI = 19.4-22.9), respectively. In the control group, these scores were 26.15 ± 5.01 (95% CI = 24.6-27.6), 26.22 ± 5.14 (95% CI = 24.7-27.7), and 26.66 ± 3.87 (95%CI = 25.5-27.8), respectively. Using Repeated Measures ANOVA, the comparison of the mean scores of depression in the two groups indicated that the scores were decreased over time.

CONCLUSION

The findings indicated that the foot reflexology technique can be effective for reducing women's depression during menopause. However, considering the study's limitations, including a small sample size and no intervention in the control group, more studies are needed to verify the findings.

The Effect of Foot Reflexology on Hospital Anxiety and Depression in Female Older Adults: a Randomized Controlled Trial

BACKGROUND

Patients with cardiovascular diseases usually suffer from hospital anxiety and depression.

AIM

This study aimed to investigate the effect of foot reflexology massage on anxiety and depression in female older adults suffering from acute coronary syndrome.

PARTICIPANTS

Ninety older women with acute coronary syndrome were randomly assigned into intervention and control groups (n=45 in each group).

RESEARCH DESIGN

A randomized controlled trial.

INTERVENTION

The intervention and control groups received foot reflexology massage and routine care, respectively.

MAIN OUTCOMES MEASURES

The levels of anxiety and depression were evaluated using the hospital's anxiety and depression scale (HADS) before and immediately after foot reflexology massage.

RESULTS

Foot reflexology massage reduced both anxiety (F(1.44)=19.11, p = .001) and depression (F(1.44)=16.76, p = .001) in acute coronary patients relative to control patients. The intervention had a large effect on hospital anxiety and depression.

CONCLUSIONS

Foot reflexology massage is an efficient and safe intervention for alleviating psychological responses among female older adults suffering from acute coronary syndrome during hospitalization.

Comparison of the Effects of Hand Reflexology versus Acupressure on Anxiety and Vital Signs in Female Patients with Coronary Artery Diseases

Hospitalization in the cardiac care unit can increase anxiety in patients. This study aimed to compare hand reflexology versus acupressure on anxiety and vital signs in female patients with coronary artery diseases. This double-blinded randomized placebo-controlled trial with a pre- and post-intervention design was conducted on 135 female patients with coronary artery diseases. Female patients hospitalized in a cardiac care unit were randomly divided into three groups of hand reflexology, acupressure and placebo (n = 45 patients in each group) using blocking and a table of random numbers. Data was collected using the Spielberger anxiety inventory. Also, their vital signs were measured before, immediately after and half an hour after the intervention. Data analysis was performed using descriptive and analytical statistics. Before the intervention, there was no statistically significant difference in anxiety levels between the groups (p > 0.05). Also, the effects of hand reflexology and acupressure immediately and half an hour later on the reduction of anxiety and vital signs were equal (p < 0.05). Implementation of hand reflexology and acupressure can have positive effects on anxiety and vital signs in patients with coronary artery diseases. They can reduce patients' anxiety with an equal effectiveness.

Effectiveness of reflexology on anxiety of patients undergoing cardiovascular interventional procedures: A systematic review and meta-analysis of randomized controlled trials

AIM

To appraise the evidence concerning the effect of reflexology on the anxiety in patients undergoing cardiovascular interventional procedures.

BACKGROUND

Anxiety, fear, and other unpleasant emotional experiences are common among patients before and after cardiovascular interventional procedures. The higher anxiety may affect prognosis and recovery of patients.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

The MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Central Register of Controlled Trials (Cochrane Library), EMBASE, PsycINFO, and Web of Science were searched between 2001-2017.

REVIEW METHODS

Randomized controlled trials evaluated the effectiveness of reflexology on anxiety among patients undergoing cardiovascular interventional procedures were included. Meta-analysis was done using Revman 5.3.

RESULTS

Ten trials, representing 760 patients with the mean age of 59, fulfilled the inclusion criteria. Reflexology significantly decreased the anxiety of patients undergoing cardiovascular interventional procedures in the treatment group compared with the control group.

CONCLUSION

Reflexology has some positive effects on anxiety among patients undergoing cardiovascular procedures. It may be a useful complementary therapy and further research is necessary to create reliable evidence.

The effect of foot reflexotherapy on the dynamics of cortical oscillatory waves in healthy humans: An EEG study

BACKGROUND

Foot reflexotherapy is a noninvasive complementary therapy that has gained considerable application in several fields of human endeavor. The therapy is used to relieve the symptoms of several ailments. For instance, foot reflexotherapy when applied to the cortical areas of the left or right foot relieves pain and stress. However, the electrophysiological mechanisms of the effect of foot reflexotherapy on cortical activity are not completely understood. While it has been shown that foot reflexotherapy exert positive effects on brain functions, little is known about the effects of this therapy on cortical activities as recorded with electroencephalogram (EEG) in healthy humans. Cortical activity is widely investigated with EEG, a noninvasive recording that is used to study brain activity in different functional states and conditions.

AIM

The aim of this study was to investigate the effect of foot reflexotherapy on EEG rhythms in healthy humans.

MATERIAL AND METHODS

EEG recording before and after reflexological therapy was carried out in seven healthy right-handed males who volunteered for the study.

RESULTS

Analysis of EEG data revealed activation offrontal cortex that resulted to significant increase in beta and gamma spectral powers after foot reflexotherapy (p ˂ 0.05).

CONCLUSION

Foot reflexotherapy is associated with increase in spectral powers in beta and gamma frequency bands. Therefore cortical beta and gamma waves of the EEG could be used as measures of functional activation of the brain, related to foot reflexotherapy.

The Effects of Music Intervention on Background Pain and Anxiety in Burn Patients: Randomized Controlled Clinical Trial

This study aimed to investigate the effect of music on the background pain, anxiety, and relaxation levels in burn patients. In this pretest-posttest randomized controlled clinical trial, 100 hospitalized burn patients were selected through convenience sampling. Subjects randomly assigned to music and control groups. Data related to demographic and clinical characteristics, analgesics, and physiologic measures were collected by researcher-made tools. Visual analog scale was used to determine pain, anxiety, and relaxation levels before and after the intervention in 3 consecutive days. Patients' preferred music was offered once a day for 3 days. The control group only received routine care. Data were analyzed using SPSS-PC (V. 20.0). According to paired t-test, there were significant differences between mean scores of pain (P < .001), anxiety (P < .001), and relaxation (P < .001) levels before and after intervention in music group. Independent t-test indicated a significant difference between the mean scores of changes in pain, anxiety, and relaxation levels before and after intervention in music and control groups (P < .001). No differences were detected in the mean scores of physiologic measures between groups before and after music intervention. Music is an inexpensive, appropriate, and safe intervention for applying to burn patients with background pain and anxiety at rest. To produce more effective comfort for patients, it is necessary to compare different types and time lengths of music intervention to find the best approach.

Psychological interventions for coronary heart disease

BACKGROUND

Coronary heart disease (CHD) is the most common cause of death globally, although mortality rates are falling. Psychological symptoms are prevalent for people with CHD, and many psychological treatments are offered following cardiac events or procedures with the aim of improving health and outcomes. This is an update of a Cochrane systematic review previously published in 2011.

OBJECTIVES

To assess the effectiveness of psychological interventions (alone or with cardiac rehabilitation) compared with usual care (including cardiac rehabilitation where available) for people with CHD on total mortality and cardiac mortality; cardiac morbidity; and participant-reported psychological outcomes of levels of depression, anxiety, and stress; and to explore potential study-level predictors of the effectiveness of psychological interventions in this population.

SEARCH METHODS

We updated the previous Cochrane Review searches by searching the following databases on 27 April 2016: CENTRAL in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and CINAHL (EBSCO).

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of psychological interventions compared to usual care, administered by trained staff, and delivered to adults with a specific diagnosis of CHD. We selected only studies estimating the independent effect of the psychological component, and with a minimum follow-up of six months. The study population comprised of adults after: a myocardial infarction (MI), a revascularisation procedure (coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI)), and adults with angina or angiographically defined coronary artery disease (CAD). RCTs had to report at least one of the following outcomes: mortality (total- or cardiac-related); cardiac morbidity (MI, revascularisation procedures); or participant-reported levels of depression, anxiety, or stress.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles and abstracts of all references for eligibility. A lead review author extracted study data, which a second review author checked. We contacted study authors to obtain missing information.

MAIN RESULTS

This review included 35 studies which randomised 10,703 people with CHD (14 trials and 2577 participants added to this update). The population included mainly men (median 77.0%) and people post-MI (mean 65.7%) or after undergoing a revascularisation procedure (mean 27.4%). The mean age of participants within trials ranged from 53 to 67 years. Overall trial reporting was poor, with around a half omitting descriptions of randomisation sequence generation, allocation concealment procedures, or the blinding of outcome assessments. The length of follow-up ranged from six months to 10.7 years (median 12 months). Most studies (23/35) evaluated multifactorial interventions, which included therapies with multiple therapeutic components. Ten studies examined psychological interventions targeted at people with a confirmed psychopathology at baseline and two trials recruited people with a psychopathology or another selecting criterion (or both). Of the remaining 23 trials, nine studies recruited unselected participants from cardiac populations reporting some level of psychopathology (3.8% to 53% with depressive symptoms, 32% to 53% with anxiety), 10 studies did not report these characteristics, and only three studies excluded people with psychopathology.Moderate quality evidence showed no risk reduction for total mortality (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.77 to 1.05; participants = 7776; studies = 23) or revascularisation procedures (RR 0.94, 95% CI 0.81 to 1.11) with psychological therapies compared to usual care. Low quality evidence found no risk reduction for non-fatal MI (RR 0.82, 95% CI 0.64 to 1.05), although there was a 21% reduction in cardiac mortality (RR 0.79, 95% CI 0.63 to 0.98). There was also low or very low quality evidence that psychological interventions improved participant-reported levels of depressive symptoms (standardised mean difference (SMD) -0.27, 95% CI -0.39 to -0.15; GRADE = low), anxiety (SMD -0.24, 95% CI -0.38 to -0.09; GRADE = low), and stress (SMD -0.56, 95% CI -0.88 to -0.24; GRADE = very low).There was substantial statistical heterogeneity for all psychological outcomes but not clinical outcomes, and there was evidence of small-study bias for one clinical outcome (cardiac mortality: Egger test P = 0.04) and one psychological outcome (anxiety: Egger test P = 0.012). Meta-regression exploring a limited number of intervention characteristics found no significant predictors of intervention effects for total mortality and cardiac mortality. For depression, psychological interventions combined with adjunct pharmacology (where deemed appropriate) for an underlying psychological disorder appeared to be more effective than interventions that did not (β = -0.51, P = 0.003). For anxiety, interventions recruiting participants with an underlying psychological disorder appeared more effective than those delivered to unselected populations (β = -0.28, P = 0.03).

AUTHORS' CONCLUSIONS

This updated Cochrane Review found that for people with CHD, there was no evidence that psychological treatments had an effect on total mortality, the risk of revascularisation procedures, or on the rate of non-fatal MI, although the rate of cardiac mortality was reduced and psychological symptoms (depression, anxiety, or stress) were alleviated; however, the GRADE assessments suggest considerable uncertainty surrounding these effects. Considerable uncertainty also remains regarding the people who would benefit most from treatment (i.e. people with or without psychological disorders at baseline) and the specific components of successful interventions. Future large-scale trials testing the effectiveness of psychological therapies are required due to the uncertainty within the evidence. Future trials would benefit from testing the impact of specific (rather than multifactorial) psychological interventions for participants with CHD, and testing the targeting of interventions on different populations (i.e. people with CHD, with or without psychopathologies).

Evaluation of the preliminary effectiveness of hand massage therapy on postoperative pain of adults in the intensive care unit after cardiac surgery: a pilot randomized controlled trial

Although many intensive care unit patients experience significant pain, very few studies explored massage to maximize their pain relief. This study aimed to evaluate the preliminary effects of hand massage on pain after cardiac surgery in the adult intensive care unit. A pilot randomized controlled trial was used for this study. The study was conducted in a Canadian medical-surgical intensive care unit. Forty adults who were admitted to the intensive care unit after undergoing elective cardiac surgery in the previous 24 hours participated in the study. They were randomly assigned to the experimental (n = 21) or control (n = 19) group. The experimental group received a 15-minute hand massage, and the control group received a 15-minute hand-holding without massage. In both groups the intervention was followed by a 30-minute rest period. The interventions were offered on 2-3 occasions within 24 hours after surgery. Pain, muscle tension, and vital signs were assessed. Pain intensity and behavioral scores were decreased for the experimental group. Although hand massage decreased muscle tension, fluctuations in vital signs were not significant. This study supports potential benefits of hand massage for intensive care unit postoperative pain management. Although larger randomized controlled trials are necessary, this low-cost nonpharmacologic intervention can be safely administered.

Effects of Reflexology on Pain in Patients With Fibromyalgia

The aim of this study was to investigate the effect of reflexology on pain intensity in patients with fibromyalgia, using an experimental repeated-measures design, and a convenience sample of 30 fibromyalgia inpatients. Thirty patients aged 18 to 70 years with fibromyalgia and hospitalized in the algology clinic were taken as a convenience sample. Patients received a total of 12 60-minute sessions of reflexology over a period of 6 consecutive weeks. Reflexology was carried out bilaterally on the hands and feet of patients at the reflex points relating to their pain at a suitable intensity and angle. Subjects had pain scores taken immediately before the intervention (0 minute), and at the 60th minute of the intervention. Data were collected over a 10-month period in 2012. The patients' mean pain intensity scores were reduced by reflexology, and this decrease improved progressively in the first and sixth weeks of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of reflexology in the routine care of patients with fibromyalgia could provide nurses with an effective practice for reducing pain intensity in these patients.

The Effect of Music on Anxiety and Cardiovascular Indices in Patients Undergoing Coronary Artery Bypass Graft: A Randomized Controlled Trial

Background:

The instability of cardiovascular indices and anxiety disorders are common among patients undergoing coronary artery bypass graft (CABG) and could interfere with their recovery. Therefore, improving the cardiovascular indices and anxiety is essential.

Objectives:

This study aimed to investigate the effect of music therapy on anxiety and cardiovascular indices in patients undergoing CABG.

Patients and Methods:

In this randomized controlled trial, 60 patients hospitalized in the cardiovascular surgical intensive care unit of Shahid Beheshti Hospital in Qom city, Iran, in 2013 were selected using a consecutive sampling method and randomly allocated into the experimental and control groups. In the experimental group, patients received 30 minutes of light music, whereas in the control group, patients had 30 minutes of rest in bed. The cardiovascular indices and anxiety were measured immediately before, immediately after and half an hour after the study. Data were analyzed using the chi-square test and repeated measures analysis of variance.

Results:

Compared to the immediately before intervention, the mean anxiety scores immediately after and 30 minutes after the intervention were significantly lower in the experimental group (P < 0.037) while it did not significantly change in the control group. However, there were no significant differences regarding the cardiovascular indices in the three consecutive measurements (P > 0.05).

Conclusions:

Music therapy is effective in decreasing anxiety among patients undergoing CABG. However, the intervention was not effective on cardiovascular indices. Music can effectively be used as a non-pharmacological method to manage anxiety after CABG.

Non-pharmacological interventions for sleep promotion in the intensive care unit

BACKGROUND

Adults in intensive care units (ICUs) often suffer from a lack of sleep or frequent sleep disruptions. Non-pharmacological interventions can improve the duration and quality of sleep and decrease the risk of sleep disturbance, delirium, post-traumatic stress disorder (PTSD), and the length of stay in the ICU. However, there is no clear evidence of the effectiveness and harms of different non-pharmacological interventions for sleep promotion in adults admitted to the ICU.

OBJECTIVES

To assess the efficacy of non-pharmacological interventions for sleep promotion in critically ill adults in the ICU.To establish whether non-pharmacological interventions are safe and clinically effective in improving sleep quality and reducing length of ICU stay in critically ill adults.To establish whether non-pharmacological interventions are cost effective.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 6), MEDLINE (OVID, 1950 to June 2014), EMBASE (1966 to June 2014), CINAHL (Cumulative Index to Nursing and Allied Health Literature, 1982 to June 2014), Institute for Scientific Information (ISI) Web of Science (1956 to June 2014), CAM on PubMed (1966 to June 2014), Alt HealthWatch (1997 to June 2014), PsycINFO (1967 to June 2014), the China Biological Medicine Database (CBM-disc, 1979 to June 2014), and China National Knowledge Infrastructure (CNKI Database, 1999 to June 2014). We also searched the following repositories and registries to June 2014: ProQuest Dissertations & Theses Global, the US National Institutes of Health Ongoing Trials Register (www.clinicaltrials.gov), the metaRegister of Controlled Trials (ISRCTN Register) (www.controlled-trials.com), the Chinese Clinical Trial Registry (www.chictr.org.cn), the Clinical Trials Registry-India (www.ctri.nic.in), the Grey Literature Report from the New York Academy of Medicine Library (www.greylit.org), OpenGrey (www.opengrey.eu), and the World Health Organization International Clinical Trials Registry platform (www.who.int/trialsearch). We handsearched critical care journals and reference lists and contacted relevant experts to identify relevant unpublished data.

SELECTION CRITERIA

We included all randomized controlled trials (RCT) and quasi-RCTs that evaluated the effects of non-pharmacological interventions for sleep promotion in critically ill adults (aged 18 years and older) during admission to critical care units or ICUs.

DATA COLLECTION AND ANALYSIS

Two authors independently screened the search results and assessed the risk of bias in selected trials. One author extracted the data and a second checked the data for accuracy and completeness. Where possible, we combined results in meta-analyses using mean differences and standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. We used post-test scores in this review.

MAIN RESULTS

We included 30 trials, with a total of 1569 participants, in this review. We included trials of ventilator mode or type, earplugs or eye masks or both, massage, relaxation interventions, foot baths, music interventions, nursing interventions, valerian acupressure, aromatherapy, and sound masking. Outcomes included objective sleep outcomes, subjective sleep quality and quantity, risk of delirium, participant satisfaction, length of ICU stay, and adverse events. Clinical heterogeneity (e.g., participant population, outcomes measured) and research design limited quantitative synthesis, and only a small number of studies were available for most interventions. The quality of the evidence for an effect of non-pharmacological interventions on any of the outcomes examined was generally low or very low. Only three trials, all of earplugs or eye masks or both, provided data suitable for two separate meta-analyses. These meta-analyses, each of two studies, showed a lower incidence of delirium during ICU stay (risk ratio 0.55, 95% confidence interval (CI) 0.38 to 0.80, P value = 0.002, two studies, 177 participants) and a positive effect of earplugs or eye masks or both on total sleep time (mean difference 2.19 hours, 95% CI 0.41 to 3.96, P value = 0.02, two studies, 116 participants); we rated the quality of the evidence for both of these results as low.There was also some low quality evidence that music (350 participants; four studies) may improve subjective sleep quality and quantity, but we could not pool the data. Similarly, there was some evidence that relaxation techniques, foot massage, acupressure, nursing or social intervention, and sound masking can provide small improvements in various subjective measures of sleep quality and quantity, but the quality of the evidence was low. The effects of non-pharmacological interventions on objective sleep outcomes were inconsistent across 16 studies (we rated the quality of the evidence as very low): the majority of studies relating to the use of earplugs and eye masks found no benefit; results from six trials of ventilator modes suggested that certain ventilator settings might offer benefits over others, although the results of the individual trials did not always agree with each other. Only one study measured length of stay in the ICU and found no significant effect of earplugs plus eye masks. No studies examined the effect of any non-pharmacological intervention on mortality, risk of post-traumatic stress disorder, or cost-effectiveness; the included studies did not clearly report adverse effects, although there was very low quality evidence that ventilator mode influenced the incidence of central apnoeas and patient-ventilator asynchronies.

AUTHORS' CONCLUSIONS

The quality of existing evidence relating to the use of non-pharmacological interventions for promoting sleep in adults in the ICU was low or very low. We found some evidence that the use of earplugs or eye masks or both may have beneficial effects on sleep and the incidence of delirium in this population, although the quality of the evidence was low. Further high-quality research is needed to strengthen the evidence base.

Evaluation of the Effect of Reflexology on Pain Control and Analgesic Consumption After Appendectomy

BACKGROUND AND OBJECTIVE

Appendicitis is the most common cause of severe abdominal pain in the world, and the associated postsurgical pain, as occurs with other surgical procedures, is one of the most common problems. Today, there is a growing tendency toward nondrug methods and alternative medicine to reduce the adverse effects of drugs. Reflexology involves applying pressure on certain areas of the palms, feet, and ears in order to reduce stress and pain in certain areas of the body. The aim of this study was to determine the effect of reflexology massage on pain relief after appendectomy.

METHODS

This clinical trial was conducted at the surgical emergency unit of Imam Reza Hospital of Mashhad, Iran, in 2013. Pain intensity and analgesic consumption were compared between 105 patients before and immediately, 1 hour, 6 hours, and 24 hours after the intervention in three groups of intervention, control, and placebo. Patients in all three groups received analgesics, as required. The experimental group received pressure on a defined area of the right foot for about 10 minutes and the Shen Men point of the ear for 1 minute. This pressure in the placebo group was applied on the left foot and the left earlobe. Patients in the control group received routine care only. The results were evaluated at a 95% confidence level, and data were analyzed using SPSS software version 12 (SPSS, Inc., Chicago, IL).

RESULTS

At the beginning of the study, the mean pain intensity in different groups according to analysis of variance was not significantly different (p = 0.439); however, there was a notable difference in pain intensity between the intervention and other groups after reflexology therapy. In addition, methadone consumption was significantly lower in the reflexology group than in the other two groups (p ≤ 0.001).

CONCLUSION

Reflexology is effective for reducing pain after appendectomy surgery.

Feasibility and acceptability of hand massage therapy for pain management of postoperative cardiac surgery patients in the intensive care unit

OBJECTIVE

The purpose was to evaluate the acceptability and feasibility of hand massage therapy in the intensive care unit (ICU).

BACKGROUND

Clinical guidelines suggest the use of non-pharmacological interventions for pain management in ICU adults. The results presented are secondary to a pilot RCT evaluating the preliminary effectiveness of hand massage on pain after cardiac surgery.

METHODS

A qualitative descriptive design was used. Acceptability was evaluated using individual interviews with participants in both groups i.e., experimental and control (n = 40). Feasibility was examined using field notes and video recordings.

RESULTS

While participants receiving the massage perceived it as appropriate, the control group suggested different dosages of the treatment and body areas targeted. Results also suggest that barriers (e.g. noise, numerous clinical activities) need to be overcome.

CONCLUSIONS

Increasing staff acceptance, reducing the rest period, involving families, and repeating the treatment are avenues to consider. Building evidence for non-pharmacological pain management in the critical care setting is necessary.

Reflexology: its effects on physiological anxiety signs and sedation needs

To investigate whether reflexology has an effect on the physiological signs of anxiety and level of sedation in patients receiving mechanically ventilated support, a single blinded, randomized controlled design with repeated measures was used in the intensive care unit of a university hospital in Turkey. Patients (n = 60) aged between 18 and 70 years and were hospitalized in the intensive care unit and receiving mechanically ventilated support. Participants were randomized to a control group or an intervention group. The latter received 30 minutes of reflexology therapy on their feet, hands, and ears for 5 days. Subjects had vital signs taken immediately before the intervention and at the 10th, 20th, and 30th minutes of the intervention. In the collection of the data, "American Association of Critical-Care Nurses Sedation Assessment Scale" was used. The reflexology therapy group had a significantly lower heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate than the control group. A statistically significant difference was found between the averages of the scores that the patients included in the experimental and control groups received from the agitation, anxiety, sleep, and patient-ventilator synchrony subscales of the American Association of Critical-Care Nurses Sedation Assessment Scale. Reflexology can serve as an effective method of decreasing the physiological signs of anxiety and the required level of sedation in patients receiving mechanically ventilated support. Nurses who have appropriate training and certification may include reflexology in routine care to reduce the physiological signs of anxiety of patients receiving mechanical ventilation.

The physiological and biochemical outcomes associated with a reflexology treatment: a systematic review

Background. Reflexology is one of the top forms of complementary and alternative medicine in the UK and is used for healthcare by a diverse range of people. However, it is offered by few healthcare providers as little scientific evidence is available explaining how it works or any health benefits it may confer. The aim of this review was to assess the current evidence available from reflexology randomised controlled trials (RCTs) that have investigated changes in physiological or biochemical outcomes. Methods. Guidelines from the Cochrane Handbook of Systematic Reviews of Interventions were followed: the following databases were searched from inception to December 2013: AMED, CAM Quest, CINAHL Plus, Cochrane Central Register of Controlled Trials, Embase, Medline Ovid, Proquest, and Pubmed. Risk of bias was assessed independently by two members of the review team and overall strength of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation guidelines. Results. Seventeen eligible RCTs met all inclusion criteria. A total of 34 objective outcome measures were analysed. Although twelve studies showed significant changes within the reflexology group, only three studies investigating blood pressure, cardiac index, and salivary amylase resulted in significant between group changes in favour of reflexology. The overall quality of the studies was low.

Is there a specific hemodynamic effect in reflexology? A systematic review of randomized controlled trials

OBJECTIVES

Reflexology claims that the feet are representative of the body and that massage to specific points of the feet increases blood supply to "mapped" organs in the body. This review provides the first systematic evaluation of existing reflexology randomized controlled trials (RCTs) to determine whether there is any evidence to suggest the existence of a reflexology treatment-related hemodynamic effect; to examine whether reflexology researchers used study designs that systematically controlled for nonspecific effects in order to isolate this specific component; and to highlight some of the methodological challenges that need to be overcome to demonstrate specific and beneficial hemodynamic effects.

DESIGN

Fifty-two RCTs of reflexology published from 1990 to September 2011 were initially retrieved.

SETTING/LOCATION

Cardiorespiratory Department, Highland Heartbeat Centre, Raigmore Hospital, Inverness.

SUBJECTS

Adult subjects.

INTERVENTIONS

Studies using reflexology foot massage techniques as the intervention versus sham reflexology treatment, simple foot massage, conventional treatment, or no treatment as the control were then selected.

OUTCOME MEASURES

OUTCOME MEASURES included any hemodynamic parameter potentially involved in the regulation of circulating blood volume and flow, including heart rate and systolic and diastolic arterial blood pressure.

RESULTS

Seven RCTs suggested that reflexology has an effect on selected cardiovascular parameters; however, five of these delivered the reflexology intervention as a whole complex treatment, with the data collector often delivering the intervention themselves.

CONCLUSIONS

This systematic review found that although reflexology has been shown to have an effect on selected hemodynamic variables, the lack of methodological control for nonspecific general massage effects means that there is little convincing evidence at this time to suggest the existence of a specific treatment-related hemodynamic effect. Furthermore, the review found that few studies of reflexology controlled for nonspecific effects in order to isolate any specific active component, despite the hemodynamic claim being a key part of the therapeutic value of reflexology. Therefore, further research approaches using more innovative designs and robust methods that can allow a treatment-induced, therapeutically beneficial hemodynamic effect to reveal itself are needed to help reflexology purchasers make a more informed decision about the safety and product quality of the reflexology hemodynamic claim and for reflexologists to be able to guarantee minimum product quality, validity, and safety standards in their practice.

Psychological interventions for coronary heart disease

BACKGROUND

Psychological symptoms are strongly associated with coronary heart disease (CHD), and many psychological treatments are offered following cardiac events or procedures.

OBJECTIVES

Update the existing Cochrane review to (1) determine the independent effects of psychological interventions in patients with CHD (principal outcome measures included total or cardiac-related mortality, cardiac morbidity, depression, and anxiety) and (2) explore study-level predictors of the impact of these interventions.

SEARCH STRATEGY

The original review searched Cochrane Controleed Trials Register (CCTR, Issue 4, 2001), MEDLINE, EMBASE, PsycINFO, and CINAHL to December 2001. This was updated by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, PsycINFO and CINAHL from 2001 to January 2009. In addition, we searched reference lists of papers, and expert advice was sought for the original and update review.

SELECTION CRITERIA

Randomised controlled trials of psychological interventions compared to usual care, administered by trained staff. Only studies estimating the independent effect of the psychological component with a minimum follow-up of six months. Adults with specific diagnosis of CHD.

DATA COLLECTION AND ANALYSIS

Titles and abstracts of all references screened for eligibility by two reviewers independently; data extracted by the lead author and checked by a second reviewer. Authors contacted where possible to obtain missing information.

MAIN RESULTS

There was no strong evidence that psychological intervention reduced total deaths, risk of revascularisation, or non-fatal infarction. Amongst a smaller group of studies reporting cardiac mortality there was a modest positive effect of psychological intervention (relative risk: 0.80 (95% CI 0.64 to 1.00)). Furthermore, psychological intervention did result in small/moderate improvements in depression, standardised mean difference (SMD): -0.21 (95% CI -0.35, -0.08) and anxiety, SMD: -0.25 (95% CI -0.48 to -0.03). Results for mortality indicated some evidence of small-study bias, though results for other outcomes did not. Meta regression analyses revealed four significant predictors of intervention effects on depression were found: (1) an aim to treat type-A behaviours (ß = -0.32, p = 0.03) were more effective than other interventions. In contrast, interventions which (2) aimed to educate patients about cardiac risk factors (ß = 0.23, p = 0.03), (3) included client-led discussion and emotional support as core therapeutic components (ß = 0.31, p < 0.01), or (4) included family members in the treatment process (ß = 0.26, p < 0.01) were significantly less effective.

AUTHORS' CONCLUSIONS

Psychological treatments appear effective in treating psychological symptoms of CHD patients. Uncertainly remains regarding the subgroups of patients who would benefit most from treatment and the characteristics of successful interventions.