The effects of reflexology on anxiety and pain in patients after abdominal hysterectomy: A randomised controlled trial
Introduction
Hysterectomy is described as the surgical removal of uterus and is the most frequently performed surgical intervention after cesarean section. Although the rate of hysterectomy has decreased significantly worldwide, it is still one of the most commonly performed major gynecologic surgeries and is performed mostly in the reproductive ages.1, 2, 3 The most frequently observed complaints after hysterectomy are pain and fatigue, including the postoperative period.4 Touch and massage therapy have been used in pain treatment for centuries. Massage, integrated with pharmacologic treatment, has been found to be helpful in the treatment of acute postoperative pain.5
Touch therapy has always been a part of nursing care and now, reflexology has become another part of it.6 Reflexology, which is defined as a holistic healing technique, is an ancient art involving various techniques and philosophical approaches.7, 8 The pictures in the Egyptian tombs show that foot massage was used as a treatment 5000 years ago.9 Reflexology is said to be introduced to the West only for around 90 years ago, although it has been long known in China and Egypt.10 The emergence of zone therapy was first described by Dr. William Fitzgerald, but Eunice Ingham is considered the mother of reflexology who mapped the body on the foot. Development of reflexology technique has developed, for example using precision reflexology that involves holding discrete reflexes on the feet, vertical reflexology and meridian focused reflexology.11, 12, 13 Reflexology is not only a method based on stimulating the reflex points at the bottom of the foot but also similar to massage in that it manipulates soft tissue for therapeutic purposes. But also differs from massage in that it involves a more superficial contact and a deeper pressure on certain parts of the foot, and it resembles a caterpillar-like movement.14, 15, 16 The feet represent a microcosm of the body, all organs, glands and other body parts are laid out in a similar arrangement on the feet. 17 In this way, It is believed that each part of the body is connected to a certain point at the bottom of the foot, and the pressure applied to these points will result in a relaxed and balanced body.18 Reflexology has also been reported to help relieve stress and tension, improve blood flow and promote homeostasis.15
Recent research findings demonstrate reflexology as a care alternative with a wider acceptance and popularity than yesterday.7, 19 Studies also have confirmed the positive effects of reflexology, especially on postoperative pain.9, 20, 21 Randomized controlled studies by Tsay et al.14 evaluating the effects of reflexology on postoperative pain and anxiety in patients with stomach cancer and hepatocellular carcinoma demonstrated that the patients in the intervention group felt less pain and anxiety.9 An experimental research investigated the effects of hand reflexology on the levels of pain in postoperative abdominal surgery patients. The result of study, the mean pain score in post abdominal surgery patients after receiving true hand reflexology was significantly lower than after receiving mimic hand reflexology.21 Reflexology also has psychological benefits such as relaxation and improving the sense of well-being.6 Nurses, who are effective on pain qualified control after surgery, should also provide non-pharmacological pain relief to patients. Reflexology is a simple noninvasive method which has no complications and can be regarded as a part of nursing care in the critical care units.22 The present study aimed to determine the effects of foot reflexology on the postoperative pain and anxiety levels of patients who underwent abdominal hysterectomy; thereby contributing to the existing non-pharmacologic pain relief interventions used by nurses and providing a holistic qualified nurse care.
The research questions were as follows: −What are the effects of foot reflexology on pain and anxiety in patients who underwent abdominal hysterectomy as compared with a control group? −Is there any difference pain control interventions (patient-controlled analgesia treatment) between experimental and control groups after abdominal hysterectomy?
Section snippets
Design
This randomized controlled trial study aimed at exploring the effects of reflexology practice on pain, anxiety levels of the patients after abdominal hysterectomy. The study was conducted with the female patients treated in the intensive care units and gynecology services at Gynecology & Obstetrics Department of Ege University Hospital in İzmir after abdominal hysterectomy between September 2013 and September 2014.
Formal enrolment into the research was based on the following inclusion criteria:
Descriptive statistics
The female patients’ average age was 47.23 ± 4.71 (min: 37, max: 57) years. All participants, 34.9% were secondary/upper secondary school graduates, 77.8% were married, 71.4% were not working, and 60.3% had one or two children. Table 1 below demonstrates that there was no statistically meaningful difference between the socio-demographic characteristics of the experimental and control groups in the chi-square analyses carried out to determine the homogeneity of the groups. A total of 63
Discussion
Most individuals have difficulty in coping with the postoperative pain.34 One of the major challenges today is to decrease the pain.35 Although they are essential for postoperative pain management, analgesics may not always sufficiently relieve the pain. Reports find the administration to be insufficient, although new drugs and methods for postoperative pain control have been acquired in 20 years. Besides, analgesics have a few undesired side effects.36, 37 Therefore complementary therapy and
Acknowledgements
The authors would like to thank them for financial support to Ege University Scientific Research Projects Committee (13-HYO-008). That greatly improved the manuscript, and the participants of the study for their highly appreciated cooperation.
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