Massage as adjuvant therapy in the management of post-cesarean pain and anxiety: A randomized clinical trial

ObjectiveThe present study was conducted to determine the effect of massage on post-cesarean pain and anxiety.MethodsThe present single-blind clinical trial was conducted on 156 primiparous women undergone elective cesarean section. The participants were randomly divided into three groups, including a hand and foot massage group, a foot massage group and a control group (n = 52 per group). The patients' intensity of pain, vital signs and anxiety level were measured before, immediately after and 90 min after the massage.ResultsA significant reduction was observed in the intensity of pain immediately and 90 min after massage (P < 0.001). Moreover, changes in some of the physiological parameters, including blood pressure and respiration rate, were significant after massage (P < 0.001); however, this change was not significant for pulse rate. A significant reduction was also observed in the level of anxiety (P < 0.001) and a significant increase in the frequency of breastfeeding (P < 0.001) after massage.ConclusionAs an effective nursing intervention presenting no side-effects, hand and foot massage can be helpful in the management of postoperative pain and stress.     

The effect of foot reflexology and back massage on hemodialysis patients' fatigue and sleep quality

ObjectiveThe aim of this study is to examine the effectiveness of foot reflexology and back massage on optimizing the sleep quality and reducing the fatigue of hemodialysis patients.MethodsThe study includes 105 volunteer patients who were registered at a private dialysis clinic and were receiving hemodialysis treatment. Foot reflexology and back massage were administered to the patients two times a week for four weeks. The Visual Analogue Scale for Fatigue and the Pittsburg Sleep Quality Index were used to collect data.ResultsThe differences between the pretest and posttest score averages of the patients on the Visual Analogue Scale for Fatigue and the Pittsburg Sleep Quality Index were statistically significant (p < 0.001).ConclusionFoot reflexology and back massage were shown to improve the sleep quality and reduce the fatigue of hemodialysis patients. Compared to back massage, foot reflexology was determined to be more effective.     

The effects of foot reflexology massage on anxiety in patients following coronary artery bypass graft surgery: A randomized controlled trial

ObjectiveTo examine the effects of foot reflexology massage on anxiety in patients following CABG surgery.MethodsIn this randomized controlled trial, 80 patients who met the inclusion criteria were conveniently sampled and randomly allocated to the experimental and control groups after they were matched on age and gender. On the days following surgery, the experimental group received foot reflexology massage on their left foot 20 min a day for 4 days, while the control group was given a gentle foot rub with oil for one minute. Anxiety was measured using the short-form of the Spielberger State-Trait Anxiety Inventory and the Visual Analogue Scale-Anxiety.ResultsBoth measurement instruments confirmed a significant decrease in anxiety following the foot reflexology massage.ConclusionThe significant decrease in anxiety in the experimental group following the foot reflexology massage supports the use of this complementary therapy technique for the relief of anxiety.     

Comparing the effects of massage and aromatherapy massage with lavender oil on sleep quality of cardiac patients: A randomized controlled trial

IntroductionSleep disorder is a common problem in cardiac patients. This study aimed to investigate the effect of massage and aromatherapy massage on sleep quality of cardiac patients.Materials and methodsin this study, 150 subjects were randomly allocated into 1)massage, 2)aromatherapy massage and 3)control. In the massage group, the subjects received hands and feet massage using sweet almond oil. In the second group, the massage was performed on the same areas using a mixture of lavender and sweet almond oil. Data collection tool included Pittsburgh Sleep Quality Index (PSQI). Before and after the intervention, the PSQI was completed by the subjects.ResultsThere was a significant difference between the mean scores of PSQI before and after the intervention in the intervention and control groups, but this difference was not statistically significant between the two intervention groups.ConclusionMassage and aromatherapy massage can improve the sleep quality in cardiac patients.     

Randomised controlled trial of the effectiveness of using back massage to improve sleep quality among Taiwanese insomnia postpartumwomen

Objective

to examine the effectiveness of using back massage to improve sleep quality in postpartum women.

Design and setting

randomised controlled trial, conducted at a postpartum centre in Northern Taiwan.

Participants

sixty postpartum women reporting poor quality of sleep were recruited from February 2012 to May2012.

Interventions

participants were assigned randomly to either an intervention or a control group. Participants in both groups received the same care except for back massage therapy. The intervention group received a single 20-minutes back massage session at the same time each evening for 5consecutive days. Sessions were administered by a certified massage therapist.

Measures and finding

the outcome measure was the Pittsburgh Sleep Quality Index (PSQI), which was administered pre- and post-test. Using a generalised estimation equation to control several confounding variables, the changes in mean PSQI were significantly lower in the intervention group (B=−3.97, standard error=0.43, p<0.001) than in the controlgroup.

Conclusions

an intervention involving back massage in the postnatal period significantly improved the quality ofsleep.

Implications for practice

midwives should evaluate maternal sleep quality and design early intervention programs to improve the quality of sleep, to increase maternal health. Midwives interested in complementary therapies should be encouraged to obtain training in back massage and to apply it in postpartumcare.     

An 'admission challenge test' to predict severe hypertension in pregnancy?

Although many pregnant women are admitted to hospital for 'high blood pressure' during the third trimester, less than a third of them will subsequently develop severe hypertension. We used a Dinamap 1846 vital signs monitor to measure the blood pressure every 5 min during the first hour in hospital of a group of 51 previously normotensive pregnant women admitted with hypertension. An average systolic pressure at or above 140 mmHg was recorded in 37% of patients and, of these, 68% went on to develop severe hypertension. Conversely, if the average systolic pressure on admission was below 140 mmHg, only 3% of patients later developed severe hypertension. In terms of sensitivity, specificity, and positive and negative predictive values of severe hypertension, the 1-hour automated blood pressure profile was superior to conventional measurements whether they were made prior to admission, on admission, or during the first 24 hours after admission.     

Maternal subjective sleep quality and nighttime infant care

The current study explored the relationship between maternal subjective sleep quality and two factors that have been independently linked to maternal sleep: infant caretaking at night and maternal depressive symptom severity. Participants were a follow‐up cohort of 94 women (mean age 33.3, SD=4.4), who were depressed during pregnancy and part of a larger randomised controlled trial. Participants were evaluated 10 weeks after delivery, using the Edinburgh Postnatal Depression Scale and daily sleep logs for one week. On average, women woke to attend to the infant 2.2 times (SD=1.1) and spent 47.3 min (SD=33.0) awake to attend to the infant. Regression analysis revealed that the number of times a woman’s sleep was disrupted by attending to her infant was a significant predictor of her perceived subjective sleep quality; however, the total amount of time she spent attending to her infant and her depressive symptom severity were not predictors. The findings of this study suggest that during the third postpartum month, sleep fragmentation appears more detrimental to maternal subjective sleep quality than amount of time awake during the night. This finding is relevant to the implementation of clinical interventions for improving maternal subjective sleep quality during the early postpartum period.     

Comparing the effects of ice massage and acupressure on labor pain reduction

BackgroundChildbirth is arguably one of the most painful experiences women undergo during their lives. This study aimed to compare the effects of ice massage, acupressure and placebo in reducing the intensity of labor pain in pregnant women from selected hospitals in Tehran, Iran.MethodsA quasi-experimental study was conducted on 90 pregnant women referred from selected hospitals in Tehran. Mean age of the participants was 27.82 ± 6.20 years. Subjects were randomly divided into three groups (n = 30) to receive ice massage, acupressure or placebo. The intervention was applied at the Hegu point and pain intensity assessed using a visual analogue scale (VAS) before the intervention, immediately 30 min and 1 h after the intervention.ResultsComparing pain intensity immediately, 30 min and 1 h post-intervention across the three groups showed a significant difference between the groups. At 30 min post-intervention (p < 0.05). A Tukey test showed this difference was related to ice massage.ConclusionIce massage and acupressure techniques reduced pain during labor. However, ice massage provided more persistent pain relief. Due to high levels of pain intensity and increased pain experienced by the women during the active phase of labor, it is suggested that repeating these techniques during the first stage of labor could be an effective, accessible, cost-effective and non-invasive technique to help reduce the intensity of labor pain.     

Effects of manual cranial therapy on heart rate variability in children without associated disorders: Translation to clinical practice

Backgroundand purpose: Heart rate variability (HRV) represents a marker of autonomic activity, self-regulation and psychiatric illness. Few studies of manual therapy have investigated the neurophysiological effects of manual cranial therapy (MC-t). This study assessed the neurophysiological short/medium-term effects of two manual therapy interventions: massage therapy (Mss-t) and MC-t.Materials and methodsA double-blind clinical trial was conducted with 50 healthy children, randomized into two groups who received a Mss-t intervention or MC-t. The variables analysed included vital signs (temperature, respiratory rate, heart rate, blood pressure) and HRV components, including the root mean square of successive differences (RMSSD), high frequency (HF), low frequency (LF) and LF/HF ratio.ResultsBoth interventions produced short-term parasympathetic effects, although the effects of MC-t were more persistent.ConclusionThe persistence of the MC-t intervention suggested a prominent vagal control and better self-regulation. Autonomic imbalances in mental pathologies may benefit from the neurophysiological effects of MC-t.     

Challenges of judging pain in vulnerable infants

The inevitability of pain during infancy and its potential for destructive impact impose a burden on caregiving adults. An armamentarium of effective pharmacological, behavioral and environmental interventions is available if pain were recognized and accurately assessed. Infants have limited behavioral repertoires that make identification of specific needs difficult, mothers and other caregivers prone to high levels of protection and redundant care. But more specific care can best suit infant requirements. Certain behaviors are sensitive to states of distress, including pain, for example, cry and disruption of usual activities such as sleep. Others appear more specific, for example, facial activity. This paper proposes that effective care is best delivered to infants and children if we recognize the complexities of the sociocommunication process; subjective states are encoded in behavioral activity and caregivers must be able to recognize the meaning of these actions. The paper delineates some features of the process whereby caregivers arrive at judgments of infant's needs and make decisions concerning interventions.     

The function of sildenafil on female sexual pathways: a double-blind,cross-over,placebo-controlled study

Objectives: To determine the changes, if any, on female sexual pathways using sildenafil (primary outcome), and to verify the safety of this drug (second outcome). Study design: Following previous research on symptomatic women, we wanted to study the effects of sildenafil on asymptomatic women. We would like to make it clear from the outset that this study is part of an ongoing line of research and this drug, and others of its type, should be used under strict medical supervision only on symptomatic patients. A randomized double-blind cross-over, placebo-controlled study was conducted at the Family Planning Centre of the Group for Sexological Research, Department of Microbiological and Gynecological Science, School of Medicine, University of Catania, Italy. Sixty-eight healthy volunteer women aged 19–38 years, asymptomatic for sexual disorders, were enrolled. The study consisted of 4 weeks sildenafil, 2 weeks washout, and 4 weeks placebo, by two possible sequences: sildenafil 50 mg, washout, placebo; or placebo, washout, sildenafil 50 mg. Efficacy of sildenafil was assessed by the Personal Experiences Questionnaire (PEQ) based on the 5-point Likert scale. The questionnaire quantified subjective sexual aspects at baseline, during washout, after treatments, and at the follow-ups. Statistical analysis was done with the Wilcoxon’s rank-sum test and Student’s t-test. Results: 50/68 women completed the study at the first follow-up, and 38 women reached the second follow-up. Six women withdrew because of adverse events. Sildenafil improved arousal (P<0.001), orgasm (P<0.05), and enjoyment (P<0.001) with respect to placebo. Significant differences were noted during sildenafil usage with respect to the baseline for arousal (P<0.01), orgasm (P<0.001), and sexual enjoyment (P<0.001). The adverse events were transient and mild or moderate. Conclusions: Our study suggests that sildenafil acts on the different sexual pathways in healthy women, improving their sexual experience. This study could help to understand the physiologic and pathophysiologic aspects of female sexuality. In comparison with current psychosexual therapies, which are long-term, compliance would be improved with use of this drug. Additional studies are required to define the use of sildenafil in a clinical setting.     

Single-shot intrathecal sufentanil with bupivacaine in late labour--analgesic quality and obstetric outcome

Objectives: To investigate the analgesic effect and obstetric outcome after single-shot intrathecal sufentanil with bupivacaine in late labour. Study design: Forty multiparous women in advanced labour were given a spinal injection of sufentanil 7.5 μg and bupivacaine 2 mg. Pain intensity was recorded by the parturient on a visual analogue scale. The quality of pain relief was also rated with a verbal score directly after delivery. Side effects, such as hypotension, pruritus, sedation, nausea and motor block were noted. Obstetric parameters were followed and recorded. Apgar score and umbilical artery pH were noted. Results: Median visual analogue scores after 5, 15, 30, 60, 90, 120 and 150 min were 1.5, 0.5, 0, 1, 1.5, 2 and 3, respectively. Seventy-seven percent of the parturients scored the analgesic quality as excellent. Six parturients had hypotension. Motor block, sedation and nausea were rare. Pruritus was seen in 85% of the cases. No ceasarean section was performed. Vacuum extraction was done in six (15%) cases. Oxytocin augmentation was needed in 26 (65%) of the parturients. Fetal heart rate disturbances following the spinal block were seen in four cases. Apgar scores were high. No neonate had Apgar <7. Conclusions: Intrathecal block with sufentanil 7.5 μg in combination with bupivacaine 2 mg is a very effective pain relief in late labour. Due to its limited duration it is important to select women in rapid progress of labour, and active obstetric management is necessary. It is also very important that the obstetrician is aware of the risk of non-reassuring fetal heart rate changes after intrathecal block.     

Effect of aromatherapy massage with lavender essential oil on pain in patients with osteoarthritis of the knee: A randomized controlled clinical trial

BackgroundOsteoarthritis of the knee is the most common chronic joint disease that involves middle aged and elderly people. The purpose of this study was to investigate the effect of aromatherapy massage with lavender essential oil on pain in patients with osteoarthritis of the knee.MethodsIn this single-blinded, randomized clinical trial, 90 patients with osteoarthritis of the knee who referred to the outpatient rheumatology clinics affiliated with Birjand University of Medical Sciences were selected through convenience sampling method. They were randomly assigned to three groups: intervention (aromatherapy massage with lavender essential oil), placebo (massage with almond oil) and control (without massage). The patients were evaluated at baseline, immediately after the intervention, 1 week, and 4 weeks after the intervention in terms of pain via visual analogue scale. The data were analyzed in SPSS (version 16) using the repeated measure ANOVA, one-way ANOVA, and chi-squared test.ResultsPain severity of the patients in the intervention group was significantly different immediately and 1 week after the intervention compared with their initial status (p < 0.001) and that of the control group (p < 0.001 and p = 0.009 respectively). However, at the third phase of follow-up (i.e., 4 weeks after the intervention), there was no significant difference between the groups according to the visual analogue scale (p = 0.67).ConclusionAromatherapy massage with lavender essential oil was found effective in relieving pain in patients with knee osteoarthritis. However, further studies are needed to confirm findings of this study.     

Variations in sleep associated with different types of hormonal contraceptives

Abstract

Progesterone and some of its metabolites are neuroactive steroids that affect sleep by increasing melatonin secretion and stimulating GABA-A receptors. The effect of progestogens in hormonal contraceptives on sleep has not been thoroughly investigated. This observational study assessed possible associations in sleep changes induced by estrogen–progestogens in contraceptives in 108 women between the ages of 20 and 50?years. We assessed mean nightly sleep time with a 31-day sleep diary, and subjective sleep quality with the five subjective subscores of the Pittsburgh Sleep Quality Index (PSQI). Included women were of childbearing age, healthy, sexually active and had been using a hormonal contraceptive method (pill, intrauterine system (IUS), subcutaneous implant, vaginal ring) for at least six months. Results were compared to a matched control group that did not use hormonal contraceptives. The longest mean nightly sleep time, compared to control (450?min), occurred in women who used progestogen-only oral contraception (510?min), followed by IUS delivery of levonorgestrel 13.5?mg (480?min) and oral ethinylestradiol 0.02/0.03?mg plus gestodene 0.075?mg (475?min). Global subjective sleep quality was influenced most by the administration of etonorgestrel 0.120?mg/ethinylestradiol 0.015?mg via the vaginal route. Our results show that low-doses of progestins affect various aspects of sleep, and that this is influenced by the route of administration.     

Uterine massage to reduce postpartum hemorrhage after vaginal delivery

Objective

To determine the effectiveness of sustained uterine massage started before delivery of the placenta in reducing postpartum hemorrhage.

Methods

A randomized controlled trial conducted in Egypt and South Africa between September 2006 and February 2009. A total of 1964 pregnant women were randomly allocated to 1 of 3 treatment groups: intramuscular oxytocin, sustained uterine massage, or both treatments. Blood loss within 30 minutes of delivery was recorded.

Results

The incidence of blood loss of 300 mL or more within 30 minutes of delivery was significantly higher in the massage group than in the massage plus oxytocin (RR 1.88; 95% CI, 1.29-2.74 in Assiut, and RR 1.3; 95% CI, 1.00-1.68 in SA) and the oxytocin only group (RR 1.7; 95% CI, 1.11-2.61 in Assiut, and RR 2.24; 95% CI, 1.54-3.27 in SA). In both centers, use of additional uterotonics was significantly higher in the uterine massage group compared with the other 2 groups.

Conclusion

Uterine massage was less effective than oxytocin for reducing blood loss after delivery. When oxytocin was used, there was no additional benefit from uterine massage. The effectiveness of uterine massage in the absence of oxytocin was not studied. ACTRN: 12609000372280.     

Effects of Swedish massage on blood pressure

Swedish massage technique includes mechanically activated muscular tissue and also skin, tendons, fascias, and connected tissue, which indirectly regulates the tonus of the autonomous nervous system. This study set out to examine the effects of Swedish massage on blood pressure. Healthy males were given massage treatment at the Karolinska Hospital, Stockholm, Sweden. Treatment was over a 12-week period divided into three parts, each consisting of 4 weeks. Two treatment periods contained massage treatment either on back, neck and chest (BNC), or leg, arm and face (LAF), with an in between washout period. The first treatment period with massage decreased systolic blood pressure directly after treatment (BNC: P<0.005, LAF: P<0.01), but no significant changes were seen in diastolic blood pressure. In the second period, BNC massage decreased systolic (P<0.005) and diastolic (P<0.005) blood pressure whereas LAF massage (P<0.05) increased systolic blood pressure. Swedish massage on the BNC resulted in a minor decrease in blood pressure possibly due to sympathetic inhibition. It may be suggested that massage may be tried as a complementary therapy in patients suffering from increased blood pressure due to stress.     

The effect of Swedish massage on pain in rheumatoid arthritis patients: A randomized controlled trial

Background and PurposeJoint pain is one of the most common symptoms in rheumatoid arthritis patients and require medical attention. The purpose of this study was to assess the effects of Swedish massage on pain and painkiller consumption in rheumatoid arthritis patients.Materials and methodsA total of 60 patients participated in the experiment, with half assigned to the control group (n = 30) and half to the experimental (n = 30) group using the block randomization method. On patients in the experimental group, a 30-min Swedish massage was performed regularly for eight weeks: twice a week for the first four weeks, and three times a week for the last four weeks. The control group received routine care. The visual analogue scale-pain was used to measure pain in the two groups at three points of time: before the beginning of the experiment, immediately after the last session, and one month after the last session of the intervention.ResultsThe analysis of covariance showed that there were significant differences between the two groups’ mean scores of pain and painkiller consumption immediately after and one month after the last session of the intervention (p = 0.01). Furthermore, in the experimental group, the mean scores of pain and painkiller consumption decreased over the three points of time (p < 0.05).ConclusionSwedish massage can be effective in reducing pain and the need to use painkillers in rheumatoid arthritis patients.     

Massage therapy and sleep behaviour in infants born with low birth weight

This study attempts to evaluate the impact of massage therapy on sleep behaviour in infants born with low birth weight (LBW) in St. Petersburg, Russia. Fifty infants (22 boys, 28 girls) who were born in St. Petersburg between 2000 and 2002 and defined as LBW babies (<2500g at birth) were enrolled onto the study at the age of 2 months. Of these, 41 (19 boys, 22 girls) were light and pre-term infants (gestational age < or =36 weeks), and 9 (3 boys, 6 girls) born light at term. The control group consisted of 50 healthy infants born with LBW who were cross-matched with an experimental group of babies and controlled for gender, gestational age, weight and date of birth. The groups were also matched for proximal geographical distribution in the city. Babies in the experimental group were assigned massage intervention therapy that include gentle rubbing, stroking, passive movements of the limbs and other means of kinaesthetic stimulation performed by professionals until the infant is 8 months old. The findings suggest that 8-month-old LBW infants who received massage intervention were less likely to snore during sleep, required less feeding on waking-up at night, and appeared more alert during the day. These apparent correlations remained significant after adjustment was made for major potential confounders. No statistically significant difference was found in sleep behaviour between LBW infants exposed to massage therapy who were either born pre-term or at term. It is suggested that massage may be a valuable approach to improve quality of sleep and reduce sleep-disordered breathing in infants born with LBW. It is acknowledged that whilst this study does not represent a large sample, it is felt that the findings suggest further investigation and offer an insight into an area previously relatively unexplored.     

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

ObjectiveThis 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.MethodsSixty-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.ResultsAfter 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.ConclusionThis 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.     

Diurnal nonstress test variations in the human fetus at risk

Objective: To compare the results of the nonstress test (NST) performed at 9:00 PM and 9:00 AM on women with high-risk pregnancies. Method: The NST was performed 2 h after a meal, at 9:00 AM and 9:00 PM, in a quiet room exposed to daylight, on 80 women with high-risk singleton pregnancies. Each session lasted 20 min. If the NST was nonreactive, the entire biophysical profile was immediately performed. The women's blood pressure was measured before, 10 min within, and at the end of the NST. Women who smoked or had uterine contractions were excluded from the study. Results: Diurnal nonstress test variations were manifested by a higher incidence of reactive NSTs and an increased number of fetal heart accelerations after 9:00 PM (82.5%) than at 9:00 AM (68.8%) (p < 0.027 P < 0.001). Conclusions: Evening appointments for fetal assessments, except in emergency conditions, may eliminate the need for additional tests such as the entire biophysical profile because of the decreased incidence of nonreactive NSTs. Evening NSTs would save time and decrease maternal anxiety.