Comparing the Effect of Foot Reflexology Massage, Foot Bath and Their Combination on Quality of Sleep in Patients with Acute Coronary Syndrome

Journal of Caring Sciences, 2016, 5(4), 299-306 doi:10.15171/jcs.2016.031 http:// journals.tbzmed.ac.ir/ JCS Comparing the Effect of Foot Reflexology Massage, Foot Bath and Their Combination on Quality of Sleep in Patients with Acute Coronary Syndrome Ali Rahmani1*, Mahdi Naseri2, Mohammad Mahdi Salaree2, Batool Nehrir2 1Department of Nursing, Atherosclerosis Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran 2Department of Nursing, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran ARTICLE INFO ABSTRACT Article Type: Introduction: Many patients in coronary care unit (CCU) suffer from decreased sleep quality caused by environmental and mental factors. This study compared the efficacy of foot reflexology massage, foot bath, and a combination of them on the quality of sleep of patients with acute coronary syndrome (ACS). Methods: This quasi-experimental study was implemented on ACS patients in Iran. Random sampling was used to divide the patients into four groups of 35 subjects. The groups were foot reflexology massage, foot bath, a combination of the two and the control group. Sleep quality was measured using the Veran Snyder-Halpern questionnaire. Data were analyzed by SPSS version 13. Results: The mean age of the four groups was 61.22 (11.67) years. The mean sleep disturbance in intervention groups (foot reflexology massage and foot bath groups) during the second and third nights was significantly less than before intervention. The results also showed a greater reduction in sleep disturbance in the combined group than in the other groups when compared to the control group. Conclusion: It can be concluded that the intervention of foot bath and massage are effective in reducing sleep disorders and there was a synergistic effect when used in combination. This complementary care method can be recommended to be implemented by CCU nurses. Original Article Article History: Received: 23 Dec. 2015 Accepted: 18 May. 2016 ePublished: 1 Dec. 2016 Keywords: Foot Massage therapy Bath Sleep Reflexology Please cite this paper as: Rahmani A, Naseri M, Salaree MM, Nehrir B..Comparing the effect of foot reflexology massage, foot bath and their combination on quality of sleep in patients with acute coronary syndrome. J Caring Sci 2016; 5 (4): 299-306. doi:10.15171/jcs.2016.031. Introduction Acute coronary syndrome (ACS) is the most common type of heart disease globally that requires hospitalization.1 Unstable coronary artery plaque is the major cause of ACS. This syndrome can be presented as sudden cardiac arrest due to ischemia and tachyarrhythmia.1,2 ACS refers to all cardiac events caused by decreased blood flow to the coronary artery caused by atherosclerosis and acute arterial occlusion from thrombosis and embolism.3,4 Coronary artery disease and its complications are the most common cause of death in developed countries.3,5 The world health organization (WHO) reported in 2002 that 22% of deaths globally and 37% of deaths in Iran were caused by cardiovascular disease. This percentage in Iran reached 41.3% in 2005 and it is predicted to reach 44.8% by 2030.6 Many patients in CCU complain of decreased sleep quality caused by environmental and mental factors. Studies have shown that sleep quality of hospitalized ACS patients decreases in the first three days in intensive care units because of monitors’ alarms, lights, sounds of instruments and ventilators, ongoing care to other patients, the effects of sedatives and inotrope drugs, severity of disease and the wakening of patients in the early morning when they still *Corresponding Author: Ali Rahmani, (PhD), email: . This study was approved and funded by the deputy of research of Baqiyatallah University of Medical Sciences (Project number: 184/340). © 2016 The Author(s). This work is published by Journal of Caring Sciences as an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited. Rahmani et al. require sleep.7 Sleep is a basic human need that is required to maintain energy and physical health. It plays an important role in cardiovascular function and its disturbance causes anxiety disorders, restlessness, nervousness, increased heart rate, and increased myocardial oxygen demand that forms a dangerous cycle. The most common treatment for lack of sleep is the use of medication, but literature review shows that there is no significant difference in sleep quality between those who used medication and those who do not.8 Studies have shown that sleep disorders observed in patients with acute myocardial infarction include short sleep duration, difficulty in falling asleep, and multiple and lengthy waking during the night. These symptoms are more common than general population and affect the physical and mental health and recovery of patients.9 The body relaxes during sleep, regains its lost energy, and prepares for physical and intellectual activity. Physical and psychological illness interfere with sleep and cardiovascular disease frequently produces sleep disorders in patients.10,11 Moreover, insomnia may result in increased heart rate, stimulates heart contractions and increases the heart muscle’s demand for oxygen. Given that cardiovascular disease, especially coronary artery disease, causes sleep disturbances that increase myocardial muscle oxygen demand, and increases the risks of myocardial infarction (MI) and the incidence of dysrhythmia. Therefore some strategies should be implemented for resolving for sleep 12 disorders. Massage therapy is a popular method of alternative medicine. It is the systematic and scientific manipulation of the soft tissues and muscles of the body to promote their maintenance, performance and healing, and improve desirable therapeutic outcomes such as mental and psychological relaxation to increase comfort and healing.13 Massage therapy is the most commonly-used form of complementary medicine and is an easy, safe, non-invasive, and relatively inexpensive 300 | Journal of Caring Sciences, December 2016; 5 (4), 299-306 method.14,15 One theory about foot reflexology massage is that psychological stress is responsible for 75% of problems and health complications in humans. More than 7000 nerves exist in each foot; when manipulated by foot massage, these are stimulated to reduce the stress and relax the body, resulting in body equilibrium. In Chinese medicine, massage is carried out to improve life energy through the release of serotonin and melatonin neurotransmitter mediators, which decreases fatigue, resolves depression and improves sleep.11 Reflexology has been a useful method of nursing care for several hundred years in China, Egypt and India.16 The review of literature indicates that massage therapy is an ancient treatment method that can bring ab (...truncated)