ANALISA JURNAL PICO

Title : Effect of Foot and Hand Massage in Post-Cesarean Section

Pain Control : A Randomized Control Trial

Author : Zahra Abbaspoor, PhD, Malihe Akbari, MSc, and Shanaz

Najar, MSc

Journal : Pain Management Nursing, Vol 15, No 1 (March), 2014: pp

132-136

1. (P) Patient, Population or Problem

One of the problems for mothers in the post–cesarean section period is pain,
which disturbs the early relationship between mothers and newborns; timely pain
management prevents the side effects of pain, facilitates the recovery of patient,
reduces the costs of treatment by minimizing or eliminating the mother’s distress,
and increases mother-infant interactions. The aim of this study was to determine
the effect of hand and foot massage on post–cesarean section pain. This study is a
randomized and controlled trial which was performed in Mustafa Khomeini
Hospital, Elam, Iran, April 1 to July 30, 2011; it was carried out on 80 pregnant
women who had an elective cesarean section and met inclusion criteria for study.
Among 244 pregnant women attended for elective cesarean section to the
obstetrics ward of Mustafa Khomeini Hospital, we included a total 80 women
who were medically able to participate in massage therapy after surgery. Patients
were selected by a random sampling method; and they were evenly ordered and
assigned to one of two treatment arms: massage therapy and control group, each
of which included 40 patients. We included only those who gave consent to
participate in each groups of study, had been scheduled for elective cesarean
operation by their obstetrician, and were 18-35 years old, 37-42 weeks’
gestational age, and were on their second pregnancy with previous cesarean
section, estimated birth weight 2,500-4,000 g, and transverse incision on uterus
and abdomen in the previous cesarean section. The excluding criteria were as
follows: those who had not been able to verbally or nonverbally report their pain
intensity, those who were at risk of taking general anesthesia, fetal death or
discomfort in neonates, abnormal body mass index in first trimester; those who
had damaged tissue and skin on their hands or feet or acute phlebitis; those who
had operating room accidents, and those who had a different surgeon for the
operation; and 10 patients were excluded from the study because of an
uncomfortable feeling about letting other people touch their feet. Patients in the
two groups were matched regarding anesthesia method, medication name and its
dosage, same surgeon, type of uterus and abdominal incision, and duration of
operation. The visual analog scale was used to determine the pain intensity before,
immediately, and 90 minutes after conducting 5 minutes of foot and hand
massage. Vital signs were measured and recorded.

2. (I) Intervention, Prognostic Factor, or Exposure

Massage Therapy
Foot and hand massage was initiated 1.5-2 hours after spinal anesthesia
medication. Before the massage, the preintervention pain measures and vital signs
were conducted. The massage was given to all of the patients by one investigator,
who had been given theoretical and practical training and was certified by a
physiotherapist before the study. Patients were provided a comfortable position
and were asked to avoid talking during the intervention unless necessary. Hand
massage was applied to each hand for 5 minutes, avoiding the intravenous
catheter insertion area if present. Following hand massage, the patient’s foot was
elevated by supporting it with a pillow. The sole was spread and rubbed by the
investigator’s fingers. The thumb was used to make circles over the entire sole of
the foot. The knuckles of one hand stroked the sole with an up-and-down motion.
The heel and ankle were kneaded between the investigator’s thumb and
forefinger. The pillow support was removed to finish the massage. In total, each
patient received 20 minutes’ massage (Wang & Keck, 2004).
Control Therapy.
Patients in the control group continued receiving standard care (e.g.,
medication was administered) and the investigator stood near the patient bed and
talked to her for 20 minutes without any other intervention. For deleting the
psychologic effect, the control group were located in a separate room. The pain
intensity of the patients was measured and recorded after the massage in both
groups. The measurements were repeated 90 minutes after the intervention to
determine the efficacy duration. In both groups, at the request of a patient for pain
relief, analgesics were used and the analgesic name, dosage and times of using
were recorded.

3. (C) Comparison or Intervention (if appropriate)

Therapy was carried out in 2 groups, the first group intervened with foot and
hand massage, foot and hand massage was initiated 1.5-2 hours after spinal
anesthesia medication. Patients in the control group continued receiving standard
care (e.g., medication was administered) and the investigator stood near the
patient bed and talked to her for 20 minutes without any other intervention.

4. (O) Outcome
Statistical Analysis Statistical analysis was carried out with SPSS software
version 13. Statistical analysis was performed using chisquare test to compare
patients’ characteristics in the two groups. Repeated-measures analysis of
variance test was used to compare pain intensity scores before and right after and
90 minutes after intervention; and paired t test was used for the comparison of
each two time periods in two groups. Postmassage pain intensity scores of both
groups were compared using independentsamples test. The difference between the
pain intensity measurements of the control group was verified with ttest. Data are
expressed asmean and SD; the significance level was set up at p < .05.
The results indicated that 20 minutes of foot and hand massage therapy is
effective for reducing post– cesarean section pain intensity within the first 90
minutes. In a study conducted by Degirmen et al. (2010) a decrease of 2.76 points
was reported for the women in the foot and hand massage group (Degirmen et al.,
2010). Nixon, Teschendorff, Finney, and Karnilowicz (1997) and Brewer (1997)
published similar findings. Also, in a study conducted by Wang and Keck (2004),
20 minutes foot and hand massages were proved to be efficient in reducing
postoperative pain, indicating that pain intensity scores were reduced after
invention (Wang & Keck, 2004), but Hulme, Waterman, and Hillier (1999) did
not obtain significant results on pain intensity scores from a 5-minute foot
massage, which suggests that the duration of massage may play an important role
in its effect on postoperative pain. Findings of the measurements recorded 90
minutes after the massage were assessed to be lower than those right after the
massage, which implied that the efficacy of performing the once-only massage
remains after 90 minutes. In our study, patients could use analgesic if they made a
request. However, the study by Hattan, King, and Griffiths (2002) indicated that
performing the massage only once would not be as effective as regular
performances. This intervention may have potentially more effective clinical pain
control when it is combined with other regimens. It was further reported that
performing the massage intervention resulted in a considerable decrease in the use
of analgesic in the massage group compared with the control group during the
first 90 minutes. There was a significant different between massage and control
groups in all analgesic types, including Diclophenac (supp or amp) and Petedine.

Conclusion and Recomendation

Based on the findings of this study, foot and hand massage, a
nonpharmacologic intervention, appears to be a useful, economic, and effective
method in reducing post–cesarean section pain level. The massage skills do not
require extensive training, and they can easily be used. Massage may be a
beneficial noninvasive pain management strategy for patients whose pain is not
adequately controlled by medication. Finally, it is advised that further trials are
required to monitor pain for a longer period and to assess the impact of massage
frequency on the efficacy of the massage in pain reduction after cesarean section.