Effect of a warm footbath before bedtime on body temperature and sleep in older adults with good and poor sleep: An experimental crossover trial

Temperature as a circadian timing cue in the visually impaired

The daily rise and fall in ambient temperature caused by Earth's 24-hour rotation may help regulate circadian rhythms in visually impaired individuals. In all mammals, circadian rhythms, the daily cycles of physiology and behavior, are time controlled by the suprachiasmatic nucleus (SCN), the brain's central clock. The SCN typically synchronizes circadian rhythms with the light/dark cycle through photoentrainment, a process in which specialized retinal cells capture ambient light and transmit this information to the SCN, allowing it to set its phase. Without light input, the rodent SCN's light-driven circuits can become desynchronized, potentially allowing alternative entrainment signals, such as ambient temperature, to influence central timing. Here, we consider whether a similar mechanism could benefit visually impaired humans who, due to retinal damage, have reduced or absent photic input to the central clock. Visually impaired individuals often experience circadian misalignment, whereby internal rhythms drift out of synchrony with the light-dark cycle, and we suggest that temperature information may mitigate some of this drift. Temperature entrainment could operate through heat shock pathways from the skin, via thermoregulatory brain regions with reciprocal connections to the SCN, or by shifting core body temperature through warm or cold baths, which can alter the phase of clocks in peripheral organs and potentially feedback to adjust central time. Given that temperature is a weaker cue than light, it remains unknown if, and to what extent, it may significantly impact central timing. However, if effective, temperature entrainment in the visually impaired could potentially improve circadian disorders, poor sleep, and adverse health outcomes associated with circadian dysfunction including depression, cognitive decline, and metabolic disorders, which are more prevalent in this population. Research is needed to confirm the long-term effectiveness of temperature as an entrainment cue in the visually impaired population, which may have broader implications for circadian timekeeping in mammals and the role of temperature in the absence of light.

Complementary and Integrative Health Practices in a Brazilian Freestanding Birth Center: A Cross-Sectional Study

The study aimed to analyze the use of complementary and integrative health practices (CIHPs) during labor and birth in a freestanding birth center. A total of 28 different CIHPs were applied with or used by laboring women. The most adopted CIHPs were mind-body practices (99.9%) and natural products (35.5%), mostly used by primiparous women ( P <.05). Adopting CIHPs can increase care quality, increase positive experiences during childbirth, and promote evidence-based choices.

Effects of Temperature, Duration, and Heating Height of Foot Thermal Therapy on Sleep Quality of Older Adults: A Systematic Review and Meta-Analysis

Background: Sleep disturbances, which are common problems in older adults, often lead to cognitive decline and depression and may even increase mortality risk. Foot thermal therapy is a simple and safe approach for improving sleep and is associated with relatively few side effects. However, the effect of different operations of foot thermal therapy on sleep quality in older adults is inconclusive. This study aimed to access the effects of temperature, duration, and heating height of foot thermal therapy (administered through a footbath) on the subjective and objective sleep quality of older adults. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, eight databases were searched for all relevant articles published up to July 2023, and a rigorous systematic review and meta-analysis was conducted. This study was registered in the PROSPERO database (CRD42022383460). Inclusion criteria were: (1) participants with a mean age ≥60 years; (2) interventions that included foot thermal therapy; (3) a control group that received routine care but no thermal therapy; (4) outcome measurements that assessed sleep quality; and (5) the studies that utilized randomized controlled trials or quasi-experimental studies. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. The meta-analysis was performed using RevMan version 5.4. Results: A total of 11 studies were included. Foot thermal therapy before bedtime improved subjective sleep quality in older adults, with optimal parameters of 40°C temperature (standardized mean difference [SMD] = 0.66, 95% confidence interval [CI]: 0.33 to 0.99), ≤20-min duration (SMD = 0.66, 95% CI: 0.39 to 0.93), and 10 cm heating height (SMD = 0.78, 95% CI: 0.45 to 1.11). Subgroup analyses revealed that a temperature of 41°C-42°C can improve objective sleep latency (SMD = 0.54, 95% CI: 0.09 to 0.99). Conclusions: It is recommended to administer foot thermal therapy (40°C; ≤20 min; 10 cm above the ankle) to older adults 1 h before their bedtime. If they have trouble falling asleep, the temperature can be increased to 41°C-42°C.

The effect of foot bath on sleep quality in the elderly: a systematic review

INTRODUCTION

Population aging is a problem that has affected most countries in the world. Poor-quality sleep is a common complaint among the elderly. Foot baths are a method of heat therapy and are performed as an independent nursing care in different departments. The present study was conducted with the aim of investigating the effects of foot baths with spa on improving the sleep quality of the elderly.

METHODS

This research is a systematic review. We systematically searched six databases, including Google Scholar, PubMed, Web of Science, Scopus, Embase, and the World Health Organization databases, to retrieve the related articles based on the keywords used in our search strategy from 2010 to March 2023.

RESULT

Finally, 10 articles were included in this study. All studies were randomized controlled trial (RCTs) and semi-experimental. In all 9 studies, the positive effects of the foot bath were reported. In 9 studies, the effect of foot baths with water above 40 degrees Celsius was reported. The PSQR questionnaire was used in most of the studies.

CONCLUSION

The total findings of this study showed that due to the high prevalence of sleep problems in the elderly, foot baths with warm water can be used as an easy, simple, and safe nursing intervention to improve sleep quality. Therefore, it can be used in nursing homes and hospitals. It is also a non-pharmacological and inexpensive nursing intervention that can be implemented by the elderly themselves after training by community health nurses.

Do ginger footbaths improve symptoms of insomnia more than footbaths with warm water only? - A randomized controlled study

OBJECTIVES

To compare the effects between warm water (WW) and ginger footbaths (WW+ginger) on sleep quality and warmth regulation in adults with self-reported insomnia symptoms.

METHODS

A prospective randomized-controlled study in which 28 participants (mean age 50.9 years, 64.3% women, insomnia symptom duration 11.4 years) were randomized to receive WW (n = 13) or WW+ginger (n = 15) daily for 2 weeks. Treatment involved nightly footbaths (12 liters of 38-42 °C warm tap water, maximum duration 20 min) with and without topical ginger (80 g of powdered ginger rhizomes).

MAIN OUTCOME MEASURES

The primary outcome measure was self-reported sleep quality (global score from Pittsburgh Sleep Quality Index, PSQI) at 2 weeks. Secondary outcomes included measures of insomnia severity (Insomnia Severity Index, ISI) and warmth regulation (Herdecke Warmth Perception Questionnaire, HWPQ and 24-hour distal-proximal skin temperature gradient, DPG).

RESULTS

WW+ginger had no greater effect on PSQI (mean between-difference 0.0 [95% CI -3.0 to 2.9], Cohen's d=0.0) or ISI (-0.2 [-3.9 to 3.4], 0.0) than WW. Nor were there any significant differences in HWPQ perceived warmth (0.1 ≥d≥0.5) or DPG (0.1 ≥d≥0.4) between WW and WW+ginger. Both groups improved over time in PSQI (WW+ginger: d=0.7, WW: d=1.3) and ISI (WW+ginger: d=0.8, WW: d=1.0). Perceived warmth of the feet increased only in WW+ginger over time (d=0.6, WW: d=0.0).

CONCLUSIONS

This dose of ginger (6.67 g/liter) did not have greater effects on sleep quality, insomnia severity or warmth regulation than WW. Considering effect sizes, costs and risks, the use of WW would be recommended over WW+ginger in this patient population.

Bright Light Decreases Peripheral Skin Temperature in Healthy Men: A Forced Desynchrony Study Under Dim and Bright Light (II)

Human thermoregulation is strictly regulated by the preoptic area of the hypothalamus, which is directly influenced by the suprachiasmatic nucleus (SCN). The main input pathway of the SCN is light. Here, thermoregulatory effects of light were assessed in humans in a forced desynchrony (FD) design. The FD experiment was performed in dim light (DL, 6 lux) and bright white light (BL, 1300 lux) in 8 men in a semi-randomized within-subject design. A 4 × 18 h FD protocol (5 h sleep, 13 h wake) was applied, with continuous core body temperature (CBT) and skin temperature measurements at the forehead, clavicles, navel, palms, foot soles and toes. Skin temperature parameters indicated sleep-wake modulations as well as internal clock variations. All distal skin temperature parameters increased during sleep, when CBT decreased. Light significantly affected temperature levels during the wake phase, with decreased temperature measured at the forehead and toes and increased navel and clavicular skin temperatures. These effects persisted when the lights were turned off for sleep. Circadian amplitude of CBT and all skin temperature parameters decreased significantly during BL exposure. Circadian proximal skin temperatures cycled in phase with CBT, while distal skin temperatures cycled in anti-phase, confirming the idea that distal skin regions reflect heat dissipation and proximal regions approximate CBT. In general, we find that increased light intensity exposure may have decreased heat loss in humans, especially at times when the circadian system promotes sleep.

Comparison of the acute effects of ankle bathing versus moderate-intensity aerobic exercise on vascular function in young adults

We examined the efficacy of ankle bathing versus aerobic exercise to improve vascular function in young adults who were randomized to aerobic exercise (AE) (n = 13, 40%-60% of heart rate reserve), ankle bathing (AB) (n = 15, 43 °C), or a control condition (CON) (n = 14, ankle bathing, 36 °C) for 40 min. Conduit vessel function [brachial artery flow-mediated dilation (FMD)], carotid and femoral artery blood flow and shear rate (SR), and arterial stiffness [carotid-to-femoral pulse wave velocity (cf-PWV), augmentation index (AIx@75), β-stiffness index, and arterial compliance] were evaluated. Compared with CON, AE and AB increased FMD at 30 min and 90 min (interaction: p < 0.05); AB decreased carotid artery blood flow and SR at 30 min, while both AE and AB increased femoral artery blood flow and SR at 30 min and 90 min (interaction: p < 0.05); AE and AB decreased cf-PWV and AIx@75 at 30 min and 90 min (interaction: p < 0.05); and AE improved both carotid and femoral β-stiffness index and arterial compliance, while AB reduced β-stiffness index and increased arterial compliance only in the femoral artery (interaction: p < 0.05). These findings suggest that ankle bathing may serve as an alternative strategy for enhancing vascular function. Novelty: We observed similar improvements in conduit vessel function, femoral artery blood flow and shear rate, and arterial stiffness following ankle bathing and acute aerobic exercise in young adults. These findings have identified ankle bathing as a potential therapeutic strategy for enhancing vascular function, which may be particularly relevant for those with limited ability to engage in regular aerobic exercise.

The Immediate Effect of Sinapis nigra and Zingiber officinale as Thermogenic Substances during Footbaths: A Randomized Controlled Crossover Trial

OBJECTIVE

Warm footbaths infused with Sinapis nigra (mustard, or MU) or Zingiber officinale (ginger, or GI) are used for various thermoregulatory conditions, but little is known about how they are perceived by individuals, both short- and long-term. We analyzed the immediate and long-term effects of MU and GI on warmth and stimulus perception in healthy adults.

METHODS

Seventeen individuals (mean age 22.1±2.4 years; 11 female) received three footbaths (mean temperature was 40 ± 0.2°C, administered between 1:30 and 6:30 p.m.) in a randomized order with a crossover design: 1. with warm water only (WA), 2. with warm water and MU, and 3. with warm water and GI. Warmth and stimulus perception at the feet were assessed at the 1st, 5th, 10th, 15th, and 20th minute of the footbaths, in the late evening (EVE), and the following morning (MG). We further assessed well-being (at EVE and MG) and sleep quality (at MG). The primary outcome measure was the warmth perception at the feet at the 10th minute of the footbath.

RESULTS

At the 10th minute of the footbath, warmth perception at the feet was significantly higher with MU and GI compared to WA. The immediate thermogenic effects pointed to a quick increase in warmth and stimulus perception with MU, a slower increase with GI, and a gradual decrease with WA. Regarding the long-term effects, warmth and stimulus perception were still higher after GI compared to WA at EVE and MG. No differences were seen for general well-being and sleep quality.

CONCLUSION

Thermogenic substances can significantly alter the dynamics of warmth and stimulus perception when added to footbaths. The different profiles in the application of GI and MU could be relevant for a more differentiated and specific use of both substances in different therapeutic indications.

The effect of footbath on the quality of sleep in older adults: A pilot study

This pilot study was a randomized controlled trial that aimed to investigate the effect of the warm footbath on the sleep quality of Iranian older adults. Males and females aged over 60 were randomly divided into three groups (footbath group with water at 40°C, footbath group with water at 37°C, and one control group) using the permutation block method. Repeated measures design was used to compare the groups after week two and week four to study the effects of footbath on sleep quality. Footbath with water at 40°C and 37°C caused significant improvement in the participants' sleep quality. No significant difference was found between the participants' sleep quality treated with water at 40°C and 37°C. Future studies with larger samples are recommended for assessing the effectiveness of warm footbath in enhancing sleep quality in older adults.

The Effects of Aroma Foot Baths on Stress and Sleep in Terminal Cancer Patients

Purpose

This study aimed to investigate the effects of aroma foot baths on stress and sleep in terminally ill cancer patients.

Methods

We performed a non-randomized intervention-control study with 30 terminal cancer patients who were admitted to a palliative care unit. Participants responded to questionnaires on stress and sleep before and after a 5-day interval. The intervention group received a daily aroma foot bath for 5 days. We performed multivariate regression analysis to examine the changes in outcomes on stress and sleep for the intervention group compared to the control group.

Results

The differences in baseline characteristics between groups, excluding subjective economic status and general weakness, did not show statistical significance. In contrast to the control group, the intervention group showed a statistically significant change in physical stress and psychological stress levels, but significant changes were not observed in quality of sleep. Compared to the control group, the intervention group showed a significant reduction in physical stress (P=0.068) and psychological stress (P=0.021).

Conclusion

Aroma foot baths are effective for reducing stress in patients hospitalized with terminal cancer.

The effectiveness of far-infrared irradiation on foot skin surface temperature and heart rate variability in healthy adults over 50 years of age: A randomized study

BACKGROUND

Far-infrared irradiation (FIR) is used in the medical field to improve wound healing, hemodialysis with peripheral artery occlusive disease, and osteoarthritis but seldom used in ameliorating poor lower extremity circulation. The purpose of this study was to evaluate the effect of FIR on changes in foot skin surface temperature (FSST) and autonomic nerve system (ANS) activity to evaluate its effectiveness in improving lower limb circulation.

METHODS

A randomized controlled study was conducted. Subjects (n = 44), all over the age of 50 years and satisfying the inclusion criteria, were randomly allocated into 2 groups. The intervention group received FIR on a lower limb for 40 minutes and the control group received no intervention. Left big toe (LBT), right big toe (RBT), left foot dorsal (LFD), right foot dorsal (RFD) surface skin temperature, autonomic nervous activity, and blood pressure were assessed.

RESULTS

The main results were skin surface temperature at the LBT increased from 30.8 ± 0.4°C to 34.8 ± 0.4°C, at RBT increased from 29.6 ± 0.4°C to 35.3 ± 0.4°C and LFD increased from 31.9 ± 0.3°C to 36.4 ± 0.4°C, RFD increased from 30.7 ± 0.3°C to 37.7 ± 0.2°C. FIR caused a significant increase of the FSST ranging in a 4°C to 7°C increase after 40 minutes irradiation (P < .001). The ANS low-frequency (LF) and high-frequency (HF) activity showed a statistically significant increase in the FIR group (P < .05) but not the LF/HF ratio.

CONCLUSION

FIR significantly increased the FSST from between 4°C and 7°C after 40 minutes irradiation, which might improve lower extremity circulation and regulation of ANS activity.

Footbath as a safe, simple, and non-pharmacological method to improve sleep quality of menopausal women

Due to the adverse effects of medication we decided to provide a safe, economic, and easy intervention to decrease sleep problems in menopausal women. This trial aimed to determine the effect of footbath on sleep disturbance in postmenopausal women. One hundred menopausal women were randomly stratified using a permuted block randomization procedure by Random Allocation Software, and assigned to one of two study groups: control (without intervention, n = 50) and intervention (footbath, n = 50). The footbath group was asked to lie their feet into the warm water for 20 min in a container with a depth of 10 cm one hour before the usual sleeping time for 6 weeks. To assess sleep quality, we used the Pittsburgh sleep quality index (PSQI). To evaluate severity of menopause symptoms, the Greene scale was applied. Before the intervention, 96% of the subjects in the footbath group and 94% in the control group were poor sleepers. The results of analysis of covariance showed significant improvement in sleep quality and decrease in severity of menopause signs in the footbath group compared to the control group. At the baseline, there was a statistically significant correlation between the severity of menopause signs and the global score of PSQI in all study individuals (p ≤ .001, r = .464). The present study findings showed that footbath intervention enhanced sleep quality in menopausal women. Thus, footbath as a safe, simple, and non-pharmacological application can improve quality of life in postmenopausal women and inhibit problems due to inadequate sleep quality.

The Effect of Warm Footbath on the Quality of Sleep on Patients with Acute Coronary Syndrome in Cardiac Care Unit

Introduction: This study aimed to determine the effect of warm footbath before bedtime on the quality of sleep on patients with acute Coronary Syndrome in Cardiac Care Unit.

Methods: This study was conducted on 120 patients admitted to CCU at Mazandaran Heart Center and randomly divided into two groups of intervention and control. In the intervention group, warm footbath was performed after the second night in hospital before bed time by 41 C water for 20 minutes for three consecutive nights; in contrast, the control group did not receive anything of this sort. The next day, St Mary's Hospital Sleep Questionnaire was completed to evaluate sleep quality. Then, the obtained data were analyzed using SPSS software and Friedman, Wilcoxon exact statistical tests.

Results: The quality of sleep in the first night of hospitalization was different from the third night after the intervention in both groups and the improvement process of sleep quality was observed in both groups. Most patients had moderate impairments (23-36), which had not changed during the intervention. In intervention groups, 8 patients had severe sleep disorders (greater than 37), which declined to 1 after three nights of intervention. While, in the control group this number fell from 10 patients with severe sleep disorders to 5. Warm footbath had a great positive impact on patients suffering from severe sleep disorders (P<0.05).

Conclusion: Although warm footbath did not improve the quality of sleep in all patients, it reduced the number of patients who had severe sleep disturbances.

Before-bedtime passive body heating by warm shower or bath to improve sleep: A systematic review and meta-analysis

Water-based passive body heating (PBH_WB) as a warm shower or bath before bedtime is often recommended as a simple means of improving sleep. We searched PubMed, CINAHL, Cochran, Medline, PsycInfo, and Web of Science databases and extracted pertinent information from publications meeting predefined inclusion and exclusion criteria to explore the effects of PBH_WB on sleep onset latency (SOL), wake after sleep onset, total sleep time, sleep efficiency (SE), slow wave sleep, and subjective sleep quality. The search yielded 5322 candidate articles of which 17 satisfied inclusion criteria after removing duplicates, with 13 providing comparable quantitative data for meta-analyses. PBH_WB of 40-42.5 °C was associated with both improved self-rated sleep quality and SE, and when scheduled 1-2 h before bedtime for little as 10 min significant shortening of SOL. These findings are consistent with the mechanism of PBH_WB effects being the extent of core body temperature decline achieved by increased blood perfusion to the palms and soles that augments the distal-to-proximal skin temperature gradient to enhance body heat dissipation. Nonetheless, additional investigation is required because the findings regarding PBH_WB are limited by the relative scarcity of reported research, especially its optimal timing and duration plus exact mechanisms of effects.

Periocular skin warming elevates the distal skin temperature without affecting the proximal or core body temperature

Periocular skin warming reportedly improves the objective and subjective sleep quality in adults with mild difficulty in falling asleep. To clarify the effects of periocular warming, we examined the distal skin temperatures (hands and feet), proximal skin temperature (infraclavicular region) and core body temperature as well as the distal-proximal skin temperature gradient (DPG). Nineteen healthy males underwent two experimental sessions, wherein they used a warming or sham eye mask under a semi-constant routine protocol in a crossover manner. Participants were instructed to maintain wakefulness with their eyes closed for 60 minutes after wearing the eye mask. The warming eye mask increased the periocular skin temperature to 38–40 °C for the first 20 minutes, whereas the temperature remained unchanged with the sham mask. Compared to that of the sham eye mask, the warming eye mask significantly increased the temperatures of the hands and feet and the DPG, whereas the proximal skin and core body temperatures were unaffected. Subjective sleepiness and pleasantness were significantly increased by the warming eye mask. These results represent physiological heat loss associated with sleep initiation without affecting the proximal skin or core body temperatures, suggesting that thermal stimulation in certain areas can provoke similar changes in remote areas of the body.

Effects of a warm hand bath on the blood flow in the shoulder, skin and deep body temperature, autonomic nervous activity, and subjective comfort in healthy women: An experimental cross-over trial

AIM

The present study was conducted in order to clarify the effects of a warm hand bath at 40°C for 10 min on the blood flow in the shoulder, skin and deep body temperature, autonomic nervous activity, and subjective comfort in healthy women.

METHODS

The study's participants were 40 healthy adult women who were randomly assigned to either a structured hand bath first and no hand bath second (Group A) or to no hand bath first and a hand bath second (Group B). The blood flow in the shoulder, skin and deep body temperature, autonomic nervous activity, and subjective comfort then were recorded in all the participants.

RESULTS

A repeated-measures ANOVA revealed no significant difference in the blood flow in the right shoulder or deep body temperature between groups. The skin temperature of the hands, forearms, and arms was significantly increased, but not of the face and upper back. The skin temperature of the forearms was maintained at 0.5°C-1°C higher for 30 min in the hand bath group, compared with the no hand bath group. The hand bath group had a significantly higher heart rate while bathing and a significantly lower parasympathetic nerve activity level during bathing. No significant difference was seen in the sympathetic activity level between groups. The hand bath group had a significantly higher subjective comfort level.

CONCLUSION

Hand baths can improve the level of subjective comfort and increase the heart rate and might affect autonomic nervous activity. The skin temperature of the forearms was maintained for 30 min in the hand bath group.

Effects of feet warming using bed socks on sleep quality and thermoregulatory responses in a cool environment

Background

As a way of helping to sleep in winter, methods of warming the feet through footbaths or heating pads before bedtime are tried. In particular, bed socks are popular during winter sleeping in Korea, but scientific evidence about the physiological effects of bed socks on sleep quality is rarely reported. The purpose of this study was to evaluate the effect of feet warming using bed socks on sleep quality and thermoregulatory responses during sleep in a cool environment.

Methods

Six young males (22.7 ± 2.0 years in age, 175.6 ± 3.5 cm in height, and 73.1 ± 8.5 kg in body weight) participated in two experimental conditions (with and without feet warming) in a random order. The following variables on sleep quality using a wrist actigraphy were measured during a 7-h sleep at an air temperature of 23 °C with 50% RH: sleep-onset latency, sleep efficiency, total sleep time, number of awakenings, wake after sleep onset, average awakening length, movement index, and fragmentation index. Heart rate and rectal and skin temperatures were monitored during the 7-h sleep. Questionnaire on sleep quality was obtained after awakening in the morning.

Results

The results showed that sleep-onset latency was on average 7.5 min shorter, total sleep time was 32 min longer, the number of awakenings was 7.5 times smaller, and sleep efficiency was 7.6% higher for those wearing feet-warming bed socks during a 7-h sleep than control (no bed socks) (all P < 0.05). Also, their foot temperature was maintained on average 1.3 °C higher and the value in the distal-proximal skin temperature gradient was higher for those wearing feet warming bed socks when compared to the control condition (P < 0.05). However, there were no significant differences in heart rate, rectal and mean skin temperature, or in the questionnaire-based subjective evaluations between the two conditions.

Conclusions

Feet warming using bed socks during sleep in a cool environment had positive effects on sleep quality by shortened sleep onset, lengthened sleep time, and lessened awakenings during sleep but had no significant influence on core body temperature. These results imply that sleep quality could be improved by manipulation of the foot temperature throughout sleeping.

The effects of footbath on sleep among the older adults in nursing home: A quasi-experimental study

OBJECTIVES

To examine the long-term effects of foot-bathing therapy, using different water temperatures, on the sleep quality of older adults living in nursing homes.

DESIGN

A quasi-experimental study design with non-equivalent control group.

SETTINGS

Thirty participants were recruited from a nursing home in Gyeong-gi Province, South Korea.

INTERVENTIONS

The participants were randomly assigned to experimental, placebo, and control groups. The foot-bathing therapy was performed for 30min daily for four weeks. Water at 40°C was used for the experimental group, while water at 36.5°C was used for the placebo group. The control group did not receive any intervention.

MAIN OUTCOME MEASURES

The participants' sleep patterns (total sleep amount, sleep efficiency, and sleep latency) and sleep-disturbed behaviors were compared based on group, using actigraphy and a sleep disorder inventory.

RESULTS

The total amount of sleep and sleep efficiency were significantly different for the experimental group, especially those with poor sleep quality. There were no differences in sleep latency or sleep-disturbed behaviors among the groups. The long-term effect of the therapy decreased in the third week of the therapy.

CONCLUSIONS

Daily, 30-min foot-bathing therapy sessions with water at 40°C were effective in improving sleep quality for older adults. The therapy was more effective for participants with poor sleep quality at baseline assessment than those with relatively good sleep quality. The long-term effects of foot-bathing therapy decreased three weeks after initiation; therefore, it might be desirable to deliver the therapy for two weeks, pause it for a week, and then resume it.

'An exploration of the health beliefs of Chinese nurses' and nurse academics' health beliefs: A Q-methodology study'

Q-methodology was used to investigate the health beliefs of Chinese clinical nurses and nurse academics. Twenty-eight participants from one hospital and nursing school in China were involved. The four stages of this study included: (i) concourse development from literature review, Internet searches, and key informant interviews; (ii) A pilot study to develop the Q-sample from the concourse; (iii) participants sorted the Q-sample statements along a continuum of preference (Q-sorting); and (iv) PQ data analysis using principal component analysis and varimax rotation. Five viewpoints were revealed: (i) factor 1--health management and the importance of evidence; (ii) factor 2--challenging local cultural belief, and Eastern and Western influences; (iii) factor 3--commonsense; (iv) factor 4--health and clinical practice; and (v) factor 5--health and nursing education. This study presents a need for nurses and nurse academics to think critically, examine their long-held health beliefs, and promote the use of evidence-based practice.

Effects of Ayurvedic Oil-Dripping Treatment with Sesame Oil vs. with Warm Water on Sleep: A Randomized Single-Blinded Crossover Pilot Study

OBJECTIVES

Ayurvedic oil-dripping treatment (Shirodhara) is often used for treating sleep problems. However, few properly designed studies have been conducted, and the quantitative effect of Shirodhara is unclear. This study sought to quantitatively evaluate the effect of sesame oil Shirodhara (SOS) against warm water Shirodhara (WWS) on improving sleep quality and quality of life (QOL) among persons reporting sleep problems.

METHODS

This randomized, single-blinded, crossover study recruited 20 participants. Each participant received seven 30-minute sessions within 2 weeks with either liquid. The washout period was at least 2 months. The Shirodhara procedure was conducted by a robotic oil-drip system. The outcomes were assessed by the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, Epworth Sleepiness Scale (ESS) for daytime sleepiness, World Health Organization Quality of Life 26 (WHO-QOL26) for QOL, and a sleep monitor instrument for objective sleep measures. Changes between baseline and follow-up periods were compared between the two types of Shirodhara. Analysis was performed with generalized estimating equations.

RESULTS

Of 20 participants, 15 completed the study. SOS improved sleep quality, as measured by PSQI. The SOS score was 1.83 points lower (95% confidence interval [CI], -3.37 to -0.30) at 2-week follow-up and 1.73 points lower (95% CI, -3.84 to 0.38) than WWS at 6-week follow-up. Although marginally significant, SOS also improved QOL by 0.22 points at 2-week follow-up and 0.19 points at 6-week follow-up compared with WWS. After SOS, no beneficial effects were observed on daytime sleepiness or objective sleep measures.

CONCLUSIONS

This pilot study demonstrated that SOS may be a safe potential treatment to improve sleep quality and QOL in persons with sleep problems.

Skin temperature changes during a footbath in patients who had had a stroke with consequent sensory impairment

AIM

The objectives of this study were to examine skin temperature changes on the unaffected and affected sides as well as changes in perceived temperature and comfort during a footbath in patients who had had a stroke with consequent sensory impairment.

METHODS

The study used a quasi-experimental design in which the results of intervention for patients who had had a stroke and healthy adults were compared. The subjects were 20 patients who had had a stroke with consequent sensory impairment and 20 healthy adults.

RESULTS

Before the footbath, the skin temperature of the dorsum of the foot on the affected side of the patient who had had a stroke was lower than that of the foot on the unaffected side. Five minutes after the start of the footbath, however, the relationship reversed, with the skin temperature on the affected side increasing in parallel with the water temperature. After the footbath, the dorsum skin temperature on the affected side was again lower than that on the unaffected side. In healthy adults, a difference was found in dorsum skin temperature between the left and right feet. In contrast with patients who had had a stroke, no reversal of the sides was found with the lower and higher temperature.

CONCLUSION

Unlike in the healthy adults, the skin temperature of the patients who had had a stroke with consequent sensory impairment was susceptible to changes in the external environment. However, no significant changes in the physiological indices were seen, while perceived temperature and comfort remained at high levels after the footbath.