Touch massage: a pilot study of a complex intervention

Clinicians' opinion on massage in the intensive care unit patients

Introduction

Physiotherapy in the Intensive Care Unit (ICU) is a common medical procedure involving mainly elements of mobilisation, electrotherapy and also, in various forms and to a lesser extent, elements of massage. Massage can positively influence the physical and psychological outcomes of the ICU) patients.

Aim

The study aimed to assess the perception of physiotherapists (PTs), physicians (PHs), and registered nurses (RNs) working in ICU about the possibilities and safety of implementing massage in the process of rehabilitation of ICU patients.

Methods

This multicentre survey was conducted in Poland in three ICUs (Gdansk, Koscierzyna, Krakow). A total of 135 people participated in the study. Of these, 25.9% (35/135) were PTs, 21.5% (29/135) were PHs, and 52.6% (71/135) were RNs. The questionnaires were distributed and collected online (directly by respondents to Google Form system) and in written form.

Results

Most PTs-71% (25/35)-perceive massage as a beneficial and safe treatment while working with ICU patients. PHs 96% (28/29) and RNs 92% (65/71) also recommend using massage by physiotherapists to rehabilitate ICU patients. In the respondents' opinion, the possibilities for the use of massage by PHs and RNs are lower (between 20% and 55%).

Conclusions

According to the surveyed clinicians working in the ICU, massage is a safe form of treatment, especially when performed by PTs and it could be a permanent element of rehabilitation among ICU patients, especially for reducing pain, anxiety and restlessness and also improving sleep quality and bowel movement.

Positive effects of tactile massage for adolescents with Attention Deficit/Hyperactivity Disorder (ADHD) - A small scale study

BACKGROUND AND PURPOSE

Epidemiological studies show the prevalence of attention deficit hyperactivity disorder (ADHD) in adolescents is around 5 %. There is strong evidence for psychosocial interventions and medication for treatment of ADHD core symptoms, but these alone do not always reach a satisfactory outcome. The aim of this small-scale study was to evaluate the impact of tactile massage on ADHD core symptoms in adolescents in a clinical setting. Secondary outcome measures addressed pain perception, ability to fall asleep, and stress levels before, during, and after the intervention.

MATERIALS AND METHODS

Fourteen adolescents aged 15-17 and previously diagnosed with ADHD received tactile massage sessions in an experimental, single-subject ABA study combined with a group-based evaluation using descriptive statistics. The adolescents and their parents answered questionnaires to follow up on the primary and secondary outcomes.

RESULTS

The results showed a statistically significant reduction in hyperactivity/impulsivity and inattention, as well as oppositional defiant disorder (ODD). Participants reported that it was significantly easier to fall asleep. There was also a tendency to perceive less pain, but these results were not statistically significant. The compliance in this study was excellent.

CONCLUSION

In this study, tactile massage appears to have had a significantly positive impact on ADHD core symptoms and the ability to fall asleep. The absence of adverse physiological changes and the excellent compliance, coupled with positive results, supports the idea that tactile massage may be considered safe and beneficial for adolescents with ADHD. Our findings need to be further investigated in future research.

Effects of Tactile Massage in Improving Older Residents' Psychological Health in Long-Term Care Facilities: A Randomised Controlled Trial

BACKGROUND

Loneliness, anxiety and depressive symptoms are common among older residents in long-term care facilities (LTCFs), which can negatively impact their quality of life and increase mortality rates. Addressing these psychological health issues is an important task for nursing staff. There is a need for easy and accessible interventions to improve older residents' negative emotions. Tactile massage (TM) is a form of touch therapy that induces oxytocin, which can help individuals feel relaxed, experience pleasure and reduce anxiety. TM can also provide a sense of security and care for individuals.

OBJECTIVE

This study aimed to evaluate the effects of TM in improving older residents' psychological health in LTCFs.

DESIGN

In this study, we applied a two-arm randomised controlled trial research design.

METHODS

We used convenience sampling to enrol 55 older residents in three long-term care facilities who were randomly assigned to an intervention group and a comparison group. The intervention group received TM by research assistants on both hands for 15 min per time, twice a week for 4 weeks and the comparison group received regular care. Data were collected before and after the intervention. Generalised estimating equations (GEEs) were used to evaluate the effectiveness of the intervention.

RESULTS

There were no significant differences in loneliness, anxiety, depressive symptoms, happiness, ear temperature, heart rate or diastolic blood pressure between the two groups after the intervention. However, the intervention group had significant improvements in comfort (B = 0.86, p < 0.001), relaxation (B = 1.00, p < 0.001), respiratory rate (B = -0.16, p = 0.021) and systolic blood pressure (B = - 4.17, p = 0.002) compared to the control group.

CONCLUSIONS

TM can help older residents who live in LTCFs feel relaxed and comfortable.

IMPLICATIONS FOR PRACTICE

TM can be easily implemented as it requires no tools. We recommend that nursing staff and healthcare professionals incorporate TM as part of their care routines. They also can encourage family members to perform TM on residents during their visits to enhance residents' comfort and relaxation.

REPORTING METHOD

The Consolidated Standards of Reporting Trials (CONSORT) checklist was used for this paper.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05052138).

A systematic review and multivariate meta-analysis of the physical and mental health benefits of touch interventions

Receiving touch is of critical importance, as many studies have shown that touch promotes mental and physical well-being. We conducted a pre-registered (PROSPERO: CRD42022304281) systematic review and multilevel meta-analysis encompassing 137 studies in the meta-analysis and 75 additional studies in the systematic review (n = 12,966 individuals, search via Google Scholar, PubMed and Web of Science until 1 October 2022) to identify critical factors moderating touch intervention efficacy. Included studies always featured a touch versus no touch control intervention with diverse health outcomes as dependent variables. Risk of bias was assessed via small study, randomization, sequencing, performance and attrition bias. Touch interventions were especially effective in regulating cortisol levels (Hedges' g = 0.78, 95% confidence interval (CI) 0.24 to 1.31) and increasing weight (0.65, 95% CI 0.37 to 0.94) in newborns as well as in reducing pain (0.69, 95% CI 0.48 to 0.89), feelings of depression (0.59, 95% CI 0.40 to 0.78) and state (0.64, 95% CI 0.44 to 0.84) or trait anxiety (0.59, 95% CI 0.40 to 0.77) for adults. Comparing touch interventions involving objects or robots resulted in similar physical (0.56, 95% CI 0.24 to 0.88 versus 0.51, 95% CI 0.38 to 0.64) but lower mental health benefits (0.34, 95% CI 0.19 to 0.49 versus 0.58, 95% CI 0.43 to 0.73). Adult clinical cohorts profited more strongly in mental health domains compared with healthy individuals (0.63, 95% CI 0.46 to 0.80 versus 0.37, 95% CI 0.20 to 0.55). We found no difference in health benefits in adults when comparing touch applied by a familiar person or a health care professional (0.51, 95% CI 0.29 to 0.73 versus 0.50, 95% CI 0.38 to 0.61), but parental touch was more beneficial in newborns (0.69, 95% CI 0.50 to 0.88 versus 0.39, 95% CI 0.18 to 0.61). Small but significant small study bias and the impossibility to blind experimental conditions need to be considered. Leveraging factors that influence touch intervention efficacy will help maximize the benefits of future interventions and focus research in this field.

The effectiveness of massage on peri-operative anxiety in adults: A meta-analysis of randomized controlled trials and controlled clinical trials

BACKGROUND AND PURPOSE

and purpose: Massage has gained increasing attention for reducing peri-operative anxiety. We aimed to investigate the effectiveness of massage for peri-operative anxiety in adults.

METHODS

Six English electronic databases were comprehensively searched from their inception to February 2020. Subgroup analysis, quality assessment, sensitivity analysis, meta-regression and publication bias assessment were performed.

RESULTS

Twenty-five controlled trials comprising 2494 participants were included. The meta-analysis indicated that massage could significantly reduce peri-operative anxiety for most types of surgical patients. Specifically, it was effective for pre-, intra- and post-operative anxiety. Acupoint or specific body reflex area massage showed a larger effect than general massage did. Massage delivered by professionals and non-professionals were both effective. Massage lasting 10-20 min per session was the most worthy of recommendation. Massage was concomitant with the improvement of peri-operative vital signs and post-operative pain.

CONCLUSION

Massage is a promising complementary therapy for ameliorating peri-operative anxiety in adults.

What nursing sensitive outcomes have been studied to-date among patients cared for in intensive care units? Findings from a scoping review

BACKGROUND

Although many studies have considered mortality and adverse effects as outcomes sensitive to nursing practice, it seems that other outcomes of nursing care in intensive care units have been explored less commonly.

OBJECTIVES

To describe the state-of-science in research in the field of nursing sensitive outcomes in intensive care units and to synthesize outcomes that have been documented to date as being influenced by nursing care.

DESIGN

A scoping review study based on the framework proposed by Arksey and O'Malley, further refined by the Levac and Joanna Briggs Institute was performed in 2019.

DATA SOURCES

The Medline, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, and Google Scholar electronic databases were searched. In addition, the reference list of included articles was screened.

REVIEW METHODS

Two researchers independently identified publications on the basis of the following criteria: (a) articles that reported nursing sensitive outcomes on critically-ill adult patients admitted to the intensive care unit, (b) as primary and secondary studies, (c) written in English, and (d) without any time frame limitation.

RESULTS

Of the 4,231 records, 112 fully met the inclusion criteria and were included. Publications were mainly authored in the US and Canada (n = 44, 39.2%), and the majority (n = 62, 55.3%) had an observational design. A total of 233 nursing sensitive outcomes emerged, categorized in 35 outcomes, with, on average, two per study included. The most often measured outcomes were pressure ulcers (20 studies) and ventilator-associated pneumonias (19 studies); the less studied outcomes were quality of life, secretion clearance, patient-ventilator dysynchrony, and post-extubation dysphagia. When categorizing outcomes, the ones concerning safety (n = 77, 33.1%) were represented the most, followed by those concerning the clinical (n = 72, 30.9%), functional (n = 70, 30.0%), and perceptual (n = 14, 6.0%) domains. The interdependent outcomes linked to multi-professional interventions (e.g., ventilator-associated pneumonias) were the most frequently studied nursing sensitive outcomes (n = 20, 57.1%), while independent outcomes resulting from autonomous interventions performed by nurses were less often studied (n = 8, 22.9%).

CONCLUSIONS

From a clinical point of view, a large heterogeneity of outcomes influenced by nursing care emerged. However, identified outcomes have been studied with different approaches and metrics, so that future efforts will need to establish homogeneous conceptual and operative definitions. Moreover, increasing efforts in establishing perceptual outcomes, or those close to the fundamentals of nursing care, are suggested in order to better depict the contribution of critical care nurses in the field.

Assessment of tissular integrity in patients with diabetic foot

ABSTRACT Objective: Evaluate the impairment of tissue integrity in patients with diabetic foot and verify its association with time of diagnosis of the disease. Methods: Cross-sectional study conducted with 134 patients in an outpatient clinic located in the Northeast region of Brazil. A semi-structured questionnaire was used for data collection, which was subjected to descriptive analysis and the Mann-Whitney U non-parametric test. Results: Indicators with the lowest average score were: skin temperature, sweating, skin lesions, right and left pedal pulses, right and left tibial pulses. Patients less than ten years old had worse scores on thickness, elasticity, right tibial pulse and tissue integrity. Those with a diagnosis time of more than ten years had a greater impairment of sensation and right pulse. Conclusion: All indicators showed some impairment of tissue integrity, and the time of diagnosis of the disease was associated with six of these.

Effects of Massage in Reducing the Pain and Anxiety of the Cardiac Surgery Critically Ill-a Randomized Controlled Trial

Objective

To evaluate the effectiveness of hand massage on the pain and anxiety of the cardiac surgery critically ill.

Design

A three-arm randomized controlled trial.

Setting

This study was conducted in a medical-surgical intensive care unit in Canada.

Subjects

Adult patients who underwent elective cardiac surgery, who were able to speak French/English and to self-report symptoms, without a high risk of postoperative complications were eligible.

Methods

Patients were randomly allocated to standard care plus either two 20-minute hand massages (experimental), two 20-minute hand holdings (active control), or two 20-minute rest periods (passive control/standard care). Pain intensity, pain unpleasantness, anxiety, muscle tension, and vital signs were evaluated before, after, and 30 minutes later for each intervention.

Results

From the 83 patients recruited, 60 were randomized (20 massage, 19 hand holding, 21 standard care). After controlling for baseline scores, the massage group reported significantly lower pain intensity, pain unpleasantness, and anxiety for the first data collection set compared with both hand holding and standard care (analysis of covariance, P < 0.02), with an average decrease of two points on a 0-10 scale. No statistically significant differences were noted between hand holding and standard care for any of the symptoms. Similar results were observed for the second data collection set (N = 43). Patients had decreased muscle tension post massage. Vital signs did not differ significantly between groups.

Conclusions

Findings suggest that a 20-minute hand massage in addition to routine postoperative pain management can concomitantly reduce pain intensity, pain unpleasantness, and anxiety by two points on average on a 0-10 scale.

Interpersonal touch interventions for patients in intensive care: A design-oriented realist review

AIM

To develop a theoretical framework to inform the design of interpersonal touch interventions intended to reduce stress in adult intensive care unit patients.

DESIGN

Realist review with an intervention design-oriented approach.

METHODS

We searched CINAHL, MEDLINE, EMBASE, CENTRAL, Web of Science and grey literature sources without date restrictions. Subject experts suggested additional articles. Evidence synthesis drew on diverse sources of literature and was conducted iteratively with theory testing. We consulted stakeholders to focus the review. We performed systematic searches to corroborate our developing theoretical framework.

RESULTS

We present a theoretical framework based around six intervention construction principles. Theory testing provided some evidence in favour of treatment repetition, dynamic over static touch and lightening sedation. A lack of empirical evidence was identified for construction principles relating to intensity and positive/negative evaluation of emotional experience, moderate pressure touch for sedated patients and intervention delivery by relatives versus healthcare practitioners.

Effects of massage on outcomes of adult intensive care unit patients: a systematic review

BACKGROUND

The critical care experience is particularly stressful for patients, which can result in a number of physiological and psychological consequences, including haemodynamic instability, increased pain, agitation and delirium, leading to prolonged mechanical ventilation, length of stay and subsequent complications. Massage therapy encompasses different techniques to promote relaxation and to counter stress, therefore potentially affecting several patients' outcomes.

AIMS

To systematically review evidence on the effects of massage on outcomes of adult critically ill patients. The outcome measures included pain, vital signs (VS), haemodynamic measurements, level of consciousness, sleep quality, muscle tension, anxiety, feelings of calm and relaxation, coping, arterial blood gases and serum biomarkers.

METHOD

This was a systematic review based on focused literature searches (PubMed, CINAHL, Scopus, EMBASE-Ovid databases, Google Scholar). The Cochrane Collaboration's tool was used to assess the risk of bias. Eligibility criteria included published experimental and quasi-experimental studies reporting on the physiological and psychological outcomes of critically ill patients.

RESULTS

Based on the selection criteria, 12 studies were included in the review. The main findings are as follows: 8 of 12 studies used randomized control designs with high internal validity, and there was a high level of evidence of favourable effects with respect to improvements in VS and a reduction in pain and anxiety. Outcomes that need to be more rigorously pursued include quality of sleep, analgesic and sedative dosages and level of consciousness.

CONCLUSION

The results suggest that massage interventions can have positive effects on critically ill patients' outcomes. However, there are several gaps in the literature, along with methodological limitations, that require further consideration in critical care settings.

RELEVANCE TO CLINICAL PRACTICE

The results of this systematic review can inform implementation of massage interventions in critical care, which can be challenging as a result of several barriers.

Neurophysiology of human touch and eye gaze in therapeutic relationships and healing: a scoping review

OBJECTIVE

The primary objective of this scoping review was to examine and map the range of neurophysiological impacts of human touch and eye gaze, and consider their potential relevance to the therapeutic relationship and to healing.

INTRODUCTION

Clinicians, and many patients and their relatives, have no doubt as to the efficacy of a positive therapeutic relationship; however, much evidence is based on self-reporting by the patient or observation by the researcher. There has been little formal exploration into what is happening in the body to elicit efficacious reactions in patients. There is, however, a growing body of work on the neurophysiological impact of human interaction. Physical touch and face-to-face interaction are two central elements of this interaction that produce neurophysiological effects on the body.

INCLUSION CRITERIA

This scoping review considered studies that included cognitively intact human subjects in any setting. This review investigated the neurophysiology of human interaction including touch and eye gaze. It considered studies that have examined, in a variety of settings, the neurophysiological impacts of touch and eye gaze. Quantitative studies were included as the aim was to examine objective measures of neurophysiological changes as a result of human touch and gaze.

METHODS

An extensive search of multiple databases was undertaken to identify published research in the English language with no date restriction. Data extraction was undertaken using an extraction tool developed specifically for the scoping review objectives.

RESULTS

The results of the review are presented in narrative form supported by tables and concept maps. Sixty-four studies were included and the majority were related to touch with various types of massage predominating. Only seven studies investigated gaze with three of these utilizing both touch and gaze. Interventions were delivered by a variety of providers including nurses, significant others and masseuses. The main neurophysiological measures were cortisol, oxytocin and noradrenaline.

CONCLUSIONS

The aim of this review was to map the neurophysiological impact of human touch and gaze. Although our interest was in studies that might have implications for the therapeutic relationship, we accepted studies that explored phenomena outside of the context of a nurse-patient relationship. This allowed exploration of the boundary of what might be relevant in any therapeutic relationship. Indeed, only a small number of studies included in the review involved clinicians (all nurses) and patients. There was sufficient consistency in trends evident across many studies in regard to the beneficial impact of touch and eye gaze to warrant further investigation in the clinical setting. There is a balance between tightly controlled studies conducted in an artificial (laboratory) setting and/or using artificial stimuli and those of a more pragmatic nature that are contextually closer to the reality of providing nursing care. The latter should be encouraged.

The use of the Medical Research Council framework in the study of complex interventions in nursing: a literature review

BACKGROUND

Nursing care addresses several complex interventions and international research into complex interventions is growing. The Medical Research Council framework (MRC-f) is the most cited framework describing the development and evaluation of interventions, but little is known about its use in nursing sciences.

AIM

To review the literature for uses of MRC-f in developing complex interventions.

DISCUSSION

Of 287 studies initially identified; the final sample comprised 13 papers. Most studies referred to the development or feasibility phase and were performed in the community. They were mainly focused on the physical dimension and few had a holistic approach. The lack of time and financial support, the subjective nature of these interventions, and difficulties in the recruitment of participants were reported as barriers.

CONCLUSION

The use of MRC-f in the study of complex interventions is recent in nursing research, but it enhances the design of more feasible and effective nursing interventions. The lack of time, difficulties in the recruitment of adequate sample sizes and lack of financial support were identified as important barriers in the development of complex nursing interventions.

IMPLICATIONS FOR PRACTICE

Nurse researchers need to develop skills in planning and conducting research into complex interventions. Academic courses may also be helpful in improving such skills.

Rethinking presence: a grounded theory of nurses and teleconsultation

AIMS AND OBJECTIVES

To develop a theory that offered an evidence-based insight into the use of teleconsultation by nurses.

BACKGROUND

Teleconsultation is the use of video to facilitate real-time, remote interaction between healthcare practitioners and patients. Although its popularity is growing, there is little understanding of how teleconsultation impacts on the role of nurses.

DESIGN

The study adopted a constructivist grounded theory method, supplemented by the use of Straussian analytical approaches.

METHODS

Using selective and theoretical approaches, registered nurses with experience of using video in health care were sampled. Data were collected using semi-structured interviews exploring experiences, knowledge and feelings surrounding teleconsultation. Interviews were recorded, transcribed and subjected to three-stage, nonlinear manual analysis (open, axial and selective coding).

RESULTS

Theoretical saturation occurred after 17 interviews. The core category identified from the data was 'nursing presence' Four subcategories of nursing presence were identified: operational, clinical, therapeutic and social. The degree to which presence could be achieved was dependent upon three influencing factors - enablers, constraints and compensation.

CONCLUSIONS

Nurses provide different types of presence during teleconsultation, with the degree of presence dependent on specific characteristics of video-mediated communication. Where the use of video constrains the delivery of presence, nurses use a range of compensatory mechanisms to enhance patient care.

RELEVANCE TO CLINICAL PRACTICE

Teleconsultation provides an innovative approach to enhancing the delivery of health care. This study provides nurses with insight into the impact of teleconsultation on their professional role, and an understanding of how best to use video-mediated communication to support patient care.

Tactile massage as a nursing intervention in child and adolescent psychiatry: nurses' experiences

WHAT IS KNOWN ABOUT THE SUBJECT?: There is little research on the implementation of tactile massage in child and adolescent psychiatry that describes children's and adolescents' experiences and outcomes. There is also limited knowledge of providing tactile massage in child and adolescent psychiatry. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This paper describes 10 nurses' experiences of tactile massage as a nursing intervention in child and adolescent psychiatry. The nurses considered tactile massage a non-verbal nursing intervention that could complement other available treatments. It reveals their reflections on the impact of tactile massage on their nursing and on themselves as a person, including the belief that they had developed deepened self-reflection and attentiveness. The nurses highlighted the importance of providing a trusting environment and collaborating with the children and adolescents. They both experienced and observed that tactile massage triggered various physical and mental processes in the children and adolescents, such as improvement in sleep disturbances, an ability to relax in body and mind and a deeper connectedness with their own bodies and feelings. The nurses described instructing next of kin in the use of tactile massage, which they believed could serve as a tool at home, mainly as a way for next of kin to help their children to relax, fall asleep more easily and to deepen connectedness. However, the nurses stressed the need to consider if it was appropriate or desired by the children and adolescents. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Tactile massage addresses the individual's emotional and physiological responses and could therefore bring holistic nursing to child and adolescent psychiatry. It could also help nurses in child and adolescent psychiatry to develop their attentiveness and sensitivity in acknowledging the needs of children and adolescents in psychiatric care.

ABSTRACT

Introduction There is limited research on tactile massage in child and adolescent psychiatry and no studies investigating experiences of providing tactile massage in child and adolescent psychiatry were found. Aim The aim was therefore to describe nurses' experiences of providing tactile massage as a nursing intervention in child and adolescent psychiatry. Method Ten nurses trained in tactile massage and employed at five different child and adolescent psychiatry clinics in Sweden participated in a qualitative study. Semi-structured interviews were conducted, transcribed verbatim and analysed by qualitative content analysis. Results Three categories emerged from the analysis. 'Confirming body and mind', 'Building a trusting relationship' and 'Instructing next of kin in tactile massage'. Attentiveness to and respect for the integrity of the children and adolescents were essential for creating a trusting relationship with them. Tactile massage was found to trigger various physical and mental processes in the children and adolescents. The nurses reflected on the impact of tactile massage on their nursing and on themselves as a person, stating that it had led to the development of self-reflection and attentiveness. Implications for practice Tactile massage addresses the individual's emotional and physiological responses and could therefore bring holistic nursing to child and adolescent psychiatry. It might also enhance attentiveness and sensitivity on the part of child and adolescent psychiatry nurses when acknowledging the needs of children and adolescents in psychiatric care.

Inhomogeneous Point-Processes to Instantaneously Assess Affective Haptic Perception through Heartbeat Dynamics Information

This study proposes the application of a comprehensive signal processing framework, based on inhomogeneous point-process models of heartbeat dynamics, to instantaneously assess affective haptic perception using electrocardiogram-derived information exclusively. The framework relies on inverse-Gaussian point-processes with Laguerre expansion of the nonlinear Wiener-Volterra kernels, accounting for the long-term information given by the past heartbeat events. Up to cubic-order nonlinearities allow for an instantaneous estimation of the dynamic spectrum and bispectrum of the considered cardiovascular dynamics, as well as for instantaneous measures of complexity, through Lyapunov exponents and entropy. Short-term caress-like stimuli were administered for 4.3–25 seconds on the forearms of 32 healthy volunteers (16 females) through a wearable haptic device, by selectively superimposing two levels of force, 2 N and 6 N, and two levels of velocity, 9.4 mm/s and 65 mm/s. Results demonstrated that our instantaneous linear and nonlinear features were able to finely characterize the affective haptic perception, with a recognition accuracy of 69.79% along the force dimension, and 81.25% along the velocity dimension.

Do Patient Profiles Influence the Effects of Massage? A Controlled Clinical Trial

Considerable scientific evidence has been published on the effectiveness of massage in different conditions, but it remains unclear whether this effectiveness is modulated by the profile of patients. The aim of this study was to compare the effects of a 21-min myofascial therapy protocol on stress responders and nonresponders stressed in the laboratory with a cold pressor test. Dependent variables included heart rate variability (HRV), blood pressure, and salivary markers such as flow rate, cortisol, immunoglobulin A (IgA), and α-amylase activity. A controlled, repeated measures, single-blind trial was conducted in 30 Caucasian students with a mean (SD) age of 20.70 (4.50) years. We found no significant between-group differences in descriptive characteristics or in any preintervention outcome measure. Analysis of covariance revealed significant increases in HRV index (F = 0.18, p = .01), salivary flow rate (F = 0.16, p = .02), and salivary IgA concentration (F = 4.36, p = .04) and significant decreases in the low-frequency domain (F = 0.18, p = .04) and LF-high-frequency ratio (F = 0.18, p = .01) in the stress responder group in comparison to the nonresponder group. In conclusion, a better response to massage was observed in stress responders than in nonresponders across various HRV parameters and salivary measures.

Caring touch as a bodily anchor for patients after sustaining a motor vehicle accident with minor or no physical injuries - a mixed methods study

BACKGROUND

Patients who sustain a motor vehicle accident may experience long-term distress, even if they are uninjured or only slightly injured. There is a risk of neglecting patients with minor or no physical injuries, which might impact future health problems. The aim of this study was to explore patients' subjective experiences and perspectives on pain and other factors of importance after an early nursing intervention consisting of "caring touch" (tactile massage and healing touch) for patients subjected to a motor vehicle accident with minor or no physical injuries.

METHODS

A mixed method approach was used. The qualitative outcomes were themes derived from individual interviews. The quantitative outcomes were measured by visual analogue scale for pain (VAS, 0-100), sense of coherence (SOC), post-traumatic stress (IES-R) and health status (EQ-5D index and EQ-5D self-rated health). Forty-one patients of in total 124 eligible patients accepted the invitation to participate in the study. Twenty-seven patients completed follow-up after 6 months whereby they had received up to eight treatments with either tactile massage or healing touch.

RESULTS

Patients reported that caring touch may assist in trauma recovery by functioning as a physical "anchor" on the patient's way of suffering, facilitating the transition of patients from feeling as though their body is "turned off" to becoming "awake". By caring touch the patients enjoyed a compassionate care and experience moments of pain alleviation. The VAS pain ratings significantly decreased both immediately after the caring touch treatment sessions and over the follow-up period. The median scores for VAS (p < 0.001) and IES-R (p 0.002) had decreased 6 months after the accident whereas the EQ-5D index had increased (p < 0.001). There were no statistically significant differences of the SOC or EQ-5D self-rated health scores over time.

CONCLUSIONS

In the care of patients suffering from a MVA with minor or no physical injuries, a caring touch intervention is associated with patients' report of decreased pain and improved wellbeing up to 6 months after the accident.

TRIAL REGISTRATION

ClinicalTrials.gov Id: NCT02610205 . Date 25 November 2015.

Does touch massage facilitate recovery after stroke? A study protocol of a randomized controlled trial

BACKGROUND

Despite high quality stroke care, decreased sensorimotor function, anxiety and pain often remain one year after stroke which can lead to impaired health and dependence, as well as higher healthcare costs. Touch massage (TM) has been proven to decrease anxiety and pain, and improve quality of health in other conditions of reduced health, where reduced anxiety seems to be the most pronounced benefit. Thus there are reasons to believe that TM may also reduce anxiety and pain, and improve quality of life after stroke. Further, several studies indicate that somatosensory stimulation can increase sensorimotor function, and it seems feasible to believe that TM could increase independence after stroke. In this study we will evaluate effects of TM after stroke compared to sham treatment.

METHODS

This is a prospective randomized open-labelled control trial with blinded evaluation (PROBE-design). Fifty patients with stroke admitted to stroke units will be randomized (1:1) to either a TM intervention or a non-active transcutaneous electrical nerve stimulation (non-TENS) control group. Ten sessions of 30 min treatments (TM or control) will be administered during two weeks. Assessment of status according to the International Classification of Functioning, Disability and Health (ICF), including body function, activity, and participation. Assessment of body function will include anxiety, pain, and stress response (heart rate variability and salivary cortisol), where anxiety is the primary outcome. Activity will be assessed by means of sensorimotor function and disability, and participation by means of health-related quality of life. Assessments will be made at baseline, after one week of treatment, after two weeks of treatment, and finally a follow-up after two months. The trial has been approved by the Regional Ethical Review Board.

DISCUSSION

TM seems to decrease anxiety and pain, increase health-related quality of life, and improve sensorimotor functions after stroke, but the field is largely unexplored. Considering the documented pleasant effects of massage in general, absence of reported adverse effects, and potential effects in relation to stroke, it is essential to evaluate effects of TM during the sub-acute phase after stroke. The results of this project will hopefully provide important knowledge for evidence-based care.

TRIAL REGISTRATION

ClinicalTrials.gov: NTC01883947.

Endocannabinoids and related lipids in blood plasma following touch massage: a randomised, crossover study

Background

The endocannabinoid system is involved in the regulation of stress and anxiety. In a recent study, it was reported that short-term changes in mood produced by a pleasant ambience were correlated with changes in the levels of plasma endocannabinoids and related N-acylethanolamines (Schrieks et al. PLoS One 10: e0126421, 2015). In the present study, we investigated whether stress reduction by touch massage (TM) affects blood plasma levels of endocannabinoids and related N-acylethanolamines.

Results

A randomized two-session crossover design for 20 healthy participants was utilised, with one condition that consisted of TM and a rest condition as control. TM increased the perceived pleasantness rating of the participants, and both TM and rest reduced the basal anxiety level as assessed by the State scale of the STAI-Y inventory. However, there were no significant effects of either time (pre- vs. post-treatment measures) as main effect or the interaction time x treatment for the plasma levels of the endocannabinoids anandamide and 2-arachidonoylglycerol or for eight other related lipids. Four lipids showed acceptable relative reliabilities, and for two of these (linoleoyl ethanolamide and palmitoleoyl ethanolamide) a significant correlation was seen between the TM-related change in levels, calculated as (post-TM value minus pre-TM value) − (post-rest value minus pre-rest value), and the corresponding TM-related change in perceived pleasantness.

Conclusions

It is concluded that in the participants studied here, there are no overt effects of TM upon plasma endocannabinoid levels. Possible associations of related N-acylethanolamines with the perceived pleasantness should be investigated further.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-015-1450-z) contains supplementary material, which is available to authorized users.