Docstoc

EFFECT OF FOOT REFLEXOLOGY ON FATIGUE AND PAIN IN

Document Sample
EFFECT OF FOOT REFLEXOLOGY ON FATIGUE AND PAIN IN Powered By Docstoc
					      EFFECT OF FOOT
  REFLEXOLOGY ON FATIGUE
  AND PAIN IN AIDS PATIENTS

• Assist.Prof.Ladawan Ounprasertpong RN,
  D.N.S
• Prof.William L.Holzemer RN, PhD, FAAN
   The scope of problem
• Newshan and Sherman (1999) in 1128
  patients

  The most frequent symptoms in HIV
 patients were:
                • fatigue 65%
               • anorexia 34%
                • cough 32 %
                 • pain 29%
                 • fever 29%
Breitbart,McDonald,Rosenfeld,Monkman,&
             Passik,1998

• Fatigue is the most
  frequent and debilitating
  complaint of HIV-positive
  people,with a prevalence
  that ranges from 20% to
  60%.
           Causes of Fatigue
• The cause of fatigue in HIV-positive
  people remains unclear.
• O’Dell,Meighen,and Riggs (1996) conclude
  that among HIV infection,fatigue is more
  strongly associated with psychosocial
  factors than with physiological
  parameters
  ( Hb,HCT,albumin, and total protein ).
  Lewis and Warfield (1990)

• Reported that “pain is
  the second most
  common reason for
  hospitalization of AIDS
  patients “
   Principal approaches used in
    treatment of chronic pain in
         persons with AIDS.

• 1.Pharmacologic treatment
• 2.Non-pharmacologic treatment
 ( Complementary therapy )
 Analgesic drugs are the main
    stay of HIV/AIDS pain
        management .
• Most pain medications have some side
  effects.
• For instance : opioids       produce
  nausea vomiting ,constipation,
  sleepiness and slow breathing.
• NSAIDS          produce gastritis,
  thrombocytopenia ,asthma, renal
  insufficiency etc.
Treatment of pain costs millions
      of dollars per year.
• Phramacologic treatment alone didn’t
  relieve pain completely.




• It can relieve pain for 70-90% of these
  patients.
( WHO,1986; Gaston-Johansson,1995)
   Now: Interest in non-pharmacologic strategies
(complementary therapy) for managing chronic pain
       and fatigue are increasing (Owen and
                 Ehrenreich,1991).
Complementary Therapy is:



  • not usually harmful
        • low cost
• less or no side effects
 Among the HIV population,complementary
therapies are frequently use to manage pain.


• One study of 256 persons with
  HIV/AIDS identified that self-
  reported pain was a significant
  predictor of CAM use ( Ostrow et
  al. 1997 ).
         Non-pharmacologic or complementary
                    approaches
•   Meditation
•   Massage
•   Spiritual healing
•   Relaxation
•   Reflexology
•   Acupuncture and
•   Guided imagery
•   Herbal remedies
REFLEXOLOGY


The intervention in
  this research

     is a non-
 pharmacologic
  treatment for
fatigue and pain
       REFLEXOLOGY
   (REFLEX ZONE THERAPY)




3 kinds of reflexology
      Hand reflexology
• *
              FOOT REFLEXOLOGY

• FOOT   zone therapy
• Reflexologists generally prefer to work on the feet.

• Since these are :
                      • larger
                  • more sensitive
               • and easily accessible.
FOOT REFLEXOLOGY
      What is reflexology
• Reflexology is gentle art, a fascinating
  science and extremely effective form of
  therapeutic foot massage.
• It is a science because it is based on
  physiologic and neurological study, and
• an art because much depends on how
  skillfully the practitioner applied his or
  her knowledge, and the dynamics which
  occur between practitioner and
  reciepient.
            Foot Reflexology

•    Is a holistic healing technique
•     Aim to treat the individual as
    entity incorporating body,mind
    and spiritual well being.
                Foot Reflexology

• Is one form of therapeutic massage.
• Focuses on pressure technique directed at
  feet.
• It is based on the premise that there are
  zones and reflexes on the feet which
  corresponds to all parts, gland and organs
  of the entire body.

              • (Booth,1994:38)
        THE GOAL OF FOOT ZONE THERAPY


• To trigger the return to homeostasis, which
   is a state of equilibrium or balance.
• To stimulate blood and lymphatic
   circulation and an intangible flow of energy
   that may affect in:
     • encouraging the clearance of toxins,
        • improving the immune system,
  • improving sleep and wound healing thus
          allowing the body to heal itself .
The benefits of reflexology
          • Reflexology can
            stimulate the pituitary
            gland, helping the body
            to produce more
            endorphins (natural pain
            killers) to reduce pain
          • ( Dougans,1996)
Asthma and allergy
       • During an asthma attack, the
         focus is on the endocrine
         system, with special attention
         on the adrenal and pituitary
         gland.
       • Then focus on the solar
         plexus, diaphragm, lung and
         bronchi to release the spasm
         in the chest, and ileocaecal
         valve to normalize mucous
         production.

                ( Wright, 2000)
 Acute pain
• Acute pain usually caused by
  an accident. So first:
• Encourage the sufferer stay
  calm and breath fully into
  abdomen.
• Shock and accidents fill the
  body with stress hormones,
  cause tension and increase
  pain.

( Wright, 2000)
Acute Pain
• Soothing massage will start
  helping to ease pain before
  you reach any specific point.
• Pain causes spasm, so help
  the body relax by working on
  the solar plexus and
  diaphragm points.
• At the same time encourage
  the patient to take some long,
  slow breaths with you.
Acute Pain (continue)
      • Next work the endocrine
        system, paying particular
        attention to the pituitary point to
        normalize glandular activity.
      • Massaging the point in the big toe that
        represents the hypothalamus will
        normalize the response of
        sympathetic nervous system,
        especially if you also work along the
        spine from top to bottom , from toe to
        heel – to calm the nerves carrying the
        pain message.
      • Work on the adrenal area will
        encourage the production of soothing
        hydrocortisone, which also calm any
        inflammation or allergic reaction.
Chronic pain
  •   Work over the whole foot encourage
      tissue to release tension.
  •   Thumb - and finger – walk the bony
      ridge along the length of side of foot
      to release tension in spine and back
      muscles.
  •   Paying extra gentle, attention to any
      parts that are sensitive.
  •   Working on diaphragm and solar
      plexus helps relax and move excess
      energy away from painful area.
  •   Hypothalamus to calm the pain-
      bearing nerves and the adrenal gland
      to ease any inflammation.
• During the reflexology session the
  reflexologist observes tender or painful area
  which, it is suggested, indicator a blockage
  or depletion of energy and thus an area of
  imbalance.

• Crystalline deposits of lactic acid,uric acid and
  calcium may be detected which are broken down
  by compression during reflexology session.

• It is claimed that these are reabsorbed and later
  eliminated.
THIS RESEARCH
         Research Question
• Is there any relief from pain and/or
  fatigue in hospitalized AIDS
  patients after receiving foot
  reflexology as compared to mimic
  foot reflexology ?
           Null hypothesis
• There is no difference in pre-post
  change scores for hospitalised
  AIDS patient’s self report of pain
  or fatigue after receiving either
  true foot reflexology or mimic foot
  reflexology.
                      Definition


• True Foot Reflexology consisted of a foot
  massage using lotion and five inches wooden stick
  ( 1/2 inch in diameter) that provides strong
  pressure on appropriate selected points on the
  foot’s meridian.

• Mimic Foot Reflexology consisted of a foot
  massage using lotion and light pressure to
  stimulate the foot.
Methodology
                   Design

• A quasi - experimental research, cross-over
  design was used to assess the impact of foot
  reflexology on AIDS patients’ perceived pain
  and fatigue.
           Inclusion and exclusion criteria
Inclusion criteria
• Male and Female patients hospitalized with
  pain and fatigue and AIDS related condition
  over the age of 17 years.
• Ability to communicate in Thai language.
Exclusion criteria
• Patients with skin lesion on the foot or legs, or
  other leg problems such as thrombosis or
  phlebitis were excluded.
• Patients with an AIDS Dementia diagnoses
  were excluded.
            Intervention
• Foot reflexology
  was provided by


Research Assistants :
2 days of TFR.
2 days of MFR.
                ตอมใตสมอง




                            ปอด
                         กระบังลม
                                    หัวใจ   10. จุดที่ตองเนนย้ําในการลดปวด
           จุดรวมประสาท

                          ตอมหมวกไต
กระดูกสันหลัง                     ไต
                              ทอไต
                   กระเพาะปสสาวะ
Eight research assistants were trained by Dr. Ladawan
                       and team.

• 1 day of theory
• 2 days of practices




       Testing with
       Dr.Ladawan
          2 days
Gave them a package of reflexology ( the
           same instruments )
                Assessment at times O0 and O8

• Demographic Variables assess
• Signs & symptoms HIV check list            For time O0 ONLY


• Vital signs assessment             were assessed at time 1-8
• Modified Piper Fatigue Scale             Pre and post test
• Modified McGill pain scale

• Days      1           2        3             4
•   O0   o1 x o2      o3 x o4    o5 x o6        o7 x o8
Random Assignment using random tables of number
to receive either foot (treatment) and mimic (control)
                      reflexology.

   •   1. CCTT
   •   2. CTCT
   •   3. CTTC           T= TREATMENT
   •   4. TTCC           C= CONTROL
   •   5. TCTC
   • 6.TCCT
     Research assistants did not let the patients
    know which kind of reflexology they received.




• Researcher didn’t know:
• which treatment the patient was receiving.
      Total number of patients would be 42
• This would give 80% power to detect a
  difference between two means of one –
  half a standard deviation ( medium
  effect size).
• Using a paired t-test with a 0.025
  two-sides significance level.
• Alpha of 0.05 is divided by two for
  each of the dependent variables.
               Approached 38 subjected

• 4 subjects (10.53%) discharged before completing the
  intervention.
• 5 subjects (13.15 %) referred to another health center.
• 1 subject (2.63%) refused to participate because he felt
  tickled.
• 28 complete subjects (73.68 %).
                   Tables 1. Demographic Data (sample = 28)
                              Frequency           Percent
Gender
 Male                         19                  67.9
 Female
                              9                   32.1
Age group
 20-30                        15                  53.57
 31-40                        11                  39.28
 41-50                        2                    7.14
Educational Level
None                          2                    7.1
Primary School                13                  46.4
Secondary School              8                   28.6
Diploma/ Certificate          4                   14.3
Bachelor                      1                    3.6
              Table1. Demographic Data
Variables             Frequency    Percent
Income (Baht)
 No income            16           57.1
 1,000-5,000           7           25.0
 5,001-10,000          1           3.6
10,001- 50,000         4           14.3
Economic Status
 Not Enough           15           53.6
 Enough               13           46.4
Report of Top Ten Symptoms (n=28)
           Symptom                            Frequency (%)
                                  Fatigue                      27(96.4%)
                                Weakness                       26(92.9%)
                                Insomnia                       25(89.5%)
                                  Thirsty                     24((85.7%)
                         Lack of Appetite                      24(85.7%)
                 Concern over weight loss                      24(85.7%)
                               Dry mouth                       23(82.1%)
                              Mucle aches                      22(78.6%)
                     Skinny arms and legs                      22(78.6%)
         Shortness of Breath and activities                    20(71.4%)
                                               RESULTS
•    Tables 1. Demographic Data on study Samples ( N = 28 )


    Variables                   M               SD            Range   N
    Age                         30.64           6.10          22-47   28
    Months                      33              23.98         <1-84   27
    HIV +
    Month of AIDS               21.8            17.29         <1-60   24
    diagnosis
    Medical Diagnosis    Frequency Percent
Tuberculosis             17        43.58
Cryptomeningitis         10        25.64
PCP                      2         5.12
Oral Candidiasis         2         5.12
Diarrhea                 2         5.12
Pleural Effusion         1         2.56
Haemorrhagic Gastritis   1         2.56
Abdominal Pain           1         2.56
Lymphoma                 1         2.56
Lymphadenitis            1         2.56
Pleural Effusion         1         2.56




* One patient can have > 1 diagnosis
Patient complaints related pain
          problems
Variables                   Frequency   Percent
•Muscle pain and weakness   8             20.41
•Numbness and pain          7             16.33
•Back pain
                            6             12.24
•Headache
                            6              12.24
•Abdominal pain
•Joint pain                 6             12.24
•Cervical pain              5             10.21
•Sore Throat                4            8.16
•Buttock pain               3            6.12
                            1            2.04
                   Numeric Rating Scale
     0                                                  10


         NO PAIN                  WORST POSSIBLE PAIN

• Present Pain Intensity (PPI)
                                              Mc.Gill Pain
 0 = no pain       0.0 %                        Score
 1= mild           3.6 %
 2= distressing 42.9 %             Before intervention O1
 3.= discomforting 28.6 %           Numeric Pain score ~ 6.5
 4.= horrible 10.7 % , 5 =excruciating 14.3 %
                 Character of Pain
1.Throbbing       8. Aching               -
                              15. Punishing Cruel

2.Shooting         9. Heavy
3. Stabbing        10.Tender
4. Sharp           11. Splitting
5 Cramping         12.Tiring-Exhausting
6.Gnawing          13.Sickening
7. Hot-burning 14.Fearful
0= none , 1=mild, 2=moderate 3=severe
           Result of total score of pain characteristic before
                              intervention


•   15 items of pain characteristics
•   Actual Score = 0 – 45
•   Possible score = 2 – 23 , mean = 8.64
•    0 - 15 = mild                                Mild pain
•   16 – 30= moderate
•   31 – 45 = severe
                   Modified Piper Fatigue Scale
                                                        Cronbach alpha Reliability =
•   14 items                                                      0 .91
•   Actual score = 0 - 140 marks
•   Possible score = 22 – 130 marks
•   Mean           = 95.92 , SD = 26.73

                rather severe
• 0 – 46 = mild
• 47 – 94 = moderate                      Before intervention
• 95 - 140 = severe
  Table 2. The difference mean score of vital signs (P,RR,BP) during two interventions before and
                                       after TFR and MFR.

Variables       Before   After                      Difference        t-value     df p-value
N=28            M     SD M     SD                   M      SD

Pulse
TFR             92.00     9.34     92.35 11.47      -0.35    7.30                 27
                                                                      0.85               0.40
MFR             92.10    10.65     91.25 11.07       0.85    6.86

RR
TFR             21.60     2.09     21.39    1.87    0.21     1.52                 27
                                                                      -0.64              0.52
MFR             21.75     2.44     21.35    2.18    0.39     1.31

Systolic
TFR             111.96   10.39     109.64 9.22       2.32    8.10                 27
MFR             111.78   11.64     113.03 10.48                       2.31               0.02*
                                                    -1.25    7.77
Diastolic
TFR             71.42    8.24
                                   69.10   7.70
                                                    2.32    9.07
                                                                                  27
                71.60    7.58
MFR                                71.60   8.82
                                                    0.00    6.23      1.12               0.27
Foot reflexology had no apparent effects on patient’s
                     vital signs




Consistent with the finding of Eungpinichpong and Montree,1999
                    For the effects on vital signs
• We could not see a significant difference because

• Every sample had normal P,RR,Diastolic BP
• Even we could not see a significant difference in pulse, respiration rate and
  diastolic blood pressure.
• The data showed that foot reflexology didn’t interfere or didn’t have a
  negative effect on vital signs.
• 4 patients had systolic hypertension.       sig.diff
     Table 3. Test of Significance for Differences for Fatigue Intensity
 Intervention             Before            After          Difference   T-value    df   P-value
                     M     SD         M      SD     M        SD


Fatigue intensity scale (item 7 of Piper Scale)
                TFR 6.26 2.04         3.28 1.92     2.98     1.78
                                                                        2.601     27    0.015
                MFR 6.91 1.91         4.94 2.02     1.96     1.46

 Modified Piper Fatigue Scale
                TFR 72.03 23.11       40.64 23.42   31.39 15.31
                                                                        3.077     27    0.005
                MFR 76.35 29.75       53.91 27.37   22.44 15.84
        Table 4. Test of Significance for Differences for Pain Intensity
 Intervention            Before           After           Difference   T-value    df   P-value
                     M    SD        M      SD      M        SD


Pain intensity scale (Numeric McGill Pain scale)
                TFR 6.41 2.09       3.50 2.02      2.91 2.25
                                                                       1.234     27    0.27
                MFR 6.91 1.91       4.94 2.02      1.96     1.46

 Pain Descriptor Intensity Scale
                TFR 6.35 4.50       3.52 3.59      2.80 3.05
                                                                       3.87      27    0.001
                MFR 4.66 3.65       3.71 4.11      0.92 1.52
             Discussion for Fatigue and Pain Reduction
• Both fatigue and pain more reduce when they received TRF as compared
  to MRF.
• These findings are consistent with the literature reguarding reflexology
  research ( Stephenson, Weinrich & Tavakoli, 2000; Oleson & Flocco,1993; Malkin, 1994;
  Sieve-Ner et al., 1997; Kesserling, Spichiger, & Muller, 1998; Ounprasertpong , Chinoros, &
  Poonsaard, 2000)
• Because True Reflexology and foot massage both potentailly release endorphines which
  cause a cascading effect upon physiological stress responses due to its targeted pressure
  points.
• Endorphine and enkephalins can inhibit the transmission of pain signals through the spinal
  cord, help the body to relax, and reduce fatigue (Dougan,1999)
    Suggestion for future research


                Should include stress cortisol levels


to explore this component of the patients’ response to the treatment
                         All most of the patients
•   1.fell asleep during either of the 30 minute session

• 2.feeling relaxed and more energy after the sessions

• 3. They prefer TRF than MRF,perhaps because the wooden stick puts more
    pressure on foot

• 4. Some reported that they felt clear-headed and light feeling

•   5. Those patients with peripheral neuropathy reported increasd perception of
    sensation in their feet and legs. The could feel the blanket covering their leg and
    feet.
          Implications to Nursing Practice
• Foot reflexology can reduce fatigue and pain
  significantly.
• Foot reflexology should be a part of fatigue and
  pain management in AIDS patients
• Foot reflexology is a method to improve
  relationships through human touch, can be
  performed anywhere, requires no special
  equipment, is noninvasive,inexpensive and does
  not interfere with patients‘ privacy.
• Professionals and lay people can be taught
  reflexology.
                           Future Research

• To teach the care giver : how to do reflexology

• Effect of reflexology on pain and fatigue
                    If we can prove:
     Care giver can do foot reflexology effectively,
it will be a part of self care for family and home care
                       community.



     to improve quality of life
                 Article Publication




• Journal of Association in Nursing on Aids Care (JANAC)

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:55
posted:9/21/2011
language:English
pages:70