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FEATURES
Effects of Reiki on Pain, Anxiety, and Blood
Pressure in Patients Undergoing Knee
Replacement
A Pilot Study
■Ann Linda Baldwin, PhD ■Anne Vitale, PhD, APN, AHN-BC ■Elise Brownell, PhD
■Elizabeth Kryak, DrNP, RN-BC ■William Rand
This blinded, controlled pilot study investigated the effects of Reiki on 46 patients undergoing knee replacement
surgery. Of the 3 groups, Reiki, Sham Reiki, and Standard of Care, only the Reiki group showed significant
reductions in pain, blood pressure, respiration rate, and state anxiety, which provides evidence for a full-scale
clinical study. KEY WORDS:
anxiety
,
knee surgery
,
pain
,
Reiki
Holist Nurs Pract 2017;31(2):80–89
Reiki is a Japanese stress-reduction technique in
which the practitioner’s hands are used to induce a
therapeutic effect in the human energy field, which, in
turn, encourages the body to heal itself.1The National
Center for Complementary and Integrative Health2
classifies Reiki as a biofield therapy and indicates that
working with energy moves the human system into a
more relaxed state that is connected to health and
healing. Reiki is becoming ever more popular in the
Author Affiliations: Laboratory for the Advances in Consciousness and
Health, Department of Psychology (Dr Baldwin), and Department of Phys-
iology, College of Medicine (Dr Baldwin), University of Arizona, Tucson;
College of Nursing and Health Professions, Drexel University, Philadel-
phia, Pennsylvania (Dr Vitale); ZephyrBiotech, LLC, Lafayette, California
(Dr Brownell); Department of Nursing Informatics, Abington Memorial
Hospital, Abington, Pennsylvania (Dr Kryak); and Center for Reiki Re-
search, Southfield, Michigan (Mr Rand).
This work was funded by the FDC Foundation. The authors acknowledge
the Department of Nursing at Abington Memorial Hospital nursing staff
from the pre- and postsurgical orthopedic units for their flexibility and assis-
tance in providing an environment conducive to the execution of the study
parameters. The authors acknowledge Andrew M. Star, MD, orthopedic sur-
geon at Abington Health, and dedicated nurse researcher, Barbara Finn, RN,
for their recruitment of patients. The authors thank the FDC Foundation, a
nonprofit foundation founded by members of the Cluck family to support
charitable organizations within the United States in the areas of health, ed-
ucation, and housing, for funding this study. The authors also acknowledge
the Center of Reiki Research for help in developing and administering the
project.
None of the authors have declared a conflict of interest.
Correspondence: Ann Linda Baldwin, PhD, Laboratory for the Advances
in Consciousness and Health, Department of Psychology, University of
Arizona, Tucson, AZ 85721 (abaldwin@u.arizona.edu).
DOI: 10.1097/HNP.0000000000000195
United States as evidenced by a survey conducted in
2007 that indicates that 1.2 million adults and 161 000
children received 1 or more sessions the previous year
in which Reiki, or a similar bioenergy therapeutic
method, was used.3The National Center for
Complementary and Integrative Health and other US
reports indicate that Reiki is now more frequently
used by a growing number of Americans for
relaxation, musculoskeletal conditions, pain
management, anxiety, and depression.3,4
USE OF REIKI IN HOSPITALS
Hospitals and medical clinics are also adding Reiki
to the list of services offered to patients. A USA Today
article reported that, in 2007, 15% of US hospitals
(>800) offered Reiki as a regular part of patient
services.5In many of these programs, physicians,
nurses, and other medical personnel with Reiki training
are providing the sessions. Reiki began being used in
hospital operating rooms as early as 19956and is now
included in a holistic nursing “scope and standards
of practice” publication as an accepted form of care.7
Despite its widespread application, most reports
about the efficacy of Reiki are still anecdotal. There is
little research addressing potential mechanisms either
to explain the Reiki healing process or to support
the use of Reiki therapy in patient care; however,
research evidence is emerging, both on the general
Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
80
Reiki for Patients Undergoing Knee Replacement 81
physiological effects of Reiki, as reviewed
previously,8and on those related specifically to
control of pain and anxiety, as reviewed by Thrane and
Cohen.9More rigorous scientific studies are required
to assess Reiki’s value and usefulness as a scientific
and evidence-based practice. The evidence is not
strong regarding the efficacy of Reiki in reducing pain
and improving anxiety management regarding
hospitalized, surgical patients,8-10 but over the last
several years, a body of work is emerging.
SIGNIFICANCE TO NURSING PRACTICE
There is growing evidence that hospitals are exploring
the usefulness of complementary and alternative
medicine as an adjunct to pain management in
response to health care provider and consumer
demands for caring-healing models of care,1and there
is even regulatory influence from The Joint
Commission on hospital accreditation,11 for provision
of nonpharmacologic approaches for inpatient pain
management standards, especially surgical pain. In
recent years, patients’ perspective of hospital care has
been collected and reported by many hospitals, using
the Hospital Consumer Assessment and Healthcare
Providers System (HCAHPS) survey. HCAHPS data
are publicly reported by the Centers for Medicare &
Medicaid Services, and patients’ perception of pain
management during the hospital stay is a critical
survey item (www.hcahpsonline.org)
To keep up with growing trends in practice and
regulatory environments, more research into the
effectiveness of Reiki as a supportive therapy in
surgical and nonsurgical pain management of
hospitalized patients is warranted among nurses and
other health care professionals.
PURPOSE AND RATIONALE
The purpose of this preliminary study was to measure
how the use of Reiki, a means of gentle touch, influences
pain, stress, and anxiety levels in hospitalized
patients undergoing total knee replacement surgery.
An equally important goal of this pilot study was
to assess the research protocol, including recruitment
and enrollment of participants and the feasibility
of achieving the data collection end points in an acute
care setting in preparation for a multisite clinical trial.
THEORETICAL FRAMEWORK
Selected nursing theory guided this investigation.
Touch practices in contemporary nursing are
influenced from Florence Nightingale’s early work
and Martha Roger’s Science of Unitary Human
Beings. These works continue to provide visionary
guidance for nurses and others to consider the healing
effects of the energetic environment to maximize
health potentials.12, 13 The advancing vision of Jean
Watson’s14,15 work in human caring guides nurses to
work within a caring-healing model embodied in
mind-body-spirit therapeutics to promote wholeness,
comfort, and well-being.
MATERIALS AND METHODS
Ethical considerations
This study was approved by the Abington Memorial
Hospital Institutional Review Board (IRB) for Human
Research Health Sciences. Eligible participants were
invited to participate in the study during their
preoperative office visit with Dr Star, the orthopedic
surgeon, and were asked by a clinical research nurse
to sign a consent form in order to enroll. Study
participants were assigned a code number, and all data
are reported in the aggregate and de-identified. A
master list of this information is kept under locked
storage as per IRB policy.
Participants
The population for this pilot study was male and
female patients in the age range 50 to 85 years who
were admitted to an acute care hospital for a scheduled
single knee replacement. Exclusion criteria included
(a) joint replacement surgery on an urgent basis and/or
previous joint replacement revision, (b) patients who
could not read or understand English, (c) patients
with a history of emotional/psychological or
anxiety-related diagnosis, (d) patients who received
antianxiety or psychotropic medication within
2 weeks of the scheduled surgery, and (e) patients
whose surgery would be performed using anesthetic
agents other than standard general anesthesia.
Study design
This pilot study was designed as a 3-armed (15
subjects per arm), randomized, blinded protocol and
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82 HOLISTIC NURSING PRACTICE •MARCH/APRIL 2017
powered to detect trends that would support entry into
a larger multicentered study. The sample size was
calculated using a power analysis at 80% power, with
5% level of significance. For this calculation, effect
sizes for self-reported pain, heart rate, and heart rate
variability (HRV) were estimated using the means and
standard deviations of an earlier experiment in which
Reiki was tested versus other healing modalities or no
treatment.16 No pilot data were available to perform a
power analysis for State-Trait Anxiety Inventory
(STAI); although the group size (n =15) is sufficient
for the other evaluation outcomes, larger group sizes
are generally used for STAI. The STAI was still
included to determine data trends for the effects of
Reiki on this important parameter.
In this pilot study, one group of participants
received three or four 30-minute Reiki treatments plus
standard of care (SOC) throughout their hospital stay;
a second group received three or four 30-minute Sham
Reiki sessions (placebo) plus SOC; and a third group
received 3 or 4 sessions of “quiet time” plus SOC. For
all groups, the first treatment/session was to be 1 hour
prior to surgery, with subsequent treatments/sessions
24, 48, and 72 hours (if not already discharged) after
surgery. All treatments/sessions were performed in the
patient’s room on the postsurgical floor, except for the
preoperative session that was carried out in a private
patient room in the preoperative area.
Randomization of participants
After participants had consented to the study, they
completed a demographics form (see the Appendix)
that was placed in an envelope. The clinical research
nurse assigned a number to the envelope, in order of
completion, and then randomly assigned the number
(and hence patient) to one of the 3 groups, according
to the throw of a dice.
Reiki and Sham Reiki providers
Reiki treatments were performed on each patient in
the Reiki group by one of 3 expert (Master Level)
Reiki practitioners. Each Reiki practitioner was
provided with a detailed printed protocol describing
the exact hand positions to be used and in which order.
Sham Reiki sessions were given to each patient in the
Sham group by one of 2 people who were not trained
in Reiki or any other touch therapy. The Sham
practitioners were also given the printed protocol and
placed their hands on the patients in the same
positions as the Reiki practitioners. A member of the
research team demonstrated and reviewed the Reiki
protocol with both the Reiki and Sham practitioners,
prior to the sessions on the patients, with return
demonstrations to ensure consistency. Reiki
practitioners and Sham Reiki providers were all health
care providers employed by Abington Hospital.
Patients in both groups were each given sessions by
the same practitioner/provider throughout their stay.
Outcome parameters
The following data were collected from patients prior
to and after all treatments/sessions: pain level (using the
0-10 visual analog numeric pain rating assessment scale
used in Abington Hospital), blood pressure (BP), and
respiration rate (RR) (using inpatient data monitors).
Heart rate (interbeat interval) was also recorded for 5
minutes prior to and after all treatments/sessions using
the emWavePC (Institute of HeartMath, Boulder,
Colorado) in order to calculate HRV, a measure
of sympathovagal balance that is an indicator of level
of emotional stress at that moment. Unfortunately,
interbeat interval data from many of the patients were
not usable due to a prevalence of cardiac arrhythmias
in this group and so this measure was discarded.
Patients completed a STAI once before treatment
on the day of surgery and again after the last
treatment. The STAI is designed to differentiate
between the temporary condition of “state anxiety”
and the more long-standing quality of “trait anxiety”
in adults. The State Anxiety scale evaluates feelings of
apprehension, tension, nervousness, and worry, which
increase in response to psychological stress at the time
of stress. The Trait Anxiety scale evaluates the same
feelings over time. The STAI has adequate validity and
reliability, with reliability coefficients ranging from
0.83 to 0.92.17 Attempts were made initially to collect
saliva samples for analysis of salivary immunoglobulin
A (IgA) before surgery and on the day of discharge,
but this measure was soon abandoned because of
difficulty collecting samples from these patients.
An additional component was initiated on the day
of discharge after the last treatment/session. Each
patient was asked: “Which group do you think you
were in?” The purpose of this question was to
determine how well the study was blinded to
participants. Other data collected from the hospital
records included length of hospital stay after surgery
and usage of narcotics/analgesics after surgery during
length of stay. All data were de-identified and
collected by trained data collectors.
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Reiki for Patients Undergoing Knee Replacement 83
Analysis of pain medication use
Only subjects who completed all study interventions
at 48 hours, who received scheduled oxycontin (10 mg
by mouth every 12 hours), and who received a patient
controlled analgesia pump in the immediate
postoperative period (morphine 2-mg dose; loading
dose 0 mg; patient control 0.5-10 mg; lockout
[minimum time between doses] 6 minutes; maximum
limit 5-10 mg/h) were included in this analysis (9
Reiki subjects, 6 Sham Reiki patients, and 5 SOC
patients). Oxycodone 5 mg/acetaminophen 325 mg 1
to 2 tablets every 4 hours as needed (when
necessary) was available to patients for breakthrough
pain. The number of dosages of this medication
used by each patient per day was noted for analysis.
Method of data analysis
Since data for pain level, BP, and RR showed adequate
statistical power (80%) for analysis of variance
(ANOVA), these parameters were compared among 4
time points (pre- and postintervention before surgery
and 24 hours after surgery) within each group, using
Friedman repeated-measures ANOVA on ranks. If
there was a significant difference between the time
points, pairwise multiple comparison procedures were
performed with an overall significance level set at .05
(the Holm-Sidak method). Because of attrition at later
time points, data from 48 hours after surgery were
treated separately using the paired ttest (or signed rank
test if data distribution was not normal) comparing
only with the preintervention before surgery data
obtained from patients who were discharged at 48
hours or more after surgery. Intergroup comparisons
could only be made if the data for a given parameter
showed sufficient statistical power (80%) for
this type of analysis. The state anxiety data were
treated similarly. It was hypothesized that Reiki
plus SOC, but not the other 2 treatments, would
reduce pain, BP, RR, and anxiety at all time points.
A between-group ttest was performed on the after
surgery, post–last intervention data to determine
whether the Reiki plus SOC group showed less pain
and anxiety on discharge than the other 2 groups.
Another between-group ttest was performed to
determine whether there was a differential usage of
postoperative analgesics and length of hospital stay
according to patient group assignment. It was
hypothesized that there would be reduced usage of
postoperative analgesics and a shorter length
of hospital stay for the patients who received
Reiki compared with those in the other 2 groups.
RESULTS
Participant enrollment
The record of participant enrollment and attrition is
shown in Table 1. Sample sizes for the Sham Reiki
and SOC groups were below the desired value of 15,
but the size of the Reiki group exceeded this value.
Pain level
When comparing pain levels assessed before surgery
with those at 24 hours postintervention after surgery,
there was a trend of pain reduction in the Reiki group
(4.25 ±0.62 [SEM] vs 2.62 ±0.42 [n =18]) that was
not seen in the Sham Reiki (3.21 ±0.61 [SEM] vs
3.54 ±0.58 [n =12]) or the SOC groups (5.85 ±1.09
[SEM] vs 5.70 ±0.75 [n =10]) (Figure 1).
In comparisons of measurements taken
preintervention before surgery with those at 48 hours
postintervention after surgery, only baseline data
from those patients still within the study 48 hours
after surgery were included in the analysis. For
this reason, the baseline results listed later are slightly
different from those that appear in Figure 1. The Reiki
group showed significant pain reduction 48 hours
postintervention after surgery compared with baseline
(from 4.11 ±0.72 [SEM] to 1.40 ±0.40 [n =16], P=
.003). The large reduction in pain score was of sufficient
magnitude to provide adequate statistical power (power
90%) for this comparison. The corresponding results for
the Sham Reiki and SOC groups were as follows: from
2.96 ±0.60 (SEM) to 2.77 ±0.45 (n =11) (NS) and
from 5.43 ±0.37 (SEM) to 5.71 ±0.56 (n =7) (NS).
The smaller sample sizes for the Sham Reiki and SOC
groups resulted in lower statistical powers than those for
the Reiki group and for that reason a statistically valid
intergroup comparison could not be made. However,
only the Reiki group showed a large percentage
reduction in pain, 48 hours after surgery (Figure 1).
Blood pressure
Only the Reiki group showed a significant difference
among the 4 BP readings taken pre- and
postintervention before and 24 hours after surgery.
Both systolic and diastolic BP levels were significantly
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84 HOLISTIC NURSING PRACTICE •MARCH/APRIL 2017
TABLE 1. On-Study Subject Number at Each Stage
Consented
Before Surgery,
Preintervention
Before Surgery,
Postintervention
24 h After
Surgery,
Preintervention
24 h After
Surgery,
Postintervention
48 h After
Surgery,
Preintervention
48 h After
Surgery,
Postintervention
72 h After
Surgery,
Preintervention
72 h After
Surgery,
Postintervention
Reiki25191918181717 9 9
Sham 19 13 13 12 12 11 11 8 8
SOC1210101010 7 7 4 4
Abbreviation: SOC, standard of care.
FIGURE 1. Effects of Reiki or Sham Reiki on pain score.
Only the Reiki group showed a significant reduction in pain
score 24 and 48 hours after surgery. Note: As stated in the
“Results” section, because of attrition, the number of
patients who contributed to the 48-hour after surgery data
was lower than for the other data points. This discrepancy
was accounted for in the statistical analysis. SOC indicates
standard of care.
reduced when comparing pretreatment, before surgery
versus posttreatment, after surgery (systolic: 141.4 ±
3.7 [SEM] mm Hg vs 116.2 ±3.6 [n =18], P<.001,
power =0.99; diastolic: 73.6 ±1.9 [SEM] mm Hg vs
59.3 ±2.4, P<.001, power =1.0).
Comparing measurements taken preintervention
before surgery with those at 48 hours postintervention
after surgery, only the Reiki group showed
significantly reduced systolic BP (143.1 ±3.9 [SEM]
mm Hg vs 115.2 ±5.9 [n =16], P<.001, power =
0.99) and diastolic BP (74.3 ±2.1 [SEM] mm Hg vs
60.4 ±2.8, P<.001, power =1.0). The decrease in
systolic BP was a desirable response in the patients
because mean systolic BP was bordering onto
hypertension before surgery. The Sham Reiki group
showed significantly reduced systolic BP (147.6 ±3.2
[SEM] mm Hg vs 131.0 ±5.2 [n =11], P=.01,
power =0.78), but diastolic BP was not significantly
changed (76.9 ±3.0 mm Hg vs 68.6 ±2.4, NS). The
SOC group showed a trend for reduction of systolic
BP (143.0 ±4.8 [SEM] mm Hg vs 130.7 ±7.6 [n =
7], NS) but little change for diastolic BP (79.4 ±4.6
[SEM] mm Hg vs 74.3 ±4.2, NS). On the basis of
observed trends, it is possible that if the sample sizes
for the Sham Reiki and SOC-alone groups had
matched those of the Reiki group, there may have
been significant reductions in BP for these groups as
well, suggesting that this effect may not be mediated
by Reiki treatment per se.
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Reiki for Patients Undergoing Knee Replacement 85
Respiration rate
The 4 RRs (pre- and posttreatment, before and 24
hours after surgery) were significantly different from
each other within the Reiki group but not within the
other 2 groups. For the Reiki group, there was a trend
toward reduced RR when comparing pretreatment,
before surgery versus posttreatment, 24 hours after
surgery. This trend became statistically significant
when data obtained from the Reiki group
pretreatment, before surgery were compared with
those taken posttreatment, 48 hours after surgery (20.1
±0.5 [SEM] breath/min vs 17.7 ±0.5, P=.008).
Anxiety state
The State Anxiety scores were only recorded before
surgery and 48 hours after surgery. Since 10 patients
had either been discharged or been withdrawn from
the study by 48 hours after surgery, the small group
sizes were reduced even more; thus, the purpose of the
resulting data analysis is to reveal promising trends for
a future large-scale study. Comparing measurements
taken preintervention before surgery with those
discharged at 48 or 72 hours postintervention
after surgery, only the Reiki group demonstrated
significantly reduced State Anxiety scores at discharge
compared with intake (39.1 ±3.3 vs 32.1 ±2.7 [n =
14], P=.004, power =0.88). The 7 patients who were
discharged at 72 hours after surgery had very similar
state anxiety levels to those who were discharged 48
hours after surgery. The corresponding results for the
Sham Reiki and SOC groups were as follows: 42.2 ±
3.3 (SEM) versus 37.4 ±2.4 (n =10) (NS), and 42.6 ±
3.6 (SEM) versus 40.3 ±4.5 (n =6) (NS). The majority
of the Sham Reiki (8/10) and SOC patients (4/6) were
discharged 72 hours after surgery. Since the sample
sizes for the Sham Reiki and SOC groups were smaller
than those for the Reiki group, leading to inadequate
statistical powers, a statistically valid intergroup
comparison could not be made. There was a trend
of reduced anxiety after Sham Reiki that may have
shown significance if the sample size had been larger.
However, the Reiki group showed the largest reduction
in state anxiety 48 hours after surgery (Figure 2).
Pain medication usage
The Reiki group used the lowest number of doses of
as-needed pain medication (22 doses or 2.4 doses per
patient) compared with the Sham Reiki group (36
doses or 6 doses per patient) and the SOC group (29
doses or 5.5 doses per patient).
FIGURE 2. Effects of Reiki or Sham Reiki on State Anxiety
score at discharge. Only the Reiki group showed a
significant reduction in state anxiety at discharge. SOC
indicates standard of care.
Retention in study
The Reiki group had the highest percentage retention
rate in the study up to, and including, the 48-hour after
surgery time point, whereas the SOC group had
significant drop-offs between 24 and 48 hours after
surgery (Table 1 and Figure 3).
Hospital stay
The Reiki group had the highest percentage of
discharges at 48 hours rather than at 72 hours
(Figure 4), implying fewer complications leading to
later discharge.
Believed group assignment
Blinding of groups 1 and 2 (Reiki and Sham Reiki,
respectively) was assessed by asking patients on
discharge to guess the group to which they had been
FIGURE 3. Effects of group assignment on percentage
retention in study. The Reiki group showed the highest
percentage rate of retention in the study up to, and including,
the time point 48 hours after surgery, after which half of the
patients were discharged. SOC indicates standard of care.
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86 HOLISTIC NURSING PRACTICE •MARCH/APRIL 2017
FIGURE 4. Effects of group assignment on the percentage of
patients discharged at various times. The term “other” refers
to the percentage of patients who were taken off the study
prior to 48 hours after surgery due to complications, such as
the need to return to the intensive care unit. The Reiki group
had the highest percentage of discharges at 48 hours. SOC
indicates standard of care.
assigned. Group 3 subjects, receiving only SOC, were
not blinded as to their assignment. For group 1, 15 of
16 subjects correctly guessed their assignments, many
mentioning that they felt relaxed, less stressed, and fell
asleep during their sessions. These comments suggest
that there are noticeable effects of Reiki treatment in
otherwise naive subjects. It is unlikely that this skewed
result was the effect of compromised blinding because
the results from the Sham Reiki group (group 2) were
highly supportive of the quality of blinding. Here, 6 of
the 10 respondents mistakenly believed they were
assigned to the Reiki group and 4 guessed otherwise.
Results summary
This blinded, sham-controlled, small pilot study has
shown, for the first time, that Reiki significantly
reduces pain, stress (as reflected by BP and RR), and
diminishes anxiety levels in hospitalized patients
undergoing total knee replacement surgery. In
addition, Reiki treatments, given pre- and
postoperatively, along with a pharmacologic pain
management protocol, enhanced postoperative pain
management and resulted in less use of narcotic pain
medication than Sham Reiki or SOC alone. Overall,
Reiki exceeded Sham Reiki and SOC in the
improvement and/or quality of all 7 of the parameters
measured in this small sample (Table 2).
DISCUSSION
Nursing, posited as a caring science, provides context
for the continued exploration of Reiki and its utility in
pain management For example, Watson15 informs
nurses to embody mind-body-spirit therapeutics, such
as the use of Reiki, to improve patient comfort and
well-being. The most striking result of this study was
that Reiki reduced pain scores in 18 subjects
undergoing single knee replacement surgery, a
procedure that is quite painful and that usually
involves powerful pain management protocols.
In the field of Reiki clinical research, no other
clinical study has been reported in peer-reviewed
literature using 3 groups: Reiki plus SOC, Sham Reiki
Plus SOC, and SOC alone. The inclusion of Sham
Reiki was a critical control for the effects of attention,
caring, and touch on pain levels, as many people
consider Reiki as having nothing more than a placebo
effect. Our exploratory study, however, indicates that
Reiki goes above and beyond a placebo effect. The
fact that Reiki is effective in reducing pain is highly
relevant to the medical field because pain medication
is the second largest market in the world of
pharmaceuticals, behind cancer, and thus the financial
aspect is very important. The reduction of patients’
pain in the hospital environment is an important
dimension of a caring-healing environment and can
enhance the patient experience and satisfaction with
care and pain management, influencing data being
collected by hospitals for quality and regulatory
compliance. Moreover, reduction of postoperative pain
TABLE 2. Rank Order of Positive Results by End Point and Treatment Group
Pain
Improvement
PRN
Medications
Average
Doses/Pt
State Anxiety
Improvement at
Discharge
Systolic BP
Improvement at
48 h
Diastolic BP
Improvement at
48 h
Retention
on Study at
48 h
%Discharge
at 48 h
Reiki 1111111
Sham Reiki 2 2 2 2 2 2 3
SOC 3333332
Abbreviations: BP. Blood pressure; PRN, as needed; Pt, patient; SOC, standard of care.
Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Reiki for Patients Undergoing Knee Replacement 87
will promote early mobility, begin the rehabilitation
phase faster, and minimize complications.
Another strength of the study was the fact that
patients were blinded regarding whether they were
included in the Reiki group or the Sham Reiki group.
The effectiveness of the blinding was verified by
asking the participants at discharge to which group
they thought they had been assigned. The majority of
patients in the Sham Reiki group thought that they had
been placed in the Reiki group, indicating that the
blinding was convincing, leading to the conclusion
that the reported pain assessment differences were
well corrected for the placebo effect.
Study limitations and benefits
Problems with the study were linked to the fact that
this was an exploratory pilot study, one aim of which
was to assess the research protocol, including
recruitment and enrollment of participants and the
feasibility of achieving the data collection end points
in an acute care setting in preparation for a multisite
clinical trial. Issues that were encountered included
low efficiency of recruitment of participants, difficulty
obtaining usable measures of HRV from many
patients, trouble collecting sufficient saliva from
patients, and a high rate of attrition from the quiet
time/SOC arm.
The recruitment problem stemmed from the fact
that we relied on a single point of enrollment and a
single clinical site to perform all recruitment
procedures. This single point of enrollment was a
bottleneck that could be corrected in a larger study by
including multiple centers. In addition, there were
patient flow considerations arising from scheduling
problems due to the limited capacity of a single center
to process subjects accounting for surgeon availability
and enrollment officer schedules. All of these
situations could be handled effectively by including
multiple sites.
The HRV recording as a measure of sympathovagal
balance was not useful as a primary end point in this
case because many patients presented with
arrhythmias. Recordings can be corrected for
occasional ectopic beats and arrhythmic events by
omitting those RR intervals and interpolating the
data.18 However, when too many RR intervals are
interpolated as a percentage of the total number of
intervals recorded, this leads to inaccurate results.
Salivary IgA was not a suitable clinical end point in
this case because the amount of saliva the patients
could produce before surgery was limited since they
were instructed to abstain from taking solids or liquids
for a certain time prior to admission. This is valuable
information because it serves to eliminate saliva-based
testing of this patient population.
The cause for the high rate of attrition from the
quiet time/SOC arm is not clear but could result from
a patient’s disappointment at not being randomized to
a treatment arm on which some benefit might
theoretically be derived. It may also suggest that in
larger pivotal studies, only 2 arms are justified: Sham
Reiki and Reiki.
In contrast, we found the pain scale to be very
useful, as were the simple and inexpensive
measurements of time to discharge and as-needed pain
medication usage. Although the group size in this
study was small for effective implementation of the
STAI test, the results were encouraging and indicate
that STAI would provide useful information in a larger
clinical trial. This study demonstrates that the benefits
of Reiki to hospital patients undergoing knee
replacement surgery can be clearly observed using
cost-effective measures that can be performed by
nurses and other health care professionals.
Implications for further research and nursing
practice
The next step is to perform a multicenter clinical study
with 50 patients per group, in which we focus on the
measurements that were informative, such as pain
scores, state anxiety, BP, on-time discharge, less
as-needed pain medication use, fewer readmissions or
trips back to the intensive care unit, and increased
patient satisfaction and pain management HCAHPS
scores.
The opportunity to differentiate between hospitals
on the basis of patient outcomes, patient satisfaction,
and readmission rates, for such a low-cost offering as
Reiki as a caring-healing approach to patient care,
should be of significant financial impact to insurers,
patients, and providers. In addition, positioning
Reiki as an adjunct to SOC should promote a more
generalized adoption and acceptance. Reiki is additive
and may increase patient compliance while allowing
on-time discharge and fewer complications.
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Reiki for Patients Undergoing Knee Replacement 89
APPENDIX
Demographic Data
Subject # ______
Age (check one):
50-55 years old _______________(1) 56-60 years old _______________(2)
61-65 years old _______________(3) 66-70 years old _______________(4)
71-75 years old _______________(5) 76-80 years old ________________(6)
81-85 years old ________________(7)
Gender (check one): Male______(1) Female_______(2)
Marital status (check one):
Single _______(1) Divorced __________(2) Separated _________(3)
Race (check all that apply):
White __________(1) Black or African- American________(2)
American Indian ___________(3) Asian________(4) Hispanic ________(5)
Native Hawaiian and Other Pacific Islander _________(6)
Medications used for pain relief taken within the past two weeks:
Medication/s name, dose, how often taken (please write in): __________________________
Not applicable: ______
Use of other energy touch therapies (check all that apply): Therapeutic touch _______
Healing touch ________ Other/s (write in )_________________________ N/A__________
THANK YOU!
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