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Received: 28 Oct. 2009 Accepted: 19 Dec. 2009
*
MSc, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
**
MSc,
Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
Correspondence to: Leila Sadat Kahangi, MSc
Email: l_kahangi@yahoo.com
Research Article of Isfahan University of Medical Sciences, No:
IJNMR/Winter 2011; Vol 16, No 1 1
Original Article
The effect of reflexotherapy on some of the patients' vital signs before
CABG surgery
Mahin Moeini*, Leila Sadat Kahangi**, Mahboobeh Valiani**, Reza Heshmat**
Abstract
BACKGROUND:
The operation is a anxious factor that causes physiological reactions in body, and consequently increase
respiratory, pulse and blood pressure physiological responses. The aim of this study is assessing the effect of reflexothera-
py on some of physiological indicators of patients before coronary artery bypass surgery in shahid chamrnn hospital of
Isfahan.
METHODS:
This study is a clinical trial. Fifty volunteer patients for coronary artery bypass surgery divided in control and
treatment groups. vital sign were measured pre and post 30 minutes reflexotherapy in treatment group also for patients in
control group vital sign were measured pre and post 30 minutes as same as conditions with treatment group but reflexothe-
rapy was not performed in control group. Descriptive and inferential statistics methods of chi square, paired t test, inde-
pendent t test with spss soft ware was applied for data analysis.
RESULTS:
The mean differences of vital sign at baseline in control and treatment groups not significant, but post reflexo-
therapy intervention systolic and diastolic blood pressure lowered significantly in the treatment group in comparison with
control group (p < 0.05). No significant changes were observed for other vital sign.
CONCLUSIONS:
The findings of the study show that reflexotherapy is a safe, effective, cheep nursing intervention in reduc-
ing systolic and diastolic blood pressure of patients before coronary artery bypass surgery.
KEY WORDS:
Reflexotherapy, vital sign, coronary artery bypass surgery.
IJNMR 2011; 16(1 ): ??
urgery is one of the most stressful inci-
dents which may occur in everybody's life.
When human life is threatened, whether it
is a real or a pseudo threat, stress would occur.
This stress is characterized in physical and men-
tal functions of the individual.
1
Psychological reactions would be manifested
in the form of anxiety, besides; physical reac-
tions would be in the form of changes in body
physiological functions.
2
Heart is one of the organs which easily and
naturally react in various mental states.
3
Anxie-
ty causes an increase in sympathetic nervous
system activity and subsequently left ventricu-
lar pressure and heart rate would be increased
(diastolic and systolic dysfunction), heart needs
more oxygen, the risk of myocardial necrosis
and ischemia process would be increased and
the signs of cardiovascular would be increased
before the surgery.
4
In the respiratory system
also, the respiratory rate may increase and
causes the respiratory problems.
5
Therefore, providing the health of the pa-
tients undergoing heart surgery seems neces-
sary particularly in those who likely have the
physical and psychological problems and their
situation is getting more dangerous.
Thus, there are many methods available in
complementary and alternative medicine
(CAM) which nurses can help their patients
S
Moeini et al
2 IJNMR/Winter 2011; Vol 16, No 1
with in order to improve their health.
6
Reflexotherapy is one of the available inter-
ventions in complementary and alternative
medicine and treatments
7
which provides an
opportunity for nurses in order to care for their
patients.
8
The most primary scientific images of the
reflexotherapy were discovered in Ankhmahor
tomb in Egypt in 2500 B.C. In that intervention,
the therapist using his fingers -specially the
thumbs- with pressurizing on reflexology areas
of planter or palm surfaces which were related
to each part of the body, caused their health re-
store and had made a balance throughout the
body.
9, 10
Reflexotherapy, as a comprehensive ap-
proach and a nursing intervention -a nursing
science which supports traditional cares- can be
used in the current medical treatments.
11, 12
So far, many studies have investigated the
reflexotherapy as a noninvasive nursing inter-
vention in its various aspects such as: the im-
pact of reflexotherapy on hypotension without
any known reasons, reducing triglyceride and
blood sugar, improving nausea and vomiting in
cancer patients undergoing chemotherapy, re-
ducing depression and improving immune sys-
tem function, improving pain and anxiety of the
cancer patients and decrease the fatigue in
pregnant women.
11-15
However, in a pilot
(small) study conducted on the anxiety of pa-
tients before and after the coronary artery by-
pass graft (CABG) surgery, the reflexotherapy
had a significant effect on the physiological pa-
rameters of the patients.
4
Based on the observations and studied re-
search in recent decades which indicated the
high level of anxiety of patients before the sur-
gery and subsequent effects on vital signs of the
patients and considering different results of the
studies on effectiveness of the reflexotherapy on
these signs and also considering that reflexothe-
rapy is a non-invasive and non-
pharmacological nursing intervention, the re-
searcher determined to conduct a study aimed
to investigate and compare the effect of reflexo-
therapy on some of the vital signs before the
CABG surgery in two groups of intervention
and control groups.
Methods
This is a two complex clinical trial. The study
population included all the male and female
patients undergoing CABG surgery who had
the inclusion criteria for entering the study in
Chamran Hospital in Isfahan in 2008. The re-
searcher started collecting the samples and
practical work after obtaining the permission
from the School of Nursing and Midwifery of
Isfahan and presenting them to the Chamran
Hospital authorities.
In the present study, the samples were se-
lected using simple random sample method i.e.
all the patients undergoing CABG surgery re-
ferred to Chamran Hospital who had the inclu-
sion criteria selected for the study and therefore,
divided into intervention group (even numbers)
and control group (odd numbers) based on the
random numbers list. This process had contin-
ued until the desired number of the samples
was prepared. The total numbers of the samples
were 5o subjects (25 in the intervention group
and 25 in the control group).
The inclusion criteria to the study included
the age over 18 years old, full consciousness,
lack of hemorrhage, epilepsy, thrombosis, kid-
ney stone or gallbladder, foot diseases, inflation,
lesion or fractures in foot and lack of heart rate
reduction and hypotension.
A Japanese analog barometer was used in
order to measure the blood pressure. The respi-
ratory rate and pulse were counted and record-
ed by a nurse. The demographic data also were
collected at the beginning of the study from
both intervention and control groups.
The process of reflexotherapy was explained
to the intervention group and an informed con-
sent form was received from them. Before im-
plementing the reflexotherapy, the vital signs of
both groups were measured by a nurse who
was aware about the nature of the intervention
and control group subjects. Therefore, reflexo-
therapy was conducted for each patient in in-
tervention group for 30 minutes, first, for the
left foot and then for the right foot (15min for
each foot). Conducting reflexotherapy, first of
Moeini et al
IJNMR/Winter 2011; Vol 16, No 1 3
all, the relaxation technique was used from the
footstalk toward the sole (plantar surfaces) at
the beginning of the session. Then, four major
plantar reflexology points were under pressure
using the thumbs which are as the following:
solar plexus, pituitary, heart and liver. The oth-
er reflexology parts on the plantar and on the
foot also were under massage and finally inter-
vention was put an end with massaging of the
solar plexus by the researcher.
The vital signs were measured again after
finishing the intervention.
The vital signs of the control group were also
measured after 30 minutes with the similar
condition but without conducting the reflexo-
therapy.
SPSS software was used in order to analyze
the data and statistically, it was considered sig-
nificant (p < 0.05). Statistical tests such as chi-
square, independent t-test and paired t-test
were also used.
Results
After sampling, both groups were studied in
terms of demographic characteristics: age, sex,
marital status, employment status, education
and the duration of the cardiac disease. The sta-
tistical tests showed that both groups were de-
mographically similar to each other.
The average age of the intervention and con-
trol group was 57.68 and 56.8 respectively. In
intervention group, 52% of the subjects were
female and 48% of them were male. In the con-
trol group also, 48% of the subjects were female
and 52% of them were male. The majority of the
subjects in both groups were housewives, and
the minority of subjects were the employee
people. The highest percentage of the subjects in
the intervention group and control group were
illiterate (48% and 64% respectively). The lowest
percentage in education was in intervention
group (4%) who had diploma or higher degree.
In addition, the highest percentage of the marit-
al status was related to married subjects (92% in
intervention and 84% in control group).
The average duration of cardiac disease in
intervention and control groups was 3.84 and
5.10 years respectively.
The statistical paired t-test showed that there
was a significant difference in intervention
group between the average systolic blood pres-
sure before and after the intervention (p = 0.029)
and diastolic blood pressure (p = 0.013). Al-
though, the results showed that average reduc-
tion of respiratory rate was 56% in the interven-
tion group and also the average heart rate was
approximately 2 beats per minute after the ref-
lexotherapy, but statistically, there was no sig-
nificant difference between the average respira-
tory rate and the average heart rate per minute
before and after the reflexotherapy (tables 1 and
2).
The comparison of the vital signs using in-
dependent t-test before conducting the inter-
vention showed that two groups had not had
any significant statistical difference. But, systol-
ic and diastolic blood pressure in both groups,
after conducting the reflexotherapy showed a
significant difference (p = 0.012), but in average
respiratory rate and average heart rate, no sig-
nificant difference was observed between the
two groups.
Table 1. Mean and SD of heart rate and respiratory rate per minute, before and after the
reflexotherapy before the CAGB surgery.
Physiological variables
Heart rate per minute Respiratory rate per minute
Intervention Control Intervention Control
Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Before reflexotherapy
70.08 (8.67) 71.32 (7.60) 20.20 (4.37) 20.48 (4.04)
After reflexotherapy
68.12 (8.42) 71.60 (7.86) 19.64 (3.35) 20.52 (3.40)
Moeini et al
4 IJNMR/Winter 2011; Vol 16, No 1
Table 2. Mean and SD of systolic and diastolic blood pressure before and after the reflexotherapy
before the CAGB surgery.
Physiological variables
Systolic blood pressure Diastolic blood pressure
Intervention Control Intervention Control
Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Before reflexotherapy
130.20 (17.64) 130.60 (12.44) 83.00 (10.40) 83.80 (11.01)
After reflexotherapy
122.20 (15.67) 130.80 (10.77) 78.40 (8.74) 84.52 (10.20)
Discussion
The results showed that the average systolic
and diastolic blood pressure between the two
groups of intervention and control had a signif-
icant difference after conducting the reflexothe-
rapy. But, for the heart rate and respiration rate,
the average changes in these parameters
showed no significant statistical difference be-
tween the two groups. However, the results
showed that in intervention group, the average
heart rate and respiratory rate per minute had
slightly decreased after the reflexotherapy.
While, in the control group, the average
changes in all the physiological parameters
have slightly increased. Meanwhile, several
studies conducted to confirm the effect of ref-
lexotherapy on some of the vital signs such as
the study of McVicar et al (2007). The results of
the mentioned study indicated that reflexothe-
rapy has significantly decreased the systolic
blood pressure and heart rate per minute, but
diastolic blood pressure showed no significant
difference.
16
In the study of Park also, reflexo-
therapy has significantly decreased the systolic
blood pressure but diastolic blood pressure had
no significant difference.
13
However, in another
study conducted on the anxiety of the cancer
patients and their vital signs, systolic blood
pressure, diastolic blood pressure, heart rate
and respiratory rate significantly decreased af-
ter 30 minutes of reflexotherapy.
12
In the present
study also, systolic blood pressure and diastolic
blood pressure in the intervention group had
significantly decreased, and even, the heart rate
and respiratory rate decreased, but statistically
were not significant. The researcher believed,
perhaps, the cause of the different changes of
mentioned vital signs in the above studies were
due to slight differences in conducting reflexo-
therapy technique, which these slight differenc-
es had changed slight physiological differences.
Kuhn (1999) believed that reflexotherapy
causes relaxation in hyperactive areas of the
body and stimulates the passive areas and con-
sequently causes a balance and relaxation in the
body.
17
In addition, Fritz wrote in his book that sti-
mulating foot in reflexotherapy can cause the
activity of the parasympathetic nervous sys-
tem.
18
In a pilot study that Guvvarsdottir had con-
ducted on the patients before and after the
CAGB surgery, the vital signs variables had de-
creased in the intervention group, but in the
control group, these changes were not signifi-
cant
4
which was not in accordance with the
present study. Perhaps, one of the reasons that
the above mentioned study could not reach to
positive results was due to low number of the
samples (5 subjects in the intervention group,
and 4 subjects in the control group) and envi-
ronmental and patients conditions.
Summarizing all these studies which have
evaluated the effects of reflexotherapy on the
vital signs, it can be concluded that in all the
studies, vital signs had decreased after conduct-
ing the reflexotherapy, although, in some of the
variables, the reduction was not significant. But,
the point that none of the variables increased is
significant. In cases in which patients had anxie-
ty in association with a phenomenon and sub-
sequently the sympathetic nervous system has
been stimulated, particularly in patients with
cardiac disease, these parameters can worsen
the patients’ status before the surgery. There-
fore, reflexotherapy, as a complementary me-
Moeini et al
IJNMR/Winter 2011; Vol 16, No 1 5
thod, can cause relaxation and reduce the stress
and also can improve the hemodynamic status
of the patients.
4
Since, reflexotherapy can improve the
hemodynamic status of the patients and is a
safe, noninvasive and cost effective intervention
which only needs the nurse's hands, therefore,
we can justify using this intervention for the
patients in a different condition.
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