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24 ALTERNATIVE THERAPIES, jul/aug 2008, VOL. 14, NO. 4 Healing Touch in Coronary Artery Bypass Surgery Recovery
THE EFFICACY OF HEALING TOUCH IN
CORONARY ARTERY BYPASS SURGERY RECOVERY:
A RANDOMIZED CLINICAL TRIAL
Barb MacIntyre, RN, BS, HTP; Jane Hamilton, RN, MPH, CHTP; Theresa Fricke, RN, MA, CHTP; Wenjun Ma, MS; Susan Mehle; Matt Michel
changes in an individual’s lifestyle and social activities often are
observed following surgery.
2
Healing touch (HT) is a biofi eld- or energy-based therapy
that arose out of nursing in the early 1980s.
3
In 1989, the
American Holistic Nurses Association (AHNA) offered HT as a
continuing education program, and in 1996 it became an
endorsed program for AHNA through Healing Touch
International, Inc. The HT curriculum is taught as a multi-level
program with a 1-year mentorship experience that leads to certi-
fi cation.
3
HT complements conventional healthcare and is used
in collaboration with other approaches to health and healing.
HT aids relaxation and supports the body’s natural healing
process, ie, one’s ability to self-balance and self-heal. This nonin-
vasive technique involves (1) intention (such as the practitioner
centering with the deep, gentle, conscious breath) and (2) place-
ment of hands in specific patterns or sequences either on the
body or above it. At its core, the theoretical basis of the work is
that a human being is a multi-dimensional energy system (includ-
ing consciousness) that can be affected by another to promote
well-being. There are a variety of theorists whose work supports
this notion. For example, nursing theorist Dr Jean Watson devel-
oped Watson’s transpersonal-caring model theory. This theory
includes an expanded view of the individual to one composed of
Barb MacIntyre, RN, BS, HTP, is clinical director of
Cardiovascular Telemetry and Jane Hamilton, RN, MPH, CHTP,
and Theresa Fricke, RN, MA, CHTP, are healing touch therapists
at HealthEast Heart Care, all at HealthEast Saint Joseph’s
Hospital, St Paul, Minnesota. Wenjun Ma, MS, was the senior
statistician at HealthEast Research and Education, St Paul, at
the time this paper was written and is currently the senior
associate in statistical programming at Amgen, San Francisco,
California. Susan Mehle is the director of research and Matt
Michel is the senior director of Research and Education, both
with HealthEast Research and Education.
E
ach year in the United States, approximately 600 000
coronary artery bypass graft surgeries are performed,
with costs totaling $25.3 billion.
1
According to the
American College of Cardiology and the American
Heart Association Task Force on Practice Guidelines,
coronary artery bypass (CAB) surgery is among the most com-
mon operations performed in the world and accounts for more
resources expended in cardiovascular medicine than any other
single procedure.
1
The total cost of this intervention clearly is
compounded when complications occur. In addition, dramatic
Context • The use of complementary therapies in conjunction
with conventional care has great potential to address patient
pain, complication rates, and recovery time. Few studies of such
therapies have been conducted in hospital settings where some of
the most stressful procedures are performed on a regular basis.
Objective • We hypothesized that patients receiving healing
touch (HT) would see improved outcomes.
Design • Patients were randomized into 1 of 3 treatment groups:
no intervention, partial intervention (visitors), and an HT group.
Setting • This study was conducted in an acute-care hospital in
a large metropolitan area.
Patients or Other Participants • Patients undergoing fi rst-
time elective coronary artery bypass surgery were invited to
participate. There were 237 study subjects.
Intervention • HT is an energy-based therapeutic approach to
healing that arose out of nursing in the early 1980s. HT aids
relaxation and supports the body’s natural healing process.
Main Outcome Measures • This study consisted of 6 outcome
measures: postoperative length of stay, incidence of postopera-
tive atrial fi brillation, use of anti-emetic medication, amount of
narcotic pain medication, functional status, and anxiety.
Results • Analysis was conducted for all patients and separately
by inpatient/outpatient status. Though no signifi cant decrease in
the use of pain medication, anti-emetic medication, or incidence
of atrial fi brillation was observed, signifi cant differences were
noted in anxiety scores and length of stay. All HT patients showed
a greater decrease in anxiety scores when compared to the visitor
and control groups. In addition, there was a signifi cant difference
in outpatient HT length of stay when compared to the visitor and
control groups. (Altern Ther Health Med. 2008;14(4):24-32.)
original research
ALTERNATIVE THERAPIES, jul/aug 2008, VOL. 14, NO. 4 25Healing Touch in Coronary Artery Bypass Surgery Recovery
spirit, a universal mind, and consciousness as energy.
4
Research
today on subtle info-energetic connections is being conducted at
Princeton University within the Princeton Engineering Anomalies
Research Program. These connections indicate that actions in
one system can potentially influence actions of another on a
quantum energetic level.
5
According to Oschman, modern
research has confi rmed work done by pioneers in energy fi eld-
work in the 1930s such as Dr Harold Saxton Burr of Yale: “Not
only does every event in the body, either normal or pathological,
produce electrical changes, it also produces alterations of the
magnetic fi elds in the spaces around the body.”
6(p18)
Candace Pert,
PhD, neuroscientist and pharmacologist, is best known for her
discovery of opiate receptors and endorphins and peptide
research. Her groundbreaking work spans several decades of
research in molecular biology. Her striking conclusion is that
one’s emotions and their biological components (“bodymind”)
function as an integrated information network that offers a new
understanding of the power of a person’s thoughts and feelings
to affect health and well-being.
7
Pert’s discoveries also have served to create bridges among
such distinct disciplines as psychology, neurophysiology, immu-
nology, and endocrinology, helping to usher in a new era of inte-
grative medicine, uniting links between not only mind and body,
but Eastern and Western traditions as well.
The holistic nursing paradigm with its concept of energetic
healing has been emerging concurrently with advances in sup-
portive research in mind-body medicine, as well as consumers’
interest in complementary and alternative medicine (CAM).
8
Many of the observations of energy practitioners that scientists
previously found unacceptable are beginning to be explored by
researchers.
9
Increased application of HT in healthcare has come
about in large part because of the interest of its practitioners and
patients’ response. In the United States alone, more than 75 000
people have taken at least a fi rst-level HT course, and it is taught
in a variety of countries worldwide.
10
HT is being used in such
diverse areas as outpatient pain centers, private practices, and
operating rooms.
11
Although there is a growing body of literature exploring the
increasing patient interest in complementary therapies
12,13
and an
increasing amount involving cardiovascular patients,
14
few studies
specifi cally apply the energy therapy known as HT to the acute-
care setting.
15
A review of the literature shows that until recently,
little attention had been paid to studies of HT in particular as a
basis for either evaluating outcomes or determining needed direc-
tions in research and clinical practice. In an article published in
2004, Diane Wardell identifi ed more than 30 quantitative studies
conducted with HT as the independent variable.
11
Wardell notes
that a key aspect of this review was to include non-signifi cant sta-
tistical fi ndings, noting that the question has been raised whether
the fi eld of energy research readily lends itself to traditional scien-
tifi c analysis due to coexisting paradoxical fi ndings.
16
The literature review done for the purpose of this paper
revealed that few published studies demonstrate HT specifi cally
as an effective energy therapy beyond case studies, anecdotal
reports, and investigations with small sample sizes. However,
several randomized controlled studies using HT were identifi ed,
all of which have taken place within the past 5 to 6 years.
In a 2-arm, single-blind randomized controlled trial, Cook
et al studied 78 (of 234 initially screened) women receiving radia-
tion therapy for gynecological or breast cancer. Participants
received either HT (provided by level-II HT practitioners) or a
mock treatment (laypeople with no previous training or knowl-
edge of HT). Each patient received 6 sessions of 30 minutes each
following radiation treatments. Study subjects who received HT
demonstrated better health-related quality of life. Statistically
signifi cant differences were seen between the 2 groups in SF-36
scores in categories of vitality (P<.03), pain (P<.02), and physical
function (P<.05).
17
Post-White et al used a randomized, prospective, 2-period
crossover design to measure HT, presence, and therapeutic mas-
sage on symptom relief in 164 outpatients undergoing chemo-
therapy. Noted outcomes were decreased blood pressure,
decreased pain, improved mood, and improved fatigue.
18
Ziembroski et al used 2 HT techniques to determine their
effects on the quality of life for individuals at the end stage of life.
In this experimental design, 55 participants were randomized
into standard care and HT groups. Study outcomes examined
were quality of life, physical symptoms, and spiritual meaning.
No signifi cant differences were found between the 2 small groups
(standard care, n=26; HT, n=29).
19
A study by Wilkinson examining the clinical effectiveness of
HT noted raised sigA concentrations in patients receiving this ther-
apy, as well as lowered stress perceptions and relief of pain. This
small study randomized 22 participants to no treatment, standard
HT, and HT plus music. The results indicated a signifi cant interac-
tion effect of the treatment stage and the practitioner training level
(P<.021), with a nearly 4 times average positive change for those
participants with the more highly trained practitioner.
20
The MANTRA study,
21
a pilot study at Duke University,
used a randomized controlled design that focused on the associa-
tion of HT and other “noetic” therapies such as prayer and relax-
ation training prior to angioplasty. The study found a 25% to 30%
decrease in adverse outcomes associated with HT, which served
as the basis for a 2-tiered 748-patient study further examining
adverse patient outcomes (adverse cardiac events and death).
Although music, imagery, and touch (MIT) therapies were shown
to lower mortality at 6 months post-procedure, no signifi cant dif-
ference was found for the primary composite endpoint in any
treatment comparison. The primary endpoint was described as
“combined in-hospital major adverse cardiovascular events and
6-month readmission or death.”
22(p147)
For the purposes of this study on CAB patients, there was
particular interest in research that addresses the hospitalized
patient, as the cardiac-surgical bypass patient is a specialized
subset of the acute care setting. As such, the needs of CAB
patients as a group are similar to those of other hospitalized
patients, yet unique as well. Two of the most common problems
associated with care of the patient who has undergone cardiac
26 ALTERNATIVE THERAPIES, jul/aug 2008, VOL. 14, NO. 4 Healing Touch in Coronary Artery Bypass Surgery Recovery
surgery have to deal with pain management
23
and heart arrhyth-
mias.
24
These are key care management issues because of the
associated stress and discomfort experienced by patients, which
increases length of stay and impact on overall recovery.
25
The use of CAM in conjunction with conventional care has
great potential to address patient pain, complication rates, and
recovery time. Although the usage of CAM by the general US
population is steadily increasing,
12
the impact of these treatments
has not been studied by means typically acceptable to Western
practitioners. Even fewer studies have been conducted in hospi-
tal settings where some of the most stressful procedures are per-
formed on a regular basis.
We hypothesized that patients receiving HT would see
improved outcomes, including decreases in length of stay, medi-
cation use, and complication rates, with improved health status
and anxiety scores.
METHODS
Participants
An experimental randomized controlled trial was conducted
between September 1999 and November 2002. All consecutive
patients who chose to undergo fi rst-time elective CAB were invit-
ed to participate in the study at St Joseph’s Hospital, a community
hospital in St Paul, Minnesota. Initially, only scheduled outpa-
tients were included in the study. In May 2000, non-emergent
inpatients were added to the recruitment process to speed enroll-
ment. Excluded were (1) valve or minimally invasive direct CAB
patients, (2) patients who had a history of CAB surgery, (3)
patients who were not competent to answer the study question-
naires, and (4) emergent CAB patients. Final enrollment consist-
ed of 120 inpatients and 117 outpatients.
This research was approved and annually reviewed by the
house institutional review board. Written consent was obtained
from all patients on the preoperative education day.
Interventions
Upon entering the study, participants were randomly
assigned to 1 of 3 study groups: full intervention or HT group, par-
tial intervention or “visitor” group, or a control group receiving no
additional intervention. All 3 groups received the same standard of
care from the hospital staff. In addition to standard care, the HT
group received preoperative education for HT and received 3 HT
interventions—the day before surgery, immediately prior to sur-
gery, and the day after surgery. Two certifi ed HT practitioners,
both registered nurses, provided all the HT sessions.
HT sessions were in accordance with standard HT practice,
26
in which the practitioner establishes a relationship with the
patient. After conversing with the patients and assessing their
energy fi elds, the practitioners performed a variety of HT tech-
niques based upon their assessment.
27
Each patient in the HT
group had the same practitioner throughout his or her hospital
stay. Treatments ranged from 20 to 60 minutes in duration, with
the exception of session 2, which occurred on the day of surgery
and lasted 60 to 90 minutes. Sessions were generally conducted
with the patient supine on a treatment table or bed and included
techniques that were done either directly on the body (light
touch) or above the body.
The visitor group was designed to control the presence
effect associated with the visit of the HT practitioners. Patients in
the visitor group received a visit by the same retired registered
nurse on 3 occasions. These followed the same schedule as the
HT interventions (day before surgery, immediately before sur-
gery, and day after surgery). The fi rst and third visits were 20 to
60 minutes in duration, and the second visit (day of surgery) last-
ed 60 to 90 minutes. Some visits were shortened at the patient’s
request. The visit consisted of general conversation or the visitor
remaining quietly in the room with the patient. At the com-
mencement of the study, training was given to the volunteer visi-
tors to standardize the content of the conversation.
The control group received the standard CAB surgery proto-
col with neither HT nor a volunteer visit.
Objectives
We hypothesized that patients receiving HT would see
improved outcomes, including decreased length of stay, medica-
tion use, incidence of atrial fi brillation, and improved health sta-
tus and anxiety scores.
OUTCOMES
This study consisted of 6 outcome measures: postoperative
length of stay, incidence of postoperative atrial fi brillation, use of
anti-emetic medication, amount of narcotic pain medication, func-
tional status, and anxiety. In order to make narcotic pain medica-
tions comparable, all were converted to morphine-equivalent
dosage.
27,28
Medications were dispensed based on standing orders
and as determined by patient need or nurse assessment.
Patients were discharged when the following criteria were met:
• vital signs stable and within normal limits per patient baseline;
• pain adequately controlled with oral analgesics;
• heart rhythm stable;
• adequate calories consumed;
• weight near baseline;
• untreated signifi cant pulmonary disease not present; and
• appropriate semi-independence in activities of daily liv-
ing and level of activity.
Atrial fi brillation is assessed by continuous cardiac monitor-
ing during the hospital stay; nurses identify any changes in heart
rhythm, document the changes, and notify the physician. Patients
with a history of atrial fi brillation or currently taking beta blockers
for any reason were excluded from the analysis comparing inci-
dence of atrial fi brillation among the study groups.
Anxiety was measured using the State Trait Anxiety
Inventory (STAI),
29
a widely accepted 40-item tool measuring
both temporary and dispositional anxiety in adults. The STAI
was administered on the preoperative education day in the hos-
pital Surgical Admit Unit and postoperative day 4 by a cardiac
rehab nurse. Functional status was measured using the Health
ALTERNATIVE THERAPIES, jul/aug 2008, VOL. 14, NO. 4 27
Healing Touch in Coronary Artery Bypass Surgery Recovery
Status Questionnaire (SF-12), a 12-item measure of general
health that is recognized for its validity and reliability.
30
The
questionnaire was given twice during the study period: on the
preoperative education day and by mail to all participants 6
months after their surgery. Patients who did not respond to the
initial survey were called by trained research staff members who
administered the survey by phone.
Additional data collected from medical records included
demographics (gender, age, type of admission) and baseline clin-
ical characteristics (height, weight, history of myocardial infarc-
tion, history of arrhythmias, comorbidities, APR-DRG [All
Patient Refined Diagnosis Related Groups] severity).
Comorbidities included hypertension, congestive heart failure
(CHF), hypercholesterolemia, chronic obstructive pulmonary
disease (COPD), depression, and diabetes.
Sample Size
It was determined that in order to detect a minimum change
of 0.5 days in length of stay, a total sample size of 402 patients was
needed: 134 patients per group was targeted to achieve statistical
power of 0.8 with a standard deviation of 4 and a type I error rate
of 0.05 (2-sided). Data collection was ended before the enrollment
goal was reached due to recruitment difficulties, impending
changes to care protocols, and an interim analysis that suggested
additional enrollment was unlikely to yield any more statistically
signifi cant fi ndings. The fi nal sample size was 237.
Randomization
A total of 601 patients were assessed for eligibility to partici-
pate in the study; of those, 163 did not meet the inclusion crite-
ria, 123 declined to participate, and 25 had insufficient time
between the eligibility assessment and scheduled surgery.
Patients were randomly assigned to the HT group, the visi-
tor group, or the control group (99, 94, and 97 patients, respec-
tively). The randomization schedule was generated by a hospital
statistician using SPSS Version 13.0 (SPSS, Inc, Chicago).
Outpatients were enrolled by staff members in the surgeon’s
offi ce and inpatients by health unit coordinators of the telemetry
unit in the hospital. Patients were assigned to a study group at
the time of enrollment. Allocation was done in blocks of 6. Upon
enrollment into the study, a sealed, sequentially numbered enve-
lope was opened to reveal study group assignment. To reduce
potential of bias from 2 differing patient populations, the non-
emergent inpatients and the scheduled outpatients were treated
as 2 different groups with separate randomization schedules.
Patients who died during their hospital stay were excluded from
the study and categorized as lost to follow-up.
Blinding
Because of the nature of HT and the required patient-
practitioner interaction, it was not feasible to blind the study for
either practitioners or participants, in part due to the logistics
necessary for preoperative procedures (arterial and central line
placement, etc) in the operating room prior to CAB surgery.
Statistical Methods
Descriptive statistics were computed for all variables (Table
1). Continuous outcome variables (length of stay, amount of nar-
cotic pain medications, functional status, and anxiety) were ana-
lyzed using analysis of covariance (ANCOVA). Total morphine or
morphine equivalent was calculated for each patient on days 1
and 2 postoperatively.
27,28
SF-12 and anxiety scores were mea-
sured pre- and post-intervention; the change from pre- to post-
was used for analysis rather than the raw scores. For categorical
outcome variables (length of stay ≤6 days, incidence of postoper-
ative atrial fi brillation, use of anti-emetic medication, and dichot-
omized postoperative length of stay ≤6 days), logistic regression
models were applied.
Fifteen variables were included in the analysis model for
adjustment: APR-DRG, severity, hypertension, CHF, hypercholes-
terolemia, COPD, depression, diabetes, gender, age, admission
status, history of MI, baseline anxiety, baseline SF-12, physical
and mental scales. To determine if there were signifi cant interac-
tions between physical and mental status, the interaction with
corresponding marginal factors was considered in the models.
Analysis was conducted for all patients, as well as separately
by inpatient/outpatient status. Residual plots (not shown) for all
models were performed to diagnose model fi t and to check all
the assumptions of ANCOVA and logistics regression.
A P value of <.05 was considered to be statistically signifi -
cant. P value was not adjusted for multiple tests. All analyses
were done through SPSS Version 13.0 by SPSS, Inc.
RESULTS
Patient recruitment began in September 1999, and the
study was closed in November 2002. Patient follow-up continued
through June 2003.
Two hundred thirty-seven patients completed the study.
There were 87 patients in the HT group, 87 in the control group,
and 63 in the visitor group; baseline characteristics are shown in
Table 1. As shown in Table 1, the 3 study groups were not signifi -
cantly different from each other at baseline, except for preopera-
tive anxiety scores (HT=41, visitor=41, and control=45, P=.04).
Average age was 64 years in the HT and control groups and 66
years in the visitor group. For all CAB patients seen during the
same time period, average age was comparable at 64 years. The
percentage of females in the HT group was 79.3%, 77% in the con-
trol group, and 74.6% in the visitor group. The CAB population in
the hospital during the same time frame was 23.1% female.
A logarithm transformation for length of stay was used to
handle the skewness of the raw data (Figure 1). The adjusted
mean length of stay for the HT group was 6.9 (95% CI=6.1, 7.7)
days, which was less than that of the visitor group (7.7 days, 95%
CI=6.7, 8.7) and the control group (7.2 days, 95% CI=6.4, 8.1).
The difference in mean length of stay was statistically signifi cant
(P=.04). Compared with the control group, patients in the HT
group had a 120% greater chance of having a length of stay ≤6
days (odds ratio [OR]=2.2, 95% CI=0.9, 7.5). Compared with the
visitor group, the chance of such a stay is 280% greater (OR=3.8,
28 ALTERNATIVE THERAPIES, jul/aug 2008, VOL. 14, NO. 4 Healing Touch in Coronary Artery Bypass Surgery Recovery
TABLE 1 Simple Comparison of 3 Study Groups*
Healing Touch
n=87
Visitor
n=63
Control
n=87
Total
n=237 P value
Continuous Variables Mean (SD)
Length of stay (days) 5.8 (1.9) 6.5 (2.6) 6.0 (1.7) 6.0 (2.2) 0.15
Preoperative anxiety 41 (11) 41 (13) 45 (13) 43 (12) 0.04
Preoperative physical function (SF-12) 40 (11) 40 (9) 37 (8) 39 (10) 0.31
Preoperative mental function (SF-12) 50 (9) 49 (10) 49 (11) 49 (10) 0.69
Morphine equivalent
for day 1 and day 2 26 (15) 26 (13) 25 (13) 25 (14) 0.65
Categorical Variables Counts (%)
Length of stay ≤ 6 days 68 (78) 39 (62) 61 (70) 68 (71) 0.10
Incidence of postoperative atrial fi brillation 19 (22) 15 (24) 26 (30) 60 (25) 0.45
Patients using anti-emetic medication 24 (28) 17 (27) 27 (31) 68 (29) 0.83
Hypertension 48 (55) 38 (60) 58 (67) 144 (61) 0.30
Congestive heart failure 9 (10) 4 (6) 11 (13) 24 (10) 0.45
Cholesterol 69 (79) 49 (78) 66 (76) 184 (78) 0.86
Chronic obstructive
pulmonary disease 7 (8) 1 (2) 5 (6) 13 (5) 0.23
Depression 5 (6) 4 (6) 5 (6) 14 (6) 0.99
Diabetes 28 (32) 18 (29) 35 (40) 81 (34) 0.29
Smoking 20 (23) 12 (19) 16 (18) 48 (20) 0.72
Age group (years) <55 18 (21) 7 (11) 19 (22) 44 (19) 0.13
55-64 24 (28) 23 (37) 31 (36) 78 (33)
65-74 31 (36) 27 (43) 21 (24) 79 (33)
>75 14 (16) 6 (10) 16 (18) 36 (15)
Myocardial infarction No 50 (57) 37 (59) 52 (60) 139 (59) 0.98
Not recent 21 (24) 16 (25) 22 (25) 59 (25)
Recent 16 (18) 10 (16) 13 (15) 39 (16)
Female 69 (79) 47 (75) 67 (77) 183 (77) 0.79
Outpatients 42 (48) 35 (56) 40 (46) 117 (49) 0.50
Body mass index class Normal 20 (23) 18 (30) 21 (24) 59 (25) 0.92
Overweight 30 (34) 19 (30) 31 (36) 80 (34)
Obese 37 (43) 25 (40) 35 (40) 97 (41)
History of atrial fi brillation 19 (22) 15 (24) 26 (30) 60 (25) 0.45
Severity 1 7 (8) 5 (8) 5 (6) 17 (7) 0.88
2 55 (63) 35 (56) 55 (63) 145 (61)
3 20 (23) 20 (32) 24 (28) 64 (27)
4 5 (6) 3 (5) 3 (3) 11 (5)
History of myocardial infarction 36 (41) 24 (38) 32 (37) 92 (39) 0.82
Number of grafts 1 5 (6) 2 (3) 3 (3) 10 (4) 0.71
2 22 (25) 18 (29) 27 (31) 67 (28)
3 43 (49) 26 (41) 33 (38) 102 (43)
4 15 (17) 15 (24) 22 (25) 52 (22)
5 2 (2) 2 (3) 1 (1) 5 (2)
6 0 (0) 0 (0) 1 (1) 1 (0.4)
TK
ALTERNATIVE THERAPIES, jul/aug 2008, VOL. 14, NO. 4 29
95% CI=1.5, 9.5). The difference among the 3 groups was statisti-
cally signifi cant (P=.01).
The mean decreases in anxiety scores from pre- to postoper-
ative for the 3 treatment groups were 6.3 (HT: 95% CI=2.0, 10.6),
5.8 (visitor: 95% CI=0.9, 10.8), and 1.8 (control: 95% CI=-2.6, 6.2,
P=.01). No signifi cant differences were detected between the 3
treatment groups for the remaining outcome variables (amount
of narcotic pain medication usage, change of physical functional
status, change of mental functional status, incidence of postoper-
ative atrial fi brillation, and patients using anti-emetic medica-
tion). The estimated means of the amount of narcotic pain
medication used were 46.7 (95% CI=32.1, 61.2), 46.1 (31.1, 61.2),
and 45.6 (31.7, 59.6) for HT, visitor, and control group, respec-
tively. For the change of physical functional status, they were -1.3
(-6.1, 3.6), -0.9 (-6.1, 4.3), and -0.6 (-5.6, 4.4). Finally, for the
change of mental functional status, the estimated means were 0.8
(-3.0, 4.7), 1.7 (-2.3, 5.8), and 2.3 (-1.7, 6.3). The results for all
patients are presented in Table 2.
In subgroup (outpatients and inpatients) analyses, there
was a significant difference in length of stay for outpatients
(P=.01). The mean length of stay of outpatients for the HT group
was 6.6 days (95% CI=5.2-7.5), 7.4 (95% CI=6.0-9.0) for the visitor
group, and 7.7 (95% CI=6.0-8.6) for the control group. The same
trend was observed in the dichotomized length of stay (OR for
HT vs control=14.3, 95% CI=2.1-30.9; OR for HT vs visitor=23.8,
95% CI=3.6-166.7; overall P value=.04) (Table 3). For inpatients,
no significant difference was found (Table 4). All analyses
revealed no statistically signifi cant interaction between covari-
ates for both subgroups.
No adverse event or side effect related to HT was reported
in any study group.
DISCUSSION
It was hypothesized that a decrease in the incidence of atrial
fi brillation, anxiety levels, and use of medications for pain and
nausea would be seen among patients receiving the HT interven-
tion. It was also hypothesized that a decreased length of stay
would be observed. Furthermore, it was anticipated that the visi-
tor group would have a higher percentage of desirable outcomes
than the control group yet fewer than the HT group.
While no signifi cant decrease in the use of pain medication
or anti-emetic medication or in the incidence of atrial fi brillation
was observed, signifi cant differences were noted in anxiety scores
and length of stay. All HT patients showed a greater decrease in
anxiety scores when compared to the visitor and control groups
(HT=6.3, visitor=5.8, control=1.8; P=.01). In addition, there was
a significant difference in outpatient HT length of stay when
compared to the visitor and control groups (HT=6.2, visitor=7.3,
control=7.2; P=.01).
Although there was a signifi cant decrease in anxiety scores
for HT patients, there is anecdotal evidence that a different
Healing Touch in Coronary Artery Bypass Surgery Recovery
20
18
16
14
12
10
8
6
4
2
0
Healing Touch
Visitor
Control
87
63
87
Study Group
Postoperative Length of Stay
FIGURE 1 Length of Stay (in Days) by Study Group
TABLE 2 Results for All Patients
Continuous Outcomes
HT Visitor Control
P valueMean CI Mean CI Mean CI
Length of stay (days) 6.9 (6.1, 7.7) 7.7 (6.7, 8.7) 7.2 (6.4, 8.1) 0.04
Narcotic pain medications (mg) 46.7 (32.1, 61.2) 46.1 (31.1, 61.2) 45.6 (31.7, 59.6) 0.97
Change of anxiety 6.3 (2.0, 10.6) 5.8 (0.9, 10.8) 1.8 (-2.6, 6.2) 0.01
Change of physical functional status -1.3 (-6.1, 3.6) -0.9 (-6.1, 4.3) -0.6 (-5.6, 4.4) 0.90
Change of mental functional status 0.8 (-3.0, 4.7) 1.7 (-2.3, 5.8) 2.3 (-1.7, 6.3) 0.59
Categorical outcomes
HT vs Control HT vs Visitor
P valueOR CI OR CI
Length of stay ≤ 6 days 2.2 (0.9, 5.3) 3.8 (1.5, 9.5) 0.02
Incidence of postoperative atrial fi brillation 0.7 (0.3, 1.8) 1.0 (0.4, 2.5) 0.79
Patients using anti-emetic medication 1.1 (0.5, 2.4) 1.1 (0.5, 2.1) 0.97
30 ALTERNATIVE THERAPIES, jul/aug 2008, VOL. 14, NO. 4
Healing Touch in Coronary Artery Bypass Surgery Recovery
methodology may have shown an even greater difference. Study
patients seemed to underreport their anxiety on questionnaires
administered before treatment. After experiencing their HT
session, these patients commented to their HT practitioner on
how unaware they had been of their stress until experiencing
deep relaxation.
We saw significantly improved length of stay in the HT
group when compared to the other study groups, and although
not signifi cant, there were positive changes in the other outcome
measures. Particularly interesting is the incidence of atrial fi bril-
lation. Atrial fi brillation is a well-recognized postoperative com-
plication typically resulting in additional treatment that
lengthens hospital stay. We hypothesized that a decreased inci-
dence of atrial fi brillation in study participants postoperatively
would be critical in decreasing length of stay. Although the dif-
ference was not statistically signifi cant, the incidence of atrial
fi brillation was higher in the control group than in the HT group
or the visitor group (HT=22%, visitor=24%, control=30%).
Although the exact mechanism remains unknown, at the
very least, an improved patient care experience may be a result of
HT therapy. Since ancient times, many cultures have recognized
“life energy” or “bio-energy,” and in recent history, the interdisci-
plinary fi eld of psychoneuroimmunology has emerged. Emotions
and beliefs can create physical changes in the body.
31
HT, by its
own defi nition, is intended to be used alongside conventional
care, not as a substitute for it.
Limitations
Pain and nausea are diffi cult to quantify. Postoperative proto-
col calls for scheduled administration of medications that is not
dependent on patient symptoms. In addition, dosage and frequen-
cy depend to some extent on the judgment of the caregivers rather
than an objective pain or nausea measurement. The same level of
pain or nausea for the same patient may be treated differently
depending on the individual who is administering care.
Given the nature of the treatment, it is very diffi cult to blind
TABLE 3 Results for Outpatients
Continuous Outcomes
HT Visitor Control
P valueMean CI Mean CI Mean CI
Length of stay (days) 6.2 (5.2, 7.5) 7.3 (6.0, 9.0) 7.2 (6.0, 8.6) 0.01
Narcotic pain medications (mg) 51.8 (35.8, 67.8) 56.7 (39.7, 73.7) 49.5 (34.3, 64.7) 0.65
Change of anxiety 4.7 (-2.0, 11.5) 5.0 (-2.3, 12.3) 1.8 (-5.1, 8.7) 0.32
Change of physical functional status -3.9 (-10.4, 2.7) -4.1 (-11.3, 3.1) -4.1 (-11.2, 3.0) 0.99
Change of mental functional status 3.8 (-2.4, 10.1) 4.0 (-2.8, 10.8) 4.8 (-2.0, 11.6) 0.90
Categorical Outcomes
HT vs Control HT vs Visitor
P valueOR CI OR CI
Length of stay ≤ 6 days 14.3 (2.1, 30.9) 23.8 (3.6, 166.7) 0.04
Incidence of postoperative atrial fi brillation 0.6 (0.2, 2.2) 1.6 (0.4, 6.5) 0.37
Patients using anti-emetic medication 1.5 (0.50, 4.4) 2.0 (0.7, 5.6) 0.40
TABLE 4 Results for Inpatients
Continuous Outcomes
HT Visitor Control
P valueMean CI Mean CI Mean CI
Length of stay (days) 7.4 (6.2, 8.8) 7.7 (6.3, 9.2) 6.8 (5.8, 8.1) 0.26
Narcotic pain medications (mg) 49.8 (34.2, 65.4) 41.7 (25.1, 58.4) 50.5 (35.6, 65.5) 0.36
Change of anxiety 8.2 (1.3, 15.1) 7.8 (0.2, 15.5) 3.3 (-3.0, 9.5) 0.10
Change of physical functional status -0.5 (-6.4, 6.3) 0.8 (-6.2, 7.8) 0.7 (-5.1, 6.5) 0.92
Change of mental functional status -3.2 (-8.6, 2.2) -0.9 (-6.8, 5.0) -1.0 (-5.9, 4.0) 0.39
Categorical Outcomes
HT vs Control HT vs Visitor
P valueOR CI OR CI
Length of stay ≤ 6 days 1.0 (0.3, 3.1) 1.26 (0.4, 4.5) 0.92
Incidence of postoperative atrial fi brillation 1.3 (0.3, 5.4) 0.6 (0.1, 3.0) 0.69
Patients using anti-emetic medication 0.9 (0.3, 2.5) 0.6 (0.2, 1.5) 0.57
ALTERNATIVE THERAPIES, jul/aug 2008, VOL. 14, NO. 4 31
Healing Touch in Coronary Artery Bypass Surgery Recovery
an HT treatment, and we had ethical concerns about doing so.
Other studies have used mock HT,
32,33
where practitioners perform
the hand motions but think non-healing thoughts (eg, perform
math problems). It seemed unethical, especially given the stressful
nature of an operating room for both patients and staff members,
for an HT practitioner to only pretend to be available to help and
to avoid physical contact with the patient. In addition, our 2 prac-
titioners would be fairly recognizable to operating room staff
members, making it diffi cult to disguise their purpose in the oper-
ating room. The practitioners also perform HT on staff members,
so having a sham practitioner available was not possible.
Because the study is not blinded, there is a certain possibility
for bias or for rival hypotheses. We addressed this through ran-
domization and through the 3-branch study design. Once patients
were enrolled in the study, they were assigned randomly to their
study group. We felt that as a result, those whose interest in HT
may skew their results would be evenly distributed among the
groups. We added the visitor group to the study to address the idea
that any additional attention given to the patient would improve
outcomes. By comparing this group to the HT group, we felt we
could get closer to the true effect of HT.
Although the study demonstrated a signifi cant change in anx-
iety (HT=6.3, visitor=5.8, control=1.8, P=.01), a more accurate
measurement may have been achieved by administering the survey
more frequently. The questionnaire was given at the beginning of
the therapeutic relationship, when hesitancy in sharing feelings,
especially stress and anxiety, is not uncommon; it was not admin-
istered again until postoperative day 4, when the treatment effect
may have waned somewhat. A better measurement may have been
to administer the survey immediately pre- and post-session to HT
and visitor patients, in addition to the existing pre- and postopera-
tive measurements.
Initial enrollment was slow due to the exclusion of inpatients
from the study. Upon review, it was determined that in the interest
of increasing sample size, the exclusion criteria should be changed
to allow for inpatient participation. Inpatients were classifi ed as
urgent, having had a coronary angiogram—most within 24 hours
before the CAB surgery—resulting in patients with higher stress
levels and increased potential for compromised renal function.
Due to the differences in inpatient and outpatient outcomes in
general, results for both groups were to be examined separately.
Toward the end of the study, as HT became more recognized
and accepted, patient recruitment became progressively more dif-
fi cult. Many study-eligible patients requested HT and chose not to
participate because of the risk that they may fall into the visitor or
control group.
Study Implications
Using our hospital data for all CAB patients, the average daily
cost in our hospital system was estimated to be about $2000 per
patient at the time of the study. This would translate to roughly
$500 000 in savings for our hospital system per year for CAB pro-
cedures alone, thus offsetting the relatively minor fi xed expense of
providing the service of an experienced, certifi ed HT practitioner.
Since initiation of this study in our hospital system, staff per-
ception of the usefulness and applicability of HT has changed dra-
matically. An increasing number of nurses who provide cardiac care
at the bedside have undergone HT training and are working toward
certifi cation. In 2005, nearly 600 HT sessions were provided for car-
diac surgical patients. As a result of this study as well as patient
demand, a hospital-funded healing arts program was designed and
implemented in our hospital. This program was expanded to offer
HT as a choice for all cardiac patients, with approximately 90% cur-
rently taking advantage of the program. Moreover, requests from
other areas of the hospital have grown, including but not limited to
those from patients undergoing stressful procedures, having diffi -
culty sleeping, or feeling depressed due to a prolonged hospital stay.
With the growing interest in the application of HT across a broad
range of patient care experiences, it is recommended that research-
ers interested in conducting additional studies include measure-
ments of patient satisfaction and employee engagement with HT as
part of their study design and outcomes.
Our study was conducted on fi rst-time elective CAB patients.
For logistic reasons, patients requiring immediate surgery were
excluded from the study as were cardiac-surgical patients undergo-
ing a second CAB surgery or a cardiac valve repair or replacement.
As a group, cardiac surgical patients have stressors in common,
and pre- and postoperative procedures are similar. There are paral-
lels with patients undergoing other types of surgery as well, includ-
ing stressors such as (1) fear of the unknown, (2) effects of
anesthesia (eg, nausea and postoperative depression), and (3) post-
operative complications such as infection affecting length of stay.
In our study on cardiac-surgical patients, we showed no dif-
ference in age or gender; therefore, these study results could be
applied to the inpatient adult cardiac population (children were
not studied). As other studies have looked at outpatient settings,
this study was intended to improve outcomes and the patient expe-
rience in a cardiac surgical inpatient setting. Due to the common
themes among surgical patients throughout a hospital setting, HT
could be expected to benefi t patients in acute settings beyond the
cardiac-surgical area.
Although diffi cult to quantify, spiritual and emotional factors
are becoming increasingly recognized as a potential aid or hin-
drance to outcomes from medical interventions. Hospitals are
increasingly creating modern-day “healing environments” that
borrow from principals of ancient wisdom and new understand-
ings of the attention to individualized care that is needed alongside
new technologies. These coupled with integrative programs are
largely based on consumer demand but also an increasing aware-
ness aided by medical research that a sense of peace, serenity, and
safety via emotional connections can have powerful infl uences on
outcomes. As such, HT lends itself as a natural complementary
therapy to be brought to the bedside as well as an approach that
warrants future study.
Healing touch is becoming more widely known at the bedside
of hospitalized patients due to its roots in nursing via nursing theo-
rists who have pioneered ideas regarding unifi ed fi eld theory.
34
As
such, it is not the technique alone that is important to the HT
32 ALTERNATIVE THERAPIES, jul/aug 2008, VOL. 14, NO. 4
Healing Touch in Coronary Artery Bypass Surgery Recovery
intervention but the rapport and partnership created with the
patient going through a potentially life-transforming event.
Practitioners of HT seek to facilitate the client’s innate self-healing
abilities, which may in part inspire consciousness—awareness,
choice, acceptance, and balance.
In this study, something that is seldom seen in a hospitalized
setting was achieved; that is, a nurse visitor or nurse/HT practi-
tioner was a consistent and familiar guide through the process
from preoperative education through the postoperative recovery
phase. Moreover, this study design necessitated cooperation and
support on the part of staff members from surgical admitting and
the operating room to intensive care and telemetry units, along
with departments ranging from chaplaincy to anesthesiology and
cardiac rehabilitation. It would be diffi cult to discuss this study
with its methodology and outcomes without addressing some of
the cultural changes that were observed in the process of its
implementation and in its aftermath. It is important to remember
that there is a story and an individual with emotions and choices
behind each painstakingly examined statistic that cannot be
ignored. At the very heart of this study is the movement toward
recognizing that the metaphoric and physical heart are both very
real, if we allow them to be.
Acknowledgments
We would like to thank the following employees of HealthEast St Joseph’s Hospital in St Paul,
Minnesota: Donna Miller, Deb Gutzman, Vickie Amundson, Colleen LaVenture, Terry Saulsbury,
Joann Dubiel, Sr Gerie Lane, Renee Thompson, Mary Pat Lebens, Aggie Bartholome, Virginia
Chappas, Ruth Hayes, Marlenee Strong, Donna McKosky, Caroline Dietz, and Joan Zabel. We also
want to thank Dr Ted Lillehei from Cardiovascular Surgeons of St Paul and Drs Arlen Holter and Kit
Arom of Cardiac Surgical Associates, St Paul. Finally, we wish to acknowledge the work done by
members of the HealthEast Research and Education Department (St Paul), particularly the follow-
ing: Stephanie Drake, Mark Laliberte, Amy Fehrer, Greg Stern, Tracy Hung, and Karen Scheltema.
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