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Research
Massage helps reduce peri-operative anxiety
Studies have shown that high levels of anxiety surrounding a surgical procedure can activate changes in a patient’s nervous and immune systems and potentially cause hypertension, impact pain thresholds and post-operative pain, delay surgery being started or completed, and delay patient discharge. Furthermore, pharmacological treatments that can be used to help control peri-operative anxiety may be short-acting or produce undesirable side-effects, such as nausea and vomiting (Guo et al, 2020).
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A meta-analysis recently published in Complementary Therapies in Clinical Practice aimed to “evaluate the effect of massage on peri-operative anxiety in adults who were about
Plantar heel pain (PHP) is characterised by pain around the heel and arch of the foot during weight-bearing tasks, particularly after a period of rest. Research suggests it predominantly affects sedentary middleaged and older adults and accounts for 8% of all injuries related to running (Taunton et al, 2002).
The authors of a review recently published in British Journal of Sports Medicine have developed a best practice guide (BPG) for the clinical management of PHP, based on their synthesised findings from high-quality randomised controlled trials, expert opinion and patient feedback (Morrissey et al, 2021). The core treatment recommended for people with PHP includes taping and stretching of the plantar fascia, alongside individualised education for the patient, “which should encourage: n individual assessment; n footwear advice to ensure comfort in shoes that allow a small rearfoot to forefoot drop while also considering social acceptability to improve adherence; n load management to break up long periods of static loading or problematically rapid training changes in more athletic populations; n support to address comorbidities such as type 2 diabetes; n teaching patients the parameters required to self-monitor the pain response to activity and how to interpret pain with respect to tissue damage in order to allay fears of long-term consequences.
“The educational delivery should adopt a realistic tone as recovery may take several weeks or months but [clinicians should] stress the positive prognosis […].”
For those patients who do not see an optimal improvement in their PHP after intervention, the authors recommend offering shockwave therapy (ESWT), followed by custom orthoses. n Access the full review by visiting bjsm.bmj.com and typing ‘PHP’ in the search engine.
to undergo, were undergoing or were recovering from major and minimally invasive surgical procedures to provide appropriate and practical suggestions for future research and practice.”
A total of 25 studies met the eligibility criteria for the meta-analysis, comprising 2,494 participants. The authors noted the following key findings: n That massage can significantly reduce peri-operative anxiety for most types of surgical patients; n In order to be therapeutically beneficial, massage lasting 10 to 20 minutes per session was worthy of recommendation in a busy clinical setting; n Acupoint or specific body reflex area massage had a better effect on perioperative anxiety than general massage; n Massage delivered by both massage professionals and nonmassage professionals (eg. short-term trained nurses and hospital staff) were both effective.
The authors concluded, “This meta-analysis demonstrated that massage is a simple, safe and effective approach for alleviating peri-operative anxiety in most types of surgical patients. More RCTs [randomised controlled trials] with high-quality and rigorous design are warranted to confirm our findings and to clarify the most suitable time at which to start massage in the peri-operative period, the duration of massage efficacy, the minimal effective dose, and the appropriate frequency of massage”.
Best practice guide developed for management of plantar heel pain
Improving sleep and anxiety in burn patients with aromatherapy and muscle relaxation techniques
Burn injuries and treatment can be both physically and psychologically traumatic (Cleary et al, 2018), with patients often experiencing a high level of anxiety and poor sleep quality (Harorani et al, 2020).
Two separate studies published in Burns looked at the effects of aromatherapy and muscle relaxation techniques on anxiety and sleep quality in burn patients.
Rafii and colleagues conducted a quasi-experimental study involving a 105 burn patients, who were assigned to a control, placebo massage or aromatherapy massage group, with the latter using lavender and chamomile essential oils (Rafii et al, 2020). The intervention was performed for 20 minutes before bedtime for three sessions across one week.
The results showed that aromatherapy massage, with lavender and chamomile, decreased anxiety and improved sleep in patients. The authors concluded, “Since the aromatherapy massage as a non-pharmacological and simple method can improve the anxiety and quality of sleep in patients with burns, it is suggested that nurses and burn medical care team apply it to reduce burn patients’ anxiety and promote their sleep quality. Applying massage alone also reduces anxiety in burn survivors.”
In a separate study, Harorani and colleagues investigated the effects of progressive muscle relaxation on anxiety and sleep quality in 80 burn patients who were either randomly assigned to a control group (usual care) or experimental group (20 to 30 minutes of Jacobson’s relaxation technique for three consecutive days) (Harorani et al, 2020).
The results showed a significant decrease in anxiety and improvement in sleep quality in the experimental group compared to the control group. The authors concluded that, “relaxation as a complementary method can be used along with modern medicine to reduce anxiety and improve sleep quality in burn patients”.
According to a report by the Office of National Statistics, by the year 2066, there will be an estimated 20.4 million adults aged 65 years and over in the UK, who will make up more than a quarter (26%) of the total population (ONS, 2018). The report also highlights that, “the likelihood of being disabled and/or experiencing multiple chronic and complex health conditions among those aged 65 years and over increases with age. As life expectancy increases, so does the amount of time spent in poor health.” Finding innovative approaches to help promote healthy ageing and also protect extra burden being placed on the health and social care services is therefore a growing priority.
A systematic review published in Complementary Therapies for Clinical Practice looked at the effects of laughter yoga on physical function and psychosocial outcomes in older adults. Laughter yoga is a non-invasive practice that comes in many forms, but typically combines yoga breathing techniques with laughter exercises, with both having reported health benefits. While the authors state that the number of studies and data quality in this field is limited, of the seven studies that met the inclusion criteria, laughter yoga was found to have the following health benefits in people over the age of 65: n Physical function — improvements in blood pressure, cortisol levels and sleep quality. n Psychosocial function — improvements in life satisfaction, quality of life, loneliness, death anxiety, depression, mood and happiness.
The authors conclude that, “Laughter yoga can be used for health promotion in older adults. It is a cost effective and enjoyable technique for older adults. Significantly in this analysis, it has been found that the intervention duration necessary to effect the outcomes in older adults appears to be a minimum of four weeks.” They also call for more high-quality randomised controlled trials with validated study protocols and guidelines.
References
For full references, go to fht.org.uk/IT-references
