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International Research Journal of Applied and Basic Sciences

© 2013 Available online at www.irjabs.com


ISSN 2251-838X / Vol, 4 (10): 3004-3008
Science Explorer Publications

The effect of the Slow-Stroke back massage on


fatigue of dialyzed patients
Hadi Hasankhani1, Fariba Ghaderi2, Sima Lakdizaji3, *Mina Nahamin4
1. Assistant Professor, medical surgical nursing Department, faculty of Nursing and Midwifery, Tabriz University
of Medical Sciences, Tabriz, Iran.
2. PhD PT, Assistant Professor, Physical Therapy Department, Faculty of Rehabilitation, Tabriz University of
Medical Sciences, Tabriz, Iran.
3. Lecturer of medical surgical nursing, faculty of Nursing and Midwifery, Tabriz University of Medical Sciences,
Iran.
4. M.Sn Student, faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
*The responsible author: Tabriz, South Shariati Avenue, faculty of Nursing and Midwifery

Corresponding Author email: mina.nahamin@yahoo.com.

ABSTRACT: Fatigue is the most common side effect that is known as one of the most stressful
factors, and it is expressed as a debilitating factor, aim of this study was to study the effect of back
massage on fatigue in hemodialysis patients by Slow-Stroke method. This study is available as
clinical trial with 60 simple examples; it was done in the city of Ardabil in Bu- Ali hospital in dialysis
ward on hemodialysis patients. The Piper Fatigue Scale questionnaire in three times (starting days
15th and thirtieth) was completed by both groups. Finally, the results were analyzed spss 13
software. Descriptive statistics and analysis of variance tests, Repeat Measures ,Independent
Samples T Test were used to analyze data and to communicate results. The results showed that
there is significantly different between the different groups tested at baseline and end of study (P
=003/0), and there was not observed significant differences the start up time of 15 days to 15 days of
the end of the study. The analysis of variance showed that among the groups at the end of the study
there was a significant difference (0/ 05>P). This study showed that massage therapy for 30 days
resulted in a reduction in fatigue and to feel comfort by patients.
Keywords: Massage as Slow-Stroke - Fatigue - dialysis.

INTRODUCTION

Hemodialysis is one of the most successful alternative treatments of Kidney; it has transformed the
treatment landscape of patients with renal failure. Around the world, hundreds of thousands of patients have
undergone such treatment (Hosseini, 2005). Today, more than 200 thousand people with kidney failure in the
United States of America and more than one million people survive on dialysis. In Iran with more than 13
thousand dialysis, 150 thousand sessions are performed each month for dialysis (Abbasian, 2007).
One of the biggest problems in hemodialysis patients is the fatigue (Bahreini, 2011). Unlike acute renal
failure, the fatigue occurs suddenly in it. in the chronic failure, the fatigue is as silent and sleepy and finally with
all changes in the body. Despite the progress made in treating, fatigue and fluid and food restrictions are still in
the early stressors that dialysis patients are facing it. O'sullivan in their study showed that Fatigue in
hemodialysis patients is a limitation in performing daily activities (Osalivan, 2007). In another study it was
observed that More than 50% of patients with chronic renal failure often complain from the continuous whole
fatigue(Ghasemi, 2010).
Fatigue in hemodialysis patients has several reasons including of physical, behavioral and dependent
therapies and individual characteristics. Physical causes include anemia, dialysis adequacy, hyper parathyroid,
chronic diseases, sleep disorders, depression, malnutrition and medical complications (Abbasian, 2008). Social
and demographic factors are including age, sex, race, education, marital status and employment status that
can be involved to patient's fatigue (Pandya, 2003). For example, it was observed that Fatigue is more common
in lower social classes (Rambod H, 2008). Women and elderly dialysis patients, or patients who are not
employed suffer more from fatigue (Logan and Hodgins, 2006). The most common massage therapy as a
nursing intervention leads to restore metabolic homeostasis of tissues by General manipulating the body's soft
tissues (Pagels, 2006). The communication, care, love make to the healing process of the patience. Most
patients have expressed that Massage therapy can strengthen the feeling of care and support in them and to
Intl. Res. J. Appl. Basic. Sci. Vol., 4 (10), 3004-3008, 2013

make the relationships between them and the caregivers (Ranjith, 2002). Massage is a valuable care and
Short-term use on hands, feet, neck and shoulders can to have a therapeutic effect (Logan and Hodgins, 2006)
and by the reduced sensitivity and muscle stiffness and improved blood flow can cause to relief from pain and
fatigue (Sundaram, 2006). The studies have emphasized on the impact of massage and therapeutic touch in
relaxation and reducing emotional behavior (Osalivan, 2007). This study aimed to determine the effects of
Slow-Stroke Massage on Fatigue in Hemodialysis Patients.

MATERIALS AND METHODS

This study was a clinical trial and it was performed in Bu-Ali hospital in the city of Ardabil on 60 patients
with dialysis (simple sampling method).In this study, All subjects were given the fatigue questionnaire of Piper.
After its completion, patients who had fatigue scores of higher than 3, were selected. Piper Fatigue Scale
includes four criteria (behavioral, emotional, sensory and cognitive), and included 27 questions from 2 to 23 or
10 point are scored from one to ten. The rest of the questions are open questions which they are to enrich the
questionnaires, without scoring. The total mean on a scale is from one to ten, zero score indicates no fatigue;
and so 1-3 scores indicates mild, 4-6 ones the medium fatigue and 7-10 scores the sever fatigue. In this study,
the validity was assessed by 10 distinguished professors. Its reliability in the abroad studies and investigation of
Masoudi et al (Masoodi R, 2008) have been confirmed by the splitting method with a Pearsons correlation
coefficient r = 0/79. In the present investigation, questionnaire reliability to the Cronbach's alpha method with
correlation coefficient 0/ 83 was approved. Other criteria included the ability to communicate, age 18 and older,
at least 3 months of dialysis and the lack of scarring, abnormal redness and swelling at the waist. In this study,
People who had score 3 or less fatigue, they suffered from the acute diseases such as fevers, colds and
infections, severe pain and heart disease, respiratory, liver, cancer and mental disorders such as depression or
with surgery operation, they were omitted from this study. Samples were selected at random. After obtaining
informed consent from patients, three times a week, on dialysis, for 10 minutes, from 3 pm to 7 pm, in the
Chambers of dialysis therapy within 4 weeks were under massage therapy. The control group in the past four
weeks, they received usual care and they were not aware from massage therapy by the intervention group.
Back massage stages in Slow-Stroke method were as follows:
1 - The patient sits on a chair and leaned his head on the pillow, 2 - the small rotational movements
with the thumb on the neck, 3- To stroke surface the base of the skull to the sacrum with the palm of a hand,
and repeat the procedure on the other side of the spine with the other hand, While at it, the first hand moves
toward the base of the skull, 4 – to do stoke on shoulder blades with thumb. 5 - Stroke with the thumb on either
side of the spine from the shoulders to the waist, 6 - stroke to sweep the neck to the sacrum with the palms of
both hands.
The Piper Fatigue Scale (the fifteenth and thirtieth day) were completed two times by group. Finally, the
results were analyzed in 13 SPSS software, and to analyze data and communicate results of statistical tests
and analysis of covariance was used independent Samples T Test and Repeat Measures.

RESULTS

Results Descriptive statistics for various groups of the present study show that the experimental and
control groups had the same baseline fatigue (3/5). However, in end of the time period (30 days after the
massage) between the experimental and control groups, is Close to 1/07 fatigue score. The measure of fatigue
in the group was done on the 15th day, and showed that the rate of fatigue between baseline days and 30
studies was to the amount of 4/89, respectively (Table 4).

Table 1 . Descriptive statistics of the data


Standard deviation Fatigue rate No group Study time
1/04 5/28 30 control Study Start
1 /3 5/36 30
1 /4 4/80 30 the 15th day
1 /1 5 /2 30 control
0/97 4/16 30 Control End of study
1 /1 135/ 30

Independent means comparisons of different groups in the present study show that the experimental
and control groups had an average nearly, There were non-significant difference (P =0/53) and also between
the two groups, although there was no difference in the fatigue test on the 15th day, But the difference was not
statistically significant (P =0/14). The results showed that during the period there were no significant differences
between the two study groups (P =0/041).
Intl. Res. J. Appl. Basic. Sci. Vol., 4 (10), 3004-3008, 2013

Table 2 . compares the means of the studied groups


significance)sig( F Mean group Study time
ns
0/35 1/74 5/28 control Study Start
5/36
ns
0/14 2/1 8/4 the 15th day
25/ control
*
0/041 6/37 4/16 Control End of study
5/13 control
ns =insignificant = * Significant at 95%

Analysis of variance between and within different groups showed that Between different stages of
fatigue tests there is a significant difference between groups in statistical significance at the 99% level, ¬ (P =
0/003).
Table 3. Analysis of variance - covariance at different times in the test group
significance level )sig( F Mean square Degrees of Sum of squares Source of change
F (sig) freedom
**
0/003 6/11 9/54 2 19/089 Among group
1/56 87 135/9 In group
89 154/989 total
= **Significant at 99 %

Repeat Measures analysis revealed that there is a significant difference between the studied groups at
the 99% level, there was not seen a significant difference in 15 days from the onset of the study to 15 days to
the study end.
Table 4. Comparisons of mean fatigue at different times
Significance level (sig) t Freedom Standard Mean Study time
degree deviation
ns 0/37 0/166 59 1/63 0/035 Study Start
the 15th day
** 0/001 3/51 59 1/65 0/75 the 15th day
ns 0/054 3/38 59 1/64 0/71 Study end

ns =insignificant = ** Significant at 99%

DISCUSSION

Massage affects the nervous system, muscles and blood flow, is causing muscle relaxation and
blood flow and oxygen supply. Massage increases blood flow to a given area, improved nutrition and
increased excretion of waste products such as lactic acid and its result is the release of energy and
fatigue reduction. There are various forms of massage movements, it used on different body parts. In
this study, the slow stroke back massage (SSBM) is used to reduce fatigue in dialyzed patients.
SSBM has firstly been introduced by Elizabeth as the slow, gentle, rhythmic hand movements on the
patient's back with a steady pace of about 60 movements per minute with gentle pressure for 3 to 10
minutes. This massage therapy is as slow stroke; it is completely sensory and is very beneficial effect
on patients (Paul J et al., 2002). This study shows that massage therapy could significantly reduce
the average amount of fatigue over 1 month. In different studies, this treatment is performed on
different patients in different parameters. For example Abbasian et al (Abbasian Z, 2007) showed in
their study that Fatigue in the delivery phase difference between two groups was statistically
significant and Massage therapy could significantly reduce the fatigue. The Bahraini and colleagues
(Bahreini S, 2011) stated in their study that score mean of severity of fatigue in patients with multiple
sclerosis at baseline was 49, and the score after massage therapy was 37/29 that reduce fatigue in
patients who were considered, it was statistically significant. Yeganeh khah and colleagues
(Yeganehkhah M, 2007), who had studied massage on the elderly anxiety, showed that Mean anxiety
in two groups before massage, "SSBM" had no significant difference (P>0/05), but after massage,
there was significant difference (P<0/05), Yaghoobi (Yaghoobi M, 2009) in their study on pain of
muscle cramps in hemodialyzed patients has shown that Frequency and severity of cramps in
hemodialyzed patients was significantly decreased (P <0.001). Mean pain before intervention was
8/73, after the intervention was 1/70. And in 19 patients (47/5%) and cramps were not observed after
treatment and in 21 patients (52/5%) and cramps and less intense than before the intervention
occurred. Ghasemi and colleagues (Ghasemi K, 2010) stated in their study that there is a difference
between rest and massage in improving fatigue. The study also found that Massage improves
muscle function after the maximum fatigue while the rest had no such effect, also a massage or relax
Intl. Res. J. Appl. Basic. Sci. Vol., 4 (10), 3004-3008, 2013

alone decreased the percept fatigue. The effect of massage is more than the rest. Abbasi et al
(Abbasian Z, 2008) also in another study in this direction showed that The pain scores in both groups
immediately after the intervention phase of labor was statistically significant (P <0.001). Difference in
pain scores before and after the massage, in the back massage group also showed significant
differences in all three phases of labor (P <0.001). Cho (Cho, 2004) also showed that before the
intervention, patients showed moderate levels of fatigue, and nearly 65% of patients with depression.
After intervention, there was significant difference between the control and intervention. So that rates
of depression and fatigue in these patients than in the control group showed a significant
improvement. Harris (Harris, 2010) in this study and found that hand massage technique and slow-
stroke back Massage lead to significant physiological and psychological effects on elderly patients.
The best protocol with most of the time was that hand massage was done during the 10-minutes, and
slow-stroke back massage in 3 minutes. Holland (Holland, 2001) also stated that after three days of
massage therapy, mean blood pressure decreased. After 3-1 days, heart rate and breathing counting
was significantly decreased. There was not observed significant physiological change in patients.
The study found that massage therapy reduces fatigue and emotional comfort of patients.

ACKNOWLEDGMENTS

The thesis of the article is approved in Tabriz University of Medical Sciences. Researchers thank
to perfection this plan from the hemodialyzed ward nurses, and administrators of Bu-Ali Hospital in
Ardabil city.

Fatigue difference curve between the two groups at different time periods

Figure 1

The diagrams of fatigue measure showed that there is reduction in fatigue between baseline and day
15 and time of study end, The decrease was between 15 days and about 0/39, While the days start to finish
was (the 30th) at around 1/12. Figure also shows that 15 Th days and the completion days of the study were
0/73.
Intl. Res. J. Appl. Basic. Sci. Vol., 4 (10), 3004-3008, 2013

Chart of the impact Massage on of patients' fatigue

Figure 2

Comparison chart of the different groups at the beginning and end of the study indicate that in the control
group, there is little difference between the beginning and end of the study (29/0). But in the experimental
group, fatigue rate difference between the beginning and end of the study was about 1/12. It shows the effect of
massage techniques in surface- stroke on patients.

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