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CLINICAL QUESTION Among 61 patients who had received surgery for digestive cancer, is reflexotherapy on acute postoperative pain and anxiety?

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CITATION Effects of Reflexotherapy on Acute Postoperative Pain and Anxiety Among Patients With Digestive Cancer Authors: Tsay, Shiow-Luan PhD, RN; Chen, Hsiao-Ling MS, RN; Chen, Su-Chiu MS, RN; Lin, Hung-Ru PhD, RN; Lin, Kuan-Chia PhD Published in Cancer Nursing: March/April 2008 - Volume 31 - Issue 2 - pp 109115

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STUDY CHARACTERISTICS

1. Patients Included The study involved 61 patients with digestive cancer (gastric cancer or hepatocellular carcinoma) who had undergone surgery and were subjected to reflexotherapy for acute postoperative pain. 2. Interventions Compared The research compared two groups, one group receiving reflexotherapy for 20 minutes per session as the intervention, versus another group that did not receive reflexotherapy. From a population of 61 patients, the clinical study involved 30 postop patients for the intervention group, and 31 post-op patients for the control group. 3. Outcomes Monitored The outcome of the study was centered to testing the hypothesis that reflexotherapy alleviates acute postoperative pain in clients with digestive cancer. The efficacy of reflexotherapy was monitored throughout the course of the study

using short-form McGill Pain Questionnaire, visual analog scale for pain, summary of the pain medications consumed, and the Hospital Anxiety and Depression Scale.

4. Does the study focus on a significant problem in clinical practice? Yes. patients with gastric and liver cancer still report moderate levels of postoperative pain even after receiving analgesia. This is an important problem as nurses are tasked to reduce the level of pain for the benefit of the clients.

III.

METHODOLOGY/DESIGN 1. Method Used Sixty-one patients who had received surgery for gastric cancer or hepatocellular carcinoma were randomly allocated to an intervention (n = 30) or control (n = 31) group. Patients in the intervention group received the usual pain management plus 20 minutes of foot reflexotherapy during postoperative days 2, 3, and 4. Patients in the control group received usual pain management. Outcome measures included the short-form McGill Pain Questionnaire, visual analog scale for pain, summary of the pain medications consumed, and the Hospital Anxiety and Depression Scale. 2. Design The research was a clinical descriptive study. It was a randomized controlled trial. 3. Setting Data were collected from 4 surgical wards of a medical center in 2005 in Taipei, Taiwan. 4. Data Sources The data was gathered from the online website of the US National Library of Medicine. The web address is as follows: http://www.ncbi.nlm.nih.gov/pubmed/18490886 5. Subject Selection a. Inclusion Criteria Patients diagnosed with digestive cancer (gastric cancer or hepatocellular carcinoma) Those who were subjected to surgical procedure.

Patients who were experiencing a moderate level of pain even after receiving analgesia.

b. Exclusion Criterion Digestive cancer patients who had not yet undergone a recent surgical procedure. 6. Has the original Study been replicated? No replication of the study has been noted. 7. What were the risks and benefits of the nursing action or intervention tested in the study? a. Risks The risks of the study included possible trauma to the feet of the patient if the performer of reflexotherapy were not able to take note of the length of time for the therapy and also if he did not have proper skills to carry out the procedure. Other than these minor risks, there were no risks noted in the study. b. Benefits The benefits of the study clearly outweigh its risks. First, foot reflexotherapy as an adjuvant therapy reduced the level of pain as well as the level of anxiety of the patients in the intervention group. Secondly, this could pass as a wakeup call for researchers to conduct further studies on the currently used analgesic drugs for post op clients, which would then result to better drug therapies in the future.

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RESULTS OF THE STUDY

Results demonstrated that studied patients reported moderately high levels of pain and anxiety postoperatively while patients were managed with patient-controlled analgesia. Using generalized estimation equations and controlling for confounding variables, less pain (P < .05) and anxiety (P < .05) over time were reported by the intervention group compared with the control group. In addition, patients in the intervention group received significantly less opioid analgesics than the control group (P < .05).

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AUTHORS CONCLUSION/RECOMMENDATION

Digestive cancer patients who had undergone surgery and were experiencing moderate pain even when they were given analgesic drugs demonstrated a significant decrease in the levels of pain and anxiety, as compared to the group of patients who did not receive the intervention. The researchers commended that findings from this study provide nurses with an additional treatment to offer postoperative digestive cancer patients. VII. APPLICABILITY

1. Does the study provide a direct, enough answer to your clinical question in terms of type of patients, interventions, and outcome? Yes. The authors of this clinical study have successfully determined that reflexotherapy reduces the levels of pain and anxiety of the digestive cancer patients. The patients included passed the inclusion criteria. The intervention, reflexotherapy, was accurately administered to patients, and the outcome suggests that this type of adjuvant therapy is necessary in improving the level of pain of post-op clients.

2. Is it feasible to carry out the nursing action in the real world? Yes. The nursing action implied in this clinical study is to perform foot reflexotherapy for cancer patients who had recently undergone surgery. This is feasible because it can be counted as an independent nursing care.

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REVIEWER`S CONCLUSION AND COMMENTARY

Both moderate levels of pain and anxiety can be effectively alleviated by foot reflexotherapy for digestive cancer patients who went to surgery and were already subjected to analgesia. Giving analgesia with reflexotherapy is more efficient than administering analgesia alone. The researchers have confirmed a relatively new adjuvant therapy for nurses to offer to their cancer patients.

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Evaluating Nursing Care Practice

a.)

Safety

Foot reflexotherapy provides rare risks to patients, therefore performing this procedure is generally safe for post operative digestive cancer patients. b.) Competence

This study will add skills to the nurses as reflexotherapy must be carefully performed, noting the maximum length of time of performing it, as well as monitoring the progress or effectiveness of the intervention. c.) Acceptability

This study is acceptable since it is factual and contributory to the current medical management of digestive cancer. d.) Effectiveness

Reflexotherapy was found effective and is under its way to be approved by hospitals and clinical centers to be included in the care plan of digestive cancer patients. e.) Appropriateness

The intervention was appropriate because moderate level of pain and anxiety were assessed in post op digestive cancer patients who were receiving analgesia and were not advised to accommodate another drug. f.) Efficiency and Accessibility

The intervention is efficient; however, training about foot reflexotherapy may be lacking here in the Philippine hospitals. The problem in accessibility can easily be solved once trainings for nurses and other health care practitioners are initiated by both the government and public institutions.

Far Eastern University

Institute of Nursing

Effects of Reflexotherapy on Acute Postoperative Pain and Anxiety Among Patients With Digestive Cancer

In partial fulfillment of the requirements in NCM: CA Related Learning Experience

Presented by: Sincero, Sarah Mae B. Group 24, BSN 206

10 August 2011
Cancer Nursing:

March/April 2008 - Volume 31 - Issue 2 - pp 109-115 doi: 10.1097/01.NCC.0000305694.74754.7b Articles Effects of Reflexotherapy on Acute Postoperative Pain and Anxiety Among Patients With Digestive Cancer Tsay, Shiow-Luan PhD, RN; Chen, Hsiao-Ling MS, RN; Chen, Su-Chiu MS, RN; Lin, Hung-Ru PhD, RN; Lin, Kuan-Chia PhD

Abstract Even after receiving analgesia, patients with gastric and liver cancer still report moderate levels of postoperative pain. The purpose of the study was to investigate the efficacy of foot reflexotherapy as adjuvant therapy in relieving pain and anxiety in postoperative patients with gastric cancer and hepatocellular cancer. The study design was a randomized controlled trial. Data were collected from 4 surgical wards of a medical center in 2005 in Taipei, Taiwan. Sixtyone patients who had received surgery for gastric cancer or hepatocellular carcinoma were randomly allocated to an intervention (n = 30) or control (n = 31) group. Patients in the intervention group received the usual pain management plus 20 minutes of foot reflexotherapy during postoperative days 2, 3, and 4. Patients in the control group received usual pain management. Outcome measures included the short-form McGill Pain Questionnaire, visual analog scale for pain, summary of the pain medications consumed, and the Hospital Anxiety and Depression Scale. Results demonstrated that studied patients reported moderately high levels of pain and anxiety postoperatively while patients were managed with patient-controlled analgesia. Using generalized estimation equations and controlling for confounding variables, less pain (P < .05) and anxiety (P < .05) over time were reported by the intervention group compared with the control group. In addition, patients in the intervention group received significantly less opioid analgesics than the control group (P < .05). Findings from this study provide nurses with an additional treatment to offer postoperative digestive cancer patients.