Effect of Foot Reflexology on Post Operative Pain and Sleep among Post Caesarean Mothers

Deepshikha¹ ,Vibha²

¹Lecturer, Obstetric and Gynaecological Nursing, Gursewa College of Nursing, Panam, Garhshankar.

²Associate Professor and H.O.D of Obstetric and Gynaecological Nursing, Faculty of Nursing, State Institute of Nursing and Paramedical Sciences, Badal

*Corresponding Author’s Email: sonideepshikha12@gmail.com, batra12345batra@yahoo.co.in

ABSTRACT:

Caesarean section is one of the common surgeries performed in obstetrics to save the life of mother and her baby. A woman with caesarean section has more problems like longer duration of hospital stay, post-operative pain and insomnia etc. Reflexology is a powerful healiung practice based on the premises that our entire body is mirrored on the feet through a system of reflexes. Foot reflexology is a complementary therapy that has great potential, safe, simple to learn and non-invasive method of management of pain and sleep. Methodology: A Quantitative Quasi experimental non randomized control group research design and approach had been adopted. The study was conducted in Guru Go bind Singh Medical College and Hospital, Faridkot, Civil Hospital, Faridkot and District Hospital, Bathinda. Purposive sampling was used to select 60 samples, 30 in experimental and 30 in control group. Structured interview had been adopted to assess level of pain by numerical rating scale and level of sleep by structured sleep scale of post caesarean mothers. Foot reflexology had been provided to experimental group once a day for 3 consecutive days from 1st post operative day for 15 minutes and control group received routine post operative care. Post interventional assessment had been done on 4th post operative day. Results: Post interventional level of pain was found to be significantly lower in the experimental group (p<0.001) than in the control group. The post interventional level of sleep of an experimental group was found to be improved (p<0.001) compared with pre-intervention. Also, there was a significant difference between groups in terms of the level of pain and sleep (p<0.001).The research hypothesis were accepted which indicates that after receiving foot reflexology therapy, the subjects showed significant pain relief and improved sleep. Conclusion: The findings of the study support the need of implementing foot reflexology to reduce post operative pain and improve sleep among post caesarean mothers. Foot reflexology is a non pharmacological, cost effective and simple intervention without any adverse effects. The results proved that the foot reflexology was effective in reducing the level of post operative pain and improving sleep.

KEYWORDS: Foot reflexology, Pain, Sleep, Post caesarean mothers, Caesarean section, Effectiveness.

INTRODUCTION:

Child birth is one of the most marvelous and memorable segments in woman’s life. It is natural physiological event.¹ The transition from being a pregnant woman to becoming a mother means an enormous change for each woman both physically and psychologically which takes place through vaginal or abdominal route.²

Caesarean section is one of the most common surgeries performed in modern obstetrics. The incidence of caesarean section is steadily rising. During the last decade there has been two to three fold rise in the incidence from the initial rate of about 10% .Caesarean section is one of the common methods of delivery with incidence of 32% of all births in United States. India is also experiencing a rapid increase in Caesarean section deliveries with incidence of 32.6% documented from South India.³In India, the rate of cesarean section delivery has increased from 3% to 10% between 1992-93 and 2005-06 (IIPS, 2007). Based on National Family Health Survey (NFHS), the cesarean delivery rate in India is 9.2% and Punjab is 14.6%. In 1992-93 (NFHS-1) caesarean rate in India was 2.9% and in Punjab it was 4.2%, In 1998-99 (NFHS-2) it was 7.1% in India and 8.3% in Punjab, In 2005-06 (NFHS-3) it was 10.6% in India and 14.4% in Punjab.⁴ The woman who has undergone caesarean section has more problems, minor or major, than a woman with vaginal delivery. Some problems are like longer duration of hospital stay, post operative pain, delayed ambulation, increased period required to return to normal meals, breast engorgement, problems in relation to bowel and bladder, lactation failure and less maternal and newborn bonding.⁵ Post operative pain and insomnia are the major concerns for the mother.10 Some alternative therapies are in the early empirical stage in reducing post operative pain and improving quality of sleep.⁶

Women undergoing caesarean section who have a high pain levels are in special need of attention and care because of a higher risk of decreased ability to breastfeed and to take care of their newborn. In a study it has been said that, persistent pain is more common one year after caesarean section and the women with persistent pain recalled significantly more pain on the day after caesarean section. Also rates of chronic pain after caesarean section have been between 6% and 18%.⁷

Effective pain control is best achieved through a combination of pharmaceutical & non pharmaceutical therapies. Pharmaceutical management has been the primary means of providing relief from pain. Post operative pain is poorly controlled by pharmacological means alone. Complementary strategies based on sound research findings are needed to aid in post operative pain relief as patients routinely report mild to moderate pain even though pain medication has been administered.⁸ Although pharmaceutical medication continue to serve as major contributor to pain management, but non pharmaceutical techniques are also being increasingly used to provide pain relief.⁹ Sleep is essential for the normal, healthy functioning of the human body. Postnatal women sleep less during early weeks after delivery as compared to during pregnancy and other periods of reproductive age. Several factors can influence sleep among new mothers, including physical changes, demands from the newborn and breast feeding.¹⁰ Reflexology is the practice of applying pressure to the feet and hands utilizing specific thumb, finger and hand techniques without the use of oil and cream or lotions based on a system of zones and reflex areas that reflect an image of the body on the feet and hands with a premise that such works effects a physical change in the body. Around the world and throughout history, reflexology has been rediscovered time and time again. Archeological evidence points to ancient reflexology medical practices in Egypt, China and Japan.¹¹

Fig. 1 Foot Reflexology Chart

Fig. 2 Technique of applying pressure

An exploratory study was conducted on early postpartum sleep and fatigue for mothers after cesarean delivery compared with vaginal delivery and it concluded that after cesarean birth, mothers averaged only about 4 hours total sleep time with 34% wake after sleep onset compared with 6.5 hours total sleep time with 14% wake after sleep onset for mothers after vaginal birth.¹²

MATERIALS AND METHODS:

A quantitative quasi experimental non randomized control group design had been used to assess the effectiveness of foot reflexology on post operative pain and sleep among post caesarean mothers at selected hospitals of Malwa region, Punjab. This study was conducted in the selected hospitals of Malwa region, Punjab. Target population of this study were post caesarean mothers admitted in selected hospitals of Malwa region, Punjab. The sample size comprised of 60 post caesarean mothers, 30 in experimental and 30 in control group from District hospital, Bathinda; Guru Gobind Singh Medical College and Hospital, Faridkot and Civil Hospital, Faridkot. Non-probability purposive sampling technique had been used to select the sample. Present at the time of data collection with recovery from anesthesia who could understand and comprehend English/Punjabi/Hindi and willing to participate were included as samples. Post caesarean mothers excluded from the study were with severe post-operative maternal complications, post partum psychiatric disorders, using any other complementary therapies such as music, transcutaneous electric nerve stimulation (TENS), herbs and having painful or infectious feet, HIV, Hepatitis B and C. The tools utilized in the study comprised of three sections namely (1) selected demographic variables: Age, Parity, History of previous caesarean section, type of caesarean section, type of incision and exclusive breast feeding; (2) Numerical rating scale (NRS) and structured sleep scale (SSS). Total score of NRS is 10. Highest scores indicate severe level of pain and as scores are declining, level of pain is also decreasing and zero scores means there is no pain. The total score of structures sleep scale is 14. Higher scores indicate good sleep and scores less than 8 indicate poor sleep. The validity of tools had been obtained from nursing experts, reflexology expert and obstetricians. For reliability Pearson’s coefficient of correlation was calculated. The scores were 0.96 for NRS and 0.78 for SSS.

The investigator obtained the permission from Research and Ethical committee and concerned authorities of college and hospitals before the study. Then post caesarean mothers with inclusion criteria were identified. The researcher initially established rapport and purpose of study was explained to each mother in Punjabi and consent was obtained. Then samples were non probably allotted into experimental and control groups using purposive sampling method. Pre interventional assessment of level of post-operative pain and sleep had been done. Intervention (Foot Reflexology) had been provided only to experimental group from 1^st post operative day for 15 minutes each day and continued for 3 days along with routine care. Control group had received only routine care. Post interventional assessment had been done after 3 days to reassess the changes in level of post-operative pain and sleep for both the experimental and control groups.

RESULTS:

The significant findings of the study were: the distribution of selected demographic variables indicated that 53.3% of post caesarean mothers in experimental and 56.7% in control group were in the age group of 24-28 years. 56.7% of post caesarean mothers in experimental and 63.3% in control group were primiparous. 83.3% post caesarean mothers in experimental and 86.7% in control group were not having any history of previous caesarean section. 80% of post caesarean mothers in experimental and 70% in control group had undergone emergency caesarean section. 93.3% of post caesarean mothers in experimental and 96.7% in control group had transverse incision. 70% of post caesarean mothers in experimental and 66.7% in control group were not exclusively breast feeding.

Table 1. Comparison of Effectiveness of foot reflexology on level of pain between experimental and control group N=60

		Pre- interventional				Post- interventional				c²	df
		No pain	Mild pain	Moderate pain	Severe pain	No pain	Mild pain	Moderate pain	Severe pain	c²	df
Experimental group (n=30)	N	0	0	7	23	8	18	4	0	49.8182***	3
Experimental group (n=30)	%	0	0	23.33	76.67	26.67	60	13.33	0	49.8182***	3
Control group (n=30)	N	0	0	12	18	0	0	17	13	1.6685^NS	1
Control group (n=30)	%	0	0	40	60	0	0	56.67	43.33
c²		1.9255^NS				47.0476***
Df		1				3

Maximum score-10 ***Significant at p<0.001

Minimum score-0 NS- Non significant

Table 2. Comparison of Effectiveness of foot reflexology on level of sleep between experimental and control group N=60

		Pre- interventional		Post- interventional		c²	df
		Good sleep	Poor sleep	Good sleep	Poor sleep

Experimental group (n=30)	n	3	27	27	3	38.4***	1
	%	10	90	90	10
Control group (n=30)	n	6	24	13	17	3.7741^NS	1
	%	20	80	43.33	56.67
c² df		1.1765^NS 1		14.7*** 1

Maximum score-14 ***Significant at p<0.001

Minimum score-0 NS- Non significant

Table 1 shows that the difference between pre and post-interventional level of post operative pain was statistically significant in the experimental group, at p<0.001. In control group statistical significance was not noted. It describes statistically significant difference in post-interventional level of pain between experimental and control group at the level of p<0.001, whereas no difference in pre-interventional level of pain. It clearly denotes that level of post-operative pain is reduced among mothers in experimental group. The chi square value between the groups shows a statistical significance at the level p<0.001 for level of pain. The comparison of the level of sleep (Table 2) shows that there was a statistically significant improvement in the level of sleep at the level of p<0.001 in the experimental group between pre and post intervention. There was statistically significant difference at the level of p<0.001 post-intervention ally between experimental and control group, where as no statistically significant difference seen pre-intervention ally between both groups. This indicates improvement in the level of sleep in experimental group after the intervention.

DISCUSSION:

The results of this study indicated a statistical significant improvement in level of sleep and a decrease level of pain following foot reflexology. Similarly, a study by Varghese J (2014) conducted on 60 post caesarean mothers to determine the effect of foot reflexology on intensity of pain and quality of sleep. Statistically significant difference at p<0.001 level of significance had been found in post test scores between experimental and control group. There was significant improvement in quality of sleep and reduced intensity of pain.⁶ Also, a study conducted by Choudhary S (2004) among 60 adult patients to find efficacy of reflexology in post operative pain. Reflexology group received therapy for 20minutes for 4 times 0, 2,6,24 hours after surgery and measurement of pain score was done before and after each therapy session by visual analogue scale. Results shown a significant decrease in pain score and the requirement and quantity of drugs in reflexology group as compared to control group.¹³ Association of post-operative pain and sleep with background variables of the experimental and control group was assessed by using chi-square test. Post operative pain was found to be associated with the age and history of previous caesarean section; sleep was found to be associated with history of previous caesarean section, type of caesarean section and type of incision. Limitations in the study were: the smaller sample size, conducted only on post caesarean mothers. The implications of nursing practice denotes the need for evidence based practices, non-pharmacological pain management, arranging complementary therapy cell and incorporating foot reflexology training of health care personnel. Recommendations for future research include conducting a study with large sample in different settings and another form of reflexology and other complementary therapy.

CONCLUSION:

Post caesarean mothers experienced moderate to severe level of pain and poor level of sleep post operatively. Foot reflexology is safe, cost effective and easy to learn which leads to rest and relaxation and furthermore alleviates and helps preventing illness. Through this study, foot reflexology is proved to be the paramount measure to improve post operative level of sleep and reduce level of pain.

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Received on 05.06.2016 Modified on 29.06.2016

Int. J. Nur. Edu. and Research. 2016; 4(4): 441-444.

DOI: 10.5958/2454-2660.2016.00081.8