i The Effect of Foot Massage on Acute Postoperative Pain in Indonesian Patients after Abdominal ...

153 Pages·2012·1.83 MB·English

The Effect of Foot Massage on Acute Postoperative Pain
in Indonesian Patients after Abdominal Surgery

Chanif

A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of
Master of Nursing Science (International Program)
Prince of Songkla University
2012
Copyright of Prince of Songkla University
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Thesis Title The Effect of Foot Massage on Acute Postoperative Pain in
Indonesian Patients after Abdominal Surgery
Author Mr. Chanif
Major Program Nursing Science (International Program)
Major Advisor : Examining Committee:

.................................................................. ............................................ Chairperson
(Asst. Prof. Dr. Wongchan Petpichetchian) (Asst. Prof. Dr. Sang-arun Isaramalai)

..................................................................
Co-advisor : (Assoc. Prof. Dr. Sasikaan Nimmaanrat)

.................................................................. ..................................................................
(Assoc. Prof. Wimonrat Chongchareon) (Dr. Marisa Suwanraj)

..................................................................
(Asst. Prof. Dr. Wongchan Petpichetchian)

..................................................................
(Assoc. Prof. Wimonrat Chongchareon)

The Graduate School, Prince of Songkla University, has approved this
thesis as partial fulfillment of the requirements for the Master of Nursing Science
Degree (International Program)
..................................................................
(Prof. Dr. Amornrat Phongdara)
Dean of Graduate School
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Thesis Title The Effect of Foot Massage on Acute Postoperative Pain
In Indonesian Patients after Abdominal Surgery
Author Mr. Chanif
Major Program Nursing Science (International Program)
Academic Year 2011

ABSTRACT
Foot massage is a non-pharmacological nursing intervention that can
be used as a complementary therapy in relieving acute postoperative pain in patients
after abdominal surgery. This randomized-controlled trial aimed to examine the
effects of foot massage on pain intensity and pain distress of patients after abdominal
surgery.
Forty subjects were randomly assigned to either the experimental
group or the control group. Five hours and seven hours after patients had received
Ketorolac 30 mg injection IV, the 30-minute foot massage was applied to the
experimental group for two sessions on the first day (24-48 hours) after abdominal
surgery. A Visual Numeric Rating Scale (VNRS) was used to measure the pain score.
Pain intensity and pain distress were measured across four time
measures: at T1 (before giving the first session of foot massage), T2 (30 minutes after
T1), T3 (120 minutes after T1 or before giving the second session of foot massage),
and T4 (150 minutes after T1 or 30 minutes after T2). Data were analyzed using non
parametric tests including the Wilcoxon match paired rank test, Friedman’s test and
Mann-Whitney U test.
The findings revealed that both the pain intensity scores and the pain
distress scores in the experimental group after receiving foot massage (T2 and T4)
were lower than those of before receiving the foot massage (T1 and T3) (p<.001). The
scores stepped down and the lowest scores were at T4. There were significant
differences in pain intensity and pain distress between the experimental group and the
control group at T2, T3, and T4. The pain scores in the experimental group were
lower than those of the control group. These findings confirm that foot massage did
work in reducing pain intensity and pain distress across times.
Keywords: foot massage, pain intensity, pain distress, abdominal surgery
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ACKNOWLEDGMENT

Bismillahirahmanirrahim, in the name of Allah Subhanahu Wata’ala
(SWT), the Compassionate and the Most Merciful. First of all thanks to Allah SWT
for guiding my spirit and giving me the strength during the study and its completion.
I would like to express my deepest appreciation to my major advisor,
the chairperson of the Master of Nursing Science (International Program), Asst. Prof.
Dr. Wongchan Petpichetchian for her guidance, enthusiasm, patience, and unwavering
support that has been given to me. She was never lacking in kindness and support
which I shall never forget. I would like to thank my co-advisor, Assoc. Prof.
Wimonrat Chongchareon for her kind advice and my sincere gratitude goes to the
examining committee for their constructive comments and suggestions both at my
proposal defense and the final thesis defense.
Special thank goes to the Dean of the Faculty of Nursing, Assoc. Prof.
Dr. Aranya Chaowalit and all of the academic office staff of the Faculty of Nursing,
also to supporting staff of the graduate studies office for their help during my study.
I wish to thank the Indonesian government, which provided me with a full scholarship
through the Directorate of Higher Education, the Ministry of Education to support my
study at Prince of Songkla University as well as the University of Muhammadiyah
Semarang that gave me opportunity for this study leave. To my beloved family (wife
and son) who always give me support to do the best for them and for my own study.
My parents have always given me praying during my study. Special thanks for my
beloved father who passed away for his love and spirit given to me in my life. Finally,
thanks go to my classmates who always help me whenever I need it.
Chanif
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CONTENTS
Page
ABSTRACT……………………………………………………………………. iii
ACKNOWLEDGEMENT……………………………………………………… iv
CONTENTS……………………………………………………………………. v
LIST OF TABLES……………………………………………………………... ix
LIST OF FIGURES……………………………………………………………. xi
CHAPTER
1. INTRODUCTION………………………………………………………… 1
Background and significance of the problem……………………………… 1
Objectives of the study.................................................................................. 6
Research questions........................................................................................ 6
Research framework...................................................................................... 7
Hypotheses.................................................................................................... 12
Definition of terms........................................................................................ 12
Scope of the study…………………………………………………………. 13
Significance of the study………………………………………….……….. 13
2. LITERATURE REVIEW............................................................................. 14
Overview of abdominal surgery…………………………………………… 15
Types of abdominal surgery………………………………………….. 15
Line of incision of abdominal surgery……………………………….. 16
Acute postoperative pain………………………………………………….. 19
Definition…………………………………………………………….. 19
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CONTENTS (Continued)
Page
Pain mechanisms……………………………………………………... 20
Pain theories………………………………………………………….. 22
Factors influencing postoperative pain………………………………. 27
Pain measurement…………………………………………………….. 31
Pain management………………………………………………….….. 36
Foot massage…………………………………………………………….… 45
Definition………………………………………………………….….. 45
Thai and Javanese foot massage…………………………………........ 46
Techniques of foot massage…………………………………………... 48
Guidelines of foot massage…………………………………………… 51
Mechanisms of foot massage in relieving pain………………………. 53
Evidences supporting the effect of foot massage on pain relief………. 56
Summary…………………………………………………………………... 58
3. METHODOLOGY....................................................................................... 60
Research design............................................................................................ 60
Variables…………………………………………………………………… 6 1
Research setting............................................................................................ 61
Population and sample.................................................................................. 62
Instrumentation............................................................................................. 65
Study protocol……………………………………………………………... 67
Ethical considerations.................................................................................... 72
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CONTENTS (Continued)
Page
Data analysis................................................................................................ 73
4. RESULTS AND DISCUSSION………………………………………….. 75
Results……………………………………………………………….…….. 75
Demographic characteristics and surgical-related data………………. 75
Pain intensity and pain distress at the first 24 hours
after abdominal surgery……….……………………………………… 77
Effects of foot massage on pain intensity and pain distress
within-subjects effect………………………………………………… 78
Effects of foot massage on pain intensity and pain distress
between-subjects effect………………………………………………. 83
Discussion………………………………………………………………… 90
Demographic characteristics and surgical-related data……….…….. 90
Pain intensity and pain distress at the first 24 hours
after abdominal surgery……….…………………………………….. 93
Effects of foot massage on pain intensity and pain distress
within-subjects effect………………………………………………… 95
Effects of foot massage on pain intensity and pain distress
between-subjects effect………………………………………………. 101
5. CONCLUSION AND RECOMMENDATIONS…………………….…… 105
Conclusion…………………………………………………………….. 105
Strengths and limitations………………………………………………. 108
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CONTENTS (Continued)
Page
Implications and recommendations…………………………………….. 109
References ………………………………………………………………... 111
Appendices………………………………………………………………... 120
A. Research information sheet………………………………………. 120
B. Informed consent form………………………………………….... 124
C. Demographic data questionnaire…………………………………. 125
D. Visual numeric pain intensity scale and visual numeric
pain distress scale........................................................................... 126
E. Guidelines of foot massage.............................................................. 127
F. Correlation between length of abdominal incision and the
scores of pain intensity and pain distress at T1 using
Spearman’s rho (N=40)…………………………………………… 138
G. Studies determining effect of foot massage in relieving
acute postoperative pain…………………………………………… 139
H. Post-hoc power analysis…………………………………………… 141
Vitae……………………………………………………………………….. 142

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LIST OF TABLES
Table Page
1 Frequency, percentage, mean and standard deviations of
demographic characteristics of the experimental group and
the control group (N = 40)………………………………………….. 76
2 Pain intensity and pain distress scores at pretest the fifth
hour after Ketorolac injection (n=40)………..……………………… 78
3 Comparison of pain intensity before and after receiving foot
massage at the first session and the second session using
Wilcoxon matched-pair signed rank test……………………………. 80
4 Comparison of pain distress before and after receiving foot
massage at the first session and the second session using
Wilcoxon matched-pair signed rank test……………………………. 81
5 Comparison of pain intensity and pain distress across four-time
measures of the experimental group using Friedman’s test ……….. 82
6 Comparison of pain intensity and pain distress scores at
Pretest between groups using Mann-Whitney-U test………….…… 84
7 Comparisons of the pain intensity and pain distress different
scores at T2 (d1), T3 (d2), and T4 (d3) between the experimental
group and the control group ….…………………………..…………. 86
8 Comparisons of the pain intensity and pain distress different
scores at T2 (d1), T3 (d2), and T4 (d3) between the experimental
group and the control group in younger adults group ……………… 88

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LIST OF TABLES (Continued)
Table Page
9 Comparisons of the pain intensity and pain distress different
scores at T2 (d1), T3 (d2), and T4 (d3) between the experimental
group and the control group in older adults group ………………… 89
10 Correlation between length of abdominal incision and the
scores of pain intensity and pain distress at T1 using
Spearman’s rho (N=40)…………………………………………… 138
11 Studies determining effect of foot massage in relieving acute
postoperative pain…………………………………………………… 139
12 Post-hoc power analysis…………………………………………….. 141

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