Effects of Reflexology on Postpartum Sleep Quality: A Randomized Controlled Trial

Abstract

Aim: Poor sleep quality is one of the major problems in the postpartum period. The foot reflexology is a useful nursing intervention that can improve sleep quality and reduce sleep problems. The aim of this study was determineed the effects of foot reflexology versus standard care for improvement of the sleep quality of postpartum women following vaginal birth. Methods: This single-blind, randomized controlled trial was conducted between July 2016 and March 2017 with the intervention group (n= 24) and control group (n= 30). In the intervention group, four sessions foot reflexology was applied for 15 minutes in each foots, every other day between postpartum 14th- 20th day. Measures included personal information form and Postpartum Sleep Quality Scale scores. Result: The postpartum sleep quality of the women in the intervention group was increased (p=0.000) and significantly higher than the control group in the posttest (p=0.001). There was no significant difference between the pre and posttest sleep quality of the women in the control group (p=0.057). A sleep duration increased (p=0.004) in the intervention group, while there was no change in the control group. Conclusion: Foot reflexology can be used to improve sleep quality and sleep duration of postpartum women after vaginal birth.

Keywords

• nursing
• post partum period
• postpartum sleep quality
• reflexology

Refleksolojinin Doğum Sonu Uyku Kalitesi Üzerine Etkileri: Randomize Kontrollü Bir Çalışma

Abstract

Amaç: Kötü uyku kalitesi, doğum sonrası dönemin en önemli sorunlarından biridir. Refleksoloji uyku kalitesini artırabilen ve uyku problemlerini azaltabilen etkili bir hemşirelik uygulamasıdır. Bu çalışmanın amacı vajinal doğum sonrası postpartum kadınların uyku kalitesinin iyileştirilmesi için ayak refleksolojisinin etkinliğini belirlemektir. Yöntem: Bu tek körlü ve randomize kontrollü araştırma, girişim grubu (n= 24) ve kontrol grubu (n= 30) ile Temmuz 2016 ile Mart 2017 tarihleri arasında yürütülmüştür. Girişim grubundaki kadınlara, doğum sonu 14-20. günler arasında gün aşırı olmak üzere her ayağa 15'er dakikalık dört seans ayak refleksolojisi uygulanmıştır. Ölçüm araçları olarak kişisel bilgi formu ve Doğum Sonrası Uyku Kalitesi Ölçeği kullanılmıştır. Bulgular: Girişim grubundaki kadınların doğum sonu uyku kalitesi, son testte kontrol grubuna göre artarak (p=0.000) anlamlı derecede yüksek olduğu belirlenmiştir (p=0.001). Kontrol grubundaki kadınların ise ön-test ve son test uyku kaliteleri arasında anlamlı bir fark saptanmamıştır (p=0.057). Girişim grubundaki doğum sonu kadınların uyku süreleri artarken (p=0.004), kontrol grubunda değişiklik olmamıştır. Sonuç: Ayak refleksolojisi, vajinal doğum sonrası doğum yapan kadınların uyku kalitelerini ve uyku sürelerini iyileştirmek için kullanılabilir.

Keywords

• hemşirelik
• doğum sonu dönem
• uyku kalitesi
• refleksoloji

References

1. 1. Harvey AG, Stinson K, Whitaker KL, Moskovitz D, Virk H. The subjective meaning of sleep quality: A comparison of individuals with and without insomnia. Sleep. 2008; 31(3): 383-93.
2. 2. Ohayon M, Wickwire EM, Hirshkowitz M, Albert SM, Avidan A, Daly FJ, et al. National sleep foundation's sleep quality recommendations: First report. Sleep Health. 2017;3(1):6-19.
3. 3. Stremler R, Sharkey KM, Wolfson AR. Postpartum period and early motherhood. In: Kryger M, Roth T, Dement W (eds). Principles and practice of sleep medicine. 6th ed. Philadelphia: Elsevier; 2017. p.1547–52
4. 4. Ko SH, Chen CH, Wang HH, Su YT. Postpartum women’s sleep quality and its predictors in Taiwan. Journal of Nursing Scholarship. 2014;46(2):74-81.
5. 5. Sivertsen B, Hysing M, Dørheim SK, Eberhard-Gran M. Trajectories of maternal sleep problems before and after childbirth: A longitudinal population-based study. BMC Pregnancy Childbirth. 2015; 15:129.
6. 6. Aksu S, Varol FG, Hotun Sahin N. Long-term postpartum health problems in Turkish women: Prevalence and associations with self-rated health. Contemporary Nurse. 2017; 53(2):167-81.
7. 7. Aksu A, Vefikulucay Yilmaz D. The relationship of postpartum sleep quality and breastfeeding self-efficacy of Turkish mothers. Scandinavian Journal of Caring Sciences. 2019; 33(4):833-9.
8. 8. Khadka R, Hong SA, Chang YS. Prevalence and determinants of poor sleep quality and depression among postpartum women: A community- based study in Ramechhap district, Nepal. International Health. 2020; 12(2):125-31.

9. 9. Bhati S, Richards K. A systematic review of the relationship between postpartum sleep disturbance and postpartum depression. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2015; 44(3):350-7.
10. 10. Khayamim N, Bahadoran P, Mehrabi T. Relationship between fatigue and sleepiness with general health of mothers in the postpartum period. Iranian Journal of Nursing and Midwifery Research. 2016;21(4):385-90.
11. 11. Yang CL, Chen CH. Effectiveness of aerobic gymnastic exercise on stress, fatigue, and sleep quality during postpartum: A pilot randomized controlled trial. International Journal of Nursing Studies. 2018;77:1-7.
12. 12. Afshar Keshavarz M, Behboodi Moghadam Z, Taghizadeh Z, Bekhradi R, Montazeri A, Mokhtari P. Lavender fragrance essential oil and the quality of sleep in postpartum women. Iran Red Crescent Medical Journal. 2015;17(4):e25880.
13. 13. World Health Organization (WHO). Traditional Medicine Strategy: 2014-2023. The World Health Report, 2013.
14. 14. Kizir Y, Kahraman S, Özcanarslan F. Reflexology and nursing. Turkiye Klinikleri Journal of International Medical Nursing-Special Topics. 2017;3(2):125-9.
15. 15. Owais S, Chow CHT, Furtado M, Frey BN, Van Lieshout RJ. Non-pharmacological interventions for improving postpartum maternal sleep: A systematic review and meta-analysis. Sleep Medicine Reviews. 2018:41;87-100.
16. 16. Gunnarsdottir TJ. Reflexology. Complementary & Alternative Therapies in Nursing. In: Lindquist R, Snyder M, Tracy MF. (eds.). 7th ed. New York: Springer Publishing Company; 2014. p.459-74.
17. 17. Embong NH, Soh YC, Ming LC, Wong TW. Revisiting reflexology: Concept, evidence, current practice, and practitioner training. Journal of Traditional Complementery Medicine. 2015;5(4):197–206.
18. 18. Pitman V, MacKenzie K (eds). Reflexology: A practical approach. 2th ed. UK: Oxford University Press; 2014. p.127-45.
19. 19. Li CY, Chen SC, Li-Yi C, Gau ML, Huang CM. Randomised controlled trial of the effectiveness of using foot reflexology to improve quality of sleep amongst Taiwanesee postpartum women. Midwifery. 2011;27(2):181-6.
20. 20. Manjuri AE, Latheef F. Effectiveness of foot reflexology and back massage in improing the quality of sleep among post-caesarean mothers. International Journal of Research in Ayurveda and Pharmacy. 2016;7(5):103-8.
21. 21. Varghese J, George J, Gowda Y. A randomized control trial to determine the effect of foot reflexology on intensity of pain and quality of sleep in post caesarean mothers. Journal of Nursing and Health Science. 2014;3(1):39-43.
22. 22. Turkish Ministry of Health (2018). Post-natal Care Management Guideline. Available from: https://dosyamerkez.saglik.gov.tr/Eklent i / 2 8 0 8 6 , d o g u m s o n u - bakimyonetimrehberipdf.pdf?0[Accessed 6th September 2019].
23. 23. Yang CL, Yu CH, Chen CH. Development and validation of the postpartum sleep quality scale. Journal of Nursing Research. 2013;21(2):148-54.
24. 24. Boz İ, Selvi N. Testing the psychometric properties of the Postpartum Sleep Quality Scale in Turkish Women. Journal of Nursing Research. 2018;26(6):385-92.
25. 25. Polit DF, Gillespie BM. The use of the intention- to-treat principle in nursing clinical trials. Nursing Research. 2009;58(6):391-9.
26. 26. Bağcı S, Altuntuğ K. The relationship between mothers' problems and quality of life. Journal of Human Sciences. 2016;13(2):3266-79.
27. 27. Ko YL, Lee HJ. Randomised controlled trial of the effectiveness of using back massage to improve sleep quality among Taiwanese insomnia postpartum women. Midwifery. 2014;30(1):60-4.
28. 28. Mindell JA, Sadeh A, Kwon R, Goh DYT. Cross-cultural comparison of maternal sleep. SLEEP. 2013;36(11):1699-706.
29. 29. Hung HM, Chen CH. Sleep quality in postpartum women: Exploring correlation with childbirth experience and household work. Journal of Nursing Research. 2014;22(1):20-7.
30. 30. Lee J, Han M, Chung Y, Kim J, Choi J. Effects of foot reflexology on fatigue, sleep and pain: A systematic review and meta-analysis. Journal of Korean Academy of Nursing. 2011;41(6):821-33.
31. 31. Yeung WF, Chung KF, Poon MM, Ho FY, Zhang SP, Zhang ZJ et al. Acupressure, reflexology, and auricular acupressure for insomnia: A systematic review of randomized controlled trials. Sleep Medicine. 2012;13(8):971-84.
32. 32. Durham R, Chapman L. Maternal-newborn nursing: The critical components of nursing care. 2th ed. Philadelphia: Davis Company; 2014. p. 309-11.
33. 33. Negron R, Martin A, Almog M, Balbierz A, Howell EA. Social support during the postpartum period: mothers' views on needs, expectations, and mobilization of support. Maternal and Child Health Journal. 2013;17(4):616-23.
34. 34. Insana SP, Costello CR, Montgomery-Downs HE. Perception of partner sleep and mood: Postpartum couples' relationship satisfaction. Journal of Sex & Marital Therapy. 2011;3(5):428–40. 35. Cooklin AR, Amir LH, Nguyen CD, Buck ML, Cullinane M, Fisher JRW, et al. Physical health, breastfeeding problems and maternal mood in the early postpartum: a prospective cohort study. Archives of Womens Mental Health. 2018;21(3):365-74.
35. 36. Creti L, Libman E, Rizzo D, Fichten CS, Bailes S, Tran DL, et al. Sleep in the postpartum: Characteristics of first-time, healthy mothers. Sleep Disorders. 2017;2017; 8520358.
36. 37. Tiran D. Reflexology in pregnancy and childbirth, London: Churchill Livingstone Elsevier. 2010.
37. 38. Wu J, Wang Y, Wang Z. The effectiveness of massage and touch on behavioural and psychological symptoms of dementia: A quantitative systematic review and meta-analysis. Journal of Advanced Nursing. 2017;73(10):2283-95.
38. 39. Elmas S, Alus-Tokat M. The effects of newborn feeding methods on the sleep and fatigue of the mother. Dokuz Eylul University Faculty of Nursing Electronic Journal. 2016;9(2): 45-51.