What do people talk about during reflexology? Analysis of worries and concerns expressed during sessions for patients with multiple sclerosis.

BACKGROUND: Our previous study evaluated the use of reflexology compared to progressive muscular relaxation in improving the psychological and physical profile associated with multiple sclerosis. In this paper audiotapes from the reflexology sessions have been analysed to give a picture of the nature of interaction between patients and therapists during treatment. METHODS: A crossover design with two groups was chosen. Each participant received six sessions of both interventions. All reflexology sessions were recorded and the tapes transcribed and analysed. RESULTS: Analysis of the available audiotapes (n=245) revealed that reflexology provided opportunities for 48 out of the 50 participants to share worries and concerns. Recurring disclosure themes related to physical symptoms and treatment, psychological concerns, home/family worries, and work/leisure issues. Explorative analysis revealed some differences in the amount of disclosure over the weeks, between for example the participant's type of MS and time living with the diagnosis. CONCLUSIONS: Reflexology appears to have created a space for patients to talk about their worries and concerns, and to receive advice and support from the nurse therapists. This work contributes to the debate about the role of the therapeutic relationship within reflexology practice.

Reflexology and progressive muscle relaxation training for people with multiple sclerosis: a crossover trial.

PURPOSE: To compare the effects of reflexology and progressive muscle relaxation training for people with multiple sclerosis, provided by nurse therapists, on psychological and physical outcomes. METHODS: A crossover design was chosen with a 4-week break between treatment phases. The Short Form 36 and General Health Questionnaire 28 were completed by patients (n=50) pre and post each of the 6-week treatment phases. Salivary cortisol levels, State Anxiety Inventory, systolic and diastolic blood pressure and heart rate data were collected pre and post the weekly sessions. RESULTS: All of the chosen measures except for three SF-36 scales recorded significant changes, however, despite the 4-week break (washout period), most outcome measures did not return to their pre-treatment baseline levels. This meant that the analysis of the data was complicated by significant effects involving ordering of treatment occurring for eight of the variables (one from SF-36, two from the GHQ, SAI, Salivary Cortisol, Systolic BP and HR). However, there was a difference in the State Anxiety Inventory values between the treatments of the order of 1.092 units (95%CI 0.211-1.976) (p=0.016, Wilks lambda=0.885, df=1, 48) in favour of reflexology. Changes in salivary cortisol comparing levels pre 1st to post 6th session favoured reflexology (95%CI 0.098-2.644) (p=0.037, Wilks lambda=0.912, df=1, 48). A significant difference was found in the way the treatments affected change in systolic blood pressure following sessions; this favoured progressive muscle relaxation training (p=0.002, Wilks lambda=0.812, df=1, 48). CONCLUSION: Positive effects of both treatments following sessions and over the 6 weeks of treatment are reported, with limited evidence of difference between the two treatments, complicated by ordering effects.

A study to assess the effect of nursing interventions at the weekend for people with stroke.

OBJECTIVE: To examine whether additional therapy provided by nurses at the weekend improved the physical outcome for people with stroke on a stroke rehabilitation unit. DESIGN: A single blind randomized controlled trial. SETTING: A 16-bed stroke rehabilitation unit in the north of England. SUBJECTS: Forty-one people with stroke were randomized by means of minimization to intervention and control groups. INTERVENTIONS: The intervention group received additional exercise at the weekend provided by the nursing staff and the control group received their usual care. Both groups received usual care during weekdays. MAIN OUTCOME MEASURES: The Motor Assessment Scale (MAS), the Barthel Index (BI) and length of stay in hospital. RESULTS: No significant differences were found between the groups in terms of MAS and BI at discharge but there was a borderline significant difference between the groups on unconditional testing in terms of length of stay in hospital and on the stroke unit (p = 0.05 and p = 0.07 respectively). However, these findings were in favour of the control group. On conditional testing (adjusting for BI on admission and age) these differences disappeared (p = 0.14 and p = 0.15) for length of stay in hospital and on the stroke unit respectively. CONCLUSIONS: The present study indicates that an increase in one-to-one input by nurses for people with stroke did not lead to a measurable difference in outcome in this small study.

Effects of a stroke rehabilitation education programme for nurses.

AIMS: This paper reports a study which aimed to explore the effects of education on the practice of nurses working in stroke rehabilitation units. BACKGROUND: It has been suggested that a key component of the success of stroke units in reducing mortality and disability is the contribution made by nurses, but debate continues around their specific role. Literature has concentrated on nurses' perceptions of their role rather than their actual activities with patients. In studying the effects of education on nurses' practice with stroke patients there is a need to identify what nurses actually do, rather than what they say they do. METHODS: A quasi-experimental, non-equivalent control group design was used to study two stroke rehabilitation units. Non-participant observation was conducted during morning care sessions, focusing on styles of physical interaction. Base-line observations were recorded in each unit, after which the staff in the intervention unit received 7 hours' education, specifically focused on therapeutic handling in relation to morning care activities. Following this, postintervention observations were conducted and comparisons of interaction styles made between units. RESULTS: Twenty-six staff and 37 patients took part in the study. Following the education, staff in the intervention unit showed a change in physical interaction style more in line with therapeutic practice, with the proportion of 'doing for' interventions reducing (45.4% vs. 33.2%; P < 0.05). The proportion of facilitatory interventions increased (3.9% vs. 6.1%) however, this difference was not statistically significant (P = 0.098). The change in styles of practice was achieved with no increased demand on nurses' time. CONCLUSION: Education for nurses which aims to change styles of interaction with stroke patients can be effective. However, further research is required to identify the effect of nursing interventions on patient outcomes following stroke.