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Effects of abdominal massage in management of constipation: a randomized controlled trial
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.ORCID iD: 0000-0002-1633-2179
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
Umeå University, Faculty of Medicine, Department of Nursing.
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2009 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 46, no 6, 759-767 p.Article in journal (Refereed) Published
Abstract [en]

Background. Associated with decreases in quality of life, constipation is a relatively common problem. Abdominal massage appears to increase bowel function, but unlike laxatives with no negative side effects. Because earlier studies have methodological flaws and cannot provide recommendations, more research is needed.

Objective. This study investigates the effects of abdominal massage on gastrointestinal functions and laxative intake in people who have constipation.

Design. Randomized controlled trial.

Participants and method. A sample of 60 people with constipation was included and randomised in two groups. The intervention group received abdominal massage in addition to an earlier prescribed laxative and the control group received only laxatives according to earlier prescriptions. Gastrointestinal function was assessed with Gastrointestinal Symptoms Rating Scale (GSRS) on three occasions; at baseline, week 4 and week 8. The statistical methods included linear regression, Wilcoxon sign rank test, and Mann-Whitney U-test.

Result. Abdominal massage significantly decreased severity of gastrointestinal symptoms assessed with GSRS according to total score (p=.003), constipation syndrome (p=.013), and abdominal pain syndrome (p=.019). The intervention group also had significant increase of bowel movements compared to the control group (p=.016). There was no significant difference in the change of the amount of laxative intake after 8 weeks.

Conclusions. Abdominal massage decreased severity of gastrointestinal symptoms, especially constipation and abdominal pain syndrome, and increased bowel movements. The massage did not lead to decrease in laxative intake, a result that indicates that abdominal massage could be a complement to laxatives rather than a substitute.

Place, publisher, year, edition, pages
Elsevier , 2009. Vol. 46, no 6, 759-767 p.
Keyword [en]
Abdominal massage, constipation, randomized controlled trial.
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-27009DOI: 10.1016/j.ijnurstu.2009.01.007OAI: oai:DiVA.org:umu-27009DiVA: diva2:275608
Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Magmassage vid förstoppning: upplevelser, effekter och kostnadseffektivitet
Open this publication in new window or tab >>Magmassage vid förstoppning: upplevelser, effekter och kostnadseffektivitet
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis evaluates experiences, effects, and costs of abdominal massage for people with constipation. The thesis comprises four papers: Paper I is a literature review of health economic analysis of nursing practice. Paper II and III is a prospective randomized controlled trial that evaluates abdominal massage in terms of effects and costs. Paper IV uses a qualitative approach to illuminate the experiences of receiving abdominal massage. Paper II and III included 60 participants who were constipated in accordance with Rome II criteria. Paper IV included nine participants.

Paper I investigated the application of economic evaluation in studies of nursing practice. Systematic database searches were performed and gave nearly 600 papers that were screened and 115 studies were relevant according to stipulated inclusion criteria. The result showed that there was a trend of increased publications from the year 2000. Few studies reported the health economic methods used and the perspective of the economic analysis. There was a large variability in number of included cost items. Because the methodological weaknesses in many studies, it was difficult to use some studies as ground for discussion of resource distribution.

Paper II investigates the effects of abdominal massage on gastrointestinal function and laxative intake on persons with constipation. The questionnaire Gastrointestinal Symptom Rating Scale (GSRS) was used and data were analyzed using multiple linear regression. The results showed that after eight weeks of abdominal massage the intervention group experienced significantly fewer gastrointestinal symptoms and had significantly more bowel evacuation compared with the control group. There were no differences in laxative intake.

Paper III evaluated the change in health-related quality of life (HRQoL) for people with constipation when receiving abdominal massage and estimates the cost-effectiveness of two alternative implementation scenarios: 1) abdominal massage given by enrolled nurses in a department; and 2) participants giving themselves abdominal massage after receiving training in self-massage. Both scenarios imply that all participants received abdominal massage for eight weeks and those who found the treatment effective continued to receive treatment for eight more weeks. EQ-5D was used to assess HRQoL and for calculating QALY. The intervention group had after eight weeks of abdominal massage significantly higher HRQoL assessed with EQ-5D VAS compared with the control group. No significant differences were assessed with the EQ-5D index. Abdominal massage is initially expensive, but for those who respond favourably abdominal massage can be a cost-effective long-term treatment.

Paper IV examines the experiences of receiving abdominal massage when having constipation. Four themes were formulated: being on one’s guard, becoming embraced by safe hands, feeling touch to body and mind, and being in a fragile state. Receiving abdominal massage was described as comfortable and lead to decreased problems with constipation. The improvement was described as easily disturbed and it was associated with demands to continue massage to maintain the new state.

Conclusion: Abdominal massage is a pleasant treatment that provides significantly fewer gastrointestinal symptoms and increased health-related quality of life. As a long- term treatment, abdominal massage can be a cost-effective treatment.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2009. 80 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1297
Keyword
nursing care, nursing evaluation research, constipation, massage, abdominal massage, life experiences, sign and symptoms digestive, quality of life, QALY, health care economics and organization, omvårdnad, omvårdnadsforskning, förstoppning, massage, magmassage, upplevelser, gastrointestinala symtom, livskvalitet, QALY, kostnadseffektivitet
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-27014 (URN)978-91-7264-886-9 (ISBN)
Public defence
2009-12-04, Aulan,, Vårdvetarhuset, Umeå universitet, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-11-16 Created: 2009-11-06 Last updated: 2011-04-08Bibliographically approved

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Lämås, KristinaLindholm, LarsStenlund, HansEngström, BirgittaJacobsson, Catrine
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