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Magmassage vid förstoppning: upplevelser, effekter och kostnadseffektivitet
Umeå University, Faculty of Medicine, Department of Nursing.
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 [en]
nursing care, nursing evaluation research, constipation, massage, abdominal massage, life experiences, sign and symptoms digestive, quality of life, QALY, health care economics and organization
Keyword [sv]
omvårdnad, omvårdnadsforskning, förstoppning, massage, magmassage, upplevelser, gastrointestinala symtom, livskvalitet, QALY, kostnadseffektivitet
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-27014ISBN: 978-91-7264-886-9 (print)OAI: oai:DiVA.org:umu-27014DiVA: diva2:275625
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
List of papers
1. Economic evaluation of nursing practices: a review of literature
Open this publication in new window or tab >>Economic evaluation of nursing practices: a review of literature
2009 (English)In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 56, no 1, 13-20 p.Article in journal (Refereed) Published
Abstract [en]

Background: The importance of cost-effectiveness of nursing practices and its influence on prioritizations has been discussed in literature. It is, however, unclear to what extent health economic analysis has been used in the area of nursing.

Aim: The aim of this paper was to investigate how studies of nursing practices apply economic evaluations.

Methods: A literature review was conducted that included studies through August 2007. The search was performed using Medline, CINAHL, PsycINFO, Econlit, DARE, HTA, NHS EED, Cochrane reviews, and clinical trials with a search term connected to nursing and health economics. Protocols were used in the screening procedure and the result is reported in a descriptive form.

Results: The search identified 115 studies published between1984 and august 2007. Studies were found in the following nursing practices: provision of support and treatment (n=17); assessing suffering/wellbeing (n=1); preventing or treating ill health (n=53); and organization of individual care (n=44). In 22% of all studies, the authors explicitly presented the health economic method used. In 25% of all studies, the perspective of the economic analysis was explicitly stated and there were a large variability in cost considered in the analysis. In 82 studies, the authors reported cost-effective intervention.

Conclusions: Although economic evaluation of nursing practice has increased, it is still a rather small area. According to the items elucidated in this study, further methodological improvement is needed to evaluate the economics of nursing.

Place, publisher, year, edition, pages
Geneva: The Council, 2009
Keyword
Healthcare economics and organization, nursing outcome assessment, review
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-27002 (URN)10.1111/j.1466-7657.2008.00672.x (DOI)
Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2017-12-12Bibliographically approved
2. Effects of abdominal massage in management of constipation: a randomized controlled trial
Open this publication in new window or tab >>Effects of abdominal massage in management of constipation: a randomized controlled trial
Show others...
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
Keyword
Abdominal massage, constipation, randomized controlled trial.
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-27009 (URN)10.1016/j.ijnurstu.2009.01.007 (DOI)
Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2017-12-12Bibliographically approved
3. Abdominal massage for people with constipation: a cost utility analysis
Open this publication in new window or tab >>Abdominal massage for people with constipation: a cost utility analysis
2010 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 66, no 8, 1719-1729 p.Article in journal (Refereed) Published
Abstract [en]

AIM: This paper is a report of a study conducted to evaluate change in health-related quality of life for people with constipation receiving abdominal massage and to estimate the cost-effectiveness of two alternative scenarios developed from the original trial.

BACKGROUND: Constipation is a common problem and is associated with decrease in quality of life. Abdominal massage appears to decrease the severity of gastrointestinal symptoms, but its impact on health-related quality of life has not been assessed.

METHODS: A randomized controlled trial including 60 participants was conducted in Sweden between 2005 and 2007. The control group continued using laxatives as before and the intervention group received additional abdominal massage. Health-related quality of life was assessed using the EQ-5D and analyzed with linear regression. Two scenarios were outlined to conduct a cost utility analysis. In the self-massage scenario patients learned to give self-massage, and in the professional massage scenario patients in hospital received abdominal massage from an Enrolled Nurse.

RESULTS: Linear regression analysis showed that health-related quality of life was statistically significantly increased after 8 weeks of abdominal massage. About 40% were estimated to receive good effect. For 'self-massage', the cost per quality adjusted life year was euro75,000 for the first 16 weeks. For every additional week of abdominal massage, the average dropped and eventually approached euro8300. For 'professional massage', the cost per quality adjusted life year was euro60,000 and eventually dropped to euro28,000.

CONCLUSION: Abdominal massage may be cost-effective in the long-term and it is relevant to consider it when managing constipation. A crucial aspect will be to identify those who will benefit.

Keyword
Abdominal massage, constipation, cost utility analysis, gastrointestinal symptoms, nursing
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-37435 (URN)10.1111/j.1365-2648.2010.05339.x (DOI)000279447100007 ()20557387 (PubMedID)
Available from: 2010-11-03 Created: 2010-11-03 Last updated: 2017-12-12Bibliographically approved
4. Experiences of abdominal massage when having constipation: an interview study
Open this publication in new window or tab >>Experiences of abdominal massage when having constipation: an interview study
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aim: This study aims to illuminate experiences of receiving abdominal massage when having constipation.

Background: Abdominal massage has been found to decrease severity of constipation and abdominal pain, but little is known about experiences receiving abdominal massage.

Method: Nine adult persons with constipation receiving abdominal massage were invited to participate. Semi-structured interviews were conducted in Sweden between 2005 and 2007. The interviews were transcribed and subjected to qualitative content analysis.

Results: Participants told about being sceptical at the beginning about whether or not abdominal massage was effective and suitable for everyone. However, as the massage sessions continued, they experienced becoming embraced by safe hands. They described how the abdominal massage influenced both body and mind and changed their bowel habits. Along with improvements, the feeling of agony was gone and they felt relieved both bodily and emotionally. Yet, their new condition was considered fragile and could be easily altered.

Conclusions: Abdominal massage was experienced as pleasurable and the participants felt more comfortable with the bowel function. Receiving abdominal massage was described as influencing the whole person.

Relevance for clinical practice: Abdominal massage has been shown to be an effective intervention for constipation. A crucial aspect is for nurses to be sensitive to patients’ perceptions about the required nearness of abdominal massage and respect the integrity associated with the abdomen.

Keyword
patient experiences, abdominal massage, massage, constipation, interviews, qualitative content analysis
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-27013 (URN)
Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2009-11-16Bibliographically approved

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