Kristina Lämås

Effects of abdominal massage in management of constipation—A randomized controlled trial

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 randomized 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.

The Umeå Ageing and health research programme (U-age) : exploring person-centred care and health promoting living conditions for an ageing population

The aim of this article is to describe the Umeå ageing and health research programme that explores person-centred care and health-promoting living conditions for an ageing population in Sweden, and to place this research programme in a national and international context of available research evidence and trends in aged care policy and practice. Contemporary trends in aged care policy includes facilitating ageing in place and providing person-centred care across home and aged care settings, despite limited evidence on how person-centred care can be operationalised in home care services and sheltered housing accommodation for older people. The Umeå ageing and health research programme consists of four research projects employing controlled, cross-sectional and longitudinal designs across ageing in place, sheltered housing, and nursing homes. The research programme is expected to provide translational knowledge on the structure, content and outcomes of person-centred care and health-promoting living conditions in home care, sheltered housing models, and nursing homes for older people and people with dementia.

Touch massage, a rewarding experience

This study aims to describe and analyze healthy individuals’ expressed experiences of touch massage (TM). Fifteen healthy participants received whole body touch massage during 60 minutes for two separate occasions. Interviews were analyzed by narrative analysis. Four identifiable storyline was found, Touch massage as an essential need, in this storyline the participants talked about a desire and need for human touch and TM. Another storyline was about, Touch massage as a pleasurable experience and the participants talked about the pleasure of having had TM. In the third storyline Touch massage as a dynamic experience, the informants talked about things that could modulate the experience of receiving TM. In the last storyline, Touch massage influences self-awareness, the participants described how TM affected some of their psychological and physical experiences. Experiences of touch massage was in general described as pleasant sensations and the different storylines could be seen in the light of rewarding experiences.

Economic evaluation of nursing practices: a review of literature

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 between 1984 and August 2007. Studies were found in the following nursing practices: provision of support and treatment (n = 17); assessing suffering/well-being (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 a large variability in cost was 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.

Prevalence of constipation among persons living in institutional geriatric-care settings - a cross-sectional study

RATIONAL The current state of knowledge about the prevalence of constipation among persons living in institutional geriatric-care settings is limited. AIM The aim was to investigate the prevalence of constipation among institutional geriatric-care residents and identify resident characteristics related to constipation. METHODOLOGICAL DESIGN In a cross-sectional study of all the institutional geriatric-care settings in a county in northern Sweden, 2970 residents were assessed. The member of staff who knew each resident best used the Multi-Dimensional Dementia Assessment Scale and the residents records of prescribed medication to monitor cognitive function, activities in daily life, behavioural and psychological symptoms, physical restraints, speech ability, nutrition and pharmacologic agents. The study was approved by the Regional Ethical Review Board. RESULT The prevalence of constipation was 67%. The mean age was higher among those with constipation. A significantly higher proportion of the constipated had cognitive and/or physical impairments, physical restraints, impaired speech, problems with nutrition, and higher numbers of drugs for regular use. Of those with constipation, 68% were prescribed laxatives for regular use. Twenty-three per cent of the constipated residents were prescribed opioid analgesics (n = 465), and 29% (n = 134) of these were not prescribed any laxatives. STUDY LIMITATION Due to the cross-sectional design, the results should be interpreted with caution in terms of causal reasoning, generalisation and conclusions about risk factors. Another limitation is the use of proxy assessments of constipation. CONCLUSION The results show that constipation is common among residents in institutional geriatric-care settings in Sweden, which is in line with previous studies from other Western countries. Despite being constipated when having prescribed opioid analgesics, a large number did not have prescribed laxatives. The results indicate the urgency of finding strategies and implementing suitable interventions to improve bowel management in residents in institutional geriatric-care settings.

Possibilities for evaluating cost-effectiveness of family system nursing: An example based on Family Health Conversations with families in which a middle-aged family member had suffered stroke

Family Health Conversations (FamHC) increase health and well-being, but knowledge about their cost-effectiveness, and how to best calculate this, is lacking. In this feasibility study we evaluated the cost-effectiveness of using FamHC with families in which a middle-aged family member had suffered stroke. Seven families participated in a FamHC intervention and seven families received ordinary care. Health-related quality of life (HRQoL) was estimated with SF-6D and EQ-5D over a six-month period. The cost-effectiveness of the intervention was calculated. Families receiving FamHC intervention had significantly increased HRQoL at follow up. Cost per quality adjusted life year differed depending on the instrument and analysis method used in the calculation. However, all calculations showed that FamHC were cost-effective. We conclude that FamHC significantly increase HRQoL and suggest that they are cost-effective. Both instruments seemed to be able to capture changes. Considering the participants’ experience of answering the two instruments, we advocate the use of EQ-5D.

Does touch massage facilitate recovery after stroke? A study protocol of a randomized controlled trial

BackgroundDespite high quality stroke care, decreased sensorimotor function, anxiety and pain often remain one year after stroke which can lead to impaired health and dependence, as well as higher healthcare costs. Touch massage (TM) has been proven to decrease anxiety and pain, and improve quality of health in other conditions of reduced health, where reduced anxiety seems to be the most pronounced benefit. Thus there are reasons to believe that TM may also reduce anxiety and pain, and improve quality of life after stroke. Further, several studies indicate that somatosensory stimulation can increase sensorimotor function, and it seems feasible to believe that TM could increase independence after stroke. In this study we will evaluate effects of TM after stroke compared to sham treatment.MethodsThis is a prospective randomized open-labelled control trial with blinded evaluation (PROBE-design). Fifty patients with stroke admitted to stroke units will be randomized (1:1) to either a TM intervention or a non-active transcutaneous electrical nerve stimulation (non-TENS) control group. Ten sessions of 30 min treatments (TM or control) will be administered during two weeks. Assessment of status according to the International Classification of Functioning, Disability and Health (ICF), including body function, activity, and participation. Assessment of body function will include anxiety, pain, and stress response (heart rate variability and salivary cortisol), where anxiety is the primary outcome. Activity will be assessed by means of sensorimotor function and disability, and participation by means of health-related quality of life. Assessments will be made at baseline, after one week of treatment, after two weeks of treatment, and finally a follow-up after two months. The trial has been approved by the Regional Ethical Review Board.DiscussionTM seems to decrease anxiety and pain, increase health-related quality of life, and improve sensorimotor functions after stroke, but the field is largely unexplored. Considering the documented pleasant effects of massage in general, absence of reported adverse effects, and potential effects in relation to stroke, it is essential to evaluate effects of TM during the sub-acute phase after stroke. The results of this project will hopefully provide important knowledge for evidence-based care.Trial registrationClinicalTrials.gov: NTC01883947