Impact of social support and religiosity/spirituality on recovery from acute cardiac events and heart surgery in Switzerland.

OBJECTIVE: The aim of this study was to evaluate the impact of social support and religiosity/spirituality (R/S) on the recovery from an acute cardiac event or cardiac surgery during cardiac rehabilitation (CR). METHODS: In this prospective study, a convenience sample of 159 patients participating in a CR program were enrolled. Religiosity/spirituality, social support, anxiety, depression, health related quality of life (QoL), and exercise capacity (6-min walk test, cycle ergometer test) were assessed. RESULTS: Social support was significantly associated with less anxiety (p < .01), less depression (p < .01), and better QoL (p < .05) on admission. After adjustment for age, gender, education level, and morbidity, social support remained significantly associated with less depression (p < .001). Religiosity/spirituality was significantly associated with less depression (p < .05), better QoL (p < .05), and better exercise capacity (p < .05) at admission. After adjustment for covariates, however, significance was lost. There were no significant impact of either social support or R/S on the course of CR measured by change in QoL or exercise capacity. CONCLUSION: Social support may be a protective factor against depression in the recovery from cardiac events or surgery. Neither social support nor R/S had a significant impact on the course of the 3-week CR program.

Investigating the Effect of Acupressure on the Patients' Anxiety Before Open-Heart Surgery: A Randomized Clinical Trial.

BACKGROUND: Anxiety is a common complaint of patients before diagnostic or therapeutic invasive procedures, especially before open-heart surgery. The most well-known method to reduce anxiety is the use of sedatives, which have pronounced side effects. OBJECTIVES: The purpose of this study was to determine the effect of acupressure on anxiety in patients undergoing open-heart surgery. METHOD: This is a randomized clinical trial study conducted on 90 patients who were candidates for open-heart surgery. The patients were randomly assigned into either intervention or control groups. Acupressure intervention was applied at three real acupoints over two consecutive days in the intervention group. The control group received acupressure on sham points. We used Spielberger State-Trait Anxiety Inventory to assess anxiety in our study. RESULTS: The results showed that before acupressure, there was no statistically significant difference between state anxiety scores and intergroup traits, and this difference was only significant in state anxiety after the second intervention. State and trait anxiety were significant before and after the intervention in the test group, respectively include (p < 0.001) (p = 0.01), but these changes in the control group did not show a statistically significant difference. After completing the second phase of the intervention at the actual sites, systolic blood pressure (p = 0.007) and heart rate (p = 0.001) decreased significantly. However, acupressure did not have a significant effect on diastolic blood pressure in any of the groups. CONCLUSION: Based on the results of this study, the application of acupressure in patients who are candidates for open-heart surgery can reduce their state anxiety. Further larger-scale and rigorous studies are warranted.

Effects of auricular acupressure on the quality of sleep and anxiety in patients undergoing cardiac surgery: A single-blind, randomized controlled trial.

AIM: This study aimed to evaluate the effects of auricular acupressure (AA), a non-invasive type of reflexotherapy, on sleep quality and anxiety in patients after cardiac surgery. BACKGROUND: Sleep disturbances and anxiety hinder the recovery of patients after cardiac surgery; thus, appropriate and adequate nursing interventions must be pursued. AA is a complementary therapy suitable for patients with limited pharmacological therapy options. METHOD: A single-blind, randomized controlled trial with a pretest-posttest control group design was applied. The study consisted of 42 patients, comprising an experimental group (n = 21) and a control group (n = 21). AA was applied for six days per trial for a total of 2 trials, while sleep (sleep score, sleep satisfaction) and anxiety (state, trait) were measured at three time points (pre-op, 7 days post-op, and 14 days post-op). RESULTS: The sleep and sleep satisfaction scores of the experimental group were significantly higher than those of the control group. No significant difference was found in anxiety state/trait between the two groups. CONCLUSIONS: We conclude that AA is a safe, effective, noninvasive, and low-risk nursing intervention that can improve sleep quality in patients after cardiac surgery.

Can hypnosis and virtual reality reduce anxiety, pain and fatigue among patients who undergo cardiac surgery: a randomised controlled trial.

BACKGROUND: Different non-pharmacological techniques, including hypnosis and virtual reality (VR) are currently used as complementary tools in the treatment of anxiety, acute and chronic pain. A new technique called virtual reality hypnosis (VRH), which encompasses a combination of both tools, is regularly used although its benefits and underlying mechanisms remain unknown to date. With the goal to improve our understanding of VRH combination effects, it is necessary to conduct randomised and controlled research trials in order to understand their clinical interest and potential benefits. METHODS: Patients (n = 100) undergoing cardiac surgery at the Liège University Hospital will be randomly assigned to one of four conditions (control, hypnosis, VR or VRH). Each patient will receive two sessions of one of the techniques: one the day before the surgery and one the day after. Physiological assessments will be made on the monitor and patients will rate their levels of anxiety, fatigue, pain, absorption and dissociation. DISCUSSION: This study will help to expand knowledge on the application of virtual reality, hypnosis and VRH in the specific context of cardiac and intensive care procedures, and the influence of these non-pharmacological techniques on patient's anxiety, fatigue, pain and phenomenological experience. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03820700. Date registered on 29 January 2019. Study recruitment date: October 6, 2018. Study anticipated completion date: December 28, 2020.

Updating EuroSCORE by including emotional, behavioural, social and functional factors to the risk assessment of patients undergoing cardiac surgery: a study protocol.

INTRODUCTION: Conventional risk assessment in cardiac surgery focus on medical and physiological factors and have been developed to predict mortality. Other relevant risk factors associated with increased risk of poor outcomes are not included. Adding non-medical variables as potential prognostic factors to risk assessments direct attention away from specific diagnoses towards a more holistic view of the patients and their predicament. The aim of this paper is to describe the method and analysis plan for the development and validation of a prognostic screening tool as a supplement to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) to predict mortality, readmissions and prolonged length of admission in patients within 90 days after cardiac surgery, as individual outcomes. METHODS AND ANALYSIS: The development of a prognostic screening tool with inclusion of emotional, behavioural, social and functional factors complementing risk assessment by EuroSCORE will adopt the methods recommended by the PROGnosis RESearch Strategy Group and report using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis statement. In the development stage, we will use data derived from three datasets comprising 1143, 3347 and 982 patients for a prospective cohort study of patients undergoing cardiac surgery, respectively. We will construct logistic regression models to predict mortality, prolonged length of admission and 90-day readmissions. In the validation stage, we will use data from a separate sample of 333 patients planned to undergo cardiac surgery to assess the performance of the developed prognostic model. We will produce validation plots showing the overall performance, area under the curve statistic for discrimination and the calibration slope and intercept. ETHICS AND DISSEMINATION: The study will follow the requirements from the Ethical Committee System ensuring voluntary participation in accordance with the Helsinki declarations. Data will be filed in accordance with the requirements of the Danish Data Protection Agency.

Guided meditation as an adjunct to enhance postoperative recovery after cardiac surgery: study protocol for a prospective randomized controlled feasibility trial.

BACKGROUND: Cardiac surgical procedures are associated with postoperative neurological complications such as cognitive decline and delirium, which can complicate recovery and impair quality of life. Perioperative depression and anxiety may be associated with increased mortality after cardiac surgeries. Surgical prehabilitation is an emerging concept that includes preoperative interventions to potentially reduce postoperative complications. While most current prehabilitation interventions focus on optimizing physical health, mind-body interventions are an area of growing interest. Preoperative mind-body interventions such as Isha Kriya meditation, may hold significant potential to improve postsurgical outcomes. METHODS: This is a prospective, randomized controlled feasibility trial. A total of 40 adult patients undergoing cardiac surgery will be randomized to one of three study groups. Participants randomized to either of the two intervention groups will receive meditative intervention: (1) commencing two weeks before surgery; or (2) commencing only from the day after surgery. Meditative intervention will last for four weeks after the surgery in these groups. Participants in the third control group will receive the current standard of care with no meditative intervention. All participants will undergo assessments using neurocognitive, sleep, depression, anxiety, and pain questionnaires at various time points in the perioperative period. Blood samples will be collected at baseline, preoperatively, and postoperatively to assess for inflammatory biomarkers. The primary aim of this trial is to assess the feasibility of implementing a perioperative meditative intervention program. Other objectives include studying the effect of meditation on postoperative pain, sleep, psychological wellbeing, cognitive function, and delirium. These will be used to calculate effect size to design future studies. DISCUSSION: This study serves as the first step towards understanding the feasibility of implementing a mind-body intervention as a prehabilitative intervention to improve postoperative surgical outcomes after cardiac surgery. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03198039 . Registered on 23 June 2017.

Perioperative Anxiety and Stress in Children Undergoing Congenital Cardiac Surgery and Their Parents: Effect of Brief Intervention-A Randomized Control Trial.

OBJECTIVE: To know the effects of psychological preparation on perioperative stress, anxiety, and mood in children undergoing cardiac surgery and their parents. DESIGN: Prospective randomized control nonblinded trial. SETTING: Single-center tertiary teaching hospital. PARTICIPANTS: A total of 60 children aged 5 to 15 years undergoing cardiac surgery were included in the study. One of the parents, preferably the father, was selected from the respective children. INTERVENTIONS: Subjects were randomized into 2 groups: noninterventional (group 1) and interventional (group 2). Intervention was in the form of toys and video games in children, and counseling and information in parents. Preoperative and postoperative anxiety in parents was measured using the State-Trait Anxiety Inventory (STAI), stress using the Index of Clinical Stress (ICS) scale by Abell, and the Ottawa mood scale. In children, the STAI-C (child version of STAI), Ottawa mood and Ottawa stress scales, and Wong-Baker faces pain scale were applied and serum cortisol was measured. MEASUREMENTS AND MAIN RESULTS: Group 2 children had significantly less (p < 0.001) stress, anxiety, and pain and improved mood. Group 2 parents had a significant reduction in state anxiety (42 ± 4.4 v 54.5 ± 7.8; p < 0.001) and ICS score (68.1±9.6 v 84.2 ± 9.2; p < 0.001) and an improvement in mood (7.5 ± 0.7 v 5.9 ± 1; p < 0.001) compared with group 1. Postoperatively, cortisol levels in group 2 were lower than group 1 (571.3 nmol/L [123.3 -1247.14] v 718.9 nmol/L [53-1642.0]). CONCLUSION: Providing video games and toys preoperatively reduced postoperative stress and anxiety and improved mood in children undergoing congenital cardiac surgery. Parents were relieved of anxiety and stress with proper counseling and information.

Effectiveness of Nurse's Intentional Presence as a Holistic Modality on Depression, Anxiety, and Stress of Cardiac Surgery Patients.

One of the important aspects of recovering after bypass surgery is mental disorders of patients. Despite the importance of intentional presence in interpersonal interactive space in holistic nursing, a few experimental and clinical trial studies are conducted on this subject. This study determines the effect of intentional presence of a holistic nurse on anxiety, stress, and depression in patients undergoing coronary artery bypass graft surgery. The study used a randomized clinical trial conducted on 80 patients referred to heart surgery department from March 2016 to June 2017, who were allocated to the control and intervention groups randomly. DASS 21 (Depression, Anxiety, Stress scale) questionnaire and a checklist to determine stressor resources were used to measure the variables. Four 30- to 45-minute sessions of nursing intentional presence were conducted for each patient individually in the intervention group. The results showed homogeneity between 2 groups in demographic variables (P > .05). But there was heterogeneity between 2 groups (P < .05) for some stressors. By using analysis of covariance and excluding the effect of stressors and the first scores before the intervention, statistics represented a significant decrease in stress, anxiety, and depression scores in the intervention group compared with the control group (P < .0001). The results of this study indicated that the intentional presence of a nurse as an effective nursing procedure can reduce the depression, stress, and anxiety of the patients undergoing coronary artery bypass surgery.

Spiritual well-being and hope in the preoperative period of cardiac surgery / El bienestar espiritual y la esperanza en el período preoperatorio de cirugía cardíaca / Bem-estar espiritual e esperança no período pré-operatório de cirurgia cardíaca

ABSTRACT Objective: To characterize relations between spiritual well-being and hope of patients in the preoperative period of cardiac surgery. Method: Exploratory cross-sectional study with quantitative approach, performed in the infirmaries of a reference hospital in cardiology. We evaluated 69 patients hospitalized in preoperative period of myocardial revascularization, valve repair or replacement. Results: We verified that patients hold relevant scores of hope and welfare in all areas, being the existential well-being significantly lower than the religious one. The average of the spiritual well-being score was below the required to be considered high. There was no significant correlation between welfare and hope. Conclusion: Nurses should develop a watchful eye to these issues, be trained in specific protocols of spiritual anamnese and use the real moments of care to strengthen the patients.

RESUMEN Objetivo: Caracterizar las relaciones entre el bienestar espiritual y la esperanza de los pacientes en el preoperatorio de cirugía cardíaca. Método: Estudio transversal, exploratorio, con abordaje cuantitativo, realizado en las enfermerías de un hospital de referencia en cardiología. Fueron evaluados a 69 pacientes internados en el período preoperatorio de cirugía de revascularización miocárdica, cambio o plastia de válvula. Resultados: Se certificó que los pacientes mantenían relevantes puntajes de esperanza y bienestar en todos los dominios, siendo que el bienestar existencial fue significativamente más pequeño que el bienestar religioso. El promedio del puntaje de bienestar espiritual quedó abajo del corte para ser considerado elevado. No hubo correlación significativa entre el bienestar y la esperanza. Conclusión: Los enfermeros deben desarrollar una atenta mirada para esas cuestiones, ser entrenados en protocolos específicos de anamnesis espiritual y aprovechar los momentos reales de cuidado para fortalecer a los pacientes.

RESUMO Objetivo: Caracterizar as relações entre o bem-estar espiritual e a esperança dos pacientes em pré-operatório de cirurgia cardíaca. Método: Estudo transversal, exploratório, com abordagem quantitativa, realizado nas enfermarias de um hospital de referência em cardiologia. Foram avaliados 69 pacientes internados no período pré-operatório de cirurgia de revascularização miocárdica, troca ou plastia valvar. Resultados: Verificou-se que os pacientes mantinham relevantes escores de esperança e bem-estar em todos os domínios, sendo que o bem-estar existencial foi significativamente menor que o bem-estar religioso. A média do escore de bem-estar espiritual ficou abaixo do corte para ser considerada elevada. Não houve correlação significativa entre bem-estar e esperança. Conclusão: Os enfermeiros devem desenvolver um olhar atento para essas questões, ser treinados em protocolos específicos de anamnese espiritual e aproveitar os momentos reais de cuidado para fortalecer os pacientes.

Spiritual well-being and hope in the preoperative period of cardiac surgery.

OBJECTIVE: To characterize relations between spiritual well-being and hope of patients in the preoperative period of cardiac surgery. METHOD: Exploratory cross-sectional study with quantitative approach, performed in the infirmaries of a reference hospital in cardiology. We evaluated 69 patients hospitalized in preoperative period of myocardial revascularization, valve repair or replacement. RESULTS: We verified that patients hold relevant scores of hope and welfare in all areas, being the existential well-being significantly lower than the religious one. The average of the spiritual well-being score was below the required to be considered high. There was no significant correlation between welfare and hope. CONCLUSION: Nurses should develop a watchful eye to these issues, be trained in specific protocols of spiritual anamnese and use the real moments of care to strengthen the patients.

Effects of pleasant olfactory mental imagery on the arterial oxygenation in patients with open heart surgery: A randomized controlled trial.

BACKGROUND AND PURPOSE: Arterial hypoxemia is one of the most common respiratory complications following cardiac surgery. This study was intended to examine the effects of pleasant olfactory mental imagery on postoperative hypoxemia in patients undergoing open heart surgery. MATERIALS AND METHODS: This is a randomized controlled clinical trial. The sample consisted of 80 patients who were randomly assigned to either practice olfactory mental imagery (experimental group) or receive routine care (control group). A card with the image of roses was given to patients and they were asked to look at the image, visualize the scent of roses in the mind, and then sniff as much as possible, hold their breath for 2 s and eventually exhale slowly through the nose. This procedure was consecutively repeated five times. After a fifteen-minute break, patients proceeded to practice olfactory mental imagery with other fruit images. The experimental group executed the olfactory mental imagery for two hours in the morning and two hours in the afternoon on postoperative days 1 and 2. RESULTS: No statistically significant differences were observed between the experimental and control groups regarding sociodemographic characteristics, medical and surgical information. This study also demonstrated that the mean Spao2 was significantly higher in the experimental group (97.400 ± 1.70) than the control group (96.465 ± 1.70) (p = 0.015). CONCLUSION: The results of this study suggest that olfactory mental imagery can improve arterial oxygenation in patients with cardiac surgery.

Not All Sounds Have Negative Effects on Children Undergoing Cardiac Surgery.

OBJECTIVE: This study was designed to evaluate the role of music therapy on the level of stress in children undergoing repair of congenital heart disease. DESIGN: Prospective, randomized, double-blind, controlled clinical trial. SETTING: Children's university hospital. PARTICIPANTS: Fifty children aged 4 to 12 years undergoing repair of congenital heart disease. INTERVENTIONS: Patients were randomized into 2 equal groups (control group and music group); in the control group, patients listened to a blank CD, and in the music group, patients listened to a recorded CD of music and songs preferred by the child. Demographic data, clinical data, and preoperative vital signs were recorded. Baseline stress markers (blood glucose and cortisol levels) were sampled. Patients were assessed intraoperatively until extubation for vital signs and stress markers and after extubation for pain and sedation scales. An interview was conducted within the first postoperative week with the patients and their parents for assessment of post-traumatic stress disorder and negative postoperative behavior changes. MEASUREMENTS AND MAIN RESULTS: There were no significant differences in demographic characteristics, clinical data, vital signs, preoperative and at-extubation blood glucose levels, and preoperative blood cortisol levels between groups. Significant differences were found between groups in blood glucose levels and cortisol levels at all intraoperative times, but only in cortisol blood levels at extubation. Significant differences were found in pain score, sedation score, occurrence of child post-traumatic stress disorder, and occurrence of negative postoperative behavior. CONCLUSION: Listening to favorable music by children undergoing repair for congenital heart disease resulted in less stress and more relaxation.

Need for psychosocial assistance in patients undergoing cardiothoracic surgery evaluated by a seven-item questionnaire.

BACKGROUND: Cardiothoracic surgery can have adverse effects on the patients' psychosocial well-being which may influence the overall prognosis. In this study, we tested the use of a seven-item screening instrument for the preoperative identification of need for psychosocial assistance in cardiothoracic patients. Methods and RESULTS: A total of 297 consecutive patients (69% male) with a median age of 70 years (59;75) completed the seven-item Hornheide Screening Instrument (HSI) on the day of admission. According to questionnaire scores predefined in the literature (cutoff ≥ 4), 130 patients (44%) exhibited a need for psychosocial support. We found female patients to have significantly higher need for psychosocial support than male patients, irrespective of their age, New York Heart Association classification or Canadian Cardiovascular Society classification, and the type of surgery they were undergoing (53 vs. 41%, p=0.034). In addition, we found that preoperative need for psychosocial support, using the predefined cutoff criterion as well as a higher absolute score, was associated with a prolonged length of hospitalization (p<0.05). CONCLUSION: We found the HSI to be a suitable tool to identify psychosocial need in cardiothoracic patients. The relatively high incidence of these patients in our study concurs with previous studies, which generally used more complex instruments. In addition, we found that preoperative scores were associated with prolonged length of stay. Therefore, the use of this questionnaire could represent an alternative, more rapid tool for the psychosocial assessment of cardiothoracic patients in daily routine.

A focus group study investigating medical decision making in octogenarians of high socioeconomic status with successful outcomes following cardiac surgery.

AIM: To explore medical decision making in octogenarians having cardiac surgery. METHODS: Five focus groups conducted in a private hospital setting with octogenarians of high socioeconomic status who had successful cardiac surgery in the previous 3-13 months. RESULTS: Octogenarian's motivations for having cardiac surgery include survival, relief of symptoms, convenience and improving quality of life. The decision to have surgery involved clinical advice by doctors that the time had come to take up a surgical option. Patient's decisions did not take into account alternative treatment options either because these had not been presented by doctors or because medical management had failed. The final decision was made by patients. CONCLUSIONS: Decisions to have cardiac surgery in octogenarians are made by patients after discussions with family based on their risks as communicated by their doctors. This underlines the importance of effective risk communication by doctors to help patients make appropriate medical decisions.

Religion and the use of complementary and alternative medicine (CAM) among cardiac patients.

This study investigates the prevalence and predictors of using complementary and alternative medicine (CAM) among middle-aged and older patients prior to cardiac surgery. Additionally, it addresses the correlates of using 10 commonly used CAM therapies. The influence of religion on itemized CAM usage is also explored. Comprehensive data were collected from adult patients undergoing cardiac surgery through a preoperative survey 2 weeks prior to surgery, followed by a telephone interview the day before surgery. More than two-thirds of participants (80.9 %) indicated at least one CAM use. Income, religiosity, education, BMI, employment, and congestive heart failure predicted greater CAM utility. After multiple controls, major cardiac indicators were significantly positively associated with greater utility of CAM. There was also a significant positive association between religiosity and CAM use. Findings suggest considerable CAM use in this cardiac sample and certain associations among cardiac conditions, religiosity, and itemized CAM utilization. Future research is needed to investigate the potential joint therapeutic and adverse effects of drug and herbal remedies in cardiac patients.

Existential relatedness in light of eudemonic well-being and religious coping among middle-aged and older cardiac patients.

This study examined the prediction of preoperative faith factors for perceived spiritual support, indicating existential relationship as a dimension of eudemonic well-being (EWB), at 30 months after cardiac surgery (N=226). The study capitalized on data from preoperative surveys and the Society of Thoracic Surgeons' National Database. Controlling for demographics, cardiac indices, and mental health, hierarchical regression showed that preoperative prayer coping, subjective religiousness, and internal control were positive predictors of spiritual support. Negative religious coping was a negative predictor. Internal control mediated the role of positive religious coping. Certain faith-based experiences may enhance aspects of EWB, but future research should investigate mechanisms.

Posttraumatic growth in patients who survived cardiac surgery: the predictive and mediating roles of faith-based factors.

Despite the growing knowledge of posttraumatic growth, only a few studies have examined personal growth in the context of cardiac health. Similarly, longitudinal research is lacking on the implications of religion/spirituality for patients with advanced cardiac diseases. This paper aims to explore the effect of preoperative religious coping on long-term postoperative personal growth and potential mediation in this effect. Analyses capitalized on a preoperative survey and medical indices from the Society of Thoracic Surgeons' National Database of patients undergoing cardiac surgery. Participants in the current follow-up study completed a mailed survey 30 months after surgery. Hierarchical regression analysis was performed to evaluate the extent to which preoperative use of religious coping predicted growth at follow-up, after controlling for key demographics, medical indices, mental health, and protective factors. Predictors of posttraumatic growth at follow-up were positive religious coping and a living status without a partner. Medical indices, optimistic expectations, social support, and other religious factors were unrelated to posttraumatic growth. Including religious factors diminished effects of gender, age, and race. Including perceived spiritual support completely eliminated the role of positive religious coping, indicating mediation. Preoperative positive religious coping may have a long-term effect on postoperative personal growth, explainable by higher spiritual connections as a part of significance-making. These results suggest that spirituality may play a favorable role in cardiac patients' posttraumatic growth after surviving a life-altering operation. The elimination of demographic effects may help explain previously mixed findings concerning the association between these factors and personal growth.

Exploring the role of music therapy in cardiac rehabilitation after cardiothoracic surgery: a qualitative study using the Bonny method of guided imagery and music.

BACKGROUND: Cardiac rehabilitation integrates physical, psychological, and vocational strategies to restore and sustain optimal health. OBJECTIVE: An innovative study using music therapy (Bonny Method of Guided Imagery and Music [BMGIM]) explored the experiences of cardiac rehabilitation participants in an outpatient setting at 2 major metropolitan teaching hospitals. METHODS: Commencing 6 to 15 weeks after cardiothoracic surgery, 6 study participants were recruited for 6 weekly music therapy (BMGIM) sessions. Qualitative analysis of the patient narrative within a semiotic framework demonstrated that patients used music therapy to spontaneously explore their recovery process. RESULTS: Five grand themes emerged: (1) looking through the frame, (2) feeling the impact, (3) spiralling into the unexpected, (4) sublime plateau, and (5) rehearsing new steps. The themes related to physical changes, adjustment after surgery, and anticipated lifestyle. CONCLUSIONS: This study demonstrates that music therapy (BMGIM) may be used to access and understand the internal recovery process of postcardiothoracic surgical patients, providing an additional clinical tool to augment the external rehabilitation process.

Massage therapy for cardiac surgery patients--a randomized trial.

OBJECTIVES: To determine whether massage significantly reduces anxiety, pain, and muscular tension and enhances relaxation compared with an equivalent period of rest time after cardiac surgery. The feasibility of delivering the treatment, effects on heart rate, blood pressure, and respiratory rate, and patient satisfaction were also assessed. METHODS: Elective cardiac surgery patients were randomized to receive massage or rest time at 2 points after surgery. Visual analog scales were used to measure pain, anxiety, relaxation, muscular tension, and satisfaction. Heart rate, respiratory rate, and blood pressure were measured before and after treatment. Focus groups and feedback were used to collect qualitative data about clinical significance and feasibility. RESULTS: A total of 152 patients (99% response rate) participated. Massage therapy produced a significantly greater reduction in pain (P = .001), anxiety (P < .0001), and muscular tension (P = .002) and increases in relaxation (P < .0001) and satisfaction (P = .016) compared to the rest time. No significant differences were seen for heart rate, respiratory rate, and blood pressure. Pain was significantly reduced after massage on day 3 or 4 (P < .0001) and day 5 or 6 (P = .003). The control group experienced no significant change at either time. Anxiety (P < .0001) and muscular tension (P < .0001) were also significantly reduced in the massage group at both points. Relaxation was significantly improved on day 3 or 4 for both groups (massage, P < .0001; rest time, P = .006), but only massage was effective on day 5 or 6 (P < .0001). Nurses and physiotherapists observed patient improvements and helped facilitate delivery of the treatment by the massage therapists on the ward. CONCLUSIONS: Massage therapy significantly reduced the pain, anxiety, and muscular tension and improves relaxation and satisfaction after cardiac surgery.

Secular reverence predicts shorter hospital length of stay among middle-aged and older patients following open-heart surgery.

This study explored the role of both traditional religiousness and of experiencing reverence in religious and secular (e.g., naturalistic, moralistic) contexts in postoperative hospital length of stay among middle-aged and older patients undergoing open-heart surgery. Reverence was broadly defined as "feeling or attitude of deep respect, love, and awe, as for something sacred." Information on demographics, faith factors, mental health, and medical comorbidities was collected from 400 + patients (age 62 ± 12) around 2 weeks before surgery via personal interview. Standardized medical indices were retrieved from the Society of Thoracic Surgeons' national database. Hierarchical multiple regression showed that reverence in secular contexts predicted shorter hospitalization, after controlling for key demographics, medical indices, depression, and psychosocial protectors. Other hospital length of stay predictors included female gender, older age, more medical comorbidities, low left ventricular ejection fraction, long perfusion time, and coronary bypass graft surgery. Secular reverence exerts a protective impact on physical health.