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Comparison of Single and Combined Effects of Nature Sounds and Foot Sole Reflexology Massage on the Level of Consciousness in Traumatic Comatose Patients

A Randomized Controlled Clinical Trial

Bahonar, Elahe, MScN; Najafi Ghezeljeh, Tahereh, PhD; Haghani, Hamid, PhD

doi: 10.1097/HNP.0000000000000326
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Consciousness disturbances are the most common posttraumatic complications. The purpose of this study was to compare the single and combined effects of nature sounds and foot sole reflexology massage on level of consciousness in traumatic comatose patients. This randomized controlled clinical trial was conducted in 2 teaching hospitals in an urban area of Iran. Samples were 120 traumatic comatose patients who were randomly assigned into control, nature sounds, foot reflexology massage, and nature sounds plus foot sole reflexology massage groups. Patients in all groups received routine care. Interventions were performed twice a day for 2 weeks, each time for 30 minutes. The patients' level of consciousness was assessed using the Glasgow Coma Scale before, 1 week, and 2 weeks after the intervention. The groups had no significant differences in the mean scores of the consciousness level before, 1 week after, and the last day of the intervention. Also, there was a significant difference in the number of patients who regained full consciousness (P = .001) in the intervention groups compared with the control group. Significant differences in the number of days of consciousness were reported in at least one of the groups compared with other groups (P = .001). This difference was significant in the control group compared with the foot reflexology massage group (P = .032), as well as the nature sounds plus foot sole reflexology massage group (P = .001). Single or combined interventions can increase the level of consciousness in comatose patients and reduce the duration of coma.

Department of Critical Care Nursing (Ms Bahonar and Dr Najafi Ghezeljeh) and Statistic and Mathematics Department (Dr Haghani), Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran; and School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (Dr Najafi Ghezeljeh).

Correspondence: Tahereh Najafi Ghezeljeh, PhD, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St, Valiasr St, Tehran, Iran (najafi.t@iums.ac.ir).

Funding support was provided by School of Nursing and Midwifery, Iran University of Medical Sciences.

This article was based on the master's degree thesis in critical care nursing. The authors sincerely appreciate the financial support provided by Iran University of Medical Sciences. Also, our gratitude should be extended to the health care staff in the ICU wards and patients for their collaboration in this research project.

Data analysis was performed by Hamid Haghani; data collection and interpretation by Tahereh Najafi Ghezeljeh and Elahe Bahonar; critical revision of the manuscript by Tahereh Najafi Ghezeljeh; and drafting of the manuscript by Tahereh Najafi Ghezeljeh and Elahe Bahonar.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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