Therapeutic back massage: A nonpharmacological approach to enhance sleep quality in orthopedic patients

Abstract

BACKGROUND:

Sleep disturbances significantly impair recovery in hospitalized orthopedic patients, primarily due to the discomfort associated with musculoskeletal injuries and surgeries. Poor sleep can exacerbate pain, delay healing, and prolong hospital stays. Nondrug interventions like therapeutic back massage have shown promise in enhancing sleep by reducing stress hormones and increasing relaxation neurotransmitters. However, their application, specifically in orthopedic care, remains underexplored. This study aims to fill this gap by evaluating the effectiveness of back massages on sleep quality in this patient group.

MATERIALS AND METHODS:

A quasiexperimental design was employed at a South Indian teaching hospital to study back massages’ impact on sleep quality among orthopedic patients. The study involved 80 participants aged over 21 years, divided into experimental and control groups. The experimental group received back massages twice daily for 7 consecutive days, while the control group continued with routine care. Pretest and post-test assessments were conducted using the Groningen sleep quality scale. Data analysis was performed using SPSS, applying descriptive and inferential statistics.

RESULTS:

Initially, 100% of patients in both groups reported poor sleep quality. Postintervention, the experimental group showed substantial improvements, with 70% reporting good sleep and 30% reporting fair sleep, with no instances of poor sleep remaining. In contrast, the control group displayed minor natural fluctuations: 5% reported good sleep, 25% fair sleep, and 70% continued to experience poor sleep. Statistical analysis revealed a significant improvement in sleep scores (paired “t” value of 10.04; P < 0.001) postmassage.

CONCLUSION:

The study confirms the effectiveness of therapeutic back massages in significantly improving sleep quality among orthopedic patients, underscoring the importance of nonpharmacological interventions in hospital settings.

Introduction

Sleeplessness is a prevalent problem among patients receiving medical treatment in hospitals, greatly impeding their recovery process.[1] This is particularly applicable to orthopedic patients who may encounter elevated levels of discomfort due to surgical procedures or musculoskeletal ailments, causing disturbances in their sleep patterns.[2] Studies indicate that inadequate sleep can impede the process of wound healing, intensify the impression of pain, and prolong the duration of hospitalization.[3] Poor sleep quality increases the likelihood of problems such as infections and delirium.[4]

Sleep disturbances in hospitals are frequently caused by variables such as noise, light, and frequent interruptions by medical personnel. These factors can hinder profound, rejuvenating sleep, essential for healing.[5] Therapeutic back massage is a possible nonpharmacological method to enhance sleep. This technique can alleviate muscle tension and decrease stress, improving sleep quality.[6] Research studies have demonstrated that back massages can reduce stress hormones such as cortisol while simultaneously increasing the levels of serotonin and dopamine, which contribute to improved sleep.[7] Similarly, a review corroborates the notion that massage therapy might enhance the quality and duration of sleep among hospitalized patients.[8]

Although the advantages of therapeutic back massage have been demonstrated, its application in orthopedic wards is still restricted.[9] This study, however, focuses on orthopedic patients, examining the specific effects of back massage for this group, considering their special pain and recovery requirements. In addition, although some data support the advantages of massage therapy on sleep, rigorous studies are scarce, such as randomized controlled trials specifically targeting orthopedic patients. Gaining insight into patient perspectives regarding nonpharmaceutical interventions, such as massage therapy, is paramount. In addition, limited data are available regarding the cost-effectiveness of integrating therapeutic back massage into regular healthcare practices, which will be investigated in this study. With the aging population and the rising prevalence of orthopedic treatments, it is crucial to enhance postoperative care using efficient, patient-centric, and cost-effective approaches. Improving sleep in this specific set of patients could result in quicker recoveries, more patient satisfaction, and lower healthcare expenses. The study’s findings have the potential to alter significantly orthopedic care and patient rehabilitation by providing insights that could shape future clinical practices and healthcare legislation.

Materials and Methods

Study design and setting

This study aims to present comprehensive information about the effectiveness of back massages in enhancing sleep quality among orthopedic patients and to establish any potential associations with sociodemographic characteristics.

This study used a quantitative, quasiexperimental design to evaluate the influence of therapeutic back massage on the quality of sleep among orthopedic patients admitted to a teaching hospital in South India. The study used a non-randomized pretest–posttest control group approach over 8 weeks.

Study participants and sampling

The sample size was calculated as 80 based on a previous study[10] using the common standard deviation of 1.45, a confidence interval of 95%, a test power of 80%, and a 10% of sample loss.

Data collection tools and technique

The study comprised patients at least 21 years old and admitted to orthopedic wards who had an insufficient sleep, could communicate in either Tamil or English, and was not in critical condition. The study excluded individuals who had injuries to their ribs, spine, or scapula; those who had burns or back surgeries; individuals who were taking sleep drugs; and individuals who were not willing to participate. The preinterventional evaluation was conducted using the Groningen sleep quality scale. The participants were categorized into the experimental and control groups of 40 orthopedic patients. The experimental group was given two 10-minute back massages daily twice for seven consecutive days, while the control group adhered to their regular care routine. A post-test was conducted 7 days later.

Ethical consideration

The study obtained approval from the Institutional Ethics Committee, SRMIST, and informed consent was obtained from all participants.

Statistical analysis

The obtained data were encoded in an MS Excel file and analyzed using IBM SPSS. The statistical methods employed in this study encompass descriptive statistics, such as frequency distributions, percentages, and mean values, as well as inferential statistics, including the Chi-square test and the extended McNemar’s test (P < 0.05).

Results

The study aims to assess the effectiveness of therapeutic back massage on sleep quality among orthopedic patients

Sociodemographic characteristics

The average age of the participants was 46.73 years with a standard deviation of 10.64 years. The age group with the highest representation, representing 55% in both categories, is “Above 50.” In terms of gender, the control group showed a greater proportion of men (80%) than the experimental group (50%). Regarding education, both categories had a predominant proportion of individuals with primary education, with each group comprising 50%. Regarding occupation, the “Others” category represented the largest portion in both categories, accounting for 50% in each. The majority of participants in both the experimental group (85%) and the control group (80%) were married. Concerning consistent sleeping patterns, 45% of individuals in both groups indicated that they slept for fewer than 5 hours.

Sleep quality

Initially, all participants (100%) reported experiencing inadequate sleep in the experimental group. Following the intervention, there was a significant improvement: 70% of participants reported experiencing good sleep, while 30% reported fair sleep. No occurrences of poor sleep were noted. This notable change emphasizes the effectiveness of the intervention in eradicating inadequate sleep and significantly improving the quality of sleep [Table 1]. Conversely, the sleep quality in a control group was assessed within the same time frame without any intervention. All 80 participants (100%) indicated experiencing inadequate sleep. The post-test results revealed slight enhancements: 5% reported good sleep, 25% reported fair sleep, and 70% still experienced poor sleep [Table 2]. This minimal inherent deviation implies that although there were some enhancements, they were significantly less significant compared with the improvements observed in the experimental group, thus highlighting the efficacy of the intervention.

Table 1.

Pretest and post-test level of sleep quality among orthopedic patients in the experimental group

Quality of sleep		Experimental group
		Pretest				Post-test
		n		%		n		%
Good sleep		0		0		28		70
Fair sleep		0		0		12		30
Poor sleep		40		100		0		0

Table 2.

Pretest and post-test quality of sleep among orthopedic patients in control group

Quality of sleep		Control group
		Pretest				Post-test
		n		%		n		%
Good sleep		0		0		2		5
Fair sleep		0		0		10		25
Poor sleep		40		100		28		70

The study uses pretest and post-test evaluations to assess the efficacy of therapeutic back massages in improving sleep quality in the experimental group. The experimental group initially had a mean sleep quality score of 11.75, with a standard deviation (SD) of 1.02. Following the implementation of therapeutic back massages, the post-test scores showed a considerable improvement, with a mean value of 4.55 and a standard deviation of 2.66. The paired “t” test statistic of 10.04 and a P value of less than 0.001 (P < 0.001) suggest a significant enhancement in sleep quality as a result of the intervention [Table 3].

Table 3.

Effectiveness of therapeutic back massage on quality of sleep among the experimental group before and after intervention

Domains		Mean		SD		Paired “t”		P
Experimental group
Pretest		11.75		1.02		10.04		0.001 (S)
Post-test		4.55		2.66

S=Significant

Association of post-test level of sleep quality and sociodemographic variables

The study examined the association between pretest sleep quality and various demographic variables among orthopedic patients. Notably, gender significantly influenced sleep quality, with men having an average score of 11.23 and women 12.00, suggesting women experienced worse sleep (P = 0.030). No significant associations were found for other variables such as age, education, occupation, marital status, and regular sleeping hours.

Discussion

The results of this study align with existing literature on the impact of nonpharmacological interventions to improve sleep quality in hospitalized patients, particularly those with orthopedic conditions. The notable improvement from 100% inadequate sleep to 70% good sleep and 30% fair sleep in the experimental group after receiving therapeutic back massages underscores the effectiveness of this intervention in enhancing sleep quality. This is consistent with findings by Ogłodek E.[11] A reported significant reductions in stress hormones and increases in neurotransmitters associated with relaxation and sleep following massage therapy. Similarly, a review by Fang CS et al.[12] supports the utility of massage therapy in hospital settings, noting improvements in sleep quality and duration among various patient populations, including those with orthopedic ailments.

Our study’s findings indicate a statistically significant improvement in sleep quality among orthopedic patients receiving therapeutic back massages, with a notable decrease in mean sleep quality score from 11.75 to 4.55, evidenced by a paired “t” test statistic of 10.04 and a P value less than 0.001. This supports research by Tang R et al.,[13] highlighting the efficacy of nondrug interventions like massage in mitigating hospital environmental disturbances that disrupt sleep. In addition, Grzelak et al.[14] demonstrated similar benefits, specifically in orthopedic patients, emphasizing the role of effective pain management through massage in enhancing sleep and overall recovery.

This study’s findings on the differential impact of gender on sleep quality, where women reported worse sleep than men, align with research by Alosta et al.,[15] which found that hormonal and psychological differences might influence sleep disturbances differently across genders. In addition, studies by Mousavi et al.[16] support the notion that sociodemographic factors like gender can significantly affect the efficacy of clinical interventions, including those aimed at improving sleep. These findings highlight the need for gender-specific approaches in managing sleep disturbances in orthopedic patients, emphasizing tailored therapeutic strategies to address these variances effectively.

Conclusion

The study conclusively demonstrates the significant impact of therapeutic back massages in improving sleep quality among orthopedic patients, highlighting the crucial role of nursing interventions in patient care. As primary caregivers, nurses have a pivotal role in implementing these nonpharmacological treatments effectively. Their close patient interactions allow them to administer massage therapy tailored to individual patient needs, monitor responses, and adjust care plans accordingly. This personalized approach enhances sleep quality and contributes to overall well-being and recovery. The findings reinforce the importance of integrating specialized training for nurses in therapeutic massage techniques, ensuring they are well-equipped to deliver this valuable care component. Emphasizing the nurse’s role in such interventions can lead to broader adoption and standardization of effective, patient-centered practices in orthopedic and broader medical care settings, ultimately improving health outcomes and patient satisfaction.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.