The Effect of Therapeutic Touch on Perceived Sleep Level and Anxiety in Hospitalised Individuals Aged 65-85 Years
Phase: NA
Conditions: Therapeutic Adherence, Nurse-Patient Relations, Sleep Disorder
Sponsor: KTO Karatay University

 
Hospitalised Individuals Aged 65-85 Years Perceived Sleep Level and Anxiety of 
Therapeutic Touch the Effect on the Body Mas Index: A Randomised Controlled Trial 
 
NCT05363787 
 
 
Assoc. Prof. BB 
MSc. Nurse BA 
 
 
 
 
 
Date of document 
2021-12-20 
 
 
 
 
 
 
 
 
 

ABSTRACT 
This study was conducted to examine the effect of therapeutic touch on perceived sleep level 
and anxiety in individuals aged 65-85 years. The research design was a randomised 
experimental study with a pre-test post-test control group. The research was conducted in 
Ankara City Hospital Orthopaedics and Traumatology Service between October 2022 and 
December 2022. The population of the study consisted of 368 patients aged 65-85 years who 
applied to the clinic within one year. The sample size of the study was calculated by G-power 
analysis. The sample consisted of 68 patients, 34 in the experimental group and 34 in the control 
group. Patients in the experimental group received therapeutic touch for two sessions for one 
week, for an average of 20 minutes between 22:00-24:00 hours. No intervention was performed 
in the control group. Socio-demographic characteristics form, visual analogue scale and sleep 
pattern questionnaire were used for data collection. Chisquare test, dependent sample t test (t*), 
independent sample t test (t), Mann Whitney U test (z) and Wilcoxon test (z*) were used for 
statistical analysis of the data.  
STUDY PROTOCOL AND STATİSTİCAL ANALYSİS 
1. Study Design 
The study found that therapeutic touch in hospitalised individuals aged 65-85 years In order to 
measure the effect on perceived sleep level and anxiety, pre-test and post-test was conducted as 
a randomised controlled trial. 
2. Hypotheses 
H1: Therapeutic touch applied to hospitalised individuals aged 65-85 increases the perceived 
sleep level. 
H2: Therapeutic touch applied to hospitalised individuals aged 65-85 reduces the level of 
anxiety. 
3. Population and sampling 
The population of the study consisted of 368 patients with chronic diseases between the ages 
of 65-85 who were hospitalised in the Orthopedics and Traumatology Department of Ankara 
City Hospital between September 2022 and December 2022. The sample size of the study was 
calculated using the G-Power programme. A similar study that will be cited as a reference to 
this research since there was no effect size, Cohen's standardised values of 0.80 effect power 

and 0.25 medium effect size were accepted (Tabachnick, G.B., Fidell, (2020). It was determined 
that the minimum required sample size was 56, 28 in the experimental group and 28 in the 
control group. A total of 68 elderly individuals, 34 in the experimental group and 34 in the 
control group, constituted the sample group of this study, taking into account the possibility of 
20% loss from the groups in order to make analyses with parametric assumptions. The 
independent variable of this study was the therapeutic touch applied to the patient, and the 
dependent variables were anxiety and perceived sleep level. The control variables of this study 
were the socio-demographic characteristics of the patients. 
3.1. Inclusion Criteria 
- Between 65 and 85 years of age according to the WHO classification of 1998 
- The patient was hospitalised in the orthopaedics and traumatology service for at least seven 
days 
- The patient is able to communicate. 
3.2. Exclusion Criteria 
- The presence of a hearing impairment, 
- Intubation. 
- In the acute pain period 
4. Randomisation and Blinding 
In the determination of the experimental and control groups in the study, a random number 
sequence was generated by an independent statistical expert after written and verbal consent 
was obtained from the patients who met the inclusion criteria of the study. Patients were divided 
into two groups as (34) experimental group and (34) control group by block randomisation 
method and closed envelope method was used. The researcher made a selection from the sealed 
envelopes and saw the patient names just before the application. The first application to the 
patient was started after this selection was made. Since the research is an individual applied 
research type due to its characteristics, blinding could not be done in terms of participant and 
researcher. In this study, only statistical analysis blinding was performed. After the pre-test and 
post-test data forms were collected by the researcher, the group to which that form belonged 
was written on the questionnaire forms. All data forms were collected in this format and 

delivered to the statistician who was not connected with the research. Data entry and analyses 
were performed by the statistician who was independent from the research. 
 
 
 
 
                                                                                                                           
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 1. Consort Flow Diagram 
5. Data Collection 
APPROACH 
Approached (n=257) 
Excluded (n=289) 
• Did not fulfil the 
inclusion criteria 
(n=189) 
• Refused to 
participate 
(n=100) 
Randomised (n=68) 
Allocated for the 
experimental group 
(n=34) 
• Intervened (n=34) 
• 
Dropped out of the 
study (n=0) 
Allocated for the control 
group (n=34) 
• Intervened(n=0) 
• 
Dropped out of the 
study (n=0) 
ALLOCATION 
• Out of follow-up 
(n=0) 
• He did not 
continue the 
initiative (n=0) 
• Out of follow-
up(n=0) 
• Did not continue the 
intervention (n=0) 
ANALYSIS 
• Analysed (n=34) 
• Excluded from the 
analysis (n=0) 
• 
Analysed (n=34) 
• 
Excluded from the 
analysis (n=0) 
FOLLOW-UP 

Socio-demographic characteristics form developed by the researcher for data collection form, 
visual analogue scale and sleep pattern questionnaire were used. The data were collected twice 
with the 'Socio-Demographic Characteristics Form', 'Visual Analogue Scale' and 'Sleep Pattern 
Questionnaire': pre-test and post-test one week after the pre-test in the control group; pre-test 
before the intervention and post-test after two sessions of Therapeutic Touch application at 
three-day intervals (one week after the first measurement) in the experimental group. 
5.1. Socio-Demographic Characteristics Form 
This form, organised by the researchers (Kürtüncü et al., 2018; Tümkaya et al., 2008), consists 
of a total of nine questions including age, gender, marital status, presence of chronic disease, 
duration of chronic disease, educational and occupational status, stress statement, and self-
report about the source of stress in order to obtain information about the characteristics of the 
patients included in the study. 
5.2. Visual Analogue Scale (VAS) 
The Visual Analogue scale consists of emotion adjectives in which each emotion experienced 
by the person at that moment is marked with a vertical line on a plane. Each emotion is evaluated 
between not experiencing that emotion at all (e.g., I am not anxious = 0) and experiencing it 
completely (e.g., I am extremely anxious = 100) (Aydın et al., 2011). The VAS assesses four 
categories of emotions (Dysphoria, Hostility, Anxiety and Positive Emotions) (Albersnagel, 
1988). Aydın et al. (2011) stated that the visual analogue scale is valid and reliable (Aydın et 
al., 2011) (Appendix-2). In this study, the anxiety subtest of the scale was used. In this test, the 
patients were shown the rating score of the anxiety level between 0-10 and asked at which level 
they evaluated their anxiety. The level determined by the patient was marked and the data were 
determined. 
5.3. Sleep Pattern Questionnaire 
This form (Buysse et al., 1989), which was designed by the researchers, consists of questions 
about the factors affecting the individual's sleep patterns. It consisted of ten questions including 
the time at which the individual sleeps, factors affecting falling asleep, factors assisting sleep, 
sleep duration at night, stress level scoring, factors affecting the individual in the sleep process, 
evaluation of sleep, mood during the day, and the individual's own statements. After this form 
was created, expert opinion was obtained from five academicians. After the expert opinions, 
the Content Validity Index score of the questionnaire was determined as 1. Since the questions 

were understandable and there were no additional suggestions, the data were collected with the 
first format. 
5.4. Collection of Pretest Data of Experimental Group and Control Group 
While collecting the pre-test data of the control group; firstly, after the researcher introduced 
himself to the patient, he gave information about the research, what therapeutic touch means, 
its benefits and studies on therapeutic touch. It was mentioned that the patients in the control 
group would not be applied in this study, only questions would be asked about their sleep 
patterns during the hospital process. After the written consent form was explained to the 
patients, a copy of the forms and the questions to be asked were left for them to read. In this 
process, the questions in their minds were answered and they were given time to think about 
participation. Consents were obtained from the consenting patients and the socio-demographic 
characteristics form, visual analogue scale and sleep pattern questionnaire were completed by 
the researcher. 
While collecting the pre-test data of the experimental group; firstly, the researcher started 
communication by introducing himself to the patient. The research, what therapeutic touch 
means, its benefits and studies on therapeutic touch were mentioned. In this study, two sessions 
of therapeutic touch will be applied to the patients in the experimental group at three-day 
intervals in total; It was mentioned that this application was carried out to measure whether 
therapeutic touch has an effect on the sleep patterns of the patients. Patients were told about the 
stages of therapeutic touch. Since it is an alternative method, the concerns of the patients were 
eliminated, and the patients who wanted to see the therapeutic touch in this process were asked 
by their teammates to show the patient what kind of application was visually. Patients were 
given time to think about participation by leaving their written consent and a copy of the 
prepared questions. After obtaining consent from the patients who gave consent, the socio-
demographic characteristics form, visual analogue scale and sleep pattern questionnaire were 
asked to the patients. The forms were filled in by the researcher according to the patients' 
statements. 
 
 
 
 
 
PATIENTS FULFILLING THE INCLUSION CRITERIA 

EXPERIMENTAL GROUP 
EVALUATION 
Sleep Pattern Survey Questions 
VAS Score 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 2. Research Flow Chart 
 
5.5. Intervention Applied to the Experimental Group 
After written and verbal consents were obtained from the experimental group, the application 
phase was started in the experimental group. Therapeutic Touch was applied to the patients in 
the experimental group for one week by the researcher who was trained in this subject. 3.11.1. 
Pre-Application Preparation The researcher received 12 hours of first stage therapeutic touch 
training from TT Turkey representative Serbülent Biçer for therapeutic touch method. In 
RANDOMISATION 
To give information to patients about the application 
Obtaining Consent from Patients with Informed Voluntary Consent Form 
To apply therapeutic touch to patients twice a week (three days each) between 22.00-
24.00 hours and to follow up the patients 
EXPERIMENTAL GROUP 1ST 
SESSION 
Socio-demographic Characteristics 
Form 
Sleep Pattern Survey Questions 
VAS Score 
TT Application 10-20 minutes 
EXPERIMENTAL GROUP 2ND 
SESSION 
Sleep Pattern Survey Questions 
TT Application 10-20 minutes 
CONTROL GROUP 1ST SESSION 
Socio-demographic Characteristics 
Form 
Sleep Pattern Survey Questions 
VAS Score 
Patients were contacted for 10-20 
minutes 
CONTROL GROUP 2ND SESSION 
Sleep Pattern Survey Questions 
Patients were contacted for 10-20 
minutes 
CONTROL GROUP 
EVALUATION 
Sleep Pattern Survey Questions 
VAS Score 

November 2021 and December 2021, she received the 2nd level of therapeutic touch training 
from Sue Conlin and Serbülent Biçer and became a therapeutic touch practitioner (ANNEX-4). 
Permission was obtained from the author for the Visual Analogue Scale. 3.11.2. Therapeutic 
Touch Application Stages Therapeutic Touch application consists of five stages: "Centering", 
"Due 
Diligence", 
"Rebalancing 
and 
Re-Determining", 
"Finishing 
and 
Resting", 
"Remembering/Reflective Thinking" (Conlin, 2021). 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 3. Therapeutic Touch Application Scheme 
 
a. Centring 
In the application phase, the patient is first told by the practitioner that the patient can touch 
his/her shoulders and ankles. The therapeutic touch practitioner first closes his/her eyes and 
starts the energy flow by rubbing his/her palms together. In this process, he/she grounds 
himself/herself in order to protect himself/herself from the stimuli in the external environment 
THERAPEUTIC TOUCH APPLICATION 
SCHEME 
CENTRING 
SITUATION ASSESSMENT 
REBALANCING AND REASSESSMENT 
FINISH AND EVALUATE / REST 
REMEMBER / REFLECTIVE THINKING 

and not to receive the negative energy of the patient to whom he/she will perform therapeutic 
touch. During the grounding phase, he/she describes himself/herself in the way and place he/she 
feels best. In general, the practitioner can think of himself/herself as a tree and feel rooted, or 
he/she can think of himself/herself as by the sea. This is completely up to the description of the 
practitioner. This is called grounding. He intends to heal. He focuses. If the practitioner thinks 
that he/she cannot do this stage and cannot focus, he/she should not start the therapeutic touch 
application. It takes between 2-5 minutes for the practitioner to centre. 
b. Situation Assessment 
After centring, the practitioner touches the patient's shoulders with permission. He starts to scan 
the energy field from inside to outside, from the centre to the outside with hand movements. 
While scanning the energy field, he actually gets information about the patient. He/she feels 
discomforts in some parts of the body, tingling sensation in his/her palms, pulling sensation, 
coldness, warmth, vibration etc. In the meantime, the practitioner can talk to the patient. 
c. Rebalancing and Reassessment 
After determining the points where the patient's energy flow is troubled, it is cleaned with hand 
movements from the inside to the outside, from the centre to the outside. This cleansing is done 
three times from the patient's back to the ankle, three times from the face to the ankles; arms 
and legs from top to bottom. After the cleansing phase is over, the patient's ankles are touched 
and grounding is done (this phase is up to the practitioner, he/she can do it whenever he/she 
feels the need for grounding for his/her patient). In order for the patient to be rebalanced, energy 
flow is sent to the patient by the practitioner according to the patient's needs. The patient is thus 
rebalanced. After the rebalancing is finished, the patient is scanned again. If there is a blockage 
in the energy flow, the same steps are repeated. 
d. Finishing and Resting  
After the re-assessment of the patient's condition, the therapeutic touch is finished. The 
practitioner does not leave the patient's energy field at once, he/she relaxes the field with slow 
and calm hand movements and then leaves. In total, the application takes 10-20 minutes. 20 
minutes and more is not recommended as it will tire the patient and the practitioner. After the 
application, the soles of the hands and feet can be washed (for both the practitioner and the 
patient). Patient and practitioner rest. 
e. Remembering/ Reflective Thinking  

After the session is completed, the practitioner notes the answers to questions about the patient 
such as 'Which clues did we perceive?' 'How did we feel about these clues?' 'How did we 
respond?' 'How do we feel about our responses?' 'Was there a change in the field or in our 
consciousness during the practice? The practitioner spares time for himself/herself. The patient 
should wait 72 hours to get the answers to these questions. 
6. Statistical Analysis 
Data were analysed using the statistical package IBM SPSS Statistics Standard Concurrent User 
V 26 (IBM Corp., Armonk, New York, USA). Descriptive statistics were given as number of 
units (n), percentage (%), mean ± standard deviation (mean±SS), median (M), minimum (min), 
maximum (max) and interquartile range (IQR) values. The normal distribution of the numerical 
variables was evaluated by Shapiro Wilk normality test. Independent sample t test (t) was used 
for variables showing normal distribution in the study groups and Mann Whitney U test (z) was 
used for variables not showing normal distribution. The analysis of the data of the numerical 
variables at the measurement times was evaluated with the dependent sample t test (t*) for 
normally distributed variables and Wilcoxon test (z*) for non-normally distributed variables. 
Chi-square tests (Pearson chi-square/Fisher exact test) were used to compare categorical 
descriptive characteristics between groups. p<0.05 was considered statistically significant. 
7. Ethical Statement of the Study 
Ethical approval for the conduct of the study was obtained from the Ethics Committee of KTO 
Karatay University (Decision No: 2021/017; Date: 20.12.2021). Institutional permission was 
obtained from Ankara City Hospital, where the study was conducted. Verbal consent and written 
informed consent were obtained from all patients in both the experimental and control groups. 
The informed consent form included information about the purpose of the study, its duration, 
potential side effects, expected benefits of participation, and the contact details of the 
researchers for communication during the study period. The researcher received therapeutic 
touch training from Serbülent Biçer, the representative of Therapeutic Touch Turkey, in order 
to perform the therapeutic touch intervention. All stages of the study were conducted in 
accordance with the principles of the Declaration of Helsinki.