Clinical (Sleep, Pain and Atrial Fibrillation) and Hospital Stay Effects of Reiki and Manual Therapy After Open Heart Surgery
Phase: NA
Conditions: Coronary Artery Diseases, Valvular Heart Diseases
Sponsor: The Cleveland Clinic

Rev_V3_08-24-17 
 
 
Clinical (Sleep, Pain and Atrial Fibrillation) and Hospital Stay Effects of Reiki and 
Manual Therapy after Open Heart Surgery 
 
Sandra Zampino RN, Reiki Master 
Terry Murray RN, MSN, NE-BC 
Rosslyn Vandenbossche, RN, MBA, NE-BC 
Rose Hosler RN, BSN, HNB-BC, Reiki Master 
Barbie Picciano RN, HN-BC 
Karen Brown RN 
Bonnie Deran RN, BSN 
Angie Hamm RN, BSN, HNB-BC 
Mary Van Gunten RN, HN-BC 
Nancy M. Albert PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FAAN (mentor) 
 

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Abstract 
Objectives: Reiki is an energy-based healing therapy using light touch. Manual therapy 
is a technique using light effleurage.  These complimentary healing services are utilized 
to promote relaxation, sleep, improve emotions, and decrease pain.  After reviewing the 
Reiki research literature, more research is required since sample sizes were small, 
subjects were generally healthy (not hospitalized), and subjects had multiple medical 
backgrounds. Only 1 study focused on cardiac surgery patients. In the current research 
study, we aim to learn if Reiki and manual therapy enhances postoperative clinical 
outcomes for patients after first time coronary artery bypass graft (CABG) and/or 
cardiac valve surgery. Design and Methods: A randomized, controlled non-blinded study 
will be used. The sample size (272 total; 136 per group) was based on a power analysis 
using the primary outcome. The intervention group will receive usual care plus Reiki and 
manual therapy, with Reiki being delivered first. Hand placements include: head, chest, 
shoulders, hands, knees, and feet for 15 minutes. Manual therapy will consist of light 
effleurage to the head and feet for 5 minutes.  Total therapies time is 20 minutes. Reiki 
and manual therapy will be delivered for 3 consecutive days beginning on the day after 
endotracheal tube removal. The usual care group will receive rest, which is part of usual 
postoperative care. There will not be a sham-treatment group, based on previous 
research findings when a sham group was used. Outcome Measures: depression and 
anxiety (Brief Symptom Inventory, 12-item self-administered tool); pain (self-reported 
and recorded in EPIC by staff nurses as part of usual care -- 0 [no pain] - 10 [worst pain]  
scale), highest (worst) and lowest (least) pain in the past 24 hours will be assessed; 
night time sleep (Richards-Campbell Sleep Questionnaire; 5 item self-administered 
tool)—to be measured at baseline and after the last Reiki/manual therapy treatment or 3 
days of usual care. Hospital length of stay and all-cause 30-day hospital readmissions 
will be pulled from the billing database, narcotic drug burden (mean dose) use on 
postoperative days 3 and 4 will be obtained from electronic medical records, and data 
on patient characteristics, medical history, surgical procedure, new onset atrial 
fibrillation and other post-operative complications will be retrieved from the IRB-
approved Cardiothoracic Surgery database. 
 
Purpose and Research Questions 
The purpose of this randomized, controlled study is to learn if Reiki and manual therapy 
lead to differences in patients’ postoperative clinical outcomes after first time coronary 
artery bypass graft (CABG) and/or cardiac valve surgery.  
 
Research questions:  
Compared to usual postoperative care, does Reiki and manual therapy: 
1.  
Reduce negative emotions (depression and anxiety)? 
2. 
Improve sleep? 
3.        Reduce pain? 
4. 
Decrease hospital length of stay? 
5.        Reduce new onset atrial fibrillation? 
6.        Reduce 30-day hospital readmissions? 
7. 
Reduce total narcotic burden (mean dose)?   

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Review of Literature 
In clinical practice, Reiki was studied by multiple investigators for its therapeutic effects. 
In a 2009 systematic review, 12 trials (that used placebo vs. treatment) were included, 
and in 9 of the 12, Reiki had a significant therapeutic effect (VanerVaart et al, 2009). Of 
the 12 trials, when assessed for quality, 11 of 12 ranked poor in quality (VanerVaart et 
al, 2009), making it difficult to determine the value of Reiki in clinical practice. In a 2008 
systematic review of trails of Reiki that included placebo vs. treatment, researchers 
reported that outcomes varied dramatically between studies (Lee, Pittler and Ernst, 
2008). For example, of the 9 papers, 3 had an outcome of depression, 1 had outcomes 
of pain and anxiety, 1 studied anxiety in pregnant women, 1 studied functional recovery 
after stroke, 1 studied pain in patients with diabetic neuropathy, 1 studied pain and 
anxiety in women undergoing breast biopsy and 1 paper had outcomes of stress and 
hopelessness. Researchers concluded that trials for any one condition were scarce and 
replication studies were not completed. Further, most studies had methodological flaws 
(small sample sizes, inadequate study design) and in one study, researchers failed to 
provide results between groups on depression, their primary outcome (Lee, Pittler and 
Ernst, 2008). In a final integrative review that included papers from 1980 to 2006, Vitale 
(2007) also found that outcomes and patient populations varied widely. Outcomes 
included both acute and chronic pain, stress/relaxation/depression, wound healing, 
biological factors (hematocrit and autonomic nervous system), and anxiety /wellbeing. 
Vitale (2007) found that there was not 1 consistent definition of Reiki and that 6 of 16 
studies failed to meet primary endpoints.   
 
Only 1 paper was published of “healing touch” (definition was consistent with our 
definition of Reiki) in patients post CABG surgery (MacIntyre et al, 2008). Patients 
received usual care; visitors (distraction) therapy or healing touch during postoperative 
recovery and 6 outcomes were studied: postoperative length of stay, incidence of 
postoperative atrial fibrillation, use of anti-emetic medications, narcotic pain use, 
functional status and anxiety. Of outcomes, only anxiety was improved (decreased) 
among healing therapy subjects, compared to the other 2 groups. In sub-analysis, 
length of stay was reduced among outpatients who received healing touch, compared to 
placebo or visitor therapy, but there were no differences among groups for patients who 
were in-hospital on the day of surgery (MacIntyre et al, 2008). Finally, researchers 
assessed autonomic nervous system factors (heart rate, vagal tone, systolic, diastolic 
and mean blood pressures, breathing rate and cardiac sensitivity to baroreflex) among 
healthy volunteers. Of factors, only heart rate was different (lower) between Reiki and 
non-Reiki groups. Further, vagal tone trended to be lower in Reiki patients (and 
corresponded to lower heart rates) (Mackay, Hansen and McFarlane, 2004).  
 
Thus, a review of the literature on Reiki therapy provided evidence that more research 
is needed. Most reports of comparative trials had small samples, used healthy subjects 
or patients with medical conditions that were different than our intended postoperative 
cardiac surgical population, or had methods that may have caused threats to internal 
validity of findings.   
 

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Integrative therapies have gained much support and interest in the literature as methods 
to help alleviate pain and anxiety (Anderson & Cutshall, 2007). However, very few 
studies revealed therapeutic benefits of massage therapy in patients post CABG 
surgery (Anderson & Cutshall 2007), including research conducted previously on this 
patient population at Cleveland Clinic (Albert et al., 2009) that include massage to arms, 
legs and back. Cardiac surgery patients undergo a long procedure, may experience 
back, shoulder, and neck pain, or generalized tension postoperatively (Anderson & 
Cutshall, 2007). In a pilot study (n=58), 1 session of 20 minutes of massage therapy 
offered between day 2 and 5 postoperatively reduced pain, anxiety and tension scores 
and patients provided positive feedback (Cutshall, et al, 2010). Although authors 
concluded that massage should be considered for the management of cardiovascular 
surgical postoperative healing and incorporated in post cardiac surgical units (Cutshall, 
et al, 2010), more research is needed, since it is not currently considered evidence-
based therapy. In another study with a very small sample, researchers compared 15 
minutes of hand massage to control care (hand holding) followed by 30 minutes of rest 
for 2-3 sessions in the first 24 hours following cardiac surgery. Patients who received 
hand massage had lower pain intensity, but vital signs were similar between groups 
(Boiter, et al, 2015). Although hand massage is a low-cost non- pharmacological 
intervention that can be safely completed at the bedside (Boitor, et al, 2015), the sample 
size was too small to provide generalizable evidence. Finally, in a randomized trial, pain 
and anxiety were assessed after 2 massage therapy or rest (usual care) sessions on 
day 3 or 4 and day 5 or 6 among 152 cardiac surgery patients (Braun, et al., 2012). The 
massage group demonstrated a reduction in both pain and anxiety. These studies 
demonstrate that massage therapy may play a significant role in supporting cardiac 
patients’ wellbeing and healing and that it should be offered along with Reiki therapy to 
determine if the combination of therapies is more important than 1 complementary 
therapy alone.  
 
 
Methodology 
Design: Randomized, controlled non-blinded study  
 
Study Groups: Adults who had first-time open heart or robotic-heart surgery involving 
coronary arteries, cardiac valves or aortic root (+ other procedures).  
 
Inclusion criteria:  
• Over 18 years of age 
• Speaks English language and capable of reading and hearing. 
• Up to 4 “To Come In” patients enrolled per day (2 standard care and 2 intervention 
group) 
• Arrive for surgery from outpatient (home) environment. 
• Scheduled for surgery (arrives in “To Come In” area) on Monday and Tuesday. 
• Lives in one of 6 counties of Northeast Ohio, to ensure access post- discharge 
hospitalization. 
 
Exclusion criteria: 

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• EPIC history of dementia, cognitive decline, Down’s syndrome or other neurologic, 
psychological or congenital deficiency that impacts ability to make decisions about 
enrollment. EPIC assessment will occur during the process prior to approaching 
patients.  
• Severe sight and hearing impairment despite assistive devices 
• Cardiac surgery on a Wednesday, Thursday or Friday. 
• Was not admitted to the hospitals for surgery via To Come In status on the morning 
of surgery. 
• Prolonged intubation (over 48 hours), or reinsertion of an endotracheal tube during 
or before the intervention is initiated (will result in intervention withdrawal). 
• Sedated due to new onset delirium.  
 
Intervention 
Reiki is a Japanese energy-based healing technique that has been utilized in the United 
States since the 1940’s. The English translation of Reiki is universal vital energy that 
flows throughout and encompasses all living forms (Rand, 1991). Reiki is delivered by 
gentle hand placement either on or slightly above the body by certified Reiki 
practitioners. In this study, Reiki will be delivered first, for 15 minutes and will involve 
light placement of hands-on patients’ head, chest, shoulders, hands, knees, and feet (~ 
3 minutes to each body part). 
 
Manual therapy techniques include light effleurage to head and feet (for 5 minutes; ~ 2.5 
minutes to each body part) by the Reiki practitioner who delivered the Reiki therapy. For 
this research study, manual therapy techniques are defined as light effleurage without 
pressure.  
 
Reiki and manual therapy will be delivered for 3 consecutive days beginning on the day 
after endotracheal tube removal. A holistic environment will be provided for healing to 
both groups.  
• Rooms will be quiet, and doors will be closed during the 20 minutes of rest (usual 
care) or intervention, unless patients are in an ICU setting; in ICU, curtains will be 
drawn.  
• Patients will lie down in bed in supine position or sit in recliner, inhaling through their 
nose and exhaling through their mouth with their eyes closed.  
• Duration of Reiki service will be 15 minutes followed by manual therapy for 5 
minutes.  
• The intervention is completed after the 3rd Reiki + manual therapy sessions are 
completed. 
 
Reiki and manual therapy will be delivered by 4 Reiki practitioners with training at a 
Level 2+. The 4 Reiki practitioners are part of this study’s research team. Intervention 
patients may receive different practitioners during the intervention period. To assure that 
both groups receive 20 uninterrupted minutes of rest (control) or intervention, 
practitioners will place a sign on the door or ICU curtain stating, “Please do not disturb 
the patient when this sign is posted”. All practitioners will use a systematic approach 
when delivering both Reiki and manual therapy. Prior to study initiation, all practitioners 

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will receive an in-service and understand the sequence of service delivery during the 
intervention. The in-service will include a mock demonstration of all steps, including 
placing the sign on the room door.   
 
To assure quality and integrity of the intervention, the study PI (SZ) will observe all 4 
practitioners deliver the intervention at least 1 time pre-study (on patients who agree to 
receive it) and will share any issues or discrepancies observed. If there is divergence 
among practitioners, SZ will lead a group discussion of expectations for the study and 
will observe all 4 practitioners complete the intervention until there is conformity in 
actions.   
 
We believe a sham group is not needed, based on (a) massage therapy research 
results that showed the benefits of massage on pain and anxiety compared to usual 
care subjects who received rest (as we will) and (b) 1 Reiki study in which investigators 
had 3 groups-- usual care, a sham group that involved a person without Reiki training 
mimicking Reiki therapy and a treatment group who received Reiki therapy by an 
experienced Reiki practitioner. Reiki had effects on the autonomic nervous system 
(reduced heart rate and diastolic blood pressure), but the sham and placebo groups did 
not experience any benefit (MacIntyre et al., 2008).  
 
Usual Care 
All usual care provided pre- and post-operative management will continue, 
uninterrupted; including the 20 minute rest period. The only non-usual care component 
will be placement of a sign on the door to discourage visitors and providers from 
entering the room and disturbing the rest period.    
 
Outcomes  
Depression and anxiety: Depression and anxiety will be assessed using the Brief  
Symptom Inventory, a 12-item survey that provides subscales severity indexes for 
depression and anxiety. The Brief Symptom Inventory was internally consistent 
(reliable); in patients with ischemic heart disease (Doering, et al., 2010). The Brief 
Symptom Inventory has been used to assess depression and anxiety in multiple patient 
populations, including cardiac diseases, and results were found to predict mortality 
(Doering, et al., 2010). The survey uses simple statements and a 5-level Likert-type 
response set, ranging from 0, not at all to 4, extremely.    
 
Pain: Pain is a subjective symptom best measured by self-report. Pain will be measured 
in 2 ways. (1) Pain intensity will be measured on a scale of 0-10 with a score of 0 for no 
pain and 10 for worst pain, as part of usual care. (2) Highest (worst) and lowest (least) 
pain in the past 24 hours will be assessed via pain scores recorded in EPIC.  
 
Sleep: The Richards-Campbell Sleep Questionnaire (RCSQ) was developed in 2000 to 
overcome issues with other sleep questionnaires used in an acute or ICU setting. 
Permission was previously given to the mentor of this study (NMA) to use the tool 
unconditionally. This tool has 5 domains: sleep depth, falling asleep, number of 
awakenings, percent of time awake, and overall quality of sleep. It uses a visual analog 

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scale to measure domains of sleep and the composite score range is 0 to 100 (to reflect 
0 to 100 mm). The RCSQ is calculated by dividing the sum of the total length in 
millimeters of the visual analog scale lines by 5. It is reliable with a Cronbach’s alpha of 
.90 in 70 critically ill subjects (Richards, O’Sullivan & Phillips, 2000). It is short, simple, 
and easy to administer and analyze. This tool will take approximately 1 minute to 
complete. 
 
Hospital length of stay: Data will be collected by analysts using EPSi administrative 
database.  
 
New onset atrial fibrillation: Data will be retrieved from the Cardiothoracic Surgery 
database, led and managed by HVI Institute. It is IRB approved and data are collected 
on every open-heart surgery as part of the Society of Thoracic Surgery data collection, 
that Cleveland Clinic participates in. Data will be received in an excel file and encounter 
record numbers will be matched to questionnaire data for analysis.   
 
All cause 30-day hospital readmission: Data will be collected by analysts using EPSi 
administrative database.  
 
Narcotic drug burden (mean dose) on postoperative days 3 and 4: Data will be collected 
via an electronic medical record pull, using our Pharmacy’s database. Of oral narcotics, 
Percocet (acetaminophen and oxycodone) is most commonly used; however, if another 
oral agent or IV agents are used (for example, fentanyl or dilaudid [hydromorphone]) we 
will create a drug dose equivalency table so that data are analyzed based on equivalent 
doses of different agents used.  
 
Patient and medical characteristics: Data will be retrieved from the Cardiothoracic 
Surgery database, led and managed by HVI Institute. It is IRB approved and data are 
collected on every open-heart surgery as part of the Society of Thoracic Surgery data 
collection (version 2.81, effective, 04-23-2015; www.STS.org), that Cleveland Clinic 
participates in. Data will be received in an excel file and encounter record numbers will 
be matched to questionnaire data for analysis.  This data will be used to compare 
groups for symmetry. Data collection will include the factors highlighted on the Appendix 
form; attached and marital status, from the EPSi (billing) database.  
 
Reiki/manual therapy practitioners: Number of practitioners who applied Reiki/manual 
therapy during the intervention.  
 
Data Collection Procedures 
From the “To Come In” (TCI) list for first time cardiac surgery patients, data collectors 
will retrieve names and interview patients that meet criteria for research and offer the 
study to patients while they are in the TCI area for surgeries that are planned for 
upcoming Monday’s and Tuesday’s, so that consent is given prior to their surgery date. 
Alternately, we will enroll potential patients in the pre-cath area of J2 when they are in 
for a cardiac catheterization as part of their upcoming survey.  

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Written consent will be acquired by patients before initiation of the research study. 
Research nurses or research coordinators, who are not involved in the intervention or in 
clinical patient care will administer the questionnaire packets preoperatively (in TCI) and 
after the last Reiki treatment or usual care day of the research intervention for the 
following data: anxiety and depression and sleep. After preoperative data collection, 
patients will be randomized to the usual care or intervention group: using envelopes 
with assignments (136 control subjects 136 experimental subjects); based on groups of 
20. Packets will be created by a nurse from the Office of Research and Innovation and 
envelope assignments will not be shared with any researcher. Research nurses or 
research coordinators can assist patients with completion of baseline and post-
intervention questionnaires, as desired.  
 
Data retrieved from administrative, EPIC and cardiothoracic surgery databases will be 
requested using usual procedures, after patients have completed the study. The 
cardiothoracic surgery database is IRB approved.  
Sample Size 
Depression and anxiety are the primary outcomes. In a study of healing touch among 
hospital patients recovering from cardiac surgery (MacIntyre et al, 2008), those who 
received healing touch had a 71% greater change in “anxiety” score, compared to 
control subjects (mean decreases: healing touch, 6.3 [2.0, 10.6] and control group, 1.8 
[-2.6, 6.2], p=0.01). For this research study, we are hypothesizing that Reiki and manual 
therapy will result in a 30% greater reduction of depression and anxiety compared to 
patients in the usual care group. A rate of 30% was selected based on previous 
research findings: In a cohort of patients who received surgical procedures, postoperative 
anxiety BSI had a mean of 0.51 and a standard deviation of 0.56, and depression BSI had 
a mean of 0.42 and a standard deviation of 0.56 (Mackay, Hansen, & McFarlane, 2004).  
Given the skewed nature of these data, a lognormal distribution was assumed, with a 
coefficient of variation (standard deviation/mean) of 1.35, based on the depression BSI 
results above.  We believe that a 30% reduction in mean depression and anxiety scores 
would be clinically important.  Based on use of a two-sided two-sample t-test with 
significance level of 0.05, with adjustment for use of analysis of covariance based on an 
assumed small positive correlation between baseline and follow-up (ρ=0.25) as described 
by Borm et al. (2007), a sample size of 123 per group would provide 80% power to detect 
this difference.  To account for loss-to-follow-up, recruitment was increased by 10%, 
creating a sample size of 136 patients per group (272 patients in total).  Sample size 
calculations were performed using SAS software (version 9.4; Cary, NC) by Jim Bena MS 
of QHS. 
 
 
Data Analysis  
Patient characteristics will be summarized using frequencies and percentages for 
categorical measures, and means and standard deviations or medians and quartiles, as 
dictated by the distribution of these measures. 
 

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Anxiety, depression and sleep analyses: an analysis of covariance models will be fit, using 
the follow-up score as the response and patient group and baseline levels of the outcome 
measure as predictors by using the Brief Symptom Inventory (BSI).   
 
Pain, LOS and other continuous factors:  will be compared between groups using analysis 
of variance models.  In each of the models, normality of the outcomes will be evaluated 
and, if necessary, data will be transformed prior to analysis.  Results will be back-
transformed for presentation of mean differences with 95% confidence intervals.  
 
Reduced new onset of atrial fibrillation and reduced 30-day hospital readmission are 
binary outcomes that will be evaluated using Pearson chi-square tests or Fisher exact 
tests, in the case of rare outcomes.   
 
Exploratory analyses will evaluate the relationship between patient characteristics and 
outcomes and adjust treatment group differences for these factors using similar 
methodology.  An analysis will be performed using SAS software (version 9.4; Cary, NC).  
A significance level of 0.05 will be assumed for all outcomes. 
 
Feasibility 
The facility has sufficient trained Reiki certified practitioners to provide these modalities 
safely and accommodate the sample size. Hand placements and manual therapy 
specific for this study will be conducive for this patient population and will not put the 
patient at risk. The facility does at least ten cardiac surgeries Monday through Friday 
specific for this study to meet criteria for sample size.  
 
Limitations and Anticipated Problems 
Patients may be off the floor, busy with another service, sleeping or too sick (worsening 
status, readmitted to the ICU, intubated and sedated) or nauseated to be approached to 
carry out the Reiki intervention, even after enrollment. Not all patients will receive 3 
sessions. To make up for possible attrition, 10% will be added to the minimum sample 
size. Patients may refuse therapy (a rare occurrence) or may not complete 
questionnaire tools. Administrative and cardiovascular registry data will be used to 
collect most variables. If there is a delay in data collection or entry into the database, we 
may be delayed with analysis.   
 
Human Subjects Protection 
Risks to patients are low since our Reiki intervention consists of light touch and light 
rhythmic effleurage with no applied pressure. Patients could develop fatigue when 
completing tools, although unlikely as both are very short (BSI: 12 items and sleep 
scale: 5 items). Study coordinators will administer the tools after the 4th session is 
provided. Sandi Zampino, RN, Principal Investigator will maintain collected paper data 
in a secure file in her office and she will also be responsible for entering data in the 
database. The office door is locked when not in use. Shredder will destroy written 
surveys after 1 year of filing.  In the informed consent letter, participants will receive the 
name and phone number of Sandi Zampino so that any questions or concerns can be 
addressed. No adverse events are anticipated.  

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References 
Albert, N. M., Gillinov, A. M,, Lytle, B. W., Feng, J., Cwynar, R., & Blackstone, E. H. 
(2009). A randomized trial of massage therapy after heart surgery.  Heart & 
Lung, 38(6), 480-90.  
 
Anderson P.G., Cutshall S.M. (2007). Massage therapy: A comfort intervention for 
cardiac surgery patients. Clinical Nurse Specialist, 21(3), 161-65.  
 
Boiter, M., Martorella, G., Arbour, C., Michaud, C., & Gélinas, C. (2015). Evaluation of 
the preliminary effectiveness of hand massage therapy on postoperative pain of 
adults in the intensive care unit after cardiac surgery: a pilot randomized 
controlled trial. Pain Management Nursing, 16(3),  354-66. 
 
Borm, G.F., Fransen, J., & Lemmens, WA. (2007). A simple sample size formula for 
analysis of covariance in randomized clinical trials Journal of Clinical 
Epidemiology, 60(12), 1234-38. 
 
Braun, L. A., Stanguts, C., Casanelia, L., Spizer, O., Paul, E., Vardaxis, N. J., & 
Rosenfeldt, F. (2012). Massage therapy for cardiac surgery patients--a 
randomized trial. Journal Thoracic Cardiovascular Surgery, 144(6), 1453-9. 
 
Cutshall S. M., Wentworth L. J., Engen D., Sundt T.M., Kelly R. F., & Bauer B. A. 
(2010).   Effect of massage therapy on pain, anxiety, and tension in cardiac 
surgical patients: pilot study. Complimentary Therapy Clinical Practice, 16(2), 92-
5. 
 
Doering, L. V., Moser, D. K., Riegel, B., McKinley, S., Davidson, P., Baker, H., Dracup, 
K. (2010). Persistent comorbid symptoms of depression and anxiety predict 
mortality in heart disease. International Journal of Cardiology, 145(2), 188-92. 
 
Gordon, D.B., Polomono, R.C. Pellino, T.A., Turl, D.C.., McCracken, L.M., and et al. 
(2010). American pain society patient outcome questionnaire for quality 
improvement of pain management in hospitalized adults: Preliminary 
psychometric evaluation: The Journal of Pain, 11(11), 1172-86. 
 
Lee, M.S., Pittler, M.H., Ernst, E. (2008). Effects of reiki in clinical practice: A systematic 
review of randomized clinical trials. International Journal of Clinical Practice, 
62(6), 947-54.  
  
MacIntyre, B., Hamilton, J., Frickle, T., Wenjun, M., Mehle, S., Michel, M. (2008). The 
efficacy of healing touch in coronary artery bypass surgery recovery: A 
randomized clinical trial. Alternative Therapies, 14(4), 24-32. 
 
Mackay, N., Hansen, S., McFarlane, O. (2004). Autonomic nervous system changes 
during reiki treatment: A preliminary study. The Journal of Alternative and 
Complementary Medicine, 10(6), 1077-81. 

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Rand W. (1991). The Healing Touch. First and Second Degree Manual. Vision 
Publication: Southfield, MI.  
 
Richards, K.C., O’Sullivan, P., Phillips, R.L. (2000). Measurement of sleep in critically ill 
patients. Journal of Nursing Measurement, 8(2), 131-44. 
 
Society of Thoracic Surgeons. The Society of Thoracic Surgeons Adult Cardiac Surgery 
Database data collection form version 2.81, April 23, 2015. Society of Thoracic 
Surgeons, www.sts.org. Accessed 09-12-2016.  
 
VanderVaart, S., Gijsen,V., De Wildt, S., Koren, G.  (2009). A systematic review of the 
therapeutic effects of reiki: The journal of alternative and complementary 
medicine, 15(11), 1157-69.  
 
Vitale, A. (2007). An integrative review of reiki touch therapy research. Holistic Nursing 
Practice, 21(4), 167-79. 
 
Timetable 
Data collection and placement in database 
 
8 months 
Data cleaning 
 
 
 
 
 
2 weeks 
Data analysis 
 
 
 
 
 
3 months 
Data dissemination  
 
 
 
 
6 months 
Research translation 
 
 
 
 
To be determined