Effects of Foot Reflexology on Post-sternotomy Hemodynamic Status and Pain in Patients Undergoing Coronary Artery Bypass Graft: A Randomized Clinical Trial

Introduction Cardiovascular diseases are considered as the main causes of death worldwide and are predicted to remain by 2020. According to Deyirmenjian et al (1), the drug cannot eliminate the problem in some patients with cardiovascular disease thus there is a need for surgery including coronary artery bypass graft (CABG), which accounts for 60% of all open-heart surgeries in Iran (2). Despite the success of cardiac surgery techniques, postoperative pain is a common complication in such patients (3). Based on the results of previous research, 33%75% of patients undergoing cardiac surgery suffer from moderate to severe pain (4). In addition, postoperative pain within the first 27-72 hours after CABG has various reasons such as surgical site incisions, chest tube insertion, tissue manipulation, and invasive procedures during the surgery (5,6). Similarly, the hospitalization of such patients in the intensive care unit (ICU) within the first two to three days after the surgery increases their chances of experiencing stress and anxiety, leading to an increase in their blood pressure (BP), respiratory rate (RR), and heart rate (HR), and generally, change their hemodynamic status (7). Hence, anxiety and pain management in such patients is very essential and unavoidable for controlling their hemodynamic status (7). The use of complementary therapies including massage techniques in medical centers has increased in recent years. Soft tissue touch in massage therapy reduces pain but increases comfort in patients and relaxes them thus increasing their ability to adapt to the new situation. It is proven that there is a relationship between cardiovascular diseases and the psychological state of patients, therefore, alternative medicine is predicted to effectively promote the health and comfort of such patients (8,9). Many studies reported the positive and beneficial effects of reflexology, therefore post-reflexology pain and the parameters of hemodynamics are controlled in Abstract Objectives: There are contradictory results regarding the effects of foot reflexology on postoperative pain and hemodynamic status in patients undergoing coronary artery bypass graft (CABG). Therefore, the present study aimed to investigate the effects of foot reflexology on post-sternotomy pain and physiological parameters in patients undergoing CABG. Materials and Methods: This randomized clinical trial was conducted on 40 women in Shahid Madani hospital of Tabriz in 2019. The sample size was determined based on previous studies using a formula and the participants were randomly assigned to treatment (n=20) and control (n=20) groups. In addition, all participants completed a three-part questionnaire (i.e., demographics, the visual analog scale, and hemodynamic symptoms forms) before and 40 minutes after the intervention. Then, the women in the test group received 20 minutes of left foot reflexology based on the existing method while those in the control group received no intervention. The data were statistically analyzed using the Kolmogorov– Smirnov and chi-square tests, as well as the paired sample and independent t tests at the significance level less than 0.05. Results: The results indicated that the intervention significantly reduced systolic (P = 0.001) and diastolic (P = 0.005) blood pressures, along with heart (P = 0.003) and respiratory (P = 0.041) rates. Further, foot reflexology significantly decreased the severity of postoperative pain in the treatment group (P = 0.003). Conclusions: Overall, the study findings revealed that foot reflexology had positive effects on the stability of hemodynamic status and thus relieved postoperative pain in patients undergoing CABG.