Clinical and Hospital Stay Effects of Reiki and Manual Therapy After Open Heart Surgery

Study Overview
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Brief Summary
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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; however, more research is required since sample sizes in the literature were small, subjects were generally healthy (not hospitalized), and subjects had multiple medical backgrounds. Only 1 study focused on cardiac surgery patients. 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. A randomized, controlled non-blinded study will enroll a sample of a minimum of 272 patient (136 per group), based on a power analysis using the primary outcome. The intervention group will receive usual care plus Reiki and manual therapy, with Reiki delivered first. 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 20 minutes of uninterrupted rest, which is part of usual postoperative care. Outcomes are depression, anxiety, pain, night time sleep, new onset atrial fibrillation, hospital length of stay, all-cause 30-day hospital readmissions, narcotic drug burden and post-operative complications.

Detailed Description
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Background: 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 20 minutes of uninterrupted rest, which is part of usual postoperative care. There will not be a sham-treatment group, based on previous research findings. Outcome Measures: depression and anxiety (Brief Symptom Inventory, 12-item self-administered tool); pain (self-reported and recorded in electronic health record 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, all-cause 30-day hospital readmissions (data top be retrieved from a billing database), narcotic drug burden (mean dose) use on postoperative days 3 and 4 (retrieved from electronic medical records), patient characteristics, medical history, surgical procedure, new onset atrial fibrillation and other post-operative complications (retrieved from the Institutional Review Board--approved Cardiothoracic Surgery database).

Official Title
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Clinical (Sleep, Pain and Atrial Fibrillation) and Hospital Stay Effects of Reiki and Manual Therapy After Open Heart Surgery

Conditions
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Coronary Artery Diseases, Valvular Heart Diseases

Intervention / Treatment
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* Other: Reiki/manual therapy


Participation Criteria
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Eligibility Criteria
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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 North East Ohio to ensure access post-discharge hospitalization Exclusion Criteria: History of dementia, cognitive decline, Down's syndrome or other neurologic, psychological or congenital deficiency that impacts ability to make decisions about enrollment Severe sight and hearing impairment despite assistive devices Cardiac surgery on a Wednesday, Thursday or Friday Treated in the hospital prior to the day 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.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Patients were recruited and enrolled into the study preoperatively. After completing baseline information, they were randomized to the intervention or control group. After surgery they received the group assignment.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Reiki/manual therapy<br>Reiki, a Japanese energy-based healing technique, is universal vital energy that flows throughout and encompasses all living forms (Rand, 1991). It is delivered by gentle hand placement either on/slightly above the body by certified Reiki practitioners. In this study, Reiki will be delivered first, for 15 min. and will involve light placement of hands on patients' head, chest, shoulders, hands, knees, and feet (  3 minutes to each body part). Manual therapy (MT) includes light effleurage to head and feet (for 5 minutes;   2.5 minutes to each body part) by the Reiki practitioner. MT techniques are defined as light circular stroking movements made with the hands. Reiki and MT will be delivered for 3 consecutive days beginning on the day after endotracheal tube removal. Reiki and MT will be delivered by 4 Reiki practitioners with training at a Level 2+. Reiki and manual therapy was delivered as one intervention. They are not two separate interventions. | Other: Reiki/manual therapy<br>* 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.<br>|
| No Intervention: Usual care quiet time<br>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. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Depression | The Brief Symptom Inventory; 12-item survey, provides severity indexes for depression and anxiety Valid and reliable; 5-level Likert-type response set, ranging from 0, not at all to 4, extremely | Paper surveys were distributed pre-operative (baseline) | 
| Depression | The Brief Symptom Inventory; 12-item survey, provides severity indexes for depression and anxiety Valid and reliable; 5-level Likert-type response set, ranging from 0, not at all to 4, extremely | Paper surveys distributed post-operative (day 3) after the final reiki and manual therapies intervention or quiet time sessions were completed. | 
| Anxiety | The Brief Symptom Inventory; 12-item survey, provides severity indexes for depression and anxiety Valid and reliable; 5-level Likert-type response set, ranging from 0, not at all to 4, extremely | Paper surveys were distributed pre-operative (baseline) | 
| Anxiety | The Brief Symptom Inventory; 12-item survey, provides severity indexes for depression and anxiety Valid and reliable; 5-level Likert-type response set, ranging from 0, not at all to 4, extremely | Paper surveys distributed post-operative (day 3) after the final reiki and manual therapies intervention or quiet time sessions were completed. | 
| Sleep | The Richards-Campbell Sleep Questionnaire (RCSQ) Valid and Reliable; has 5 item survey as 5 domains: sleep depth, falling asleep, number of 5 items awakenings, percent of time awake, and overall quality of sleep. | Paper surveys distributed pre-operative (baseline) | 
| Sleep | The Richards-Campbell Sleep Questionnaire (RCSQ) Valid and Reliable; has 5 item survey as 5 domains: sleep depth, falling asleep, number of 5 items awakenings, percent of time awake, and overall quality of sleep. | Paper surveys distributed post-operative (day 3) after final reiki and manual therapies intervention or quiet time sessions were completed. | 
| Pain level | Pain intensity was assessed on a scale of 0-10 (higher score = worst pain) • Highest (worst), lowest (least), mean and median pain scores were assessed. | Mean (SD) value through study completion, an average of 6.4 days | 
| Pain level | Pain intensity was assessed on a scale of 0-10 (higher score = worst pain) • Highest (worst), lowest (least), mean and median pain scores were assessed. | Mean (IQR) value through study completion, an average of 6.4 days | 
| Hospital length of stay, days | Data retrieved via a hospital billing database. | Through study completion, an average of 6.4 days | 
| New-onset postoperative atrial fibrillation rate (%) | Data retrieved from the Society of Thoracic Surgeons Registry | Frequency (%) of new-onset atrial fibrillation complication after open heart surgery | 
| All cause 30-day hospital readmission rate, (%): | Data retrieved via a hospital billing database | 30 days after discharge | 
| Total opioid IV narcotic burden (mean): | Data retrieved via a hospital billing database | Total opioid IV narcotic medication dose, using morphine equivalent data, during the length of stay, an average 6.4 days | 
| Total oral narcotic burden (mean): | Data retrieved via a hospital billing database | Total oral narcotic medication dose, using morphine equivalent data, during the length of stay, an average 6.4 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cardiac surgery, Coronary artery bypass grafting (CABG), Valve surgery, Reiki, Manual therapy