A Systematic Review of the Studies About Therapeutic Touch After the Year of 2000

International Journal of Caring Sciences January – April 2020 Volume 13 | Issue 1| Page 231

Original Article

A Systematic Review of the Studies about Therapeutic Touch after the Year of 2000

Hazel Bagci, PhDc, RN Instructor, Department of Fundamentals Nursing, Dokuz Eylul University Hospital, Izmir, Turkey

Sebnem Cinar Yucel, PhD, RN Associate Professor, Department of Fundamentals Nursing, Ege University Nursing School, Izmir, Turkey Correspondence: Hazel Bagcı, Department of Fundamentals Nursing, Dokuz Eylul University Hospital, 35000, Izmir, Turkey, e-mail: [email protected]

Abstract Aim: This systematic review was carried out to evaluate the studies about therapeutic touch which were conducted after the year of 2000. Methodology: The databases such as Pubmed, Cochrane and Medline were searched to find related articles. Key words such as touch, therapeutic touch, nursing, therapeutic touch nursing and touch therapy were used to search. 25 studies were found in accordance with the inclusion criteria between January 2017 and May 2017. Results: When the studies were examined, pain (in 10 studies), anxiety and agitation (in 7 studies), psychological and behavioral symptoms (in 4 studies), vital signs (in 3 studies), cortisol levels (in 3 studies), sleep quality (in 2 studies), fatigue (in 2 studies), vomiting intensity (in 1 study), hemoglobin and hematocrit levels (in 1 study) and life quality (in 1 study) were investigated. Six of the studies were conducted with the pre- and post-operative patients; five of them were conducted with the elderly individuals; four of them were conducted with the ecancer patients; four of them conducte with the individuals with dementia; three of them were conducted with the neonates; one of them was conducted with the pregnant women. Conclusion: In conclusion, it has been thought that nurses can include therapeutic touch into care in order to provide more effective care because it can be easily applied and give effective results. Key Words: Touch, Therapeutic Touch, Nursing, Complementary Therapies.

Introduction and support messages together with the professional-functional relationship will further Touch is one of the first senses and a basic human strengthen the patient-nurse relationship. While the need. It is a concept which is so close with the nurses give messages such as sincerity, interest, word of therapy (Arslan & Yucel, 2017). Touch trust, courage, willingness to help and empathy to increases the communication between nurses and their patients by touching, the studies found that patients, ensures the regulation of vital signs and is few of the nurses included touching in nursing care effective on the physiological healing process. It (Moroles, 1994; Ekizler, 1987). Complementary ensures feeling of self-esteem by individuals and therapy is the name of all interventions that are thus reduce the psychosocial problems of patients applied in parallel to modern medicine in order for (Gleeson & Timmins, 2005). While touching individuals to regain their health. According to the patients by nurses only for applications and the definition of the National Cancer Institute and the profession is not an effective way to communicate American Cancer Association, complementary with patients, the co-use of touching with interest

www.internationaljournalofcaringsciences.org International Journal of Caring Sciences January – April 2020 Volume 13 | Issue 1| Page 232 therapies are the therapies used with modern Healing touch and the therapeutic touch are the medicine (Ozcelik & Fadıloglu, 2009). most frequently confused applications, so the word Complementary and integrative therapies have of healing touch was not used for literature search. been used since the first days of humankind. The research articles and theses about TT in However, there has been an increase in the use of English which were published between the years of complementary therapies since the mid-20th 2001-2016 were included in the study, congress century (Muslu & Ozturk, 2008). abstracts and reviews were excluded from the Therapeutic touch (TT) is an approved study. As a result of the literature review conducted complementary and alternative medicine method between January 2017 and May 2017, 16195 which allows the individuals to find their inner studies were found. The studies were firstly balance and in which the energy in the universe is evaluated according to their titles; 16127 studies affectionately used with a certain intention (Bagci which were not related to the subject of the study & Yucel, 2019; Yucel, Arslan & Bagci, 2019). TT were excluded. The remaining 68 studies' abstracts is the process of energy exchange; practitioners and full texts were evaluated in terms of inclusion focus on healing by directing his hands on patients' and exclusion criteria; total of 25 studies were foud bodies. According to Krieger, the imbalance in the to met the criteria. energy field around the body can be accepted as a The sample of the study consisted of 25 studies disease and can be rearranged after an evaluation about the therapeutic touch, one of the by TT practitioners (Coppa, 2008). In recent years, complementary and integrative care practices TT has been widely used in health care in other which are the independent functions of nurses countries due to its low cost and easy of use. (Figure I).Medline, Pubmed, Cochrane databases Nurses' hands are the only tools required for TT were searched and relevant articles were found. (Moeini, et al. 2008). Despite the use of TT in Key words such as touch, therapeutic touch, health care settings, there is limited evidence to nursing and touch therapy were used for literature support it's effectiveness (Blankfield, et al. 2001). search. Healing touch and the therapeutic touch are There are also some disagreements about the the most frequently confused applications, so the effectiveness of TT. Many researchers do not word of healing touch was not used for literature consider TT as an effective approach to improve search. The research articles and theses about TT in patient health (Rosa, et al. 1998; Olson & Sneed, English which were published between the years of 1995). It is thought that this literature review will 2001-2016 were included in the study, congress facilitate the determination of the priorities for abstracts and reviews were excluded from the future studies in this research area and will provide study. As a result of the literature review conducted significant data for nurses by evaluating the results between January 2017 and May 2017, 16195 of the studies more clearly. This systematic review studies were found. The studies were firstly is a descriptive study which was conducted to evaluated according to their titles; 16127 studies analyze the results of the studies about TT between which were not related to the subject of the study the years of 2001 and 2016 in terms of type, year, were excluded. The remaining 68 studies' abstracts sample and subject. and full texts were evaluated in terms of inclusion and exclusion criteria; total of 25 studies were foud Materıals and Methods to met the criteria. The sample of the study Medline, Pubmed, Cochrane databases were consisted of 25 studies about the therapeutic touch, searched and relevant articles were found. Key one of the complementary and integrative care words such as touch, therapeutic touch, nursing and practices which are the independent functions of touch therapy were used for literature search. nurses (Figure I).

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The studies found as a result of literature search

n= 16227 Unrelated Studies according to Their Titles n= 16058 The Studies Published at Any Other Time n= 137

Related Studies n= 32 The Studies Which did not Met the Inclusion Criteria (Reviews=7) n=7

Total Number of Studies n=25

Figure 1. Study Selection Process of the Systematic Review

Table I. Characteristics of the Studies on Hand Massage Practices

Name of tek Study Authors and Type of Number and Result Publication Date the Study Characteristic of the Sample Therapeutic Blankﬁeld, Randomize 11 patients in the TT There was no significant Touch in the Sulzmann, d, single group, 10 patients in the difference between the TD group Treatment of Fradley, blind, pseudo TT group, and the pseudo TD group from Carpal Tunnel Tapolyai & experiment totally 21 Carpal the first treatment session to the Syndrome Zyzanski al study Tunnel Syndrome last treatment session in terms of (2001) patients. the mean motor nerve distal latencies, pain and relaxation scores. However, immediately after each treatment, basal improvements were observed in the outcome variables in both groups. In this study, it was not concluded that TT was more effective than placebo in median motor nerve distal latencies, pain and relaxation scores.

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The Effects of Smith, Rosa & Experimen A total of 12 people As a result of this study, it was Integrating Wells-Federman tal between the ages of found that the patients who Therapeutic (2002) 31-56, consisting of 3 received TT were significantly Touch in men and 9 women. more improved in terms of Cognitive self-efficacy and unitary power Behavioral Pain than those who received cognitive Treatment behavioral therapy; this effect was Program: A lower in wear rates. In this pilot Clinical Pilot study, it was supported that Study Report providing TT in addition to cognitive behavioral therapy to improve clinical outcomes and to be effective in patients with chronic pain. Effects of Woods & Experimen 10 patients with According to the variance analysis Therapeutic Dimond (2002) tal moderate to severe in repeated measurements, Touch on Alzheimer's disease significant decreases were Stimulated who were in the private observed in general agitation Behavior and care unit, aged between behavior, two specific behaviors, Cortisol Levels in 71-84 years. vocalization, stepping or walking Alzheimer's during and after the treatment. Patients According to ANOVA and Friedman tests, there was no significant decrease in salivary and urine cortisol levels. This is because the small sample size and the lack of a comparison group. The Outcomes of Smith , Reeder , Randomize Totally 88 adult Massage therapy was effective in Touch Therapies Daniel , d, patients in the bone altering chemotherapy induced During Bone Baramee & controlled marrow transplantation psychological and neurological Marrow Hagman clinial trial unit, 31 of them in the complications during bone Transplantation (2003) TT group, 27 of them in marrow transplantation. Both the massage therapy massage and TT provided comfort group, 30 of them in the to the patients living this difficult friendly visit (control) process. group. The Effect of Larden, Palmer Randomize 54 pregnant women In the TT group, the anxiety score Therapeutic & Janssen d who were admitted to significantly decreased on the 1st, Touch in the (2004) controlled the substance addiction 2nd and 3rd days. When they Treatment of Drug study unit to be included in evaluated individually, no Addict Pregnant the application, control significant difference was found Women and placebo groups. between the groups in terms of symptom levels . TT was thought to be have value as an adjunctive measure in the treatment of chemical dependence in pregnant women. The Effect of Woods , Randomize 57 elderly individuals According to the ANOVA and Therapeutic Craven d, with dementia-related Kruskal-Wallis tests, a significant Touch on the & Whitney double-bli behavioral symptoms, difference was found inthe Frequency and (2005) nd, aged between 67-93 behavioral symptoms in the Severity of experiment years, in the long-term experimental group. In Behavioral al study special care facility in conclusion, the study supported Symptoms of the placebo, the clinical significance of TT for Dementia experimental and alleviating the behavioral control groups. symptoms in the demented patients.

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Effects of Movaffaghi, Randomize 45 female students in TT and pseudo TT significantly Therapeutic Hasanpoor, d, the application group, increased hemoglobin and Touch on Farsi, controlled, 28 of them in the hematocrit levels. There was no Hemoglobin and Hooshmand& double-bli placebo group,13 of significant change in the control Hematocrit Levels Abrishami nd, clinical them in the control group. TT was more effective (2006) study group, totally 89 female than pseudo TT in terms of students. increasing hemoglobin levels. Effectiveness of Wang & Nonrando Totally 14 patients with There was a significant decrease Therapeutic Hermann (2006) mized dementia who were in the agitation behaviors of the Touch in Patients semiexperi hospitalized in the subjects in the treatment group. In with Dementia mental dementia care unit, 8 of the control group, there was less study them in the control decrease. group and 6 of them in the application group Does Therapeutic Frank, Frank, Randomize 82 female patients with No significant difference was Touch Facilitate March, Judson, d, non-palpable, found between the TT group and the Problems and Barham & controlled non-mammographically the pseudo TT group in terms of Distress of Mertens (2007) experiment detected breast lesions post-biopsy pain, anxiety, fear or Patients with al study physiological parameters. Stereotactic Breast Similarly, no difference was Biopsy? found between the groups when pre- and post-biopsy parameters in any of the measured psychological or physiological variables were taken into account. It was concluded that the women undergoing stereotactic core biopsy obtained no significant benefit from TT. The Effect of Smith, Kimmel Single A total of 60 patients The results showed that TT Therapeutic & Milz (2008) blind, with osteoarthritis in at administration (2 times a week for Touch on the Pain, randomize least one knee, over the 8 weeks) reduced the Function and Life d, age of 50 years who osteoarthritis pain and stiffness of Quality of Patients controlled admitted to a family the knees. with Osteoarthritis pilot study medicine center. Gradual Effects of Quantitativ A total of 42 students, The data analysis revealed Gomes, Silva & Therapeutic e type 21 of them in the statistically significant decreases Araújo (2008) Touch for experiment experimental group and in anxiety in both groups. Reducing Anxiety al study 21 of them in the in University control group. Students Randomize 51 patients with Non-physical aggressive behavior Effectiveness of Hawranik , d, Alzheimer's disease significantly reduced in the TT Therapeutic Johnston & controlled who were hospitalized group. The study provided Touch on the Deatrich experiment in long-term care preliminary evidence to Agitation in (2008) al study facilities in TT, pseudo demonstrate that TT is an Individuals with Alzheimer's TT and routine effective treatment for reducing Disease treatment groups physically non-aggressive behavior, such as wandering and uneasiness. The Effectiveness Domínguez Experimen A total of 78 premature TT reduced hospitalization and of Therapeutic Rosales , tal neonates in the the presence of complications. Touch on the Albar Marín , intensive care unit, 39 Weight, Tena García , of them in the control Complications and Ruíz Pérez , group and 39 of them in Duration of Garzón the experimental group. Hospitalization in Real , Rosado Preterm Infants in Poveda the Newborn Unit & González

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Caro (2009) The Use of McCormack Randomize 30 elderly individual in In the experimental group, a Therapeutic (2009) d, each groups as significant decrease was observed Touch to Manage controlled experimental, control in the pain level scores of 22 Post-operative clinical and placebo groups, (73%) of 30 elderly individuals Pain in Elderly study totally 90 postoperative from the pre-test to post-test (t Individuals elderly individuals. [7]= 7.24, p<0.01). The Effect of Zare , Shahsavari Clinical 44 patients with The test results showed Therapeutic & Moeini Study coronary artery bypass significant differences between Touch on the Vital (2010) graft surgery were the mean heart rates and Signs of Patients included in the respiratory rates in both groups Before Coronary treatment and control before and after TT. Artery Bypass groups. Graft Surgery The Effect of Coakley & Experimen Totally 21 The participants receiving TT Therapeutic Duffy (2010) tal post-operative patients were found to have lower levels Touch on after vascualr surgery, of pain and cortisol, and higher Postoperative 12 of them in the levels of natural killer Patients application group, 9 of lymphocytes compared to the them in the control individuals receiving routine group treatment. The findings support that TT may be a beneficial intervention for patients. The Effect of Marta, Baldan, Experimen 30 patients aged 60 As a result of the analysis of the Therapeutic Berton, Pavam tal years or older with data, there were significant Touch on Pain, & Silva (2010) chronic pains except decreases in pain intensity, Depression and oncological pain. depression, self-evaluation scores Sleep in Patients and the scores on sleep quality with Chronic Pain: index (p<0.05). TT was found to Clinical Study be effective for alleviating pain intensity, depressive attitudes and symptoms, as well as for improving sleep quality. The Effect of Aghabati, Randomize A total of 90 female Therapeutic Mohammadi & d, patients having pain Touch on the Pain Esmaiel (2010) controlled and fatigue symptoms There were significant decreases and Fatigue of clinical and receiving in the pain and fatigue scores of Patients Receiving study chemotherapy were the treatment group compared to Chemotherapy included in the study, the usual care group; the pain and 30 of them in the fatigue scores of the placebo placebo group, 3 of group decreased compared to the them in the application usual care group. group and 30 of them in the control group. Application and Busch , Experimen 38 burned individuals. Pain-related anxiety decreased in Evaluation of Visser , tal the TT group on the 10th day. Therapeutic Eybrechts , Less morphine was given to the Touch in Burned van Komen , subjects in the TT group on days Patients: An Oen , Olff , 1 and 2. On the second day, the Educational Dokter cortisol level was higher in the TT Experience to & Boxma group before changing medical Conduct a (2012) dressing. Scientific Study in a Non-Academic Nursing Environment The Effect of Zolfaghari, Semi 23 women at the ages TT was an effective approach to Therapeutic Eybpoosh, Experimen of 23-65 year in each manage situation anxiety, to Touch on the Hazrati (2012) tal groups as application, regulate vital signs and to reduce Anxiety, Vital control and placebo cardiac arrhythmia during

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Signs and Cardiac groups, totally 69 stressful conditions in the Dysrhema in the women Iranian women with heart disease Iranian Women such as cardiac catheterization. with Cardiac Catheterization The Effect of Ramada, Semi 40 newborns in the TT was shown to increase the Therapeutic Almeida & Experimen neonatal intensive care relaxation of babies, to help to Touch on the Vital Cunha (2013) tal unit, who sent for reduce vital signs and basal Signs of therapeutic touch after metabolic rate. Newborns painful interventions Therapeutic Johnston , Randomize Totally 55 preterm No statistically significant Touch was Not Campbell-Yeo , R d newborns under the age difference was found between the Therapeutic to ich , Controlled of 30 gestational weeks groups. reduce the Pain of Whitley , Clinical who hospitalized in the Preterm Babies: A Filion , Trial second-stage neonatal Randomized Cogan & Walker intensive care unit, 27 Clinical Study (2013) of them in the therapeutic touch group; 28 of them in the pseudo therapeutic touch group A Younus , Cohort It consited of 2 groups There was no significant Case-Controlled, Lock , study as TT and control difference in terms of life quality, Single-Center, Vujovic, Yu , Ma groups, 49 women who mood and fatigue before and after Open-Labeled lec , received adjuvant the study. Pilot Study D'Souza radiation for Stage I/II Investigating the & Stitt (2015) breast cancer after Feasibility of conservative surgery. Therapeutic Touch in Preventing Radiation Dermatitis in Women with Breast Cancer Receiving Adjuvant Radiotherapy. Effect of Matourypour, Single 36 women having As a complementary treatment, Therapeutic Vanaki, Zare, blind, cancer and receiving TD was found to be effective in Touch on the Mehrzad, randomize chemotherapy in each chemotherapy-induced vomiting. Acute Dehghan & d, clinical groups as control, Chemotherapy Ranjbaran trial plkacebo and Induced Vomiting (2015) intervention groups, Intensity in the totally 108 patients Women Having Breast Cancer and Receiving Chemotherapy Effect of Tabatabaee , Taf Randomize 3 groups as application, There were significant differences Therapeutic reshi , Rassouli , d control and placebo between these 3 groups in terms Touch on the Pain controlled groups consisted of 90 of their post-test scores of general Parameters in the Aledavood , clinical male patients at the patient activities, mood, walking Cancer Patients: AlaviMajd trial ages of 20-65 years ability, relationships with others Randomized & Farahmand (2 with cancer-related pain and sleep. According to the paired Clinical Trial 016) approved by a comparison of groups, there were physician. significant differences between both the experimental and control groups and the experimental and placebo groups. No significant

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difference was found between the placebo and control groups. The post-test revealed a significant difference between the sleep scores of the patients in these three groups. In addition, positive and negative significant differences were observed between the application, placebo, and control groups, respectively, at the beginning and at the end of the procedure, in terms of the effect of pain on walking ability.

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with 89 anemic female students and found that TT Dıscussıon significantly increased hemoglobin and hematocrit Although there are many studies on TT which is levels (Movaffaghi, et. al. 2006). Domínguez one of the complementary and integrative therapies Rosales et al. (2009) investigated the effects of TT as an independent function of nurses, which were on the weight, the status of having complications conducted with different sample groups, the and the duration of hospital stay of 78 premature number of published studies in Turkey is quite low neonates in the NICU and found that TT decreased (Yılmaz, Birer & Baydur, 2016).Most of the the duration of hospital stay and the status of studies were conducted to analyze the pain and having complications (Dominguez, et. al. 2009). anxiety levels of the elderly patients, cancer In another study conducted with the neonates, the patients and postoperative patients (Tabatabaee, et effect of TT on the vital signs of the neonates was al. 2016; Matourypour, et al. 2015; Johnston, et al. examined; it was found that TT increased the 2013; Busch, et al. 2012; Zolfanghari, Eybpoosh & relaxation of the neonates and helped to reduce the Hazrati, 2012; Aghabati, Mohammadi & increased vital signs due to painful stimulus PourEsmaiel, 2010; Coakley & Duffy, 2010; (Ramada, Almeida & Cunha, 2014). In another Marta, et al. 2010; Gomes, Silva & Araújo, 2008; study conducted with the adult patients which McCormack, 2009; Hawranik, Johnston & evaluated the effect of TT on their vital signs, it Deatrich, 2008; Smith, Kimmel & Milz, 2008; was found that there was a significant difference Frank, et al. 2007; Wang & Hermann, 2006; between the mean heart rates and respiratory rates Larden, Palmer & Janssen, 2004; Smith, et al. of the patients received TT and the patients not 2003; Smith, et al. 2002; Woods & Dimond, 2002; received TT (Zare, Shahsavari & Moeini, 2010). Blankfield, et al. 2001). In the studies that Matourypour et al. (2016) investigated the effect of investigated the effect of TT on pain, it was found TT on the acute chemotherapy-induced vomiting that most of the studies were performed with intensity in the women with breast cancer postoperative patients or patients with small receiving chemotherapy. It was found that TT was interventional procedures (Zolfanghari, Eybpoosh effective in chemotherapy-induced vomiting & Hazrati, 2012; Coakley & Duffy, 2010; Frank, et (Matourypour, et. al. 2015). In another study al. 2007; Smith, et al. 2003). As a result of some conducted with a different group of patients with studies, TT was found to be effective in reducing breast cancer who treated with a different and controlling pain while it was ineffectivein for treatment method, it was concluded that TT had no orthers (Tabatabaee, et al. 2016; Matourypour, et effect on their quality of life, mood and fatigue al. 2015; Johnston, et al. 2013; Busch, et al. 2012; (Younus, et al. 2014). Aghabati, Mohammadi & PourEsmaiel, 2010; Coakley & Duffy, 2010; Marta, et al. 2010; Conclusion McCormack, 2009; Smith, Kimmel & Milz, 2008; In conclusion, the studies on TT which has no side Frank, et al. 2007; Smith, et al. 2002; Blankfield, et effect, is non-invasive, silent, non-distracting, al. 2001).When the studies were examined, it was painless easily applicable in every environment, seen that the other variables which effectiveness does not require any intervention to the patient's levels were evaluated were anxiety and agitated privacy and any mandatory position of the patient, behaviors. Most of these studies were performed in which the duration and the number are with elderly and demented individuals (Hawranik, completely dependent on the practitioner and the Johnston & Deatrich, 2008; Wang & Hermann, patient, were shown. The studies showed that TT is 2006; Woods, Craven & Whitney, 2005; Woods & an effective method for managing pain, anxiety Dimond, 2002) The results of these studies showed and many other symptoms. The inclusion of TT in that TT is an effective method for reducing and nursing care by nurses receiving training about TT eliminating anxiety and agitated behaviors (Busch, has been thought to decrease the number of et. al. 2012; Gomes, Silva & Araújo, 2008; symptoms in patients and to strengthen the Hawranik, Johnston & Deatrich, 2008; Wang & patient-nurse relationships. As a result of this Hermann, 2006; Larden, Palmer & Janssen, 2004; systematic review, it has been thought that the Smith, et. al. 2002; Woods & Dimond, number of evidence-based studies related to this 2002).Movaffaghi et al. (2006) conducted a study

www.internationaljournalofcaringsciences.org International Journal of Caring Sciences January – April 2020 Volume 13 | Issue 1| Page 240 practice, which is very little known in Turkey, will da ansiedade de estudantes universitários. Rev Bras increase. Thus, it's using in clinical applications Enferm. 61(6): 841-6. will increase. Hawranik, P., Johnston, P., Deatrich, J. (2008). Therapeutic Touch and Agitation in Individuals with References Alzheimer’s Disease. West. J. Nurs. Res. 30,

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