|Year : 2022 | Volume
| Issue : 2 | Page : 81-89
The effect of warm water footbath versus Swedish massages on hemodialysis patients' sleep quality and insomnia
, Shekoofeh Hamzhiekia
, Asadolah Mosavi, Sima Mohammad Hossini
Department of Nursing, School of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran
|Date of Submission||15-Jul-2021|
|Date of Decision||18-Oct-2021|
|Date of Acceptance||27-Oct-2021|
|Date of Web Publication||10-Jun-2022|
Shahid Jalil Boulevard, Next to Emam Sajad Hospital, School of Nursing, Yasuj
Source of Support: None, Conflict of Interest: None
Context: Low sleep quality as a common problem in patients undergoing hemodialysis can lead to negative impacts such as poor quality of life. Many studies were performed in order to improving sleep quality in these patients; however, few comparative studies have been conducted to compare the effects of nonpharmacological interventions on sleep disturbances of patients undergoing hemodialysis.
Aims: This study was carried out to examine the effect of warm water footbath versus Swedish massage on sleep quality and insomnia severity in patients undergoing hemodialysis.
Materials and Methods: Seventy patients undergoing hemodialysis referring to two dialysis wards affiliated to Yasuj University of Medical Sciences, Yasuj Iran have included in this randomized clinical trial from November 2015 to April 2016. The eligible patients undergoing hemodialysis were selected as convenience sampling method but randomly assigned to one of the three groups of warm water footbath (n = 24), effleurage (n = 23) and petrissage (n = 23). The interventions have been performed for 15 min over 2 months. Pittsburgh Sleep Quality Index and Insomnia Severity Index was used to collect data.
Statistical Analysis Used: Collected data were analyzed using SPSS, version 21, which involved running statistical tests including repeated measures ANOVA. P < 0.05 was considered to be a statistical significant difference.
Results: Twenty six men (41.9%) and 36 women (58.1%) completed this study (mean age: 51.01+/-13.91). Mean global sleep quality was reported for patients in the group of warm-water footbath (14.1 ± 1.8; 7.15 ± 2.1and 5.37 ± 2.4), effleurage (13.2 ± 1.7; 8.1 ± 2.8 and 5.82 ± 2.7), and petrissage (14.1 ± 1.9; 9.18 ± 2.4 and 6.4 ± 2.8) on the baseline, the end of the 1st and the 2nd month of interventions, respectively. Mean scores of insomnia severity for patients in the group of warm-water footbath (21.38 ± 3.6; 11.95 ± 3.2 and 9.48 ± 3.4), effleurage (19.65 ± 3.1; 12.5 ± 3.67 and 9.1 ± 4.7), and petrissage (21.05 ± 3.68; 13.81 ± 3.1 and 10.6 ± 3.6) was observed. No statistical significant (P > 0.05) differences were observed by sleep quality and insomnia severity among three groups.
Conclusion: Warm-water foot bath is as effective as Swedish massages for improving sleep quality and insomnia severity in patients undergoing hemodialysis. Further investigations are suggested to determine whether the same findings are replicated.
Keywords: Hemodialysis, Insomnia, Massage, Sleep quality, Baths
|How to cite this article:|
Afrasiabifar A, Hamzhiekia S, Mosavi A, Mohammad Hossini S. The effect of warm water footbath versus Swedish massages on hemodialysis patients' sleep quality and insomnia. J Nurs Midwifery Sci 2022;9:81-9
|How to cite this URL:|
Afrasiabifar A, Hamzhiekia S, Mosavi A, Mohammad Hossini S. The effect of warm water footbath versus Swedish massages on hemodialysis patients' sleep quality and insomnia. J Nurs Midwifery Sci [serial online] 2022 [cited 2022 Jun 25];9:81-9. Available from: https://www.jnmsjournal.org/text.asp?2022/9/2/81/347146
| Introduction|| |
Despite the medical benefits associated with hemodialysis, patients undergoing hemodialysis suffer from sleep problems including deficits in quantity and quality of sleep. Available research evidence shows that patients undergoing hemodialysis experience poor sleep quality, and insomnia. Poor sleep quality in patients undergoing hemodialysis has been variously found to be 60.6%, 67%, and 76.1%. In addition, compared with the general population, lower sleep quality has been reported.,
Even if there is no unanimous consensus on the definition of sleep quality, the National Sleep Foundation recently released the key indicators of good sleep quality such as sleep duration while in bed (i.e., at least 85% of the total time), falling asleep in 30 min or less, waking up no more than once per night, and being awake for 20 min or less after initially falling asleep. Sleep disturbances can result in diminished quality of life (QOL), health-related QOL (HRQOL), cardiovascular diseases, behavioral problems, and disturbance in cognitive functioning in patients undergoing hemodialysis.
Anxiety and age, restless legs syndrome, psychiatric morbidity, sociodemographic factors, and duration of hemodialysis have also been associated with poor sleep quality in patients undergoing hemodialysis. The results of a study by Cengic et al. showed that, in comparison to other patients, younger and employed hemodialysis patients have better sleep quality. In addition, correlation was observed between sleep quality with gender, education level, place of residence, comorbidity including diabetes, and addiction to sedatives in patients undergoing hemodialysis.
Insomnia is also a common problem in patients undergoing hemodialysis. Insomnia includes trouble falling asleep, staying asleep, or waking too early, which could result in daytime impairment. Patients undergoing hemodialysis have reported problems such as staying up overnight (90%), difficulty falling asleep (60%), and daily drowsiness (60%). Insomnia can have adverse effects on the body systems and functions, including mental function, psychological health, and survival of patients undergoing hemodialysis.
Early diagnosis of sleep disorders and proper interventions could improve QOL in patients undergoing hemodialysis. However, based on the research evidence gleaned so far, sleep disorders in patients undergoing hemodialysis still persist. Even if pharmacological therapy has been effective in improving sleep quality, nevertheless, hemodialysis patients' kidneys are unable to excrete drug metabolites and thus waste them. Therefore, they are prone to kidney toxicity or general side effects. For example, long-term use of benzodiazepines may lead to dependency, withdrawal, and emotional changes. Moreover, some nonpharmacological interventions have also produced promising results. For example, for improving sleep quality in patients undergoing hemodialysis, cognitive-behavioral therapy and Auricular Acupressure have turned out to be somewhat effective.
One of the nonpharmacological therapy interventions for improving sleep quality is massage therapy. World Health Organization has dubbed massage “green medicine,” which is due to its remarkable effectiveness, affordability, and nontoxic side effects. As one of the most common massages, Swedish massage includes effleurage, petrissage, tapotement, and vibration techniques. The benefits of massage therapy have been reported by literatures. For example, the effectiveness of the intradialytic massage therapy in the improvement of leg cramps and reflexology in alleviating fatigue, pain, and cramps in patients undergoing hemodialysis have been reported. Khojandi et al. concluded that reflexology massage and stretching exercises can reduce restless leg syndrome severity in patients undergoing hemodialysis.
Warm-water foot bath is also a noninvasive intervention. In addition to neurological and psychological effects, it can induce a sense of comfort and relaxation in patients. Fatigue Relief and arteriovenous puncture-related pain have been reported following warm-water foot bath in patients undergoing hemodialysis. Uchiyama Tanaka investigated the effects of thermal therapy on plasma brain natriuretic peptide (BNP) level in patients undergoing hemodialysis using hot water bottles. He concluded that this therapy could reduce plasma BNP level and improve patients' symptoms and their ability to perform daily activities. The result of a study by Ren et al. showed that herb foot bath therapy can effectively improve the sleep quality of patients undergoing hemodialysis and their symptoms.
Assessing sleep-related problems of patients undergoing hemodialysis is an important part of nephrology nurses' responsibility. They can do many interventions to improve the sleep quality of patients undergoing hemodialysis. If not remedied, poor sleep quality could bring about negative effects on QOL and HRQOL of patients undergoing hemodialysis. Review literatures showed that many studies were performed in order to improve sleep quality in patients undergoing hemodialysis; however, few comparative studies have been performed to compare the effects of nonpharmacological interventions on sleep disturbances in patients undergoing hemodialysis. Therefore, this study aimed to determine the effect of warm-water footbath versus Swedish massage on sleep quality and insomnia severity of patients undergoing hemodialysis.
| Materials and Methods|| |
Design and participants
This study is a randomized clinical trial. A total of ninety four patients undergoing hemodialysis referring to two dialysis wards affiliated to Yasuj University of Medical Sciences, Yasuj, Iran were assessed for eligibility criteria from November 2015 to April 2016. Out of these, seventy patients met the eligibility criteria and were included in the study. The eligible patients were selected using convenience sampling method. Then, they were randomly assigned to one of the three groups of warm water foot bath or A group (n = 24), effleurage or B group (n = 23), and petrissage or C group (n = 23) massage, using randomized blocked allocation method. Because there were three groups in this study, we created six blocks, namely, ABC, ACB, BAC, BCA, CAB, and CBA based on the factorial rule (3! =3 × 2× 1 = 6). There were three participants in each block. However, their arrangement varied. We selected blocks from these six blocks using replacement random sampling. Eight patients were later dropped out because of kidney transplantation (n = 2), death (n = 1), emigration (n = 2), and personal decision to withdraw from the study (n = 3). Finally, sixty two patients undergoing hemodialysis completed this study [Figure 1].
Inclusion and exclusion criteria
The inclusion criteria included age range of 18–75 years, underwent hemodialysis for at least 6 months, score of sleep quality ≥5 as poor quality sleep, moderate or severe level of insomnia severity, ability to get sitting, supine and prone positions to perform interventions, not having medications for sleep disorders, lack of lower extremity amputation or skin lesions such as redness, and lack of wound in the area of back, neck and feet. Unwillingness to participate in the study, lack of inclusion criteria, and low scores of sleep quality were considered as exclusion criteria.
The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were used to measure sleep quality and insomnia severity, respectively. The PSQI assesses sleep quality over the preceding month. It consists of 18 self-rated questions and five items which are independently rated by a partner or a roommate. Only self-rated questions are included in the scoring and are used to generate the seven subscales: Subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, and sleep disturbances, use of sleep medications and daytime dysfunction. Subscales scores range from 0 to 3 (0 = very good; 1 = fairly good; 2 = fairly bad, and 3 = very bad or poor sleep quality. According to the instruction of the PSQI, global scores of the PSQI range from 0 to 21. Based on this range, a global score of 5 or greater indicates poor sleep quality. The validity and reliability of the Persian version of this index have been established. For the purposes of the current study, the reliability of the index was determined using test the test–retest method, which turned out to be r = 0.86.
The ISI is a self-report tool to measure patients' insomnia severity in nighttime sleep over the previous 2 weeks. This index assesses seven items: Difficulty falling asleep, difficulty staying asleep, problem waking up too early, satisfaction with the current sleep pattern, interference with daily functioning, impairing the QOL, and being worried about the current sleep problem, based on a 5-point Likert scale (0 = never and 4 = very high). According to the instruction of the ISI, the global score ranges from 0 to 28. The global score of the ISI is also classified as no clinically significant insomnia (0–7), sub-threshold insomnia (8–14), moderate severity or clinical insomnia (15–21), and severe insomnia (22–28). The validity and reliability of the Persian version of the ISI measure have already been determined. For the purposes of the present study, the reliability of the measure was established using the test–retest method of determining reliability, which was found to be r = 0.94
Interventions were performed two times a week over a period of 2 weeks in the dialysis wards before starting dialysis and then continued for 2 months at home. In the 1st week, the interventions were carried out by the second and third authors of the article. In the 2nd week, patients' caregivers were also trained to conduct the interventions. All the interventions continued at home an hour before the patients went to sleep every night over a period of 2 months. The patients' fidelity to the interventions was assessed in a number of ways by the second researcher. At times, in the dialysis units, the patients were specifically asked to provide details about the interventions. Sometimes, as a follow-up, the researcher called the patients and asked them to provide details about the interventions. As a last resort, the patients were asked to complete a self-report form about the interventions. Patients in each group were also provided with a pamphlet detailing how interventions should be performed in that particular group.
Warm water footbath was performed according to the relevant guidelines. A container with dimensions of 45 cm × 27 cm × 40 cm filled with warm water with a temperature of 42°C–43°C and a depth of 10 cm was provided. First, the patient was instructed to sit on a chair, and then put his/her feet in the container for 15 min. The water temperature was controlled through a thermometer. In case of a drop in temperature, warm water was added to maintain the temperature between 42°C and 43°C. Upon the completion of the intervention, the patient was instructed to dry his/her feet using a towel and go to bed.
A massage therapist provided training in Swedish massage for a male nurse (the third author of article) who did the interventions for the male patients and the second author of article (female nurse) for the female patients. The trained nurses subsequently performed the massage techniques based on the suggested protocol. Effleurage massage was performed in a comfortable prone position so that no pressure was applied on the shunt or fistula. After baring the patient's back and lumbar, the masseur placed the palms of both hands on the patient's back (i.e., starting point) and moved them slowly towards the lumbar, shoulders, and neck (i.e., end point), while his/her fingers were moving toward the shoulder and returning from the shoulder to the back. The masseur's palm and fingers were in touch with the patient's body so that the patient could feel a continuous and smooth movement. Hand pressure during the massage of the back (i.e., starting point) toward the shoulder and the neck area (i.e., end point) was slightly higher. However, when returning to the starting point, the massage involved less pressure. The movement was repeated 15–20 times over a period of 15 min based on the suggested protocol.
Petrissage massage – including a set of the muscular grabbing and squeezing actions – was conducted by the masseur. After the patient was placed in a sitting or prone position, his/her shoulder and neck were bared. In the first movement (i.e., the grabbing action), the palms of the masseur's hands were placed on the patient's shoulder and neck so that the thumb and other fingers formed the letter C. This was done to allow the muscles (not the skin) of these areas to be easily separated from the bone and to be slowly pushed or grabbed. In the second movement, i.e., squeezing or grabbing together with rotation, in addition to grabbing, the muscles of the shoulder, neck, and lumbar areas were rotated all the time toward the opposite side of the thumb and were rotated inward or outward. In other words, the thumb squeezed the muscles towards other fingers and vice versa. The frequencies of movements were 15–20 times over a period of 15 min according to the respective guidelines.
The data were collected at three times as baseline or prior to the interventions, the end of the 1st month and the 2nd month of the interventions. The collected data were analyzed, using SPSS version 21 (IBM SPSS Statistics v21 x86/x64). P < 0.05 was considered to be significant for the statistical analyses. Before the analysis of the dependent variables including sleep quality and insomnia severity, it was necessary to examine their distribution. The results of the normality test were indicative of normal distribution. Repeated measures analysis of variance (ANOVA) was run to compare mean scores.). Since the assumption of compound symmetry or Mauchly 's test of Sphericity was not met, the results of Epsilon Correction (Greenhouse-Geisser) were reported. It should be noted that data collectors and data analysts were blind to the assignment of the patients to different groups.
The purpose of the study was first explained to the patients by one of the researchers, and subsequently written informed consent was obtained from those who expressed their willingness to participate in the study. Detailed information about the principles of voluntariness to participate in this study and confidentiality of the information obtained was also communicated. The interventions were carried out in a quiet and suitable room. The study was registered on the site of the Iranian Registry Clinical Trials (IRCT) with registration number: IRCT2015031021425N1 and was approved by the Research Ethics Committee of Yasuj University of Medical Sciences.
| Results|| |
Sixty and two patients undergoing hemodialysis with a mean of age 51.01 ± 13.91 years old (range; 26–75) completed the interventions. Twenty and six (41.9%) patients were male and 36 patients (58.1%) were female. Mean values for the duration of ESRD diagnosis, hemodialysis therapy, and numbers of hemodialysis sessions per week were 47.16 ± 41.38 months (range: 7–180), 32.51 ± 27.24 months (range: 6–144), and 2.43 ± 0.59 times (range: 1–3), respectively.
Mean scores of global sleep quality were reported for patients in the group of warm-water footbath 14.1 ± 1.8; 7.15 ± 2.1 and 5.37 ± 2.4 at the times of baseline, the end of the 1st month and the 2nd month of interventions, respectively. These values for patients in the group of effleurage were 13.2 ± 1.7, 8.1 ± 2.8, and 5.82 ± 2.7 and for patients in the group of petrissage were 14.1 ± 1.9, 9.18 ± 2.4, and 6.4 ± 2.8, respectively [Figure 2].
The same results were found for insomnia severity. Mean scores of insomnia severity at baseline time was 21.38 ± 3.6 for warm water foot bath, 19.65 ± 3.1 for effleurage massage and 21.05 ± 3.68 for petrissage massage. These values for the three groups at the end of the second month of interventions were 9.48 ± 3.4, 9.1 ± 4.7, and 10.6 ± 3.6, respectively [Figure 3].
Between-group comparison using repeated measures ANOVA indicated that the three groups did not significantly differ from each other in terms of global sleep quality (P = 0.37), subscales of sleep quality (P > 0.05), and insomnia severity (P = 0.32) [Table 1]. Within-group comparisons also showed that the patients in the three groups significantly (P < 0.05) scored better sleep quality and lower insomnia severity at the end of the 1st month and the 2nd month of the interventions, compared to the time of baseline [Table 2].
|Table 1: Between-group comparison for mean scores of sleep quality subscales|
Click here to view
|Table 2: Within-group comparison of mean differences of sleep quality subscales|
Click here to view
| Discussion|| |
This study compared the effect of warm water footbath versus Swedish massage on sleep quality and insomnia severity of patients undergoing hemodialysis. The results showed that warm water footbath, effleurage, and petrissage massages could improve sleep quality of patients undergoing hemodialysis and diminish their insomnia severity. In other words, similar changes were observed following the three interventions. This means that warm water footbath is as helpful as effleurage and petrissage massages.
Effectiveness of warm water footbath has been the subject of considerable controversy. Improved sleep latency and sleep duration following warm water footbath, has already been reported, which is consistent with the findings of the current study. On the other hand, in some studies, no positive changes were observed for sleep quality following warm water footbath. This controversy may be attributed to the fact that in such studies, the adopted methodology such as the study population, sample size, measures, time, and duration of interventions were different from those in the current study.
To explain improved sleep quality and reduced insomnia following warm water footbath, it can be said that the use of an external source such as warm water footbath could increase local skin temperature and induce a psychological sense of comfort, help patients undergoing hemodialysis to fall asleep and stay asleep, and finally lead to improved sleep quality.
The findings of the present study are also in line with reported sleep quality following effleurage and petrissage massages in both nonhemodialysis and patients undergoing hemodialysis. For example, the benefits of massage therapy for sleep quality of patients with cardiac surgery and fibromyalgia have been reported. A similar study has also reported improvement in sleep quality in patients undergoing hemodialysis after massage therapy. A study by Unal et al. reported improved sleep quality and reduced fatigue in patients undergoing hemodialysis following foot reflexology and back massage therapy. Improved sleep quality following the vibration and massage therapy and hot stone massage therapy have also been observed. The benefits of massage therapy are attributed to biochemical and physiological effects such as increasing local blood flow, skin, and muscle temperature, neurological effects such as increasing pain threshold as well as psychological effects such as improving mood status.
Although all three interventions statistically improved the quality of sleep and reduced the severity of insomnia and there was no significant difference among patients who received warm water footbath and those who received Swedish massages, however, the observed effect sizes of our study indicate the fact that it is difficult to make a clinical judgment due to low sample size as a main limitation which will be mentioned later. Therefore, further studies with more samples are required to make a better clinical judgment in this area. If future studies confirm that warm water foot bath will be as helpful as massage therapy, it can be said that the use of warm water footbath is more convenient for patients undergoing hemodialysis than Swedish massages. Patients undergoing hemodialysis may unable to receive massage therapy due to physical conditions such as arteriovenous shunt, fistula, and Shaldon catheter. Furthermore, warm water foot bath does not require special equipment or professional training compared with massage therapy. These patients are able to do warm water footbath either alone or with the support of their caregivers in their homes when they are trained by nurses of hemodialysis ward.
The present study is one of the very few studies which have been compared the effects of warm-water foot bath with Swedish massage on the sleep quality of patients undergoing hemodialysis. Randomized allocation and relative prolonged intervention could be cited as its strengths. Nonetheless, there are some limitations which should be kept in mind when it comes to generalizing the findings. First, the sample size of the present study was relatively small, which was due to the fact that it was impossible to select more patients undergoing hemodialysis due to the limited population. Therefore, more large-scale studies with patients undergoing hemodialysis or nonhemodialysis are recommended to make more informed clinical judgments.
As a second limitation, for practical reasons, it was not possible for the researchers to directly observe the interventions at home settings. In addition, even if hemodialysis patient's fidelity to the implementation of the specified intervention in their homes was checked through various means, the interventions were not carried out according to the plan all the time, and minor deviations from the plan are conceivable. Therefore, replication of the study under more controlled conditions is recommended.
Finally, sleep quality is a subjective concept, which makes its evaluation difficult. We used the PSQI to evaluate sleep quality and the ISI to assess insomnia severity. Although these tools are valid and reliable, they involve self-reporting and patient s' mental and cognitive status may affect their responses to the items. Even if we were aware of this shortcoming, it was not possible for us to use physiological or objective instruments such as Polysomnography and Actigraphy or ambulatory monitoring to better clinical judgment, which was due to the high costs associated with the latter instruments. Therefore, more studies are required to evaluate the clinical effectiveness of the abovementioned interventions using both objective and subjective measures.
| Conclusion|| |
Warm-water foot bath was as effective as Swedish massage including effleurage and petrissage massage to improve sleep quality and insomnia severity of patients undergoing hemodialysis. These findings may be opened a new avenue for further investigations to determine whether the same findings are replicated. This means that we need to examine the effectiveness of alternative therapies, as the comparative studies on the effectiveness of drugs are conducted. If the results of this study are confirmed by future researches, warm water footbath can be suggested to patients undergoing hemodialysis as a simple method to improve their sleep quality. In this case, nurses will be able to sharing with hemodialysis patients who to alternative choices to improve sleep quality or the patients who are unable to take chemical drugs or are allergic to them.
Conflicts of interest
There are no conflicts of interest.
Ardashir Afrasiabifar (1 author), methodologist, statistical analyst and supervisor of the research process, (35%), Shekoofeh Hamzhiekia (2 author), senior researcher, data collection, introduction, discussion of the manuscript (35%), Asadolah Mosavi, (3 author) assistant researcher, introduction, discussion of the manuscript (15%), Sima Mohammad Hossini (4 author), assistant researcher, introduction, discussion of the manuscript (15%).
Financial support and sponsorship
This article is the result of the master thesis of the second author of the article and is supported by the Vice Chancellor for Research of Yasuj University of Medical Sciences.
We sincerely thank all the HD patients and their families, the HD nurses employed in Shahid Beheshti Hospital in Yasuj and Shahid Rajaee Hospital in Gachsaran who helped us to conduct this study. We also appreciate the support provided by the Research Deputy of YUMS. The authors also gratefully acknowledge the contribution of Ali Kazemi, PhD, to the meticulous language editing of the manuscript.
| References|| |
Emine DI. Common sleep disorders and risk factors in hemodialysis patients. Asian Pac J Trop Med 2018;5:189-94.
Trbojević-Stanković J, Stojimirović B, Bukumirić Z, Hadzibulić E, Andrić B, Djordjević V, et al.
Depression and quality of sleep in maintenance hemodialysis patients. Srp Arh Celok Lek 2014;142:437-43.
Parvan K, Lakdizaji S, Roshangar F, Mostofi M. Quality of sleep and its relationship to quality of life in hemodialysis patients. J Caring Sci 2013;2:295-304.
Tomita T, Yasui-Furukori N, Oka M, Shimizu T, Nagashima A, Mitsuhashi K, et al.
Insomnia in patients on hemodialysis for a short versus long duration. Neuropsychiatr Dis Treat 2016;12:2293-8.
Einollahi B, Motalebi M, Rostami Z, Nemati E, Salesi M. Sleep quality among Iranian hemodialysis patients: A multicenter study. Nephrourol Mon 2015;7:e23849.
Menon V, Alla P, Madhuri S, Sanathan S, Shetty M, Ram D. Sleep quality in end-stage renal disease patients on maintenance hemodialysis: A six month prospective survey. Int J Pharm Sci Res 2015;6:660-8.
Danielle FM, Mahamat M, Francois KF, Marie-Patrice H, Gloria A. Sleep quality on maintenance hemodialysis patients in Douala general hospital in Cameroon. Open J Nephrol 2017;7:61-8.
Masoumi M, Naini AE, Aghaghazvini R, Amra B, Gholamrezaei A. Sleep quality in patients on maintenance hemodialysis and peritoneal dialysis. Int J Prev Med 2013;4:165-72.
Turkmen K, Erdur FM, Guney I, Gaipov A, Turgut F, Altintepe L, et al.
Sleep quality, depression, and quality of life in elderly hemodialysis patients. Int J Nephrol Renovasc Dis 2012;5:135-42.
Ohayon M, Wickwire EM, Hirshkowitz M, Albert SM, Avidan A, Daly FJ, et al.
National sleep foundation's sleep quality recommendations: First report. Sleep Health 2017;3:6-19.
Reynaga-Ornelas L, Baldwin CM, Arcoleo K, Quan SF. Impact of sleep and dialysis mode on quality of life in a Mexican population. Southwest J Pulm Crit Care 2019;18:122-34.
Dai H, Mei Z, An A, Wu J. Association between sleep problems and health-related quality of life in Canadian adults with chronic diseases. Sleep Med 2019;61:26-30.
Matsuda R, Kohno T, Kohsaka S, Fukuoka R, Maekawa Y, Sano M, et al.
The prevalence of poor sleep quality and its association with depression and anxiety scores in patients admitted for cardiovascular disease: A cross-sectional designed study. Int J Cardiol 2017;228:977-82.
Chen HY, Cheng IC, Pan YJ, Chiu YL, Hsu SP, Pai MF, et al.
Cognitive-behavioral therapy for sleep disturbance decreases inflammatory cytokines and oxidative stress in hemodialysis patients. Kidney Int 2011;80:415-22.
Kusuma H, Ropyanto CB, Widyaningsih S, Sujianto U. Relating factors of insomnia among haemodialysis patients. Nurse Media J Nurs 2018;8:44-57.
Rohani M, Aghaei M, Jenabi A, Yazdanfar S, Mousavi D, Miri S. Restless legs syndrome in hemodialysis patients in Iran. Neurol Sci 2015;36:723-7.
Zubair UB, Butt B. Assessment of quality of sleep and its relationship with psychiatric morbidity and socio-demographic factors in the patients of chronic renal disease undergoing hemodialysis. J Coll Physicians Surg Pak 2017;27:427-31.
Lufiyani I, Zahra AN, Yona S. Factors related to insomnia among end-stage renal disease patients on hemodialysis in Jakarta, Indonesia. Enferm Clin 2019;29:331-5.
Cengić B, Resić H, Spasovski G, Avdić E, Alajbegović A. Quality of sleep in patients undergoing hemodialysis. Int Urol Nephrol 2012;44:557-67.
Norozi Firoz M, Shafipour V, Jafari H, Hosseini SH, Yazdani-Charati J. Relationship of hemodialysis shift with sleep quality and depression in hemodialysis patients. Clin Nurs Res 2019;28:356-73.
Thorpy M. International classification of sleep disorders. In: Chokroverty S, editor. Sleep Disorders Medicine: Basic Science, Technical Considerations and Clinical Aspects. New York: Springer; 2017. p. 475-84.
Hamzi MA, Hassani K, Asseraji M, El Kabbaj D. Insomnia in hemodialysis patients: A multicenter study from Morocco. Saudi J Kidney Dis Transpl 2017;28:1112-8.
] [Full text]
Lin YF, Liu ZD, Ma W, Shen WD. Hazards of insomnia and the effects of acupuncture treatment on insomnia. J Integr Med 2016;14:174-86.
Orasan OH, Muresan F, Mot A, Sitar Taut A, Minciuna I, Coste SC, et al.
Hemodialysis patients with pruritus and insomnia have increased risk of death. Blood Purif 2020;49:419-25.
Gencdal IY. Subjective sleep quality and excessive daytime sleepiness in hemodialysis patients waitlisted for renal transplant. Cogn Behav Neurol 2019;32:25-30.
Dashti-Khavidaki S, Chamani N, Khalili H, Hajhossein Talasaz A, Ahmadi F, Lessan-Pezeshki M, et al.
Comparing effects of clonazepam and zolpidem on sleep quality of patients on maintenance hemodialysis. Iran J Kidney Dis 2011;5:404-9.
Kennedy KM, O'Riordan J. Prescribing benzodiazepines in general practice. Br J Gen Pract 2019;69:152-3.
Vyas UK. Non-pharmacological management of insomnia. Br J Med Pract 2013;6:6-10.
Wu Y, Zou C, Liu X, Wu X, Lin Q. Auricular acupressure helps improve sleep quality for severe insomnia in maintenance hemodialysis patients: A pilot study. J Altern Complement Med 2014;20:356-63.
Zhong H, Wang C, Wan Z, Lei J. The possible mechanisms of massage therapy. Biomed Res 2019;30:1-6.
Atchison JW, Tolchin RB, Ross BS, Eubanks JE. 16 – Manipulation, traction, and massage. In: Cifu DX, editor. Braddom's Physical Medicine and Rehabilitation. 6th
ed. Philadelphia: Elsevier; 2021. p. 316-37.e7.
Mastnardo D, Lewis JM, Hall K, Sullivan CM, Cain K, Theurer J, et al.
Intradialytic massage for leg cramps among hemodialysis patients: A pilot randomized controlled trial. Int J Ther Massage Bodywork 2016;9:3-8.
Ozdemir G, Ovayolu N, Ovayolu O. The effect of reflexology applied on haemodialysis patients with fatigue, pain and cramps. Int J Nurs Pract 2013;19:265-73.
Khojandi S, Shahgholian N, Karimian J, Valiani M. Comparison the effect of two methods of reflexology massage and stretching exercises on the severity of restless leg syndrome among patients undergoing hemodialysis. Int J Nurs Res 2015;10:86-94.
Kim BS, Chae SH, Hwang IC. The effects of aroma foot baths on stress and sleep in terminal cancer patients. J Hosp Palliat Care 2021;24:109-15.
Abdelaziz S. Effect of warm water foot bath on fatigue in patients undergoing hemodialysis. Int J Nurs Didact 2018;08:26-32.
Azimian J, Abbas Ali Madadi Z, Falahatpisheh F, Alipour Heidari M. Effect of warm footbath on arteriovenous fistula puncture-related pain in dialysis patients. J Inflamm Dis 2015;18:39-45.
Uchiyama-Tanaka Y. Effect of thermal therapy using hot water bottles on brain natriuretic peptide in chronic hemodialysis patients. Cardiol Ther 2012;1:2.
Ren L, Li J, Zhang X, Wang J, Liu W, Chen J, et al.
Herb foot-bath has improving effects on sleep quality and symptom distress of maintenance hemodialysis patients. Biomed Res (Aligarh) 2017;28:9749-55.
Farrahi Moghaddam J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh sleep quality index (PSQI-P). Sleep Breath 2012;16:79-82.
Chehri A, Goldaste N, Ahmadi S, Khazaie H, Jalali A. Psychometric properties of insomnia severity index in Iranian adolescents. Sleep Sci 2021;14:101-6.
Yazdi Z, Sadeghniiat-Haghighi K, Zohal MA, Elmizadeh K. Validity and reliability of the Iranian version of the insomnia severity index. Malays J Med Sci 2012;19:31-6.
Seyyedrasooli A, Valizadeh L, Zamanzadeh V, Nasiri K, Kalantri H. The effect of footbath on sleep quality of the elderly: A blinded randomized clinical trial. J Caring Sci 2013;2:305-11.
Lindquist R, Tracy MF, Snyder M. Complementary & Alternative Therapies in Nursing. New York: Springer Publishing Company; 2018.
Shafeik HF, Abdelaziz SH, ElSharkawy SI. Effect of warm water foot bath on fatigue in patients undergoing hemodialysis. Int J Nurs Educ 2018;8:26-32.
Liao WC, Wang L, Kuo CP, Lo C, Chiu MJ, Ting H. Effect of a warm footbath before bedtime on body temperature and sleep in older adults with good and poor sleep: An experimental crossover trial. Int J Nurs Stud 2013;50:1607-16.
Yaghoubi A, Golfeshan E, Azarfarin R, Nazari A, Alizadehasl A, Ehasni A. Effects of acupressure on sleep quality after coronary artery bypass surgery. Iran Heart J 2017;18:28-34.
Ughreja RA, Venkatesan P, Balebail Gopalakrishna D, Singh YP. Effectiveness of myofascial release on pain, sleep, and quality of life in patients with fibromyalgia syndrome: A systematic review. Complement Ther Clin Pract 2021;45:101477.
Malekshahi F, Aryamanesh F, Fallahi S. The effects of massage therapy on sleep quality of patients with end-stage renal disease undergoing hemodialysis. Sleep Hypn 2018;20:91-5.
Unal KS, Balci Akpinar R. The effect of foot reflexology and back massage on hemodialysis patients' fatigue and sleep quality. Complement Ther Clin Pract 2016;24:139-44.
Azimpour S, Hosseini HS, Eftekhari A, Kazemi M. The effects of vibration and massage on severity of symptoms of restless leg syndrome and sleep quality in hemodialysis patients; a randomized cross-over clinical trial. J Ren Inj Prev 2019;8:106-11.
Ghavami H, Shamsi SA, Abdollahpoor B, Radfar M, Khalkhali HR. Impact of hot stone massage therapy on sleep quality in patients on maintenance hemodialysis: A randomized controlled trial. J Res Med Sci 2019;24:71.
] [Full text]
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]