Volume 23, Issue 6 (Feb - Mar 2020)                   2020, 23(6): 514-525 | Back to browse issues page

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Azimian J, Yekeh Fallah L, Oveysi S, Nazifi F. The Effect of Warm Foot Bath on the Consciousness Level of Patients With Head Trauma. Journal of Inflammatory Diseases. 2020; 23 (6) :514-525
URL: http://journal.qums.ac.ir/article-1-2656-en.html
1- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.
2- Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
3- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran. , fateme.nazifi@gmail.com
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Extended Abstract
1. Introduction

Head trauma is one of the major problems in the world. The annual incidence of head trauma in Tehran is estimated 144 per 100,000 people [1]. According to the World Health Organization, head trauma will be one of the leading causes of death and disability by 2020 [2]. One of the most important consequences of head trauma is the change in consciousness level, which can lead to coma and, as a result, several complications [6]. Sensory deprivation is one of the side effects that threatens patients in intensive care units by reducing the consciousness level [8]. Since sensory stimulation is one of the basic human needs [2], in order to facilitate the recovery process and prevent sensory deprivation after a brain injury, an early sensory stimulation program can be useful [9]. This study aimed to examine the effect of warm foot bath on the consciousness level of patients with head trauma.
2. Materials and Methods
This is a clinical trial using control group conducted on 50 patients with head trauma having glasgow coma scale (GCS) score of 5-12 admitted to the intensive care unit of Shahid Rajaee Hospital in Qazvin, Iran from June to December 2017. They were selected using a convenience sampling method and randomly assigned into two groups of intervention (n=25) and control (n=25). First, the demographic and clinical characteristics and the GCS score of patients were recorded. Then, the control group received routine care, while the intervention group, in addition to routine care, received warm foot bath from the ankle to the toes for 7 days, once a day between 4-6 PM for 15 minutes using a foot spa massager (EmsiG FW328, China). Their GCS was recorded again one hour and three hours after the intervention. Data were analyzed in SPSS v. 22 using repeated measures ANOVA, chi-square, t-test, and descriptive statistics (Mean±SD). The significance level was set as P<0.05.
3. Results
The mean age of the patients was 38.96±13.52 years in the intervention group and 38.56±14.47 years in the control group. Of 50 patients, 76% were male and 24% were female in both groups. The causes of head injuries were car accident (76% in the intervention group and 68% in the control group), falling (20% in both groups) and motorcycle accident (4 and 12%) (Table 1). The mean level of patients› consciousness at the beginning of the study (first day of the study) was 8.28±1.83 in the intervention group and 7.72±1.94 in the control, but it was not statistically significant based on t-test results (P=0.254). Three hours after the intervention (7th day of the study), it became 9.32±1.86 in the intervention group and 8.44±2.48 in the control group, which was significantly different (P=0.005).

4. Discussion
The results of this study showed that although the mean GCS score of the patients in the two groups was not significantly different on the first day of the study, but on the seventh day, the mean GCS score in the intervention group was higher than in the control group. Mandeep (2012) using early intervention of coma arousal therapy in traumatic head injury patients, also examined for changes in the levels of consciousness in the intervention group on the first to 14th day, which had an increasing trend and there was a significant difference between the results on first, 7th and 14th days. This is consistent with our results. In our study, the increase in GCS score of the intervention group showed a significant difference from one hour after the intervention to the third day (the end of study). Hosseinzadeh et al. [6] also reported a significant increase in the level of consciousness of the patients from the third day of the study compared to the controls, but in the study by Oh and Seo [30], patients had significant changes in their level of consciousness 2 weeks after the sensory stimulation. In their study, the intervention was performed for 5 days a week, while in the present study, the intervention was conducted for 7 consecutive days. The reason for this difference may be due to the continuous form and interruption of the intervention.
Overall, it was concluded that, by sensory stimulation programs such as a warm foot bath, we can help increase traumatic head injury patients’ level of consciousness and reduce its complications. Proper sensory stimulation increases consciousness and can improve the prognosis of the disease. Therefore, the use of complementary therapies such as warm foot baths is recommended as a common clinical method.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Qazvin University of Medical Sciences (Code: IR.QUMS.REC.1396.26). It is a registered clinical trial (Code: IRCT20180731040658N1). Prior to study, permissions were obtained from the Qazvin University of Medical Sciences and the study objectives and methods were explained to the patient companions and their informed consent was obtained. They were assured of the confidentiality of their information. 

This article is taken from the Ms. thesis of  Fatemeh Nazifi  from Faculty of Nursing and Midwifery, Special Care, Qazvin University of Medical Sciences.
Authors' contributions
Conceptualization, design, methodology, review, supervision and project administration: Jalil Azimian and Leili Yeke Fallah; Editing and review: Leili Yeke Fallah and Fatemeh Nazifi; Data analysis: Sonia Oveysi; Writing, data collection, intervention, funding acquisition: Fatemeh Nazifi.
Conflicts of interest
The authors declared no conflict of interest.
We would like to express our gratitude to the Vice-Chancellor for Research of Qazvin University of Medical Sciences, officials, professors of the Faculty of Nursing and Midwifery of Qazvin University of Medical Sciences and the staff of Shahid Rajaei Hospital in Qazvin who helped us in this research.
Type of Study: Research | Subject: Nursing & Midwifery

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