The effect of foot reflexology on pain intensity, sleep quality and bowel functions in patients undergoing appendectomy surgery

This study aimed to evaluate the effect of foot reflexology on pain intensity, sleep quality, and bowel function in patients who underwent appendectomy for appendicitis. The study population consisted of 178 patients who underwent appendectomy due to acute appendicitis. The sample of the study was determined as 120 with α=0.05, 0.60 effect size, 90% power by performing power analysis in G power 3.1.9.7 programme. In the postoperative period, the patients were divided into intervention (n=60) and control (n=60) groups by applying double block randomisation with a computer-aided program (www.randomizer.org). The study was conducted with patients who agreed to participate in the study and who had appendectomy surgery with the inclusion criteria. Data were collected using a patient identification form, the Visual Analogue Scale, the Richard Campbell Sleep Questionnaire (RSCQ), and the Bowel Function Monitoring Form. In the intervention group, the information of the patients was first recorded by means of a patient identification form. Pain intensity was evaluated just before foot reflexology was performed. Reflexology was applied to each foot of the patient for 10 minutes at the 1st hour and 3rd hour after the operation, for a total of 20 minutes. At the 1st and 3rd hours, the pain intensity of the patients was measured 5, 30, and 60 minutes after the application of each foot reflexology. 24 hours after the application, the patients' sleep quality and bowel functions within 24 hours and the time they first needed analgesics were evaluated. The control group was measured at the same period without foot reflexology. Sleep quality, bowel function within 24 hours, and the time of first analgesic requirement were evaluated in both groups after 24 hours. Number, percentage, mean, and standard deviation were used as descriptive statistical methods in the evaluation of the data. Chi-square tests analysed differences between the rates of categorical variables in independent groups. Data that were found to be normally distributed were analysed by independent groups t-test, dependent groups t-test, repeated measures ANOVA test, complementary Bonferroni test, and ANCOVA test. In the study, it was determined that pain levels tended to decrease over time after the application in the intervention group, and this situation became especially evident in the measurements after the third hour, while it increased in the control group (p<0.001). Repeated measures ANOVA results showed that pain levels changed significantly over time and that this change was due to the group effect (Fb=351.014 and 105.707; p=0.000). Bonferroni multiple comparison results also showed that pain levels decreased rapidly immediately after the application and this decrease was stronger in the intervention group (η²=0.856 intervention, η²=0.642 control). The mean total Richard Campbell Sleep Questionnaire scores of the patients in the intervention group (83.200±9.271) were found to be significantly higher than those of the control group (65.717±13.128) (t=8.426; p=0.000). There was no statistically significant difference between the groups in terms of the time of first flatulence (t=1.076; p=0.284) and time to defecation (t=2.237; p=0.064). This study showed that foot reflexology applied in the early postoperative period to patients undergoing appendectomy surgery had a positive effect on the patients' pain levels and sleep quality, but had no effect on bowel functions. Keywords: Appendectomy, bowel function, foot reflexology, nursing, pain, sleep qualİty