A combination of complementary medicine and standard care shows potential to reduce preoperative anxiety levels and improve the outcome of the operation, state authors of a new report.
Science Daily September 29, 2016
A new study conducted at the University of Haifa has some complementary things to say about complementary medicine. The combination of complementary medicine with standard care for preoperative anxiety reduces anxiety levels among patients. Prof. Lital Keinan Boker, one of the researchers, notes that “…combined treatment using complementary medicine and standard care shows real potential to reduce preoperative anxiety levels and improve the outcome of the operation. Consideration should be given to offering this combination to patients who are interested in it.”
Preoperative anxiety, which may manifest itself in elevated blood pressure, rapid pulse, sugar metabolism changes, and other symptoms, is one of the most significant factors predicting mortality among postoperative cardiovascular patients. In addition, preoperative anxiety can also influence and extend the postoperative recovery period.
The current study was undertaken by Samuel Attias as part of his master’s studies in the School of Public Health at the University of Haifa, under the supervision of Prof. Lital Keinan Boker of the University of Haifa and Dr. Elad Schiff of Bnai Zion Hospital in Haifa. The researchers sought to examine whether complementary medicine practices, applied alongside conventional care, could help reduce anxiety levels.
The study examined 360 patients over the age of 16 about to undergo elective or acute surgery in the general surgery ward. The patients were divided into three groups. The first group received standard care for preoperative anxiety, including anti-anxiety drugs according to the anesthesiologist’s instructions 120-160 minutes before entering the surgical waiting room.
The second group received standard care as well as complementary medical care, including one of the following therapeutic means: acupuncture, reflexology, individual guided imagery, or a combination of reflexology and guided imagery.
The third group received standard care combined with generic guided imagery, provided in the form of a recording for the patient, rather than in person. The anxiety levels were measured on a scale of 1 to 10, before and after the intervention (both pre-operationally); scores of 4 and above constitute an intermediate or higher anxiety level.
Results of the study show that, in general, patients who received the combination of complementary medicine and standard care showed a reduction of 60 percent in their anxiety level, from a mean score of 5.54 to 2.32, representing a reduction from intermediate-high anxiety level to low anxiety level. By contrast, standard care alone actually caused the average anxiety level to slightly rise from 4.92 to 5.44, and 70 percent of patients in this group continued to report intermediate to high anxiety even after receiving medication.
Study findings also show that the greatest reduction in anxiety – by an average of 4.22 points – was achieved when patients received a combination of standard care together with reflexology and guided imagery. A reduction of 3.63 points was secured when patients received a combination of standard care and guided imagery; 3.52 points, when they received a combination of standard care and acupuncture; and 3.28 points, when they received a combination of standard care and reflexology.
The group of patients that received a combination of standard care and generic guided imagery, without intervention by a caregiver, showed a reduction in preoperative anxiety level from an average of 4.9 to 3.5. The researchers state that this reduction is statistically significant, but not clinically significant. They acknowledged that this method enables a broad population to receive treatment, since there is no limit to the number of patients who may be treated. However, it is logistically complex. Moreover, since this method does not include the presence of a caregiver close to the patient, it is subject to external interruptions, for example when the anesthesiologist or nurses come to perform routine preoperative tasks on the patient.
“Despite the growing popularity of complementary medicine, studies providing evidence of its therapeutic effectiveness are still lacking,” the researchers conclude. “In this study, we showed that complementary treatments are apparently helpful in the context of preoperative anxiety.”
Effectiveness of integrating individualized and generic complementary medicine treatments with standard care versus standard care alone for reducing preoperative anxiety, Attias S, Keinan Boker L, Arnon Z, Ben-Arye E, Bar’am 5, Sroka G6, Matter I, Somri M, Schiff E8. J Clin Anesth. 2016 Mar;29:54-64. doi: 10.1016/j.jclinane.2015.10.017. Epub 2016 Feb 2.