hkm0810sp5p32.pdf

Study Purpose

To assess the feasibility of using relaxation and patient education

Intervention Characteristics/Basic Study Process

Patients were placed in group 1 or 2 (no randomization information). Group 1 received training of progressive muscle relaxation (PMR) and guided imagery (GI) with audiotapes daily on days 0–5, then practiced daily for two months. Group 2 received two 30-minute patient/parent education sessions on day 0 and day 2 focusing on risk assessment, antiemetic use, and meal planning. All subjects completed instruments at baseline (prior to chemotherapy), then daily for seven more days. At one and two months after the intervention, anxiety, compliance with PMR and GI (group 1 only), satisfaction with care, and quality of life were assessed. Pulse and blood pressure were reported in the findings but not listed in the procedure.

Sample Characteristics

N = 40–20 historical controls
MEAN AGE = 8.6 years
AGE RANGE = 4–11 years
MALES: Not reported
FEMALES: Not reported
KEY DISEASE CHARACTERISTICS: The majority of children (n = 20) had acute lymphocytic leukemia, and 12 children had osteosarcoma. The remaining diagnoses were not reported.

Setting

SITE: Single site
SETTING TYPE: Hospital
LOCATION: Hong Kong

Phase of Care and Clinical Applications

PHASE OF CARE: Active treatment
APPLICATIONS: Pediatrics

Study Design

Clinical trial with pre and post-test design

Measurement Instruments/Methods

Morrow Assessment of Nausea and Emesis (MANE)
Chinese version of A-State scale of the State-Trait Anxiety Inventory
Play performance scale for children
Physiological indices of caloric intake and changes in body weight
Use of antiemetics
Satisfaction with care—4-point Likert-type scale from 0 (unsatisfactory) to 3 (extremely satisfactory)
Self-rating of intervention usefulness—6-point Likert-type scale from 0 (not at all useful) to 5 (extremely useful)
Health diary to record PMR and GI practice

Results

At baseline, group 1 had significantly lower anxiety than group 2 (p = 0.032). Group 1 had less vomiting on day 3 compared to the control group (p = 0.036). No significant differences of antiemetic use existed between the intervention and control groups. No significant differences existed in body weight, chemotherapy-induced nausea and vomiting (CINV), antiemetic use, quality of life, and caloric intake between groups. The health diaries indicated that the patients practiced PMR 3–4 times weekly at home with no significant changes in blood pressure or pulse. Patient and parents reported that the interventions were moderately useful.

Conclusions

This study is poorly designed, and the findings should be used cautiously. The authors reported that PMR and education can reduce CINV; however, no conclusions should be made except that further research is warranted.

Limitations

Small sample
No randomization reports
No discussion on how historical control cases were identified or what information was collected
No discussion on how the intervention was performed in younger children
No report on how blood pressure, pulse, body weight, and caloric intake were measured and recorded
Whether data were provided by the child or parent is unclear
Parents’ anxiety and satisfaction of care were discussed in the findings but not described in the procedure
No discussion of missing data

Nursing Implications

The study is of too poor a quality to provide any implications for nurses. Well-designed research in this area is needed.