Xiangfu Community Health Center, Gongshu District, Hangzhou,

Zhejiang 310011, China

CLINICAL STUDY

Therapeutic Efficacy Observation on Combining Foot Bath and Massage with Auricular Point Sticking for Community Senile Insomnia

Lai Cai-fen, Zhu Chen-xi

Xiangfu Community Health Center, Gongshu District, Hangzhou,

Zhejiang 310011, China

Author:Lai Cai-fen, attending nurse.

E-mail: wayne0622@163.com

Objective: To observe the therapeutic efficacy of combining foot bath and massage with auricular point sticking for community senile insomnia.

Methods: A total of 210 cases treated in our community health center were randomized into an observation group and a control group by their visit sequence numbers, 105 cases in each group. Cases in the observation group were treated with foot bath and massage plus auricular point sticking, whereas cases in the control group were treated with auricular point sticking alone. After four courses of treatment, the therapeutic efficacies were evaluated. In addition, the sleep quality was also assessed using the Pittsburgh sleep quality index (PSQI).

Results: The total effective rate in the observation group was 95.2%, versus 68.6% in the control group, showing a statistical significance (P＜0.05).

Conclusion: Combining foot bath and massage with auricular point sticking could obtain better effect for community senile insomnia than auricular point sticking alone.

Tuina; Massage; Auricular Point Sticking; Insomnia; Aged

Insomnia has become a global public health issue. In mild conditions, patients may have difficulty falling asleep or interrupted sleep. In severe cases, patients may stay awake throughout the night and experience dizziness, poor memory and palpitations[1]. Previous studies have shown that insomnia is very common among the aged. Long-term insomnia in the aged may cause anxiety, depression[2], dysfunctions of multiple organs and impaired immune system, further resulting in hypertension, diabetes, digestive tract diseases, Alzheimer’s disease and Parkinson’s disease. Since these can greatly affect patients’ quality of life, insomnia has become a severe health and social concern and requires more attention from the society and medical field[3-4]. Currently, sleeping pills are often prescribed for insomnia patients. Despite their positive immediate effects, sleeping pills can cause independence and side effects due to underlying diseases and decreased metabolism in the aged[5]. As a non-invasive physical therapy, auricular point sticking works for insomnia[6-7]. Considering from the disease features of the community elderly population, this study aims to investigate the effect of combining foot bath and massage with auricular point sticking for community senile insomnia and find a safe, effective and convenient nondrug intervention for insomnia among the aged.

1 Clinical Materials

1.1 Diagnostic criteria

This was made according to the internationally recognized SPIEGEL scale[8]. Six items in the scale are sleep latency, total sleep duration, night wake-ups, sleep quality, dreams and function after wake-up. Poor sleep can be concluded if the SPIEGEL score was≥9 but ＜12; and insomnia can be diagnosed if the SPIEGEL score was ≥12.

Insomnia can be categorized as mild, moderate or severe by its severity:

Mild: SPIEGEL score ≥12 but ＜18.

Moderate: SPIEGEL score ≥18 but ＜24.

Severe: SPIEGEL score ≥24.

1.2 Inclusion criteria

Those who met the above diagnostic criteria; having classic insomnia symptoms at least twice a week for six months or longer period of time; men and women aged ≥60; patients treated in Xiangfu Community Health Center, Gongshu District, Hangzhou; willing to participate in this clinical trial.

1.3 Exclusion criteria

Those who didn’t meet the above diagnostic and inclusion criteria; having systemic diseases such as surgery, pain or cough that affect sleep; having taken sleeping pills over the recent week; having mental disorders or complications of acute severe conditions such as heart failure or respiratory failure; those with a poor compliance.

1.4 General data

A total of 210 cases who met the inclusion criteria were randomized into an observation group and a control group, 105 in each group. There were no between-group statistical differences in gender, age, duration, educational background, marital status and insomnia severity (P＞0.05), indicating that the two groups were comparable (Table 1).

Table 1. Between-group comparison of general data

2 Treatment Methods

2.1 Observation group

2.1.1 Foot bath and massage

The patients were asked to receive foot bath and massage therapy in Xiangfu Community Health Center, Gongshu District, Hangzhou, after dinner.

Points: Sanyinjiao (SP 6), Zusanli (ST 36), Yongquan (KI 1), Taichong (LR 3) and Shenmai (BL 62).

Method: Conducted foot bath using the CH-2821 foot bathtub for 15-20 min at the water temperature of 38 ℃-40 ℃ until the generation of a slight warm sensation of the body. After wiping the foot dry, a trained nurse applied one-thumb pushing manipulation to above points for 5-10 min. The treatment was done successively for 5 d as one course of treatment, 4 courses in total. There was a 2-day interval between two courses.

2.1.2 Auricular point sticking

Points: Shenmen (TF4), Sympathetic (AH6), Heart (CO15), Liver (CO12), Kidney (CO10) and Subcortex (AT4).

Method: StuckWang Bu Liu Xing(Semen Vaccariae) seeds to one ear, press 30-60 s for each point every day. Exchange once every day on two ears alternately. Five days made up one course of treatment, 4 courses in total and there was a 2-day interval between two courses.

2.2 Control group

Auricular point sticking alone was employed for the patients in the control group. Both the method and courses of treatment were the same as those of the observation group.

3 Treatment Effects

3.1 Criteria for therapeutic efficacy

The criteria for therapeutic efficacy were made by referring to the therapeutic efficacy criteria for insomnia in theModified Drafts of Therapeutic Efficacy Criteria for Mental Disorders[9].

Recovery: The sleep duration restored normal or longer than 6 h, sound and refreshed sleep.

Marked effect: Substantially better sleep and the sleep duration increased by 3 h or longer.

Improvement: Despite slightly increased sleep duration, the sleep duration remained less than 3 h.

Failure: Insomnia did not improve at all.

3.2 Pittsburgh sleep quality index (PSQI)

The PSQI was employed to evaluate the sleep quality. The PSQI scale is made up of seven components, including sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Each component is scored from 0 to 3, and the global PSQI score (from 0 to 21) is made by adding the seven component scores. A higher score indicates a poorer sleep quality.

3.3 Statistical method

The SPSS 16.0 version software was employed for statistical analysis,t-test for measurement data [usingfor expression] andZ-test for numeration data (using percentage expression).P＜0.05 indicated a statistical significance.

3.4 Treatment results

3.4.1 Between-group comparison of clinical effects

As shown in Table 2, the total effective rate in the observation group was 95.2%, versus 68.6% in the control group, showing a statistical difference (P＜0.05).

Table 2. Between-group comparison of clinical effects (case)

3.4.2 Between-group comparison of PSQI before and after treatment

Before treatment, there was no between-group statistical significance in PSQI score (P＞0.05). After treatment, the PSQI score in the observation group was significantly lower than that in the control group (P＜0.05). The PSQI scores in the control group after treatment showed a statistical significant difference (P＜0.05), and that in the observation group showed a more remarkable statistical significance (P＜0.01), (Table 3).

Table 3. Between-group comparison of PSQI before and after treatment (point)

Table 3. Between-group comparison of PSQI before and after treatment (point)

Note: Compared with the intra-group result before treatment, 1) P＜0.01, 2) P＜0.05; compared with the control group after treatment, 3) P＜0.05

4 Discussion

Today, China has entered an aging society. The aging population is increasing at the pace of 3% per year. Along with this trend, the health problem about the aged has become a public concern. Among other problems, insomnia is a common disorder. In fact, insomnia has become a global public health issue among the aged. It’s of practical significance to study the effective treatment mode for senile insomnia[10-11]. Clinically, sleeping pills are often prescribed for insomnia patients. Despite their positive immediate effects, sleeping pills can cause independence and side effects due to underlying diseases and decreased metabolism in the aged[5]. According to the report by Glass J, et al, considering the hidden danger of sleeping pills, their risk outweighed the benefits for the aged[12]. Unlike medications, this study aims to investigate the effects of foot bath and massage plus auricular point sticking for senile insomnia in local communities, find a safe, effective and convenient nondrug intervention mode and thus provide theoretical foundation and reference for diagnosis and treatment of insomnia-related problems.

This study has proven that combining foot bath and massage with auricular point sticking could obtain better effect than auricular point sticking alone. In addition, both methods could improve the patients’sleep quality; however, the combined method achieved a better effect.

As a non-invasive physical therapy, auricular point sticking works for insomnia and does not cause adverse reactions[13-14]. Chinese medicine believes that ears are the gathering places for the twelve regular meridians. Stimulating ear points can therefore regulate meridians and balance yin and yang. The heart dominates the spirit and is considered as a fire organ. The kidney stores essence and is considered as a water organ. Coordination between water and fire ensures a peaceful mind. According to the five-element theory, the liver is wood and wood generates fire. As a result, tonifying the liver can help to tonify the heart. Heart (CO15), Liver (CO12), Kidney (CO10) and Subcortex (AT4) can tonify the heart and spleen and harmonize the heart and kidney[14]. Shenmen (TF4), Sympathetic (AH6), Heart (CO15), Liver (CO12), Kidney (CO10) and Subcortex (AT4) used in this study can tranquilize the mind and improve the patients’ sleep quality.

Foot bath and massage were originated in China. The documentation of foot points can be traced back to theHuang Di Nei Jing(Yellow Emperor’s Classic of Internal Medicine). According to meridian theory, points or reflex areas on the foot can manifest functions of the Zang-fu organs. Foot massage canactivate meridian qi, regulate meridians, circulate qi and blood and improve the sleep quality. Previous studies have shown[15-16]that foot bath and massage are safe, reliable and effective for insomnia. What’s more, they do not cause independence or adverse reactions. In this study, we conducted 15-20 min of foot bath and 5-10 min of massage to improve the patients’ sleep. Foot bath and massage are easy to operate and can be popularized in community healthcare centers. We believe that this safe, reliable and low-cost healthcare method can benefit senile insomnia patients in local communities.

Conflict of Interest

The authors declared that there was no potential conflict of interest in this article.

Acknowledgments

This work was supported by Zhejiang Provincial Scientific Study Fund Project of Traditional Chinese Medicine (No. 2012ZB137).

Statement of Informed Consent

All of the patients in the study signed the informed consent.

[1] Wang GL. Clinical observations on auricular point plaster therapy for insomnia. Shanghai Zhenjiu Zazhi, 2012, 31(10): 725-726.

[2] Gu J, Jiang SF, Li WC, Yang H, Gong J, Zhou J, Tao GX, Zeng H, Zhu SZ. Pharmacological and cognitive-behavior therapies for community older adults with chronic insomnia: a randomized controlled trial. Zhongguo Linchuang Yixue, 2012, 19(1): 27-30.

[3] Liu JX, Li JS. Drug analysis for insomnia in the elderly and advantage of Chinese medicine. Zhongguo Laonianxue Zazhi, 2011, 31(17): 3433-3436.

[4] Ren WW, Shao M, Ye XH, Zhou GL, Chen SL. Psychological behavior characteristics of patients with insomnia. Hangzhou Shifan Xueyuan Xuebao: Yixue Ban, 2006, 26(4): 201-202.

[5] Chen H, Yang C. Insomnia, anxiety and depression in the elderly. Zhongguo Zhongyi Jizheng, 2012, 21(2): 297-298.

[6] Wang CH, Cheng HY. Clinical effect of auricular point plaster therapy for patients with chronic hepatitis coupled with insomnia. Shanghai Huli, 2011, 11(6): 31-33.

[7] Wu ZF. Auricular point plaster therapy for 80 patients with insomnia due to kidney yin deficiency. Yunnan Zhongyi Zhongyao Zazhi, 2012, 33(5): 41-42.

[8] Buyss DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res, 1989, 28(2): 193-213.

[9] Wang YH. Practical Psychiatry in Chinese Medicine. Beijing: People’s Medical Publishing House, 2000: 89.

[10] Chen H. Therapeutic efficacy comparison of two treatment strategies for chronic insomnia in the elderly. Xiandai Zhongxiyi Jiehe Zazhi, 2012, 21(15): 1668-1669.

[11] Lin J, Lu HF, Ma S. Sleep quality of senior people in nursing home of Wuhan. Huli Xuebao, 2012, 19(4): 23-26.

[12] Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ, 2005, 331(7526): 1169-1175.

[13] Yu XQ. Clinical study on combined acupuncture and vibroacoustic therapy for primary insomnia. Master thesis of Guangzhou University of Traditional Chinese Medicine, 2011.

[14] Wang GL. Clinical observation on auricular point plaster therapy for insomnia. Shanghai Zhenjiu Zazhi, 2012, 31(10): 725-726.

[15] Zhang P, Liu JM. Therapeutic effect of podiatric bath and massage with Chinese herb on somnipathy in elderly patients. Hulixue Zazhi, 2008, 23(3): 4-6.

[16] Zong LC, Ji XD. Observation on curative effect of foot bath and massage to treat type 2 diabetes patients with insomnia. Huli Yanjiu, 2010, 24(2A): 327-328.

Translator:Han Chou-ping

R244.1

: A

Date:October 18, 2013