Parent and Child Stress Reduction in the Hospital Setting Following Two Complementary (CAM) Interventions: New Approach to Family Centered Care Sheila Wang, PhD*, Rosalyn L. Bruyere DDiv, Ken Weintrub MA, Patricia Megregian MDiv, Suzanne O’Brien, Lynne Morrison, MA,Holly Luenemann LMT, Richard Kamasinski LMT, Elizabeth Chazen, David M. Steinhorn* MD Judith Nan Joy Integrative Medicine Initiative, Children’s Memorial Hospital/ *Northwestern University Feinberg School of Medicine, Chicago, IL Abstract (APS 2007 Abstract # ) Results Conclusions Background: Hospitalization creates physical and psychic stress for children and their parents 1,2. Parents may provide comfort or they may create additional stress if they are anxious or agitated. While most care and supportive services are focused on patients, reducing parental distress may allow them to be more effective in supporting their hospitalized child and creating an environment for optimal recovery to occur. Objective: We evaluated whether Massage Therapy or Touch Healing interventions would be associated with reduced patient and parental reports of distress, pain, tension, discomfort and upset mood. Design/Methods: Patients newly admitted to a general pediatric ward were offered opportunities to participate in a study evaluating the impact of Massage Therapy or Touch Healing on their distress, pain, tension, discomfort and upset mood. Parents rated their child in these five areas before and after the CAM intervention using a 1-5 scale (least to greatest); adolescents rated themselves. Parents were also offered the opportunity to receive Touch Healing or Massage Therapy and rated their own pre/post distress, pain, etc. Safety and acceptability of interventions were also evaluated. Analysis of pre vs. post-intervention responses was done using paired t-tests. Results: No adverse events were reported in over 760 interventions. Ninety-four percent (94%) of parents surveyed were moderately or extremely satisfied and felt that these modalities should be available to all patients and parents. One hundred percent (100%) of parents would recommend these modalities to another patient or parent. In general, parents rated their own level of distress higher than their child’s. A consistent and very significant fall in stress ratings was seen in all subjects following Massage Therapy or Touch Healing interventions. Conclusions: Parents experience distress in response to their child’s hospitalization which is often perceived to be greater than their child’s distress. Both parents and children experience a reduction in stress through Massage Therapy or Touch Healing interventions. These two CAM modalities may improve symptom management in hospitalized children and may enable parents to be more emotionally available to support their child. Future studies using suitable control and placebo interventions are needed. Methods Results Pediatric Hospital (or Clinic) Patients as Participants  Informed consent obtained  Parents asked to rate their child’s level of distress, pain, tension, discomfort and upset mood on a scale of 1-5 (e.g. for “distress” 1 = very calm, 5 = very distressed) before and after their child received Touch Healing and Massage Therapy (though adolescents rated themselves).  Length of interventions were approximately minutes.  The interventions took place, for the most part, in hospital rooms with patients in their beds or in clinic treatment rooms with patients on treatment tables.  Touch Healing was administered by practitioners who had completed at least 500 hours of training with Rosalyn L. Bruyere in a “hands on” technique that helps to balance and support the body’s energy centers. Hand pressure is very light and does not involve manipulation of tissues. Hand placement is typically on feet, knees, hip, abdomen, chest, shoulder, elbow, hand, and head.  Massage Therapy was administered by licensed massage therapists with training in pediatric massage. Patients were massaged in hospital gowns (or fully clothed in clinic) without the use of lotions or oils. Common areas massaged were hands and feet (85%), back (60%), shoulders (50%), and head (50%) with very light to moderate pressure depending on patient diagnosis, severity of illness and tolerance. Light petrissage, compression and friction techniques were used. Massage Therapists checked in often for feedback on patient comfort level during the intervention. Parents of Hospitalized Children as Participants  Informed consent obtained  Parents asked to rate their own level of distress, pain, etc., (as above) before and after they received Touch Healing or Massage Therapy interventions.  Most interventions took place in hospital rooms with the parent seated in a chair and without the use of lotions or oils. Shoulders, neck and upper back were massaged with moderate pressure using petrissage, compression, focused finger pressure and friction techniques. Parent Ratings of Their Child Before and After Their Child Received Touch Healing or Massage Therapy Highly significant reductions in all categories of parental ratings of their child’s level of distress, pain, tension, discomfort upset mood were found after their child received either Touch Healing (Figure 1) or Massage Therapy interventions (Figure 2). The magnitude of the t values and the extremely low probability values indicate that there was marked consistency in the direction of the pre to post- intervention parent ratings. Figure 1. Parent Ratings of Their Child's Level of Distress, Pain, Tension, Discomfort and Upset Mood Before and After Receiving Touch Healing Intervention (Mean + SD). Mean age = 7.7 years. For all categories t > 12.9, **** p < 1 x Figure 2. Parent Ratings of Their Child's Level of Distress, Pain, Tension, Discomfort and Upset Mood Before and After Receiving Massage Therapy Intervention (Mean + SD). Mean age = 13 years. For all categories t > 11.1, ****p < 1 x Parents Rating Themselves Before and After They Receive Touch Healing or Massage Therapy Interestingly, before the interventions, parents who participated in the study rated themselves as more distressed, in more pain, experiencing more tension and discomfort and being more upset than parents rating their hospitalized children. Similar to the results with the patients, highly significant reductions were found in parents ratings of themselves after they received Touch Healing (Figure 3) or Massage Therapy (Figure 4). Figure 3. Parent Rating of Their Own Level of Distress, Pain, Tension, Discomfort and Upset Mood Before and After Receiving Touch Healing Intervention (Mean + SD). For all categories t < 5.2, **p < Figure 4. Parent Ratings of Their Own Level of Distress, Pain, Tension, Discomfort and Upset Mood Before and After Receiving Massage Therapy Intervention (Mean + SD). For all categories, t > 12.1, ****p < 1 x Parent Feedback: Ninety-four percent (94%) of parents who responded to a follow-up survey were moderately or extremely satisfied and felt that these modalities should be available to all patients and parents. One hundred percent (100%) of parent respondents said they would recommend these modalities to another patient or parent. Safety: No adverse events were reported in over 760 interventions.  Touch Healing and Massage Therapy interventions performed in tertiary care pediatric hospitals by trained professionals are safe and well accepted by children and their parents.  Parents experience distress in response to their child’s hospitalization which is often perceived to be greater than their child’s distress.  Both parents and children perceive a significant reduction in stress through Massage Therapy or Touch Healing interventions.  Parents are an important part of the healing environment for hospitalized children. These two CAM modalities may enable parents to be more emotionally available to support their child and therefore contribute positively to the overall healing environment.  Massage Therapy and Touch Healing may have a role to play in improving symptom management in hospitalized children.  Future studies using adequate control and placebo interventions are needed. N = 378 Touch Healing Interventions (147 patients) **** N = 233 Massage Therapy Interventions (136 Patients) **** N = 25 Touch Healing Interventions (19 parents) N = 130 MassageTherapy Interventions (74 parents) ** **** References 1 Iwasaki, M (2005) Interventional study on fatigue relief in mothers caring for hospitalized children-effect of massage incorporating techniques from Oriental Medicine, Kurume Medical Journal, 52, Milstein, J (2005) A paradigm of integrative care: healing with curing throughout life, “being with” and “doing to”. Journal of Perinatology 25 (9)