The Effects Of Herb Foot-bath Therapy On The Sleep Quality And Symptom Burden Among Maintenance Hemodialysis Patients

Objectives To measure the sleep quality and symptom burden among maintenance hemodialysis patients,and evaluate the effect of herb foot-bath therapy on the sleep quality and symptom burden among maintenance hemodialysis patients.Methods This study was a randomized trial, consisting of two stages.The first stage was the baseline survey of sleep quality,143maintenance hemodialysis patients from Xiangya hospital and the third Xiangya hospital of Central South University were recruited to explore their sleep quality and symptom burden.The second stage was herb foot-bath therapy intervention. According to the scoring standard of Pittsburgh sleep Quality Index,82subjects who got PSQI score≥7point were recognized as the subjects of intervention, were randomly assigned to intervention group and control group with41cases in each one. The intervention group were treated with herb foot-bath therapy intervention in addition to routine health education,the intervention was implemented for30～40miniutes every night for8weeks. while the control group just received routine health education. The levels of sleep quality and symptom burden were compared before and after intervention between both groups to explore the effect of intervention.Results1.The baseline results of PSQI showed that27cases (18.89%) sleep well,and116cases (81.11%) suffer sleep disorder,the mean score of PSQI was10.96±4.46.The average score of subjective sleep quality was (1.62±0.838)、the time of falling sleep (2.03±1.077)、 sleeping time (1.81±1.081)、sleeping effect (1.61±1.139)、the handicap of sleeping (1.54±0.591)、the drugs of hypnosis (0.43±1.003)、function handicap in daytime (1.92±0.953)2.The prevalence of MHD patients’every symptom burden was13.3%～72.0%.the mean score of symptom burden was76.69±37.95.The highest frequency symptoms were feeling tired、dry mouth、trouble staying asleep、trouble falling asleep、decreased interest in sex、difficulty becoming sexually aroused、itching、feeling irritable、worrying、swelling in legs.the most disturbing symptoms were trouble falling asleep、 restless legs、trouble staying asleep、shortness of breath、feeling tired; The highest frequency symptoms were trouble falling asleep、trouble staying asleep、feeling tired、decreased appetite、dry mouth; the most serious symptoms were trouble falling asleep、restless legs、trouble staying asleep、feeling tired、shortness of breath decreased appetite、dry mouth.Multivariable stepwise regression showed there were statistically significant correlation between the symptom burden and PSQI score,level of education and course of the chronic renal failure (P<0.05). Spearman correlate test showed the sleep quality were positive correlated with the symptom burden.3.Two independent-samples t-test and Mann-Whitney U test showed that the score of PSQI、subjective sleep quality、sleeping time、the handicap of sleeping and function handicap in daytime(post-Intervention-pre-intervention) of two groups was statistically significant (P<0.05). Paired-samples t-test and nonparametric Wilcoxon test showed that the score of PSQI in intervention group was declined significantly(P<0.01) after intervention, and in the control group had no statistics significance (P>0.05)except the dimension of mean score of PSQI and function handicap in daytime(P<0.05).Repeated measures analysis of variance showed that the main effects of intervene on subjective sleep quality and the handicap of sleeping were statistically significant (P<0.05),and the main effects of time on PSQI were statistically significant (P<0.05). There were significant interactions between time and intervention on above variates (P<0.05).4.Two independent-samples t-test and Mann-Whitney U test showed that the score of DSI、symptom distress、symptom severity and symptom numbers of two groups was statistically significant (P<0.05).Paired-samples t-test and nonparametric Wilcoxon test showed that the scores the score of DSI in intervention group was declined significantly(P<0.05) after intervention, and in the control group had no statistics significance (P>0.05)except the dimension of mean score of DSI、symptom frequency and symptom numbers(P<0.05).Repeated measures analysis of variance showed that the main effects of intervene on symptom distress were statistically significant (P<0.05),and the main effects of time on DSI were statistically significant (P<0.05). There were significant interactions between time and intervention on the total score of DSI and other dimensions (P<0.05).Conclusion1.Most of the maintenance hemodialysis patients suffer from somnipathy and most of them experienced several symptoms at the same time,suffer from severe DSI.2.The main influential factors of DSI were the sleep quality,level of education and course of the chronic renal failure.The sleep quality were positive correlated with the symptom burden.3.To some extent,herb foot-bath therapy can effectively improve sleep quality in patients with maintenance hemodialysis and reduce symptom burden.