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.
The 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.
The 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.”
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