Objective: This study was conducted to examine the effects of massage and foot reflexology on the sleep of premature infants. Materials and Methods: The research was designed as a randomized controlled experimental study. The study population consisted of premature infants born at 30–37 weeks of gestation who were admitted to the Neonatal Intensive Care Unit of a hospital in the Central Anatolia Region. The sample included 108 premature infants divided into three groups: Massage group (n = 36), Foot reflexology group (n = 36), and Control group (n = 36). Data were collected using a neonatal follow-up form and actigraphy. Massage and foot reflexology interventions were administered to the respective groups twice daily (Morning: 07:00–09:00 and Evening: 19:00–21:00) for 15 minutes each session over two consecutive days, making up a total of four sessions. The control group received routine nursing care without any additional intervention. Pre-test (once) and post-test (once) measurements of 24-h sleep durations were assessed using actigraphy for all groups. Results: Sleep duration in the massage group increased compared to pre-intervention (251 minutes) and the control group (272 minutes), while the sleep duration in the foot reflexology group similarly increased compared to pre-intervention (268 minutes) and the control group (266 minutes) (p < .001). Sleep efficiency also showed a significant increase post-intervention, rising to 73% in the massage group and 71.8% in the foot reflexology group compared to the control group (p < .001). Furthermore, the number of awakenings and wakefulness duration significantly decreased in the massage and foot reflexology groups compared to the control group (p < .05). Conclusion: The findings indicate that massage and foot reflexology are effective non-pharmacological methods for improving sleep duration and sleep efficiency while reducing wakefulness duration and the number of awakenings in premature infants.
Abd-Elaziz MohamedE.Saber Mohamed IsmailM.Mohamed AhmedM.Ibrahim EldemeryN. (2022). Impact of foot reflexology technique on pain intensity, sleep quality, and fatigue among children undergoing surgical procedures. Egyptian Journal of Health Care, 13(4), 1458–1473. DOI:10.21608/ejhc.2022.272202
2.
Alinejad-NaeiniM.Heidari-BeniF.MohagheghiP.SohrabiS.JeshvghanieS. (2022). The effect of the ‘M’ technique ® massage on physiological parameters in preterm neonates: A randomized controlled trial study. JPNIM, 11(2), Article e110212. https://doi.org/10.7363/110212
3.
AllamN. A. (2019). Effects of reflexology strategy on the mothers breast milk volume and their premature weight gain. Asian Journal of Pediatric Research, 2(4), 1–14. https://doi.org/10.9734/AJPR/2019/v2i430111
4.
Amal HashemM.MS.HhM.RmA.ShA.RaA. (2024). The impact of foot reflexology on fatigue and sleep quality in school - aged children undergoing hemodialysis. J Integr Nurs, 6(2), 76–82. https://doi.org/10.4103/jin.jin
Bahig AnwrD.Elzaher MohamedO.Ahmed AyedM. (2020). Effect of massage on increasing growth parameters and inducing sleep among premature neonates. Egyptian Journal of Health Care, 11(3), 530–540. https://doi.org/10.21608/ejhc.2020.146733
7.
BaniasadiH.HosseiniS. S.AbdollahyarA.SheikhbardsiriH. (2019). Effect of massage on behavioural responses of preterm infants in an educational hospital in Iran. Journal of Reproductive and Infant Psychology, 37(3), 302–310. https://doi.org/10.1080/02646838.2019.1578866
8.
BastaniF.RajaiN.FarsiZ.AlsH. (2017). The effects of Kangaroo care on the sleep and wake states of preterm infants. Journal of Nursing Research: JNR, 25(3), 231–239. https://doi.org/10.1097/JNR.0000000000000194
9.
BennetL.WalkerD. W.HorneR. S. C. (2018). Waking up too early – the consequences of preterm birth on sleep development. The Journal of Physiology, 596(23), 5687–5708. https://doi.org/10.1113/JP274950
10.
BikA.SamC.de GrootE. R.VisserS. S. M.WangX.TatarannoM. L.BendersM. J. N. L.van den HoogenA.DudinkJ. (2022). A scoping review of behavioral sleep stage classification methods for preterm infants. Sleep Medicine, 90(February 2022), 74–82. https://doi.org/10.1016/j.sleep.2022.01.006
11.
CohenJ. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates Publishers.
DaliliH.SheikhiS.ShariatM.HaghnazarianE. (2016). Effects of baby massage on neonatal jaundice in healthy Iranian infants: A pilot study. Infant Behavior and Development, 42(February 2016), 22–26. https://doi.org/10.1016/j.infbeh.2015.10.009
14.
de GrootE. R.KnoopM. S.van den HoogenA.WangX.LongX.PillenS.BendersM.DudinkJ. (2021). The value of cardiorespiratory parameters for sleep state classification in preterm infants: A systematic review. Sleep Medicine Reviews, 58(2021 Aug), 101462. https://doi.org/10.1016/j.smrv.2021.101462
15.
DenizA. Ö.AçıkgözA. (2023). A randomized controlled trial: The effect of acupressure and foot reflexology on pain during heel-lancing in neonates. Clinical Nursing Research, 32(2), 306–312. https://doi.org/10.1177/10547738211061815
16.
DükenM. E.YayanE. H. (2024). The effects of massage therapy and white noise application on premature infants’ sleep. Explore, 20(3), 319–327. https://doi.org/10.1016/j.explore.2023.09.002
17.
Farouk AbolwafaN.Gamal HasanA. S.Boshra ShehataH. (2024). Effect of foot reflexology on fatigue, pain and insomnia among children undergoing chemotherapy. Egyptian Journal of Health Care, 15(1), 169–179. https://doi.org/10.21608/ejhc.2024.338787
18.
FauziaR. L.BudihastutiU. R.AdrianiR. B. (2022). Meta-analysis the effect of baby massage in increasing quality of sleep and infant body weight. Journal of Maternal and Child Health, 07(01), 64–74. https://doi.org/10.26911/thejmch.2022.07.01.07
19.
FirminoC.RodriguesM.FrancoS.FerreiraJ.SimoesA. R.CastroC.FernandesJ. B. (2022). Nursing interventions that promote sleep in preterm newborns in the neonatal intensive care units: An integrative review. International Journal of Environmental Research and Public Health, 19(17), 1–11. https://doi.org/10.3390/ijerph191710953
20.
GhaljaeiF.MahmoodiN.ZeinabadiF. Z. (2023). The effect of aromatherapy with rose water on the deep sleep status of premature infants admitted to NICU: A randomized clinical trial. Anaesthesia, Pain & Intensive Care, 27(2), 179–184. https://doi.org/10.35975/apic.v27i2.2181
21.
GolbafA. A.RamezaniM.VashaniH. B.AvalS. B.MoharreriF. (2024). Effect of foot reflexology massage on sleep habits in children with autistic spectrum disorder: A randomized clinical trial. J Chronic Dis Care, 13(2), Article e141083. https://doi.org/10.5812/jjcdc-141083
22.
GonzálezA. P.Loredo AguayoC. H.Barbosa SabaneroG.Vasquez MendozaM. G.Aguiñaga ZamarripaM. L.Linares SalasV. H.Sosa BustamanteG. P. (2024). Salivary Cortisol Levels and Clinical Signs of Stress in Premature Neonates Treated with Vimala Massage: A Randomized Controlled Trial. J Integr Complement Med, 30(2), 165–172. DOI:10.1089/jicm.2022.0756
23.
HarahapM.NoviyatiN. (2022). Comparison of breast massage (oxytocin massage, Oketani massage, and Marmet massage) against the smoothness of breast milk from the aspect of baby’s sleep frequency. Journal of Biomedicine and Translational Research, 6(8), 2103–2107. https://doi.org/10.37275/bsm.v6i8.564
24.
HartantiA. T.SalimoH.WidyaningsihV. (2019). Effectiveness of infant massage on strengthening bonding and improving sleep quality. Indonesian Journal of Medicine, 4(2), 165–175. https://doi.org/10.26911/theijmed.2019.04.02.10
25.
HuangH. C.ChenK. H.KuoS. F.ChenI. H. (2021). Can foot reflexology be a complementary therapy for sleep disturbances? Evidence appraisal through a meta-analysis of randomized controlled trials. Journal of Advanced Nursing, 77(4), 1683–1697. https://doi.org/10.1111/jan.14699
26.
Ibrahim Mabrouk BarakaN.Reda Ali El-kestH.Abdl Elsalam Mohamed ElwanS.Hassan El sharkawyM. (2022). Effect of foot massage and acupressure on pain levels and physiological parameters during heel lancing in full-term neonates. IEJNSR, 3(1), 133–145. https://doi.org/10.21608/ejnsr.2022.130365.1163
27.
JazayeriZ.SajadiM.DalvandH.ZolfaghariM. (2021). Complementary Therapies in Medicine Comparison of the effect of foot reflexology and body massage on physiological indicators and bilirubin levels in neonates under phototherapy. Complementary Therapies in Medicine, 59(2021 Jun), 102684. https://doi.org/10.1016/j.ctim.2021.102684
28.
KaratasN.DalgicA. I. (2020). Effects of reflexology on child health: A systematic review. Complementary Therapies in Medicine, 50(102364), 1–8. https://doi.org/10.1016/j.ctim.2020.102364
29.
KhanR. (2015). Evaluation of effect of massage with or without oil on the weight gain of low birth and very low birth weight babies. Paediatrics and Child Health, 6(9), 1–7. https://doi.org/10.-67943/pch.2015.1632.718
30.
LanH.YangL.HsiehK.-H.YinT.ChangY.-C.LiawJ.-J. (2018). Effects of a supportive care bundle on sleep variables of preterm infants during hospitalization. Research in Nursing & Health, 41(3), 281–291. https://doi.org/10.1002/nur.21865
31.
LiaoJ.-H.HuR. N. R.-F.SuL.WangS.XuQ.QianX.-F.HeH.-G. (2018). Nonpharmacological interventions for sleep promotion on preterm infants in neonatal intensive care unit: A systematic review. Worldviews on Evidence-Based Nursing, 15(5), 386–393. https://doi.org/10.1111/wvn.12315
32.
LiguoriC.MombelliS.FernandesM.ZucconiM.PlazziG.Ferini-strambiL.LogroscinoG.BiagioN.FilardiM. (2023). The evolving role of quantitative actigraphy in clinical sleep medicine. Sleep Medicine Reviews, 68(2023 Apr), 101762. https://doi.org/10.1016/j.smrv.2023.101762
33.
MahdyN. M.El KreemH. E. A.MohamedN. T.AzizS. M. A. (2023). Effect of foot reflexology on physiological index for neonates with hyperbilirubinemia at neonatal intensive care unit introduction: Subjects and method: Significance of the study. Assiut Scientific Nursing Journal, 11(40), 240–249. https://doi.org/10.21608/asnj.2024.249869.1716
34.
MansouriA.ShadadiH.Poudineh-MoghadamM.VahedA. S.DehghanmehrS. (2017). Evaluation of the effect of foot reflexology massage on vital signs and anxiety after blood transfusions in children with thalassemia. Bali Medical Journal, 6(3), 623–629. https://doi.org/10.15562/bmj.v6i3.622
35.
ManurungR. (2020). The effect of infant massage on the quality of sleep of infants aged 0–12 months. Jurnal Aisyah: Jurnal Ilmu Kesehatan, 5(2), 221–225. https://doi.org/10.30604/jika.v5i2.594
36.
MasoumiZ.SeyedbagheriS.BakhtarB.SadeghiT. (2023). The effect of foot reflexology before suctioning on pain and SPO2 in neonates under nasal CPAP hospitalized in the NICU. Journal of Neonatal Nursing, 29(3), 540–544. https://doi.org/10.1016/j.jnn.2022.11.006
37.
MiralizadehA.PeymanA.Jamali SoltaniN.AshktorabT. (2022). Comparison of the effect of foot and palm reflexology massage on respiratory distress syndrome in premature infants under noninvasive ventilation. Complementary Medicine Research, 29(2), 100–108. https://doi.org/10.1159/000517982
38.
Naseri-SalahshourV.SajadiM.AbediA.FournierA.SaeidiN. (2019). Reflexology as an adjunctive nursing intervention for management of nausea in hemodialysis patients: A randomized clinical trial. Complementary Therapies in Clinical Practice, 36(2019 Aug), 29–33. https://doi.org/10.1016/j.ctcp.2019.04.006
39.
NasiriM.RanjkeshF.MafiM.SenmarM.HosseinigolafshaniS. Z. (2019). The effect of foot reflexology on sleep quality among high risk pregnant women: A randomized controlled trial. Sleep and Hypnosis, 21(4), 293–301. https://doi.org/10.37133/Sleep.Hypn.2019.21.0198
40.
NasutionA. F. D.NuraidahN.ImeldaI. (2021). The effect of baby massage on the sleep quality of 3-12 months babies in private Midwive Jambi City. Nsc Nursing, 3(2), 23–35. https://doi.org/10.32549/OPI-NSC-51
41.
NoorbayaS.SaidahR. N. M. S. (2020). The effect of baby massage toward baby sleep quantity on the age of 3-6 months in south Sempaja sub-district, North Samarinda in 2019. MJMR, 4(1), 37–42. https://doi.org/10.31674/mjmr.2020.v04i01.006
42.
PallantJ. (2017). In BalcıS.AhiB. (Eds.), SPSS Kullanma Kılavuzu (2nd ed., p. 224). Anı Yayıncılık.
PitreS. (2014). Effect of massage on physiological and behavioral parameters among low birth weight babies. International Journal of Scientific Research, 3(5), 474–487.
47.
PurnamawatiI. G. A. D.SukyatiI.SimanjuntakM. (2023). Effect of foot reflexology therapy on fatigue and sleep quality in children undergoing hemodialysis: A systematic review. Jurnal EduHealth, 14(04), 620–625. https://ejournal.seaninstitute.or.id/index.php/healt/article/view/3565.
48.
RezaeiR.NiaH. S.BeheshtiZ.SaatsazS. (2023). The efficacy of massage as a nightly bedtime routine on infant sleep condition and mother sleep quality: A randomized controlled trial. Journal of Neonatal Nursing, 29(2), 393–398. https://doi.org/10.1016/j.jnn.2022.07.026
49.
RibasC. G.AndreazzaM. G.NevesV. C.ValderramasS. (2019). Effectiveness of hammock positioning in reducing pain and improving sleep-wakefulness state in preterm infants. Respiratory Care, 64(4), 384–389. https://doi.org/10.4187/respcare.06265
50.
SalvoS. G. (2009). Massage therapy (3rd ed.). Sounders Elsevier.
51.
SamadiN.AllahyariI.MazaheriE.RostamnejadM.MehrnoushN.NamadiM.NaseriR.NahaminM. (2014). Effect of foot reflexology on physiologic index of neonates. IJN, 5(1), 19–22. DOI:10.22038/ijn.2014.2352
52.
SaputroH.BahiyaC. (2021). The effects of baby massage to sleep quality in infant age 1-7 months. Journal for Research in Public Health, 2(2), 88–94. https://doi.org/10.30994/jrph.v2i2.32
53.
SentnerT.WangX.de GrootE. R.SchaijkL. V.TatarannoM. L.VijlbriefD. C.BendersM. J. N. L.BartelsR.DudinkJ. (2022). The sleep well baby project: An automated real-time sleep – wake state prediction algorithm in preterm infants. Sleep, 45(10), 1–11. https://doi.org/10.1093/sleep/zsac143
54.
SetiawatiI.PrihartiniN.SebayangA. P.HuluV. K. (2022). The influence of baby massage on the sleep quality of babies aged 6-7 Months in Percut village in 2021. Contagion: Scientific Periodical Journal of Public Health and Coastal Health, 4(2), 280–289. https://doi.org/10.30829/contagion.v4i2.15251
55.
ShahroudiP.ChehrzadM.GhanbariA.PourghaneP.Naderi-nabiB.MohammadiM.AtrkarrousshanZ. (2023). The effect of foot reflexology massage on pain during vaccine injection in infants referred to Rasht comprehensive health center: A randomized clinical trial. International Journal of Pediatrics, 11(2), 17366–17373. https://doi.org/10.22038/ijp.2023.65387.4932
56.
SoltaniN. J.PeymanA.TorabT. A.SaatchiK. (2021). The effect of foot reflection massage on the reduction of respiratory distress syndrome in premature infants under non-invasive ventilation in the neonatal intensive care unit. J Nurs Midwifery Care, 29(2), 113–125. DOI:10.30699/ajnmc.29.2.113
57.
SungM.AdamsonT. M.HorneR. S. C. (2009). Validation of actigraphy for determining sleep and wake in preterm infants. Acta Paediatrica, 98(1), 52–57. https://doi.org/10.1111/j.1651-2227.2008.01002.x
58.
SuralagaC.ChoirunissaR.CahyawatiE. (2022). The effect of baby massage on sleep quality of babies aged 3-6 months in Posyandu in Rancabango village, in the working area of Cipanas public health center, Garut. Nat Volatiles & Essent. Oils, 9(1), 66–71. https://www.cabidigitallibrary.org/doi/pdf/10.5555/20220156968.
59.
UchitelJ.VanhataloS.AustinT. (2022). Early development of sleep and brain functional connectivity in term-born and preterm infants. Pediatric Research, 91(4), 771–786. https://doi.org/10.1038/s41390-021-01497-4
60.
UsM. C.SaranM. G.CebeciB.AkkuşE.ŞekerE.Şimsek AybarŞ. (2023). A randomized comparative effectiveness study of Reflexology, sucrose, and other treatments for needle procedures in newborns. Pediatric Neurology, 140(2023 Mar), 78–85. https://doi.org/10.1016/j.pediatrneurol.2022.11.019
61.
WangW.HungH.ChenY.ChenK.YangS.ChuC.ChanY. (2020). Effect of foot reflexology intervention on depression, anxiety, and sleep quality in adults: A meta-analysis and metaregression of randomized controlled trials. Evidence-based Complementary and Alternative Medicine: eCAM, 2020(2020 Sep), 1–21. https://doi.org/10.1155/2020/2654353
62.
WelcomeM. O.DaneS. (2020). Effect of foot reflexotherapy in babies with fuss-cry-irritability, abdominal bloating, distension and sleep disorder syndrome. Journal of Research in Medical and Dental Science, 8(4), 71–76. https://www.nveo.org/index.php/journal/article/view/4351.
63.
YilmazD.KurtF. Y. (2021). The effect of foot reflexology on procedural pain before heel lancing in neonates. Archives de Pédiatrie, 28(4), 278–284. https://doi.org/10.1016/j.arcped.2021.02.015
