Warm Water Footbath

Warm Water Footbath

PEP Topic 
Sleep-Wake Disturbances
Description 

Soaking the feet in warm water has been examined for its effect on sleep disturbances in patients with cancer, due to the potential for a warm water foot bath to facilitate relaxation.

Effectiveness Not Established

Research Evidence Summaries

Yang, H. L., Chen, X. P., Lee, K. C., Fang, F. F., & Chao, Y. F. (2010). The effects of warm-water footbath on relieving fatigue and insomnia of the gynecologic cancer patients on chemotherapy. Cancer Nursing, 33, 454–460.

doi: 10.1097/NCC.0b013e3181d761c1
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Study Purpose:

To evaluate the effects of promoting sleep and relieving fatigue of warm-water footbaths for female patients with gynecologic cancer undergoing chemotherapy.

Intervention Characteristics/Basic Study Process:

Using a footbath device (40x27x45 cm) with water temperatures at 41°C to 42°C, participants in the experimental group soaked their feet to a depth of 10 cm above the ankle. Participants soaked their feet between 8 and 9 pm for 20 minutes and went to bed within one hour of completing the foot soaking. Participants started the foot soaking the eve of first dose of chemotherapy. Participants in the control group did not soak their feet in footbaths. All participants, those receiving and not receiving footbaths, completed fatigue and insomnia items on days 1, 2, 4, 7, and 14 after each scheduled chemotherapy treatment.

Sample Characteristics:

  • The sample comprised 43 women (control group, n = 25; experimental group, n = 18).
  • Mean (standard deviation [SD]) age was 50.6 years (SD = 11.5) in the control group and 47.6 years (SD = 11.2) in the experimental group. Participants were included if they were between the ages of 20 and 70 years.
  • Participants had newly diagnosed cervical, ovarian, endometrial sarcoma, or other gynecologic malignancy.
  • Participants were receiving platinum chemotherapy in a four-series regimen. 
  • Women were excluded if they had a history of diabetes mellitus and neuropathy, had skin breaks or foot fracture, were receiving Lipo-Dux chemotherapy, were taking any medications that might intensify the effects of peripheral neuropathy, had stage IV cancer, or had severe nausea and vomiting within 48 hours of the chemotherapy.

Setting:

  • Single site
  • Outpatient
  • Northern Taiwan

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

The study used a pre-/post, two-group, prospective, longitudinal cohort design. Control group participants were enrolled and completed measures (no intervention) prior to starting the experimental intervention.

Measurement Instruments/Methods:

  • Brief Fatigue Inventory-Taiwan Form (BFI-Taiwan)
  • Verran and Snyder-Halpern (VSH) Sleep Scale, Chinese translation

Results:

Fatigue levels, except in the first session, were significantly lower in the experimental group than in the control (p < 0.001).

The experimental group had higher sleep scores (better quality sleep) than the comparison group at every observation point. All differences but the measurement on the first session were significant (p < 0.001).

Conclusions:

Warm-water footbaths administered prior to bedtime during chemotherapy improved sleep and fatigue scores in a small sample of Taiwanese women with gynecologic cancer.

Limitations:

  • Compliance was monitored by telephone follow-up only. It was not possible to accurately ensure that water temperature, level, and timing were delivered as prescribed.
  • The timing of data collection and lack of monitoring calls to the control group was a limitation. Researchers were unable to assess the possible effect of daily telephone calls.
  • The study had a small sample size and was conducted at a single site.

Nursing Implications:

A warm-water footbath, also referred to as local moist heat, is a noninvasive, easy-to-administer technique that may improve sleep and fatigue in women with gynecologic cancers. Further study is warranted.


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