Pinar, R., & Afsar, F. (2015). Back massage to decrease state anxiety, cortisol level, blood pressure, heart rate and increase sleep quality in family caregivers of patients with cancer: A randomised controlled trial. Asian Pacific Journal of Cancer Prevention, 16, 8127–8133. 

To study the effectiveness of back massage on anxiety, stress markers, and sleep quality in the caregivers of patients with cancer

Caregivers were randomized to treatment and control groups. Caregivers in the treatment group rested for 10 minutes in a silent room then were given a 15-minute back massage each evening. The control group rested quietly in a separate silence room. Study measures were obtained at baseline and on day 7. Blood samples were obtained on day 7 for cortisol levels.

• N = 44
• MEAN AGE = 42.31 years (range = 24–60 years)
• MALES: 36.4%, FEMALES: 63.6%
• KEY DISEASE CHARACTERISTICS: Not stated
• OTHER KEY SAMPLE CHARACTERISTICS: Caregivers had secondary school education or less. About 50% were spouses, and the rest were parents of the patient. 

• SITE: Single site  
• SETTING TYPE: Inpatient  
• LOCATION: Turkey

Randomized, controlled trial

• State-Trait Anxiety Inventory (STAI)
• Cortisol levels
• Blood pressure and heart rate
• Pittsburgh Sleep Quality Index (PSQI)

Overall, 100% of the intervention group had moderate levels of anxiety at baseline, and those in the control group had low to high anxiety. Anxiety declined in the intervention group (p = 0.000) and remained essentially stable in the control group. Cortisol levels declined in the intervention group (p = 0.01) and were within reference levels. At baseline, 77.3% of caregivers in both groups had PSQI scores of 5 or greater, indicating poor sleep quality. Sleep quality scores declined in the intervention group (p = 0.000) and increased in the control group (p = 0.003) among those with initial scores greater than 5.

Daily back massages for caregivers reduced anxiety and improved sleep quality.

• Small sample (< 100)
• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Other limitations/explanation: Cortisol levels were within reference levels, so it was not clear how meaningful these changes were. Many patients in the control group had low baseline anxiety levels, and there could have been floor effects in this measure. Measurements were taken immediately after the massage was given, so the duration of effect was not clear.

Back massage is a simple technique that nurses can use to help reduce anxiety and stress for the caregivers of patients with cancer. This is a complementary nursing action that can be used to support caregivers.