Healing Touch

• FINAL NUMBER STUDIES INCLUDED = 13 
• TOTAL PATIENTS INCLUDED IN REVIEW = 1,003
• SAMPLE RANGE ACROSS STUDIES = 16–230 patients
• KEY SAMPLE CHARACTERISTICS: Various tumor types, patients in active treatment undergoing chemotherapy or radiation therapy

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Palliative care

Interventions considered to be BT were healing touch, Reiki, and therapeutic touch. The effect on pain was examined in seven studies. There were some mixed findings, but most showed a reduction in pain over short time periods. Fatigue was assessed in five studies. These demonstrated fatigue reduction post-treatment, but data were conflicting over a longer period of four to eight weeks. Anxiety and depression were examined in seven studies. All but one found a significant reduction in mood disorders, but a study comparing Reiki, sham Reiki, and usual care found no difference between the sham and actual Reiki groups. Most studies were of descriptive or quasi-experimental design; potential confounding variables were not examined, and placebo effects could not be ruled out.

Studies using biofield therapies for relief of pain, anxiety, fatigue, and depression generally showed benefit; however, the evidence is not strong due to the limitations of the studies included.

Low-quality design studies and the short duration of study follow-up

BT therapies have not demonstrated effectiveness in well-designed clinical studies; however, though it is weak, evidence suggests potential benefit. There were no adverse effects of these interventions reported. Biofield therapies are not expensive and are low-risk, so they can be considered in the management of cancer-related symptoms. Well-designed clinical trials are needed to establish efficacy.

To determine whether biofield therapies affect positive health outcomes and reduce disease symptoms.

Databases searched were PubMed, CINAHL, PyscINFO, and Allied and Complementary Medicine (AMED).

Search keywords were spiritual healing, subtle energy, energy healing, biofield healing, external qi therapy, emitted chi, emitted qi, qi therapy, Johrei, pranic healing, polarity therapy, Reiki, therapeutic touch, and healing touch. Investigators also manually searched the reference sections of studies and review papers.

Studies were included if they

• Were published in a peer-reviewed journal in the English language
• Used a proximally practiced (that is, practiced with the practitioner and client in the same room) biofield-based modality and included quantitative endpoints
• Were randomized, controlled trials (RCTs) with a within-subject design.

Studies were excluded if they related to distant healing or intercessory prayer; integrated modalities that were not biofield-based modalities with biofield-based modalities in such a way that the interventions could not be separated; were animal, plant, and/or in vitro studies; were clinical studies with group assignment but without randomization; were purely descriptive studies; or were unpublished dissertations.
 

• The number of references retrieved was 88.
• Investigators evaluated studies by means of an evaluation quorum that used a checklist of guidelines.
• Ten studies examined the outcomes associated with the use of biofield therapies for patients with cancer.
   

• The number of studies analyzed was 66.  
• The authors did not report the total sample size or the sample size range across studies.
• The sample included patients with pain; hospitalized and postoperative patients; and patients with dementia, cardiovascular issues, and cancer.
   

Patients were undergoing the active treatment phase of care.

The authors presented results according to type of patient and levels of evidence.

• Pain:  The analysis revealed Level I evidence to support biofield therapies as a means of reducing the intensity of pain; Level 4 evidence of affecting comprehensive pain assessment; and Level 4 evidence on affecting anxiety and depression. The analysis also revealed that biofield therapies could have positive effects on health-related quality of life.
• Cancer:  The analysis revealed Level 2 evidence to support biofield therapies as a means of reducing acute pain in patients with cancer; Level 4 of reducing chronic pain; Level 4 of affecting fatigue; Level 4 of affecting quality of life; and Level 4 of affecting physiological measures of relaxation response.
• Hospitalized and Postoperative Patients:  The analysis revealed Level 2 evidence to support biofield therapies as a means of reducing anxiety and Level 2 of reducing pain. The evidence that the analysis revealed about the effect of biofield therapies on depression and functional or autonomic outcomes was insufficient to allow conclusions.
• Dementia:  The analysis revealed Level 2 evidence to support biofield therapies as a means of reducing negative behavioral symptoms associated with dementia.
• Patients with Cardiovascular Issues:  The analysis revealed Level 4 evidence to support biofield therapies as a means of reducing anxiety and Level 4 of reducing diastolic blood pressure. Study quality and duration of each treatment session were not associated with the number of positive outcomes; however, the total number of treatment sessions was positively associated with the number of positive psychological outcomes.

Proximally practiced biofield therapies are promising complementary interventions as means of reducing pain intensity in multiple populations, reducing anxiety in hospitalized populations, and reducing agitated behaviors in patients with dementia. The long-term effects of the therapies on fatigue and autonomic nervous system activity are unclear.

• The review was systematic but not a meta-analysis.
• The authors relied on p-values versus effect size.
• Nonquantitative studies were not included.

Future research should compare biofield therapies with empirically supported treatments for specific conditions.

To examine the effect of therapeutic touch (TT) on pain and fatigue in patients undergoing chemotherapy.

Patients were randomized to one of three groups:  the TT group; the placebo group, which underwent a procedure that mimicked TT; or the control group, which received standard treatment. Interventions were used for five days. Patients in the TT group received 30 minutes of TT delivered by a trained researcher. The same researcher delivered all interventions.

• The study was comprised of 90 women (30 patients in each group).
• Mean age was 36.86 years in the TT group, 42.70 years in the placebo group, and 43.30 years in the control group.
• All patients were receiving inpatient cancer treatment.

• Three inpatient units (Whether they were at one site or multiple sites is unknown.)
• Iran

• Patients were undergoing the active treatment phase of care.
• The study has clinical applicability for end of life and palliative care.

The study was a randomized, controlled trial with an intervention group and a usual care control.

• 10-point, 10-cm visual analog scale (VAS) (patient marked line for pain score)   
• Rhoten Fatigue Scale (RFS), 0 to 10 scale (0 = no fatigue, 10 = as much fatigue as I can bear)

• The pain scores of the TT group were lower than the pain scores of the placebo and control groups (p = 0.04).
• The fatigue scores of the TT group were lower than the scores of the placebo and control groups (p = 0.002).
• On some days, the scores of the placebo group were significantly lower (p < 0.05) than the scores of the control group.
• At all times, the fatigue scores of the TT group were lower than the scores of the placebo and control groups (p < 0.05).

TT was more effective at decreasing pain and fatigue than were placebo and control treatments. The placebo arm showed \"control\" that was superior to that in the control group.

• The study had a small sample size, with less than 100 patients.
• The sample was comprised of Muslim women in Iran, which may affect the applicability of the findings.
• The authors did not describe the actual intervention.

TT may decrease pain and fatigue scores in patients undergoing chemotherapy. The fact that a therapist must receive significant training to deliver TT may affect the practicality of the intervention.

To determine the feasibility of conducting a randomized, clinical trial testing the effectiveness of healing touch (HT) for patients undergoing induction for acute leukemia and to obtain preliminary data to determine the effect size.

A prospective cohort of patients was selected to participate in the intervention trial. They completed self-report questionnaires and rated fatigue, nausea, pain, and distress at baseline, within seven days of hospital admission. Follow-up data collection was performed during the fifth week of hospitalization or prior to discharge. The HT intervention consisted of nine 30-minute sessions during weeks 2, 3, and 4. Family members were allowed to stay or leave during the session, depending on patient preference. All who provided the sessions were certified and had at least two years of experience with HT. All sessions were provided to the patient by the same practitioner. Sessions were standardized and included (1) the practitioner setting an intention for the patients’ highest good and (2) a standardized sequence of hand positions progressing from the ankles upward to the top of the head, with the hands placed either touching the patient or several inches above the body for one minute.

• The sample was comprised of 12 patients (33.3% male, 66.7% female).    
• Mean age was 59.8 years (standard deviation = 10.7 years).
• Of the patients, 91.7% had acute myeloid leukemia (AML), 8.3% had acute lymphoblastic leukemia (ALL), and 66.7% were in relapse.
• Of the patients, 75% had at least some college level education, 50% were employed, and 100% were white.

• Single site  
• Inpatient 

Patients were undergoing the active treatment phase of care.

The study was a prospective trial.

• MD Anderson Symptom Inventory (MDASI):  13 symptoms rated from 0 (not present) to 10 (as bad as you can imagine) for severity; six items rate the degree to which symptoms interfered with functioning on the same type of 11-point scale
• Women’s Health Initiative Insomnia Rating Scale (WHIIRS):  five-item measure of sleep quality
• Profile of Mood States Short Form (POMS-SF):  37 items on a five-point Likert scale
• Distress Thermometer
• Self-rating of symptoms on a 0- to 10-point scale
• Questionnaire to obtain general feedback on the HT intervention
   

Of the individuals approached for study participation, 48% declined (66% due to lack of interest and 34% due to medical issues or feeling too ill). Three patients who initially entered withdrew, one due to family request and concerns about interference with medical treatment, one due to medical complications, and one after speaking with his minister who had religious objections to participation.

There were no significant changes from baseline to the five-week follow-up measurement on the MDASI, sleep quality measures, or POMS.

There were significant improvements on the patient self-report scale for fatigue (–1.8 change; p < 0.01) and nausea (–0.5 change; p < 0.01). Changes in distress were not significant. There were no changes in pain, and baseline values for pain were low (median = 1), although patient feedback suggested short-term pain reduction and improved sleep.

Of the patients, 91% liked HT “very much,” and most stated they felt more calm and relaxed during and after the sessions. All said they would recommend HT to others, and eight patients (73%) wanted to continue using HT.

Patients suggested improvements of providing a better explanation of HT, offering longer and more frequent sessions, and offering 30 minutes of protected quiet time for patients in addition to HT sessions.

The study demonstrated that use of HT in the acute setting is feasible and may benefit patients.

• The study had a very small sample size. 
• No comparison group was included. 
• Because patients suggested protected quiet time, it is not clear if the benefits seen were from the HT or from the fact that the sessions provided such uninterrupted time.

The study findings suggest that a simple intervention of providing protected, uninterrupted quiet time to patients can be helpful to patients. This is something that could be readily incorporated into nursing care. Findings suggest that further research in this area is feasible in acutely ill patients. Findings suggest that provision of quiet time control in further research would be a viable approach, as well as comparison to other strategies to elicit a relaxation response. Information regarding drop-out reasons suggest that more extensive explanation of HT and mechanisms of effects is warranted with use of HT.

To compare weekly healing touch to weekly sham therapy on fatigue in women receiving radiation therapy for breast cancer

Participants were randomized to receive either weekly healing touch or weekly sham therapy. Participants were blinded to group assignment. Each session was 45 minutes in length. Participants either wore a neck drape or blindfold so as not to see how the treatment was delivered.

• N = 41  
• MEAN AGE = 51.5 years (SD = 9.2)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Patients with breast cancer receiving radiation therapy
• OTHER KEY SAMPLE CHARACTERISTICS: 34 of 41 were Caucasian

• SITE: Single site  
• SETTING TYPE: Outpatient  
• LOCATION: Not identified

• PHASE OF CARE: Active anti-tumor treatment

• Randomized, controlled pilot study

• Brief Fatigue Inventory (BFI)
• Hospital Anxiety and Depression Scale (HADS)
• Functional Assessment of Cancer Therapy–Breast (FACT-B)

Depression was positively correlated with fatigue measures. Anxiety was positively associated with fatigue interference. Healing touch participants reported higher levels of fatigue throughout study than control participants. The control group reported greater reduction in fatigue than did the healing touch group.

This pilot study demonstrated that the intervention was feasible. However the study did not demonstrate any benefit in reduction of fatigue in this small sample.

• Small sample (< 100)
• Baseline sample/group differences of import
• Selective outcomes reporting
• Findings not generalizable
• Intervention expensive, impractical, or training needs are required

Healing touch is not harmful to patients, but this small study does not support its use to reduce fatigue in women receiving radiation therapy for breast cancer.

To examine, within a blinded, randomized, controlled trial design, whether biofield therapy (hands-on healing) would significantly reduce fatigue in survivors with persistent cancer-related fatigue compared to mock healing and a wait-list control group.   

Energy chelation (hands-on-healing with standard hand positions focusing for five to seven minutes over each body part, i.e., feet, hips, knees, bladder, stomach, hands, elbows, shoulders, heart, throat, head, and heart) for one hour, two times each week for four weeks in the intervention group; mock biofield therapy for one hour, two times each week for four weeks; and a wait-list with no specific intervention. All participants submitted saliva samples at four time points. Timing of self-reported measures of quality of life (QOL) and depression were not reported.

• In total, 76 participants (100% female) with breast cancer were included. 
• Age ranged from 31 to 75 years. Mean age was 52 years in the healing group, 52 years in the mock group, and 50 years in the wait-list control group.
• Patients were included if they
  • Were aged 18 to 70 years
  • Were stage I to IIIA
  • Were one month to 10 years post completion of adjuvant or neoadjuvant therapy
  • Scored less than 50 on the RAND SF-36 vigor-fatigue subscale
  • Had no current use of biofield therapy.

• Single site  
• Outpatient
• University of San Diego, San Diego, California

• Patients were undergoing the long-term follow-up phase of care.
• The study has clinical applicability for late effects and survivorship.

The study used a blinded, randomized, controlled design.

• RAND SF-36 vigor-fatigue subscale    
• Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF)
• Center for Epidemiologic Studies Depression (CESD) Scale
• Functional Assessment of Cancer Therapy-Breast (FACT-B)
• Biofield Therapies Use and Expectations Questionnaire
   

• Overall attrition was 9%, with no differential attrition between groups. 
• No adverse events were reported.
• Previous use of biofield therapy was 49% prior to the study.
• The passage of time predicted changes for the overall sample for fatigue and QOL but not depression.
• There were no significant differences between biofield healing and mock healing on belief.
• Of the participants, 75% thought they received biofield healing.
• Compared with controls, biofield healing significantly decreased total fatigue (p < 0.0005; Cohen's d = 1.04), as did mock healing (p = 0.02; Cohen's d = 0.68), with no significant differences between biofield healing and mock healing.
• Cortisol slope significantly decreased for biofield healing versus both mock healing and control (p < 0.04 for both; Cohen's d = 0.58).
• Belief predicted changes in QOL over and above group (p = 0.004; Cohen's d = 0.84).
• Belief did not affect fatigue or cortisol variability.

Nonspecific factors are important in responses to biofield interventions for fatigue. Belief predicts QOL responses but not fatigue or cortisol variability. Biofield therapies increase cortisol variability independent of belief and other nonspecific factors. A need exists to further examine the effects of specific processes of biofield healing on outcomes for cancer populations.

• The study had a small sample size, with less than 100 participants.
• The study lacked follow-up assessment.
• The study lacked generalizability.
• Participants older than 70 years of age were included, which was determined to be an exclusion criterion.
   

Use of a hands-on healing intervention takes time and a skill set not traditionally taught in undergraduate or graduate nursing programs. Few clinical nurses have the time or skills to practice hands-on healing as described in the study. The intervention is noninvasive and a potentially effective independent nursing intervention with a minimal side effect profile.

All participants received four weekly 45-minute sessions of therapeutic massage (MT), healing touch (HT), or presence (P) and four weekly sessions of a standard care control. Credentialed practitioners who were also registered nurses delivered MT and HT. The three interventions all included music, a centering message, and a message to focus on breathing and letting go of extraneous thoughts. The order of the conditions was randomized. MT included a written Swedish massage protocol using massage gel. For HT, the protocol developed by Healing Touch International was used, and touch and nontouch techniques were used. Energy techniques used included centering, unruffling, magnetic unruffling, full-body connection, mind clearing, chelation, and lymphatic drain to modulate the energy field. For P, participants lied on a table listening to relaxing music. An MT or HT therapist sat with the participant during the session. The purpose was to be attentive and caring but to avoid therapy or physical intervention. In the control group, symptoms and vital signs were assessed.

• Of the 230 adults who consented to participate, 164 completed all eight sessions.
• Of those who completed the study, mean age was 54.7 years, 87% were female, 98% were Caucasian, and 68% were married.
• The majority had stage III or IV disease, and 52% had breast cancer.
• Mean time since diagnosis was 17.4 months.
• All participants rated fatigue, pain, anxiety, or nausea as greater than 3 on a scale of 0 to 10.

Patients were from two outpatient chemotherapy clinics in the Midwest.

Patients were undergoing the active treatment phase of care.

This was a randomized, two-period crossover (between one of the interventions and standard care) study.

• Profile of Mood States (POMS) for fatigue
• Blood pressure
• Heart rate
• Respiratory rate
• Pain
• Nausea
• Medication use
• Anxiety
• Mood disturbance
• Satisfaction

Compared to the control group, there was no effect of presence on fatigue. When comparing individual interventions to their matched control periods, the effect of MT on fatigue was close to significance (p = 0.057). HT was found to reduce fatigue (p = 0.028).

There was no clear evidence that one intervention was superior to the other, but MT and HT seemed to be more effective than presence alone or standard care in improving fatigue.

• Interventions also included centering, breathing, and music, which may confound the results.
• The commitment to complete the study was great, and the dropout rate was high.
• Cross-over designs may be more appropriate for healthy participants or those with earlier stage disease.
• The study design was complex. There was no blinding, there was variability in the research assistant and practitioners collecting assessments, and there was variation in the intervention technique.
• A greater number of participants assigned to the presence group dropped out due to treatment preference.
• A registered nurse certified in massage or healing touch therapy is required.