Gebe masajının gebe ve fetus üzerine etkisi: Randomize kontrollü bir çalışma
Yükleniyor...
Tarih
2017
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çalışma gebe masajının gebe ve fetus üzerine etkisini saptamak amacı ile gerçekleştirilmiştir. Yöntem: Çalışma, bir üniversite hastanesinin Obstetri Polikliniği'ne I. trimester tarama testi sonuçlarının değerlendirilmesi için gelen, infertilite öyküsü ve yüksek riskli gebeliği olmayan, 20-35 yaş, primipar gebeler ile gerçekleştirilen randomize kontrollü deneysel bir çalışmadır. Katılımcılar paralel karşılaştırma gruplarına tek merkez tarafından rasgele atanmıştır. Çalışmanın örnek seçim süreci CONSORT kriterlerine göre uygulanmış, çalışmanın uygulandığı merkezden tahsis edilen kayıtlara permütasyon yöntemi ile blok randomizasyon yapılmıştır. Veri toplama sürecinde körleme yöntemi uygulanamamış sadece veri analizinde uygulanmıştır. Çalışmaya uygunluğu değerlendirilen 430 gebeden 46'sı randomize edilmiş, kontrol grubu için 17, gebe masajı grubu için 13 gebenin verileri analiz edilmiştir. Çalışmanın gücünün %90-99 ve etki büyüklüğünün 0.52-1.89 arasında olduğu, gruplardaki örnek sayılarının yeterli olduğu saptanmıştır. Çalışmanın bağımsız değişkeni gebe masajı uygulaması, bağımlı değişkenleri maternal ve fatal iyilik hali, gebenin genel iyilik hali algısı, prenatal bağlanma düzeyi, prenatal distres düzeyi, biyofizik profil (BFP) ve gebe masajı memnuniyet düzeyidir. Etik kurul ve kurum izinleri alındıktan sonra, araştırmacı gebe masajı eğitimlerini tamamlamış, gebelerin bilgilendirilmiş gönüllü onamlarını aldıktan sonra çalışma uygulamaları gerçekleştirilmiştir. Uygulamalar çalışma kapsamında oluşturulan masaj ofisinde gerçekleştirilmiştir. Rutin gebelik izlemleri devam eden gebelere; kontrol grubunda 30. ve 34. gebelik haftalarında elektronik fetal monitörizasyon (EFM), BFP, yaşamsal bulgular, fetal kalp atım hızı (FKH) değerlendirmesi yapılmış ve Gebe Tanıtım Formu, Görsel Kıyaslama Ölçeği (GKÖ), Prenatal Bağlanma Envanteri (PBE), Prenatal Distres Ölçeği (PDÖ) uygulanmıştır. Gebe masajı grubunda 30-34. haftalar arası beş hafta boyunca her hafta, haftada bir kez, 60 dk derin doku ve İsveç masajı yöntemlerini içeren gebe masajı uygulanmıştır. Uygulamalar esnasında gebelere özgü tasarlanmış Yan Yatış Pozisyon Alma Sistemi kullanılmıştır. İlk görüşmede gebe masajı öncesi ve son görüşmede gebe masajı sonrası kontrol grubundaki gibi tüm formlar ve ölçümler uygulanmıştır. 31-33. gebelik haftalarında da masaj öncesi ve sonrası GKÖ ve diğer ölçüm verilerinin değerlendirilmesi yapılmıştır. Ayrıca her gebe masajı sonrası Görsel Analog Hasta Tatmini Skalası (GAHTS) ile memnuniyet düzeyi ölçülmüştür. Çalışma sürecinde uygulamaya bağlı herhangi önemli bir yan etki oluşmamıştır. Veri toplama aşamasının tamamlanma kararı PASS programı ile yapılan güç analizi ile belirlenmiştir. Çalışma verilerinin çözümlenmesi ise SPSS 16 programı ile gerçekleştirilmiştir. Bulgular: Çalışma sonucunda; maternal ve fetal sağlık göstergelerinin kontrol ve gebe masajı grubunda ilk ve son görüşmelerde gruplar içi ve gruplar arası anlamlı olarak benzer olduğu saptanmıştır (p>0.05). Çalışmanın başlangıcında grupların sosyodemografik ve ölçek puanları açısından anlamlı olarak benzer oldukları saptanmıştır (p>0.05). Çalışmanın sonunda ölçek puanları açısından her iki grup arasında anlamlı fark olduğu (p<0.05) ve kontrol grubunun ilk görüşme ve son görüşme ölçek puanları arasında anlamlı değişme olmadığı saptanmıştır (p>0.05). Gebe masajı grubunda ilk görüşme ve son görüşme ölçek puanları değerlendirildiğinde gebenin genel iyilik halinin ve prenatal bağlanma düzeyinin anlamlı bir şekilde arttığı, prenatal distres düzeyinin anlamlı bir şekilde azaldığı (p<0.05) ve BFP düzeyinin çalışma sürecinde anlamlı bir şekilde hep iyi düzeyde olduğu saptanmıştır (p>0.05). Ayrıca her gebe masajı öncesi ve sonrası gebenin genel iyilik halinin anlamlı olarak iyi yönde artış gösterdiği (p<0.05) ve gebelerin gebe masajından memnuniyetlerinin %99 olduğu saptanmıştır. Sonuç: Çalışmanın birincil sonucu gebe masajının fetusa ve gebeye zarar vermediği, kadınların genel iyilik halini belirgin bir şekilde arttırdığı, prenatal bağlanmayı arttırdığı ve prenatal distresi belirgin bir şekilde azalttığıdır. İkincil sonuçlar ise gebelerin ilk uygulamadan son uygulamaya kadar tüm masajlardan memnuniyetlerinin oldukça yüksek olduğudur. Bu uygulamanın bölgesel ya da tüm vücut masajı şeklinde doğuma hazırlık sınıfları ve gebe polikliniklerinde hizmet veren ebe ve hemşireler tarafından öğrenilerek rutin gebelik hizmetleri içinde verilmesi önerilmektedir. Hatta ebe ve hemşirelerin masaj merkezlerinde gebe masajı uygulamaları için istihdam edilme imkanlarının sağlanması, ülkemizde bu uygulamanın öncelikle oluşturulup sonra geliştirilmesi için çalışma bulgularından yola çıkılarak eğitimlerin düzenlenmesi önerilmektedir. Gebe masajının yüksek riskli gebelik ve fetus üzerine etkisini saptamaya yönelik araştırmaların yapılmasına ihtiyaç duyulmaktadır.
The Effect of Pregnant Massage on Pregnants and Fetus: A Randomized Controlled Trial Aim: The study has been held to determine the effect of pregnant massage on pregnant and fetus. Method: As a randomized controlled experimental trial, the study has been carried out with 20-35 years–old primipara pregnant women that came to obstetrics polyclinic of a university to evaluate the results of first-trimester screen test, have no infertility story and are not at high risk (inclusion criterias). The participants were randomly allocated to the parallel comparison groups by a central office. The sample selection process in the study has been applied according to CONSORT criteria, and through permutation method, blocked randomization has been done to the records assigned from the center that the study was applied. In the process of gathering data, blinding method hasn't been applied, and it has only been applied to data analysis. 46 pregnant women within 430 ones whose suitability for the study was evaluated have been randomized, the data of 13 pregnant women for pregnant massage group and the data of 17 ones for control group have been analyzed. It has been ascertained that the strength of the study is between 90% and 99% and its effect size is between 0.52 and 1.89, and the sample numbers in the groups are sufficient. The independent variable of the study is pregnant massage practice, and its dependent variables are maternal and fetal well-being, general well-being perception of pregnants, prenatal attachment level, prenatal distress level, biophysical profile (BPP) and pregnant massage satisfaction level. The study practices were carried out after receiving ethics committee and institution approvals after the researcher completed the pregnant massage trainings, and after taking the voluntarily informed consent of the pregnants. The practices have been carried out in the massage office that was formed within the scope of the study. Electronic fetal monitoring (EFM), BPP, vital signs, fetal heart rate (FHR) evaluation have been carried out for the pregnants whose routine gestational monitoring went on during their gestational week between the 30th and 34th in the control group, and Pregnant Description Form, VAS, Prenatal Attachment Inventory-PAI, Revised Prenatal Distress Questionnaire-PDQ have been applied. In the pregnant massage group, between the 30th and 34th weeks, each week for five weeks, a pregnant massage including a 60 minutes deep tissue and Sweden massage methods had been applied once a week. Side-Lying Positioning System that is designed specifically for the pregnant has been used during the practices. Like before the pregnant massage on the first date and after the pregnant massage in the last date in the control group, all the forms and measurements have been applied. Pregnant women's VAS measured before and after the pregnant massage and the evaluation of the other measured data have been held between the 31st and 33rd gestational weeks. Also Visual Analog Patient Satisfaction Scale-VAPSS measured after the each pregnant massage for finding satisfaction level. In the process of the study, any significant side effect related to the practices hasn't occurred. The completion decision of the data gathering process has been determined with power analysis that is carried out by PASS program. The analysis of the study data has been carried out through SPSS 16 program. Findings: At the end of the study, it has been determined that maternal and fetal health indicators are significantly similar as in-groups and intergroups in the control and pregnant massage group during the first and the last follow-up (p>0.05). At the beginning of the study, it has been confirmed that the groups are significantly similar with regard to sociodemographic and measuring device scores (p>0.05). At the end of the study, it has been ascertained that there is a significant difference between both groups in terms of measuring device scores (p<0.05) and there is no a significant difference in the first and the last follow-up measuring device scores of the control group (p>0.05). It has been determined that the general well-being and prenatal attachment level of the pregnant significantly increased, the prenatal distress level of the pregnant significantly reduced (p<0.05) and BBP level of the fetus was significantly above average in the process of the study when the first and the last follow-up measuring device scores in the pregnant massage group were evaluated (p>0.05). Moreover it has been found that the general well-being of the pregnant before pregnant massage and after it showed an increase positively (p<0.05) and the satisfaction of the pregnant women with the pregnant massage is 99%. Conclusion: The primary outcomes of the study is that pregnant massage is not harmful for fetus and pregnant, it increases the general well-being of women significantly, increase prenatal attachment and decrease prenatal distress prominently. As for the secondary outcomes, the satisfaction of the pregnants is quite high for all the massages starting from first massage therapy till the end. This practice is suggested to be implemented as local or full body massage within the routine pregnancy services after learned by the midwives and nurses providing services in pregnancy policlinics and in antenatal preparation classes. It is even suggested that midwives and nurses to be employed in massage centers for pregnancy massage practices and then to organize trainings depending on the findings of studies in our country to be able to implement this practice firstly and then to improve. It is required to do some studies to find out the affects of pregnancy massage on highly risky pregnancy and on fetus.
The Effect of Pregnant Massage on Pregnants and Fetus: A Randomized Controlled Trial Aim: The study has been held to determine the effect of pregnant massage on pregnant and fetus. Method: As a randomized controlled experimental trial, the study has been carried out with 20-35 years–old primipara pregnant women that came to obstetrics polyclinic of a university to evaluate the results of first-trimester screen test, have no infertility story and are not at high risk (inclusion criterias). The participants were randomly allocated to the parallel comparison groups by a central office. The sample selection process in the study has been applied according to CONSORT criteria, and through permutation method, blocked randomization has been done to the records assigned from the center that the study was applied. In the process of gathering data, blinding method hasn't been applied, and it has only been applied to data analysis. 46 pregnant women within 430 ones whose suitability for the study was evaluated have been randomized, the data of 13 pregnant women for pregnant massage group and the data of 17 ones for control group have been analyzed. It has been ascertained that the strength of the study is between 90% and 99% and its effect size is between 0.52 and 1.89, and the sample numbers in the groups are sufficient. The independent variable of the study is pregnant massage practice, and its dependent variables are maternal and fetal well-being, general well-being perception of pregnants, prenatal attachment level, prenatal distress level, biophysical profile (BPP) and pregnant massage satisfaction level. The study practices were carried out after receiving ethics committee and institution approvals after the researcher completed the pregnant massage trainings, and after taking the voluntarily informed consent of the pregnants. The practices have been carried out in the massage office that was formed within the scope of the study. Electronic fetal monitoring (EFM), BPP, vital signs, fetal heart rate (FHR) evaluation have been carried out for the pregnants whose routine gestational monitoring went on during their gestational week between the 30th and 34th in the control group, and Pregnant Description Form, VAS, Prenatal Attachment Inventory-PAI, Revised Prenatal Distress Questionnaire-PDQ have been applied. In the pregnant massage group, between the 30th and 34th weeks, each week for five weeks, a pregnant massage including a 60 minutes deep tissue and Sweden massage methods had been applied once a week. Side-Lying Positioning System that is designed specifically for the pregnant has been used during the practices. Like before the pregnant massage on the first date and after the pregnant massage in the last date in the control group, all the forms and measurements have been applied. Pregnant women's VAS measured before and after the pregnant massage and the evaluation of the other measured data have been held between the 31st and 33rd gestational weeks. Also Visual Analog Patient Satisfaction Scale-VAPSS measured after the each pregnant massage for finding satisfaction level. In the process of the study, any significant side effect related to the practices hasn't occurred. The completion decision of the data gathering process has been determined with power analysis that is carried out by PASS program. The analysis of the study data has been carried out through SPSS 16 program. Findings: At the end of the study, it has been determined that maternal and fetal health indicators are significantly similar as in-groups and intergroups in the control and pregnant massage group during the first and the last follow-up (p>0.05). At the beginning of the study, it has been confirmed that the groups are significantly similar with regard to sociodemographic and measuring device scores (p>0.05). At the end of the study, it has been ascertained that there is a significant difference between both groups in terms of measuring device scores (p<0.05) and there is no a significant difference in the first and the last follow-up measuring device scores of the control group (p>0.05). It has been determined that the general well-being and prenatal attachment level of the pregnant significantly increased, the prenatal distress level of the pregnant significantly reduced (p<0.05) and BBP level of the fetus was significantly above average in the process of the study when the first and the last follow-up measuring device scores in the pregnant massage group were evaluated (p>0.05). Moreover it has been found that the general well-being of the pregnant before pregnant massage and after it showed an increase positively (p<0.05) and the satisfaction of the pregnant women with the pregnant massage is 99%. Conclusion: The primary outcomes of the study is that pregnant massage is not harmful for fetus and pregnant, it increases the general well-being of women significantly, increase prenatal attachment and decrease prenatal distress prominently. As for the secondary outcomes, the satisfaction of the pregnants is quite high for all the massages starting from first massage therapy till the end. This practice is suggested to be implemented as local or full body massage within the routine pregnancy services after learned by the midwives and nurses providing services in pregnancy policlinics and in antenatal preparation classes. It is even suggested that midwives and nurses to be employed in massage centers for pregnancy massage practices and then to organize trainings depending on the findings of studies in our country to be able to implement this practice firstly and then to improve. It is required to do some studies to find out the affects of pregnancy massage on highly risky pregnancy and on fetus.
Açıklama
Anahtar Kelimeler
Gebelik, Masaj Terapi, Fetus, Prenatal, Distres, Ebe, Hemşire, Pregnancy, Massage Therapy, Fetus, Prenatal, Distress, Midwife, Nurses
