The Effect of Warm-Water Footbath on Fatigue, Sleep and Quality of Life of Stroke Patients

Purpose:

Fatigue and sleep disturbance are two common problems in stroke patient. They are multifactorial, and can develop in different phase of stroke. Stroke itself and its treatment often stress the patients significantly; fatigue and sleep disturbance may further impair patients’ quality of life. Since increased distal (foot)-proximal (abdominal) skin temperature gradient (DPG) is a known predictor for one’s “readiness” for sleep, and it is also associated with shorter sleep latency and better sleep quality, we aimed to validate the safety of and explore the effect of warm-water footbath on fatigue, sleep and quality of life in hospitalized post-stroke patients.

Methods:

In our study, a quasi- experimental design was applied. The stroke subjects were recruited from two rehabilitation wards in a regional hospital in northern Taiwan. A total of fifty-one subjects were in the control group (under routine care) whereas fourty- one subjects were in the experimental group (added warm water footbath). The warm water footbath with 41°Cwas lasted 15 minutes before bedtime for 7 nights. The feet and legs of samples were immersed in a standardized footbath tank, with a depth of 10 cm above ankles. All subjects received structured questionnaires, such as: demographic data, Fatigue Severity Scale, Verran and Snyder-Halpern Sleep Scale, and Stroke Impact Scale. Data were processed by SPSS 18.0 for Windows.The major statistical procedures applied were frequencies and percentages, independent t test, paired t-test, chi-square test,and repeated-measures ANOVA. A value of P < 0.05 was considered statistically significant.

Results:

In total, 92 subjects (experiment group=41, control group=51) were included in the study, all of them completed the study. There was no adverse effect noted during the study period, and no significant demographic differences noted between the experiment group and control group.

The results showed that:

1). Fatigue was common in both the experimental and control groups. However, the severity of fatigue increased significantly in the control group whereas the severity of fatigue was decreased in the experimental group.

2). Similar quality of sleep was found between control and experimental groups in the pretest. After the implementation of footbath, samples in the experimental group reported better daily quality of sleep than samples in the control group.

3). During research period, no significant changes in quality of life was reported by the control group. But the experimental group showed a significant improvement in the “emotion” (p<.05), “ADL” (p<.05), and “mobility” (p<.05) domains of quality of life.

Conclusion:

In post-stroke patients receiving hospitalized rehabilitation, fatigue is not only common, but could significantly worsen during the hospital stay. Significant improvement over fatigue, sleep and quality of life were noted in the patients. Moreover, none of the subjects experienced burn injury, erythematous change of the skin, pain or other adverse effect, either before, during or after the footbath treatment.

Warm water footbath is a relatively safe and effective modality for post-stroke hospitalized patients receiving rehabilitation program, especially in improving the patient’s fatigue, sleep and certain domains in quality of life; and its easiness to be applied by non-professional care giver and even the patients themselves may further enhance the accessibility of post-stroke rehabilitation. Further study in a larger cohort with longer study period is needed.