The effect of warm water footbath versus Swedish massages on hemodialysis patients' sleep quality and insomnia

Context: Low sleep quality as a common problem in patients undergoing hemodialysis can lead to negative impacts such as poor quality of life. Many studies were performed in order to improving sleep quality in these patients; however, few comparative studies have been conducted to compare the effects of nonpharmacological interventions on sleep disturbances of patients undergoing hemodialysis. 
Aims: This study was carried out to examine the effect of warm water footbath versus Swedish massage on sleep quality and insomnia severity in patients undergoing hemodialysis.
Materials and Methods: Seventy patients undergoing hemodialysis referring to two dialysis wards affiliated to Yasuj University of Medical Sciences, Yasuj Iran have included in this randomized clinical trial from November 2015 to April 2016. The eligible patients undergoing hemodialysis were selected as convenience sampling method but randomly assigned to one of the three groups of warm water footbath (n = 24), effleurage (n = 23) and petrissage (n = 23). The interventions have been performed for 15 min over 2 months. Pittsburgh Sleep Quality Index and Insomnia Severity Index was used to collect data.
Statistical Analysis Used: Collected data were analyzed using SPSS, version 21, which involved running statistical
tests including repeated measures ANOVA. P < 0.05 was considered to be a statistical significant difference.
Results: Twenty six men (41.9%) and 36 women (58.1%) completed this study (mean age: 51.01+/‑13.91). Mean global sleep quality was reported for patients in the group of warm‑water footbath (14.1 ± 1.8; 7.15 ± 2.1and 5.37 ± 2.4), effleurage (13.2 ± 1.7; 8.1 ± 2.8 and 5.82 ± 2.7), and petrissage (14.1 ± 1.9; 9.18 ± 2.4 and 6.4 ± 2.8) on the baseline, the end of the 1st and the 2nd month of interventions, respectively. Mean scores of insomnia severity for patients in the group of warm‑water footbath (21.38 ± 3.6; 11.95 ± 3.2 and 9.48 ± 3.4), effleurage (19.65 ± 3.1; 12.5 ± 3.67 and 9.1 ± 4.7), and petrissage (21.05 ± 3.68; 13.81 ± 3.1 and 10.6 ± 3.6) was observed. No statistical significant (P > 0.05) differences were observed by sleep quality and insomnia severity among three groups.
Conclusion: Warm‑water foot bath is as effective as Swedish massages for improving sleep quality and insomnia severity in patients undergoing hemodialysis. Further investigations are suggested to determine whether the same findings are replicated.