The Effect of Back Massage on Anxiety Components of Mothers With Preterm Infants

* Corresponding Author: Mina Jouzi. PhD. Address: Department of Nursing, School of Nursing and Midwifery, Najafabad Branch, Islamic Azad University, Najafabad, Iran. Tel: +98 (31) 42292208 E-mail: minajouzi@pnu.iaun.ac.ir 1. Department of Nursing, School of Nursing and Midwifery, Najafabad Branch, Islamic Azad University, Najafabad, Iran. 2. Nursing and Midwifery Sciences Development Research Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran. Maryam Lali1 , *Mina Jouzi1,2 , Maryam Moghimian1,2


Introduction
Preterm infant is a baby born before the 37th week of pregnancy [1,2]. Mothers experience a high level of anxiety upon hospitalization of their preterm infant immediately after birth [15]. Anxiety control methods are pharmacological and non-pharmacological (complementary) [17]. Massage is one of the most important non-pharmacological interventions to control anxiety [19]. One of the massage techniques is Swedish massage A therapy, which was used to reduce anxiety [22]. The anxiolytic effects of massage have been confirmed in a variety of cases, including primiparous women, post-operative cardiac surgery patients, and patients with heart failure [24][25][26]. Since the effect of massage on reducing anxiety of mothers with preterm infants has not been investigated so far, this study aimed to investigate this issue.

Materials and Method
The study was a clinical trial that included mothers with preterm infants hospitalized in Al-Zahra Hospital, and the research environment was the mothers' room. 105 samples were selected by simple sampling method based on inclusion criteria, and then according to the first letter of the mother's surname and after obtaining informed consent from them, they were randomly divided into massage group (n=35) and control group (n=70). The data collection tool consisted of two parts: the first part was demographic characteristics of the research unit and the second part related to the Lehrer Woolfolk physical, cognitive and behavioral anxiety questionnaire. This questionnaire was completed before and after the intervention by questioning the research units of the groups. Back massage was performed using Swedish surface massage techniques for 20 minutes. The control group did not receive any intervention. At the end of the study, the control group received training videos. Data were analyzed using SPSS V. 13 software.

Results
In this study, 105 mothers with hospitalized preterm infants were divided into two groups of massage (n=35) and control (n=70). Based on the results, demographic data of the mothers in terms of their age, gestational age, and duration of their infant hospital stay did not show any significant difference (P=0.05) using Chi-square and Fisher's exact tests. Using Chi-square test, the results of the study on the level of education and occupation of mothers with preterm infants did not show any significant difference (P>0.05) ( Table 1). Demographic characteristics of research units were confirmed by homogeneity of groups. The results of dependent t-test showed that the mean of physical, cognitive and behavioral anxiety of mothers with preterm infants did not differ significantly in the intervention group before intervention (P>0.05).
The mean of physical, cognitive and behavioral anxiety of mothers with preterm infants were significantly different after intervention in the intervention group (P<0.05). Results of dependent t-test showed that the mean of physical, cognitive and behavioral anxiety of mothers with preterm infants were significantly different (P<0.05) before and after intervention (P<0.05) ( Table 2), and in control group there was no significant difference (P>0.05). Statistical test results showed that the mean of physical, cognitive and behavioral anxiety of mothers with preterm infants before and after intervention in massage and control group were significantly different (P<0.05) ( Table 2).

Discussion
Since the present research was the first study to investigate the effects of back massage on the anxiety components of mothers with preterm infants, the discussion was conducted using studies close to the subject of the research. The results showed that back massage can be effective in reducing anxiety components (physical, cognitive and behavioral). Similarly, the study by Boitor et al. showed that massage is effective in reducing pain and anxiety in patients after  [25]. In the study of Atashi et al. and also in the study of Mohammadpour et al., the effect of Slow Stroke Back Massage (SSBM) on reducing anxiety in patients with stroke and patients undergoing cataract surgery has been mentioned [28,29]. The reasons for the present study's concordance with the aforementioned studies include the synchrony of the intervention and the numerical similarity of the samples. Anxiety is an unpleasant feeling that is often accompanied by physical, cognitive, and behavioral symptoms [21]. Massage affects the parasympathetic nerve and can relieve pain, as well as can reduce the effects of heart rate, blood pressure, metabolism, respiratory rate, and anxiety [19]. The results of some studies have shown that massage cannot reduce anxiety, which indicates a discrepancy between the findings of the present research and those studies. For example, the study by Gholami Motlagh et al. suggests that Swedish massage has no effect on anxiety in healthy women [30]. The reason for this discrepancy may be due to the type of samples in the study. Also, a study by Razmjo et al. showed that foot massage reduced pain severity after cesarean section but did not affect anxiety [31]. This discrepancy may be due to some cultural differences between the study population as well as the nature of the surgeries, the number of sessions, and the duration of the intervention.

Compliance with ethical guidelines
All ethical principles were considered in this article. The participants were informed about the purpose of the re-search and its implementation stages; they were also assured about the confidentiality of their information; Moreover, They were allowed to leave the study whenever they wish. This project was registered (Clinical trial Code: IRCT 20190 9120445N1) and ID: IR.IUA.NAJAFABAD. REC1398.054.

Funding
This paper extracted from the master thesis of the first author, Department of Nursing, School of Nursing and Midwifery, Najafabad Branch, Islamic Azad University.

Authors' contributions
All authors of the article were aware of the submission, completed the commitment form, and participated in all stages.

Conflicts of interest
The authors did not declare a conflict of interest.

Acknowledgements
We wish to express our special gratitude to the subjects of the present study and the Vice-Chancellor for Research and Technology of the University as well as to the officials of the Faculty of Nursing and Midwifery of the Islamic Azad University of Najaf Abad Branch who made this research possible.