Interpersonal touch interventions for patients in intensive care: A design-oriented realist review.
Sansha J Harris, Elizabeth D E Papathanassoglou, Melanie Gee and 3 others
PMID 30918674WHAT IT FOUND
Evidence for ICU touch interventions is weak and mixed.
Dynamic touch such as hand massage may help pain more than static handholding, but do not expect it to replace standard care.
Key findings
01Two studies comparing dynamic touch with predominantly static touch reported results favouring dynamic touch, including moving hand massage or massage combined with acupressure.
02Between-study comparison suggested that restricting sedation may make touch interventions more effective, but the finding was tentative because few studies and outcome measures differed.
03Groups receiving at least five treatments had stronger evidence for time-dependent effects, and some benefits appeared only after multiple treatments.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The review used only 13 studies to test its construction principles, and no study met all quality appraisal criteria. Search, screening, appraisal and extraction were completed by one person, which increases the risk of bias. Studies were small, heterogeneous and variably reported, especially for intervention details such as pressure, velocity, eye contact and facial expression. Most studies were randomized trials against standard care, and control patients may have been disappointed by their allocation. Two sedation studies were conducted before current lighter sedation practices, so participants may have been over-sedated relative to today. The review focused on positive effects and may have missed harms, including trauma triggers, pro-stress light touch and antisocial oxytocin effects. Empirical evidence for several proposed principles was weak, unsupportive or unavailable, and outcomes could not be linked to specific mechanisms.
Declared interests
No conflict of interest was declared by the authors.
The easy way to misread this
Do not conclude that ICU touch interventions are proven to reduce stress or pain. The review found weak, mixed or unavailable evidence and produced design propositions, not tested interventions.