Aim: To examine the effect of reflexology on perceived perineal pain during episiotomy
repair.
Hypothesis(s):
H0: There is no difference between the perineal pain of the group in which reflexology
was applied and the group in which reflexology was not applied during episiotomy repair.
H1: There is a difference between the perineal pain of the group in which reflexology was
applied and the group in which reflexology was not applied during episiotomy repair.
Type of Research: This study was designed as a randomized controlled experimental study.
In order to determine the sample size in the study, it was calculated according to the
research conducted by Sharifi et al (2022). Considering the sample size in the R pwrss
(Statistical Power and Sample Size Calculation Tools) program, a type 1 (alpha) error of
0.05 and a power of 0.80, it was calculated that the study group should be at least 32 in
the reflexology group and 32 in the control group. Considering the confounding variables,
it was planned to recruit 25% more participants for each group, and therefore it was
decided to recruit 40 participants per group, 80 participants in total.
The participants included in the study will be divided into two groups by determining
which group they will be included in from the website called "Random List", a random
number generation program. Thus, each participant's number and group number will be
determined and recorded.
Research data will be collected using the Participant Information Form, VAS (Visual
Analog Scale) and McGill Pain questionnaire to assess pain during episiotomy repair.
Participant Information Form It was prepared by the researcher within the framework of
the literature. The form consists of a total of 14 questions that question women's
socio-demographic and obstetrics-related information.
VAS for Evaluation Pain during Episiotomy Repair: The participant marks his or her own
pain on a 10 cm ruler, which is marked as "no pain" at one end and the most severe pain
at the other end. The participant is told that there are two endpoints and to mark any
place between these points that matches the severity of the pain. The distance between
the onset of no pain and this point marked by the patient is measured and recorded in
centimeters. It is stated that VAS is more sensitive and reliable than other
unidimensional scales in pain severity measurement. The VAS is more sensitive than the
simple descriptive scale.
McGill Short Form for Assessment of Pain Following Episiotomy Repair: The McGill Pain
Questionnaire was developed by Melzack and Torgerson and is used to evaluate pain
multidimensionally. There are 15 criteria by which pain is evaluated. 11 of these
criteria are to evaluate the emotional dimension of pain, and 4 are to evaluate the
perceptual dimension of pain. Assessment of pain was rated on an intensity scale from 0
to 3 (0 = none, 1 = mild, 2 = moderate, 3 = severe). In the first part of the scale, a
total of three pain scores are obtained: sensory pain score, perceptual pain score and
total pain score. Sensory pain score ranges from 0-33, perceptual pain score ranges from
0-12, and total pain score ranges from 0-45. An increase in the score indicates that the
pain also increases. Second Part: In this part, there are five word groups ranging from
"mild pain" to "unbearable pain" to determine the severity of the patient's pain. Third
Part: In the third part of MAS-CF, the patient's current pain intensity was evaluated
using a visual comparison scale.
Application of Research After obtaining the necessary ethics committee and institutional
permissions to conduct the research, the institution will be visited and participants who
gave birth normally with episiotomy and meet the inclusion criteria for the study will be
interviewed. Data will be collected by the researcher in the hospital delivery room.
Women will be informed about the research and the purpose of the research will be
explained. Those who agree to participate in the research will be asked to read and sign
the Informed Consent Form. Participants who meet the criteria will be divided into
reflexology and control groups. The website called "https://www.randomlists.com/", a
random number generation program, will be used to determine the selection process. Thus,
each participant's number and group number will be determined and recorded. Episiotomy
repairs will be performed by the same midwife. We were going to do another investigative
reflexology application. Data collection forms will be filled out by an independent
midwife who is not involved in the research. One of the researchers, SDA, has approved
international training and certification in the ability to apply foot reflexology
techniques based on standard protocol.
For the reflexology group, first a 4-minute general massage will be applied to each foot,
then a 2-minute specific reflexology will be applied in the form of rotational pressures
to each point of the pelvis, sacrum, uterus and solar plexus. The application will take
approximately 20-30 minutes. These points were agreed upon by experts in reflexology as
effective points in reducing pain and anxiety. The control group will receive only
general massage on each foot for 4 minutes.
Statistical analysis will be performed using IBM SPSS Statistic 29.0 (IBM Corp., Armonk,
NY, USA). Descriptive statistical methods (number, percentage, mean, standard deviation)
will be used in the evaluation of socio-demographic data. When the data is found to be
suitable for normal distribution, parametric tests (chi-square, T test, etc.) will be
used to compare categorical variables, and when the data is not found to be suitable for
normal distribution, non-parametric tests (Mann-Whitney U Test) will be used. Statistical
significance level will be accepted as p<0.05.