Researchers from Haifa, Israel, have proven that a combination of complementary medicine and standard care for preoperative anxiety is more effective in reducing symptoms caused by patient anxiety and consequently improves postsurgical outcomes.

Preoperative anxiety, which can lead to elevated blood pressure, rapid pulse and sugar metabolism changes, is one of the most significant factors predicting mortality among postoperative cardiovascular patients, according to Prof. Lital Keinan Boker from the Faculty of Social Welfare and Health Studies at the University of Haifa.

These symptoms of preoperative anxiety can influence and extend the postoperative recovery period, added Boker, who also is deputy director of the Israel Center of Disease Control and currently is a visiting associate professor at Trinity College, Dublin.

She and Dr. Elad Schiff of Bnai Zion Hospital in Haifa supervised the study by master’s student Samuel Attias at the university. Attias’ goal was to examine whether complementary medicine practices, applied alongside conventional care, could help reduce anxiety levels.

The study involved 360 patients over the age of 16 about to undergo elective or acute surgery in the general surgery ward. The patients were divided into three groups.

The first group received standard care for preoperative anxiety, including anti-anxiety drugs according to the anesthesiologist’s instructions, 120 to 160 minutes before entering the surgical waiting room.

The second group received standard care as well as complementary care, including one of the following therapies: acupuncture, reflexology, individual guided imagery or a combination of reflexology and guided imagery.

The third group received standard care combined with generic guided imagery, provided in the form of a recording for the patient, rather than in person.

Anxiety levels were measured before the surgery on a scale of 1 to 10, before and after the intervention. Scores of 4 and above indicate an intermediate or higher anxiety level.

Reflexology and guided imagery help most

In general, patients who received the combination of complementary medicine and standard care showed a reduction of 60 percent in their anxiety level, from a mean score of 5.54 to 2.32, representing a reduction from an intermediate-to-high anxiety level to a low anxiety level.

By contrast, standard care alone actually caused the average anxiety level to rise slightly from 4.92 to 5.44, and 70% of patients in this group continued to report intermediate to high anxiety even after receiving medication.

The study found that the greatest reduction in anxiety – by an average of 4.22 points – was achieved when patients received a combination of standard care together with reflexology and guided imagery.

The patients who received a combination of standard care and generic guided imagery, without intervention by a caregiver, showed a reduction in preoperative anxiety level from an average of 4.9 to 3.5, although the researchers said this is not clinically significant and acknowledged that this method would be difficult to implement without the presence of a therapist to keep external interruptions to a minimum.

“Despite the growing popularity of complementary medicine, studies providing evidence of its therapeutic effectiveness are still lacking,” the researchers concluded. “In this study, we showed that complementary treatments are apparently helpful in the context of preoperative anxiety.”