Research Reports - The effects of family-centered affective stimulation on brain-injured comatose patients' level of consciousness

Int J Nurs Stud. 2017 Jun 4;74:44-52. doi: 10.1016/j.ijnurstu.2017.05.014. [Epub
ahead of print]

Salmani F(1), Mohammadi E(2), Rezvani M(3), Kazemnezhad A(4).

BACKGROUND: Despite the well-defined effects of sensory stimulation, the
knowledge of the pure effects of affective stimulation is scarce.
OBJECTIVE: To evaluate the effects of family-centered affective stimulation on
the level of consciousness among comatose patients with brain injuries.
DESIGN: This study was designed as a three-group double-blinded Randomized
Controlled Trial.
METHODS: Ninety consecutive patients with traumatic brain injuries and a Glasgow
Coma Scale score of 5-8 were selected. Patients were randomly allocated to an
experimental, a placebo, and a control group using permuted block randomization.
Affective stimulation intervention was provided to patients in the experimental
group by their family members twice a day during the first seven days of their
hospitalization. In the placebo group, a sensory stimulation program was
implemented by a fixed trained person who was not familiar with the patients.
Patients in the control group solely received sensory stimulation which was
routinely provided to all patients. The level of consciousness among the patients
using the Glasgow Coma Scale and Coma Recovery Scale-Revised were measured both
before and after a family visit. The SPSS software (version 17.0) was used to
analyze the data through running the one-way and the repeated measure analyses of
variance.
RESULTS: Despite an insignificant difference among the groups regarding baseline
level of consciousness, the results of the one-way analysis of variance revealed
at the seventh day of this study, however, the level of consciousness in the
experimental group was significantly higher (9.1±2.1) than the placebo (7.2±1.1),
the control groups (6.6±1.7) (P<0.001), subsequently. Moreover, at the seventh
day of the study, the Coma Recovery Scale score in the experimental group
(11.9±3.7) was significantly greater than the placebo (9.0±2.0) and the control
(6.6±1.6) groups (P<0.001). Recovery rate and effect size values also confirmed
the greater effectiveness of affective stimulation compared with pure sensory
stimulation.
CONCLUSION: Our findings in this study indicate that early family-centered
affective stimulation is more effective than sensory stimulation in improving the
level of consciousness among comatose patients with brain injuries.
Family-centered affective stimulation is recommended to be integrated into the
nursing curricula and routine care plans for comatose trauma patients in
intensive care units. 

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