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Journal of Complementary and Integrative Medicine

Editor-in-Chief: Lui, Edmund

Ed. by Ko, Robert / Leung, Kelvin Sze-Yin / Saunders, Paul / Suntres, PH. D., Zacharias

CiteScore 2017: 1.41

SCImago Journal Rank (SJR) 2017: 0.472
Source Normalized Impact per Paper (SNIP) 2017: 0.564

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Comparison of the effects of nature sounds and reflexology on hemodynamic indices among traumatic comatose patients: A randomized controlled clinical trial

Elahe Bahonar
  • Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr St., 1996713883 Tehran, Iran
  • Other articles by this author:
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/ Tahereh Najafi GhezeljehORCID iD: https://orcid.org/0000-0002-2779-2525
  • Corresponding author
  • Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr St., 1996713883 Tehran, Iran
  • Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
  • orcid.org/0000-0002-2779-2525
  • Email
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/ Hamid Haghani
  • Statistic and Mathematics Department, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr St., 1996713883 Tehran, Iran
  • Other articles by this author:
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Published Online: 2019-02-06 | DOI: https://doi.org/10.1515/jcim-2018-0106



Traumatic comatose patients may experience disturbances in hemodynamic indices due to the nature of their disorder. This study aimed to compare the effects of nature sounds and reflexology on hemodynamic indices in traumatic comatose patients.


This randomized clinical trial using a factorial design was conducted on 120 traumatic comatose patients in two teaching hospitals in two urban areas of Iran. The patients were selected using a sequential sampling method and assigned into randomized quadruple blocks as control, nature sounds, reflexology and nature sounds-reflexology (combined) groups. The interventions were performed twice daily in two consecutive days lasting 30 min each time. The hemodynamic indices were measured before, and immediately, 30 min, and 2 h after the intervention using calibrated monitors. Descriptive and inferential statistics, including one-way ANOVA, Scheffe ad hoc, repeated measure ANOVA, Bonferroni ad hoc Chi-square test and Fisher’s exact tests were used for data analysis via the SPSS software V.16.


Significant differences were reported in terms of the mean arterial pressure between the control and reflexology groups (p=0.002), and the combined group (p=0.008) immediately after the interventions. The combined group showed statistically differences in systolic blood pressure compared to the nature sounds (p=0.007) and control (p=0.015) groups 30 min after the interventions. The nature sounds group showed differences in the pulse rate from the reflexology (p=0.048) and control (p=0.015) groups 30 min after the interventions in the second day.


While the immediate effects of the interventions on induction of the feeling of relaxation and tranquility, and reduction of hemodynamic indices were reported, they diminished over time. Nature sounds and reflexology as low-cost and relaxing tranquilizing methods can be used for the reduction of tension and improvement of hemodynamic indices among traumatic comatose patients.

Keywords: hemodynamic indices; nature sounds; reflexology; traumatic comatose patients


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About the article

Received: 2018-06-26

Accepted: 2018-11-08

Published Online: 2019-02-06

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: Iran University of Medical Sciences provided support to this study.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Journal of Complementary and Integrative Medicine, 20180106, ISSN (Online) 1553-3840, DOI: https://doi.org/10.1515/jcim-2018-0106.

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