The purpose of this study was to test the effect of (1) a combination of muscle relaxation, mental imagery, and relaxing music (MRMIM), and (2) slow stroke back massage (SSBM) on the sleep and psychophysiological arousal of elderly males with a cardiovascular illness hospitalized in a critical care unit. The 69 subjects were randomly assigned to a control group that received the usual nursing care (N = 17), a MRMIM group that received a brief teaching session on relaxation and listened to a 7.5 minute MRMIM audiotape (N = 28), and a SSBM group that received a back massage given by the investigator (N = 24). The variables measuring psychophysiological arousal were anxiety, frontalis muscle tension (FMT), heart rate (HR), and respiratory rate (RR). Sleep variables were sleep efficiency index (SEI), percent stage 2 NREM, percent stages 3 and 4 NREM, and percent stage REM.

Because there were significant pretest differences in anxiety scores between the MRMIM and the SSBM groups, ANCOVA was used to test for differences in anxiety among the three groups. Pretest anxiety measures served as covariates. The ANCOVA revealed that both the MRMIM and the SSBM groups had significantly less posttest anxiety than the control group. A MANOVA comparing the three groups on HR, RR, and FMT did not reveal differences. Independent two-tailed t-tests tested the effectiveness of the interventions on sleep. There were significant differences between the SSBM and the control group in SEI, percent stage 2, and percent stage REM. There were no significant differences between the MRMIM and the control group in sleep.

A stepwise multiple regression to predict the SEI was performed. Two variables, SSBM and receiving theophylline, entered the model and accounted for 16% of the variance. Additional findings were that 37 (54%) subjects experienced sleep disordered breathing, and 73% of the 37 experienced oxygen desaturation to less than 90% during apneic episodes. Subjects accurately estimated total sleep time (r =.61), and the Richards Campbell Sleep Questionnaire was significantly correlated with SEI (r =.57).

Manifest content analysis was performed to analyze qualitative data. Thirty subjects, ten from each of the three groups, comprised the sample. Effects of the SSBM were relaxing, comforting, soothing, helped backache, made me feel a lot better, and helped me go to sleep. Essential elements of a therapeutic backrub as perceived by subjects were a willingness to give the patient a backrub, feeling comfortable touching the patient, having a rapport between the patient and the nurse, and a gentle touch.