Effect of the Palming Technique on Preoperative Anxiety and Hemodynamic Responses in Thyroid Surgery

Purpose of the Observational Study: The purpose of this observational study was to evaluate the effects of the palmar technique on preoperative anxiety, hemodynamic parameters, and intubation-related hemodynamic responses in patients undergoing thyroidectomy.

Primary Research Question: Does the palmar technique applied preoperatively reduce preoperative anxiety and associated hemodynamic changes in thyroidectomy patients? Study Design: Type: Prospective, single-blind, observational study Location: A single-center tertiary care hospital in Turkey Sample: 80 patients aged 18-65, ASA I-II

Methods:

Patients were divided into two groups using a sealed envelope method:

Group P: Patients who received the palm-based technique Group N: Control group without intervention

When admitted to the preoperative waiting room (T1), all patients:

Baseline vital signs (SpO₂, heart rate, blood pressure) State-Trait Anxiety Inventory (STAI) scores were recorded. Patients in Group P received the palm-based technique; Group N received no intervention.

The same parameters were measured again 15 minutes later (T2).

After transfer to the operating room, standard monitoring was performed, and hemodynamic data were recorded at the following times:

Pre-intubation (T3)

1 min (T4), 3 min (T5), 5 min (T6), and 10 min (T7) after intubation Main Outcome Measures: Changes in preoperative anxiety level Changes in hemodynamic parameters after the palmar technique Sample Size:Total: 80 patients

Study Overview

• Status: Completed
• Conditions: Preoperative Anxiety and Associated Hemodynamic Changes
• Intervention / Treatment: Behavioral: Group P

Detailed Description

Purpose of the Observational Study: The purpose of this observational study was to evaluate the effects of the palmar technique on preoperative anxiety, hemodynamic parameters, and intubation-related hemodynamic responses in patients undergoing thyroidectomy.

Primary Research Question: Does the palmar technique applied preoperatively reduce preoperative anxiety and associated hemodynamic changes in thyroidectomy patients? Study Design: Type: Prospective, single-blind, observational study Location: A single-center tertiary care hospital in Turkey Sample: 80 patients aged 18-65, ASA I-II

Methods:

Patients were divided into two groups using a sealed envelope method:

Group P: Patients who received the palm-based technique Group N: Control group without intervention

When admitted to the preoperative waiting room (T1), all patients:

Baseline vital signs (SpO₂, heart rate, blood pressure) State-Trait Anxiety Inventory (STAI) scores were recorded. Patients in Group P received the palm-based technique; Group N received no intervention.

The same parameters were measured again 15 minutes later (T2).

After transfer to the operating room, standard monitoring was performed, and hemodynamic data were recorded at the following times:

Pre-intubation (T3)

1 min (T4), 3 min (T5), 5 min (T6), and 10 min (T7) after intubation Main Outcome Measures: Changes in preoperative anxiety level Changes in hemodynamic parameters after the palmar technique Sample Size:Total: 80 patients

• Study Type: Observational
• Enrollment (Actual): 80

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Van, Turkey (Türkiye), 65080
    • Van Yüzüncü Yıl Universitesi

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

The study population consisted of adult patients scheduled to undergo thyroidectomy at a tertiary care hospital in Türkiye. A total of 80 patients aged 18-65 years and classified as ASA I-II according to the American Society of Anesthesiologists physical status classification were included. All participants were thoroughly informed about the study procedures and provided written informed consent. Eligible patients had no active psychiatric or neurological disorders, no history of glaucoma, and no prior ophthalmic surgery. Following randomization, patients were assigned to either the palming group (n = 40) or the control group (n = 40).

Description

Inclusion Criteria:

• Patients aged 18-65 years
• Patients classified as ASA I-II
• Patients scheduled for thyroid surgery
• Patients without a history of glaucoma
• Patients without active psychiatric or neurological disease
• Patients who were informed about the study and provided written informed consent

Exclusion Criteria:

• Patients with a diagnosed psychiatric disorder
• Patients using sedatives, antidepressants, or antiepileptic medications
• Patients with impaired cooperation, comprehension, vision, or hearing
• Patients with a history of ophthalmic surgery
• Patients classified as ASA III or higher

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Group P; Patients who received the palm-based technique	Behavioral: Group P; When admitted to the preoperative waiting room (T1), all patients: Baseline vital signs (SpO₂, heart rate, blood pressure) State-Trait Anxiety Inventory (STAI) scores were recorded. Patients in Group P received the palm-based technique; Group N received no intervention. The same parameters were measured again 15 minutes later (T2). After transfer to the operating room, standard monitoring was performed, and hemodynamic data were recorded at the following times: Pre-intubation (T3) 1 min (T4), 3 min (T5), 5 min (T6), and 10 min (T7) after intubation Main Outcome Measures: Changes in preoperative anxiety level Changes in hemodynamic parameters after the palmar technique
Group N; Control group without intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Preoperative Anxiety Score (State-Trait Anxiety Inventory - STAI-State)	Baseline (TPreoperative anxiety will be assessed using the State-Trait Anxiety Inventory - State (STAI-State) scale (range: 20-80; higher scores indicate higher anxiety). The primary outcome is the change in STAI-State score from baseline (T1) to 15 minutes after the palming technique (T2).1) and 15 minutes after intervention (T2)	Baseline (T1) and 15 minutes after intervention (T2)
Change in Heart Rate	Change in heart rate (beats per minute) between baseline (T1) and 15 minutes after the palming technique (T2).	Baseline (T1) and 15 minutes after intervention (T2)

Collaborators and Investigators

• Sponsor: Yuzuncu Yil University
• Investigators: Principal Investigator: Nureddin Yuzkat, Yuzuncu Yil University

Publications and helpful links

General Publications

• Wang R, Huang X, Wang Y, Akbari M. Non-pharmacologic Approaches in Preoperative Anxiety, a Comprehensive Review. Front Public Health. 2022 Apr 11;10:854673. doi: 10.3389/fpubh.2022.854673. eCollection 2022.

Helpful Links

• Bates method. In: Wikipedia [Internet]. 2025 [cited 2025 May 11].

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2022
• Primary Completion (Actual): April 15, 2022
• Study Completion (Actual): May 1, 2022

Study Registration Dates

• First Submitted: November 15, 2025
• First Submitted That Met QC Criteria: December 1, 2025
• First Posted (Actual): December 2, 2025

Study Record Updates

• Last Update Posted (Actual): December 2, 2025
• Last Update Submitted That Met QC Criteria: December 1, 2025
• Last Verified: February 1, 2022

More Information

Terms related to this study

• Keywords: thyroidectomy; Hemodynamics; intubation; preoperative anxiety; relaxation techniques
• Other Study ID Numbers: The Palming Technique

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be made available to other researchers due to confidentiality considerations and because data sharing was not included in the informed consent obtained from participants.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No