Comparison of the Effectiveness of Two Different Methods in Reducing Pain and Anxiety

Comparison of the Effectiveness of Two Different Methods in Reducing Pain and Anxiety During Blood Collection: Breathing Exercises and Stress Ball

Aim: This study was conducted to determine the effect of distraction techniques (breathing exercises and stress ball squeezing) applied to adults during blood collection on pain and anxiety. Materials and Methods: The sample consisted of 90 patients who applied for admission to the Physical Therapy and Rehabilitation Department of Turgutlu State Hospital between March 2025 and February 2026, comprising 30 breathing exercise, 30 stress ball, and 30 control groups. Data collection utilised the 'Demographic Characteristics Form', the 'State Anxiety Scale' and the 'Visual Anxiety Scale', the 'Visual Pain Scale'the 'Life Findings Form' to record life and the 'Informed Consent Form' were used . Descriptive statistical methods (number, percentage, median, mean, standard deviation), chi-square, Kolmogorov-Smirnov, Kruskal- Wallis, Wilcoxon, Bonferroni and Friedman were used when evaluating the data.

Study Overview

• Status: Completed
• Conditions: Stress; Pain, Acute
• Intervention / Treatment: Behavioral: stress ball; Behavioral: breathing exercises

Detailed Description

Inclusion Criteria for the Study Individuals who are 18-65 years of age, have no verbal, perceptual, or visual communication problems, have person-place-time orientation, have an average pressure pain threshold of 8-16 pounds (Lb), have not used any medication that would produce an analgesic effect in the last 6 hours before blood sampling, do not have chronic or acute pain, do not have a disease that would impair their ability to feel pain (such as neuropathy), are on their first day of hospitalization, and are willing to participate in the study were included.

Exclusion Criteria Individuals who cannot have IV procedures performed on their forearm veins, have a diagnosis of stroke from cerebrovascular diseases (CVD), cannot actively use their hands (hemiplegia, fracture, fistula, etc.), have respiratory tract disease, have a condition that prevents them from performing breathing exercises, and have never had blood drawn before were not included in the study.

• Study Type: Interventional
• Enrollment (Actual): 90
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Yunusemre
    • Manisa, Yunusemre, Turkey (Türkiye), 45140
      • Kıvan ÇEVİK KAYA

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Individuals with no communication difficulties in terms of verbal, sensory, or visual aspects,
• who are oriented to person, time, and place,
• with an average pressure pain threshold of 8-16 pounds (lb),
• who have not taken any medication that would produce an analgesic effect within the
• last 6 hours prior to the blood draw,
• who do not have chronic or acute pain,
• who do not have a condition that would impair their ability to feel pain (such as neuropathy),
• who are on the first day of their hospital admission,
• who are willing to participate in the study

Exclusion Criteria:

• Individuals who cannot undergo IV procedures in their forearm veins,
• who have been diagnosed with stroke due to cerebrovascular disease (CVD),
• who cannot actively use their hands (e.g., due to hemiplegia, fractures, or fistulas) for the breathing exercises group;
• individuals with respiratory diseases,
• those with conditions preventing them from performing breathing exercises,
• individuals who have never had blood drawn before

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; No intervention
Experimental: Stress ball; Stress balls were provided to the individuals in this group during routine venous blood draws.	Behavioral: stress ball; The stress ball, made of soft plastic and designed to be held comfortably in the hand, can be squeezed and released to return to its original shape; it measures 8-10 cm in diameter and has a smooth surface. The stress ball was given to the participant's hand on the side opposite the blood draw site, and they were instructed to squeeze and release it throughout the procedure. A separate stress ball was used for each participant. Information was provided about the Visual Analog Scale (VAS) to be used to measure pain levels during the blood draw, and the researcher asked about pain levels and anxiety levels during the procedure. After the blood draw was completed, participants were asked to complete the Vital Signs Form, the State Anxiety Scale, the Visual Anxiety Scale, and the Visual Pain Scale again.
Experimental: Breathing exercise; Breathing exercises were started before the blood draw began, and participants continued the breathing exercises during the blood draw; the breathing exercises were concluded at the end of the procedure.	Behavioral: breathing exercises; After individuals were taught breathing exercises, they were asked to begin the breathing exercises before the blood draw began. The individuals continued the breathing exercises during the blood draw, and the breathing exercises were stopped at the end of the procedure. Information was provided regarding the VAS to be used to measure pain levels during the blood draw, and the researcher asked about pain levels and anxiety levels during the procedure. After the blood draw was completed, participants were asked to complete the Vital Signs Form, the State Anxiety Scale, the Visual Anxiety Scale, and the Visual Pain Scale again.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anxiety	Anxiety of patient was assessed with State Anxiety Scale. The scale consists of 20 items and is a 4-point Likert-type scale (1 = "not at all," 2 = "somewhat," 3 = "very," 4 = "completely"). The individual is asked to assess how they feel "right now" and select the appropriate response based on the intensity of the emotions or behaviors described in the items. The total score on the State Anxiety Scale ranges from 20 to 80. The score categories are as follows: 0-19 points: no anxiety; 20-39 points: mild anxiety; 40-59 points: moderate anxiety; 60-79 points: severe anxiety; 80 points: panic. Items 1, 2, 5, 8, 10, 11, 15, 16, 19, and 20 on the scale are reversed and used in the scoring. Higher scores indicate a higher level of anxiety, while lower scores indicate a lower level of anxiety. As scores increase, the level of anxiety also rises.	day 1
Acute Pain	Pain of patient was assessed with Visual Analogue Scale. The Visual Analogue Scale (VAS) may be preferred as an alternative to the Numerical Rating Scale. It is a 10-cm-long vertical or horizontal line with "No pain" written at one end and "Unbearable pain" at the other, used to measure the intensity of acute pain.	day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
blood pressure	Physiologically, pain can lead to tachycardia, increased cardiac output, improved myocardial oxygenation, hypoxia, reduced lung ventilation, nausea, vomiting, and other such issues; psychologically, it can result in increased anxiety and stress levels, behavioral disorders, and sleep problems. This form was developed to record vital signs-including pulse, blood pressure, and oxygen saturation-measured in patients both before and immediately after the procedure.	Day 1
Pulse	Physiologically, pain can lead to tachycardia, increased cardiac output, improved myocardial oxygenation, hypoxia, reduced lung ventilation, nausea, vomiting, and other such issues; psychologically, it can result in increased anxiety and stress levels, behavioral disorders, and sleep problems. This form was developed to record vital signs-including pulse, blood pressure, and oxygen saturation-measured in patients both before and immediately after the procedure.	Day 1
oxygen saturation	Physiologically, pain can lead to tachycardia, increased cardiac output, improved myocardial oxygenation, hypoxia, reduced lung ventilation, nausea, vomiting, and other such issues; psychologically, it can result in increased anxiety and stress levels, behavioral disorders, and sleep problems. This form was developed to record vital signs-including pulse, blood pressure, and oxygen saturation-measured in patients both before and immediately after the procedure.	Day 1

Collaborators and Investigators

• Sponsor: Celal Bayar University

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2025
• Primary Completion (Actual): March 30, 2025
• Study Completion (Actual): February 28, 2026

Study Registration Dates

• First Submitted: March 23, 2026
• First Submitted That Met QC Criteria: May 23, 2026
• First Posted (Actual): June 1, 2026

Study Record Updates

• Last Update Posted (Actual): June 1, 2026
• Last Update Submitted That Met QC Criteria: May 23, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: breathing exercises; Pain; anxiety; stress ball
• Additional Relevant MeSH Terms: Neurologic Manifestations; Mental Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Anxiety Disorders; Acute Pain; Therapeutics; Mind-Body Therapies; Complementary Therapies; Exercise Movement Techniques; Physical Therapy Modalities; Breathing Exercises
• Other Study ID Numbers: MCBU-K-CEVIK-005

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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