Effectiveness of mental simulations on the early mobilization of patients after cesarean section: a randomized controlled trial

Anna Prokopowicz, Katarzyna Byrka, Anna Prokopowicz, Katarzyna Byrka

Abstract

We aimed to investigate whether psychological intervention (single mental simulation) among women after cesarean surgery (CC) can affect their willingness to verticalize, actual verticalization, and the duration of the first mobilization. In this prospective randomised, controlled study, 150 women after CC were divided into 3 groups: experimental group with process-simulation with elements of relaxation, experimental group with outcome-simulation with elements of relaxation and control group with elements of relaxation only. After a 5-h stay in the post-operative room, women listened to a recording with a stimulation. Pain and anxiety of verticalization were measured before and after listening to the recording and after verticalization. Almost 12% more patients verticalized in the process-simulation group than in the control group. Percentages of mobilized patients were: 39.4% the process-simulation group; 32.8% in the outcome-simulation group; 27.7% controls (p = 0.073). Mobilization was 5 min longer in the process-simulation group then in control (p < 0.01). Anxiety after the simulation was a significant covariate of the willingness to verticalize, actual verticalization and time spent in mobilization. We conclude that a single mental simulation can effectively motivate patients for their first verticalization after CC. Perceived anxiety before verticalization may affect the effectiveness of interventions, so we recommend to check it at the postoperative care.ClinicalTrials.gov Identifier: NCT04829266.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Figure 1
Figure 1
A proportion of verticalized patients in the control, process-simulation, and outcome-simulation groups.
Figure 2
Figure 2
Distribution of time spent in mobilization in the control, process simulation, and result groups.

References

    1. Thompson C, French DG, Costache I. Pain management within an enhanced recovery program after thoracic surgery. J. Thorac. Dis. 2018;10:S3773–S3780. doi: 10.21037/jtd.2018.09.112.
    1. Scott NB, et al. The use of enhanced recovery after surgery (ERAS) principles in Scottish orthopaedic units–an implementation and follow-up at 1 year, 2010–2011: A report from the Musculoskeletal Audit, Scotland. Arch. Orthop. Trauma Surg. 2013;133:117–124. doi: 10.1007/s00402-012-1619-z.
    1. Yip VS, et al. Adherence to early mobilisation: Key for successful enhanced recovery after liver resection. Eur. J. Surg. Oncol. 2016;42:1561–1567. doi: 10.1016/j.ejso.2016.07.015.
    1. Ituk U, Habib AS. Enhanced recovery after cesarean delivery. F1000Res. 2018;7:1513. doi: 10.12688/f1000research.13895.1.
    1. Enhanced Recovery in Gynaecology. Scientific Impact Paper No. 36., (February 2013).
    1. Prokopowicz A, Korzeniewska A, Byrka K. Patient anxiety of verticalization on day 0 after a Cesarean section. Arch. Gynecol. Obstetr. 2020 doi: 10.1007/s00404-020-05748-3.
    1. Mkrtchian A, Aylward J, Dayan P, Roiser JP, Robinson OJ. Modeling Avoidance in Mood and Anxiety Disorders Using Reinforcement Learning. Biol. Psychiatry. 2017;82:532–539. doi: 10.1016/j.biopsych.2017.01.017.
    1. Şimşek BK, Şahin SK, Akyılmaz AA, Özkaplan SE, Ozdurak IH. Effect of calming conversation on anxiety levels in Cesarean section. Cukurova Med. J. 2019;43:7–14.
    1. Zardosht R, Basir A, Sahebkar A, Emami SA. Effect of chamomile oil on cesarean section pain in primiparous women: a randomized clinical trial. Curr. Clin. Pharmacol. 2020 doi: 10.2174/1574884715666200331133157.
    1. Abbasijahromi A, et al. Compare the effect of aromatherapy using lavender and Damask rose essential oils on the level of anxiety and severity of pain following C-section: A double-blinded randomized clinical trial. J. Complement Integr. Med. 2020 doi: 10.1515/jcim-2019-0141.
    1. Abbaspoor Z, Akbari M, Najar S. Effect of foot and hand massage in post-cesarean section pain control: a randomized control trial. Pain Manag. Nurs. 2014;15:132–136. doi: 10.1016/j.pmn.2012.07.008.
    1. Solehati T, Rustina Y. Benson relaxation technique in reducing pain intensity in women after cesarean section. Anesth. Pain Med. 2015;5:e22236–e22236. doi: 10.5812/aapm.22236v2.
    1. Chen HM, Chang FY, Hsu CT. Effect of acupressure on nausea, vomiting, anxiety and pain among post-cesarean section women in Taiwan. Kaohsiung J. Med. Sci. 2005;21:341–350. doi: 10.1016/s1607-551x(09)70132-9.
    1. Reza N, Ali SM, Saeed K, Abul-Qasim A, Reza TH. The impact of music on postoperative pain and anxiety following cesarean section. Middle East J. Anaesthesiol. 2007;19:573–586.
    1. Macintyre PE, Schug SA. Acute Pain Management. A Practical Guide. 4. CRC Press Taylor and Francis Group; 2015.
    1. Bitzer, J. in Psychological Challenges in Obstetrics and Gynecology The Clinical Management (eds J. J. Cockburn & M.E. Pawson) 3–14 (Springer-Verlag, 2007).
    1. Taylor SE, Pham LB, Rivkin ID, Armor DA. Harnessing the imagination. Mental simulation, self-regulation, and coping. Am. Psychol. 1998;53:429–439. doi: 10.1037//0003-066x.53.4.429.
    1. Szpunar KK, Spreng RN, Schacter DL. A taxonomy of prospection: introducing an organizational framework for future-oriented cognition. Proc. Natl. Acad. Sci. USA. 2014;111:18414–18421. doi: 10.1073/pnas.1417144111.
    1. Jeannerod M. Motor representations and reality. Behav. Brain Sci. 1994;17:229–245. doi: 10.1017/S0140525X0003435X.
    1. Gilbert DT, Wilson TD. Prospection: Experiencing the future. Science. 2007;317:1351. doi: 10.1126/science.1144161.
    1. Suddendorf, T. & Corballis, M. C. The evolution of foresight: What is mental time travel, and is it unique to humans? Behav. Brain Sci.30, 299–313; discussion 313–251. 10.1017/s0140525x07001975 (2007).
    1. Suinn RM. Mental practice in sport psychology: Where have we been, where do we go? Clin. Psychol. Sci. Pract. 1997;4:189–207. doi: 10.1111/j.1468-2850.1997.tb00109.x.
    1. Slimani M, Tod D, Chaabene H, Miarka B, Chamari K. Effects of mental imagery on muscular strength in healthy and patient participants: A systematic review. J. Sports Sci. Med. 2016;15:434–450.
    1. Taylor SE, Schneider SK. Coping and the simulation of events. Soc. Cogn. 1989;7:174–194. doi: 10.1521/soco.1989.7.2.174.
    1. Endler NS, Parker JD. Multidimensional assessment of coping: a critical evaluation. J. Pers. Soc. Psychol. 1990;58:844–854. doi: 10.1037//0022-3514.58.5.844.
    1. Pham LB, Taylor SE. From thought to action: Effects of process-versus outcome-based mental simulations on performance. Pers. Soc. Psychol. Bull. 1999;25:250–260. doi: 10.1177/0146167299025002010.
    1. Marszał-Wiśniewska M, Jarczewska-Gerc E. Role of mental simulations in the weight loss process. J. Psychol. 2016;150:1–14. doi: 10.1080/00223980.2014.987102.
    1. Kim Y-J, Song S-Y. The effect of mental simulation (process- versus outcome-focus) on extension evaluation: A bipolarized fit perception. Jpn. Psychol. Res. 2017;59:201–208. doi: 10.1111/jpr.12150.
    1. Benson H, Beary JF, Carol MP. The relaxation response. Psychiatry. 1974;37:37–46. doi: 10.1080/00332747.1974.11023785.
    1. Research Randomizer v. Version 4.0 (2013).
    1. de Saint-Exupéry, A. Mały Książę, (2008).
    1. Labaste F, et al. Validation of a visual analogue scale for the evaluation of the postoperative anxiety: A prospective observational study. Nurs. Open. 2019;6:1323–1330. doi: 10.1002/nop2.330.
    1. Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of the pain scales in adults: Which to use? Am. J. Emerg. Med. 2018;36:707–714. doi: 10.1016/j.ajem.2018.01.008.
    1. Twohig MP, Hayes SC, Masuda A. Increasing willingness to experience obsessions: acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behav. Ther. 2006;37:3–13. doi: 10.1016/j.beth.2005.02.001.
    1. Davey HM, Barratt AL, Butow PN, Deeks JJ. A one-item question with a Likert or Visual Analog Scale adequately measured current anxiety. J. Clin. Epidemiol. 2007;60:356–360. doi: 10.1016/j.jclinepi.2006.07.015.
    1. Munzert J, Lorey B, Zentgraf K. Cognitive motor processes: the role of motor imagery in the study of motor representations. Brain Res. Rev. 2009;60:306–326. doi: 10.1016/j.brainresrev.2008.12.024.
    1. Nicholson VP, Keogh JW, Low Choy NL. Can a single session of motor imagery promote motor learning of locomotion in older adults? A randomized controlled trial. Clin. Interv. Aging. 2018;13:713–722. doi: 10.2147/CIA.S164401.
    1. Conroy D, Hagger MS. Imagery interventions in health behavior: A meta-analysis. Health Psychol. 2018;37:668–679. doi: 10.1037/hea0000625.
    1. Hagger, M. S. Changing Behaviour Using Mental Imagery Manual. PsyArXiv Preprints, 10.31234/ (2017).
    1. Greitemeyer T, Würz D. Mental simulation and the achievement of health goals: The role of goal difficulty. Imagin. Cogn. Per. 2006;25:239–251. doi: 10.2190/d4ua-rqfq-0h5t-w9yy.
    1. Chan CK, Cameron LD. Promoting physical activity with goal-oriented mental imagery: a randomized controlled trial. J. Behav. Med. 2012;35:347–363. doi: 10.1007/s10865-011-9360-6.
    1. Gollwitzer, P. M. in The Psychology of action: Linking cognition and motivation to behavior (eds P.M. Gollwitzer & J.A. Bargh) 287–312 (Guilford Press, 1996).
    1. Gollwitzer, P. M. & Sheeran, P. in Advances in Experimental Social Psychology Vol. 38 69–119 (Academic Press, 2006).
    1. Oettingen G. Future thought and behavior change. Eur. Rev. Soc. Psychol. 2012;23:1–63. doi: 10.1080/10463283.2011.643698.
    1. Chou R, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J. Pain. 2016;17:131–157. doi: 10.1016/j.jpain.2015.12.008.
    1. Mohammadi MM, Parandin S. Effect of the combination of Benson's relaxation technique and brief psychoeducational intervention on multidimensional pain and negative psychological symptoms of pregnant women: A randomized controlled trial. J. Educ. Health Promot. 2019;8:91–91. doi: 10.4103/jehp.jehp_286_18.
    1. Ibrahim A, et al. The effect of Benson relaxation method on anxiety in the emergency care. Medicine (Baltimore) 2019;98:e15452–e15452. doi: 10.1097/MD.0000000000015452.
    1. Meslot C, Gauchet A, Allenet B, François O, Hagger MS. Theory-based interventions combining mental simulation and planning techniques to improve physical activity: Null results from two randomized controlled trials. Front. Psychol. 2016;7:1789. doi: 10.3389/fpsyg.2016.01789.

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