Original Article Egyptian Journal of Health Care, 2021 EJHC Vol.12 No.

Effect of Abdominal Massage on Gastrointestinal Function

among Enterally Fed Critically Ill Patients
Assist. Prof. Howyda Ahmed Mohamed (1), Dr.Zeinab Hussein Bakr (2)
Dr. Ahmed Mohamed Naguib (3)
(1) Assistant Professor of Medical Surgical Nursing - Faculty of Nursing
(2) Lecturer of Medical Surgical Nursing, Faculty of Nursing
(3) Lecturer of Medicine, Faculty of Mdedical- Ain Shams University

Abstract
Background: Critically ill patient need a nursing practice that can enhance getting all benefits of
enteralfeeding and improving the gastrointestinal function. Gastrointestinal function was gastric
residual volume, abdominal distension, vomiting and constipation. Aim: This study aimed to
explore the effect of abdominal massage on gastrointestinal function of enteral-feed critical ill
patients. Research Design: A Quasi experimental design was used. Setting: the study was
conducted at General Intensive Care Units in El Demerdash Hospital Affiliated from Ain Shams
University Hospital. Subjects: A purposive sample of 60 Patients who distributed randomly to
equal intervention and control groups from the previous mentioned setting. Results: there were
statically significant difference between the study group and control group subjects regarding
Gastric Residual Volume (GRV)was statistically significant in the 3rd, 4th, and 5th days indicating
higher GRV among control group. The abdominal circumference between the five days was
significantly in the two groups. None of patients in the study group were vomited along the study
period (5days) in compared to 5% of control patients without statistical significant differences.
Conclusions: The abdominal massage was significantly effective in lowering GRV, preventing
distension and avoiding vomiting. Recommendations: the current study recommended that this
practice can be applied as a caring procedure in the daily ICU care program.

Keywords: Abdominal massage, Critical ill patient, Enteral-feeding, Gastrointestinal function,

Introduction patients with gastrointestinal dysfunction as an
auxiliary care (Keose&Ayhan, 2018).
Critically ill patients are characterized by
existence of actual or potential lifethreatening Massage is considered one of the most
health problems which require constant widely practiced complementary therapies.
observation, intervention and dependence on Abdominal massage or stomach massage can
the health care providers and advanced be defined as a gentle, non-invasive therapeutic
technology. One of the key elements in the technique that doesn’t need a lot of hard work,
management of critically ill patients is applied on the stomach and pelvic area to
nutritional support, which is amedical relieve gastrointestinal complications. Stomach
treatment as well as abasic part of the nursing massage is not only helpful in relieving stress
care. Timely and adequate nutritional support but alsoimproves oxygen circulation through
play an important role in improving patient's blood in necessary area and body fluid which
recovery, reducing physiological stress, ensures the body secret enough enzymes for
increasing theimmunity capacity and clearing bowel and prevents constipation
eliminating malnutrition (El-Feky& Ali, 2020). (Ogunyewo&Afemikhe, 2020).

Gastrointestinal dysfunction is one of the Abdominal massage can stimulate

major problems faced by the intensive care unit parasympathetic activity that enhancing the
(ICU) patients. If patients do not have enough gastrointestinal function. Abdominal massage
calories intake each day, they may suffer from accelerates peristalsis by changing intra-
malnutrition and other problems. In non-drug abdominal pressure and producing a
therapy, abdominal massage is widely used in mechanical and reflexive effect on the
intestines, decreasing abdominal distension and

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Original Article Egyptian Journal of Health Care, 2021 EJHC Vol.12 No.1
increasing intestinal movements (Narmadha& nurses(CCN) in carefully assessing, planning
Priyanka, 2019 ) feeding requirement, providing feeding safely
and efficiently, monitoring patients'response
Abdominal massage presents several
carefully and preventing enteral feeding related
benefits for critically ill patients who are
complications through applying alternative
always in need for careful and continuous
measures as abdominal massage. Also intra-
observation to avoid or prevent gastrointestinal
abdominal pressure (IAP) monitoring usually is
complications related enteral feeding
under CCN role through continuous
byincreasing stimulation of blood flow to and
observation and identifyingof dynamic changes
from the organs, nerves and muscles inthe
in the status of critically ill patients
abdominal region, enhancing hormone
(Abdelhafez &AbdElnaeem, 2019; El-Feky&
production and accelerate waste removal.
Ali, 2020).
Several studies in Egypt, Turkey, Iran,
Germany and others suggested and described Significance of the study:
using the abdominal massage for patients in
ICUs as a complementary therapy for Improving Gastrointestinal functions still
improving gastrointestinal outcomes such as the major problem that facing the critically ill
“high gastric residual volume, vomiting, patients' especially enteral-fed one and can
abdominal distension and constipation”, which increase the suffering (Mohamed., 2016). In
it has been shown to be effective, non invasive the meantime, several studies have focused on
and without any side effects on patients the roles of ICU' nurses to perform such
(Fareed&Elsayad, 2017). intervention (Jamaati et al., 2015). The main
focus problem that studied the effectiveness of
Enteral nutrition(EN) is the preferred abdominal massage on patients was
route of nutritional support in the critically ill constipation. Therefore, this research was
patient. EN helps to maintain peristalsis, carried out trying to help the nurses to find out
improve blood supply,reduces catabolic the solution for all GIT function (GRV,
responses and strengthens the immune system, abdominal circumference, Distention and
consequently it may reduce disease severity, vomiting) by applying the costless, safe and
diminish complications, decrease intensive care simple strategy which is abdominal massage.
unit length of stay, and favorably impact Moreover, this study aimed to explore the
patients' outcomes (Momenfar,Abdi, Salari, effect of abdominal massage on gastrointestinal
Soroush&Hemmatpour, 2018). function for enterally feed critical ill patients
Critical care nurses (CCN) are usually (Sandoval, Ghamande &Surani, 2017).
occupied with improving the patient' status and Adequate nutritional support is important
trying to decrease suffering or complications for the comprehensive management of
derived from ICU management. Critical care critically ill patients. Inspite of simplicity of
nurses are in charge for the assessment of administering enteral nutrition through
enteral-fed patients. Most of enteral feeding nasogastric tube, it has serious adverse effects
complications that progress as a result of suchas high gastric residual volume, increase
feeding intolerance can be prevented by frequency of vomiting and abdominal
nursing care. According to nurse scholars, distension that may indicatefeeding intolerance.
nutrition is a part of nursing care as well as The most important reasons for unsuccessfully
medical treatment. Nurses perform a significant nutritional support among those patientswho
role starting from the assessment phase of a have gastric feeding are the feeding intolerance
patient’s requirement of feeding, until planning that occurs in more than 60% of patients all
and applying the feeding safely and efficiently. over theworld (Mohammad, 2016).
Most of the success in enteral tube feeding
depends on the role of CCN in giving the Many literatures described abdominal
nutrition, continuous monitoring and evaluation massage as the preferred non-pharmacological
the patient (Narmadha& Priyanka, 2019 ). nursing intervention for managing and
preventingenteral feeding related
The success in enteral nutrition depends gastrointestinal complications because it has
on the role responsibility of the critical care many advantages such as it is easily and
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Original Article Egyptian Journal of Health Care, 2021 EJHC Vol.12 No.1
independently applied bynurses and free from Research design:
side effects. So, this study will be conducted to Quasi-experimental research design was
evaluate the effect of abdominal massage on used to conduct this study.
gastrointestinal function among enterally fed Setting:
critically ill patients. The study was conducted in the general
Intensive Care Unit at El Demerdash Hospital
Aim of the Study: affiliated from Ain Shams University Hospital,
Cairo, Egypt.
This study aimed to evaluate the effect of Subjects:
abdominal massage on gastrointestinal function  A Purposive sample of 60 critically ill
among enterally fed critically ill patients patients who met the inclusion criteria at
through the following: previously mentioned setting, and divided
1. Assessment of the patients for into two equal groups; study and control
gastrointestinal function among enterally group (30 patients for each group).
fed critically ill patients. Sample size was calculated statistically
by power analysis considering the total number
2. Implementing abdominal massage on of critically ill patients admitted to El
enterally fed critically ill patients Demerdash hospital during the year (2019).
3. Evaluating the effect of the abdominal Based on sample size equation 60 patients
massage on gastrointestinal function participated in the study. The sample size was
among enterally fed critically ill patients. calculated by adjusting the power of the test to
80% and the confidence interval to 95% with
Research Hypothesis: margin of error accepted adjusted to 5% and a
The current study hypothesizes that: known total population of 60 patients
 Patient in the study group will have better considering that:
gastrointestinal function than patients in Type I error (α) = 0.05%
the control group. Type II error (B) = 0.20%
Operational definitions: With power of test 0.80%
 Abdominal massage (Swedish Inclusioncriteria:
Peristalsis Massage): It is an intervention  Adult patients from both gender >20 years
that helps to tone and reinforce the old.
muscles located in abdomen and digestive  Patients with newly inserted nasogastric
system, in which the abdomen and tube for intermittent enteral feeding every 4
intestinal areas are massaged (with hrs.
lavender oil) with various movements and  Hemodynamically stable.
pressure using four basic techniques;  Free from intestinal obstruction.
stroking, effleurage, kneading, and  Didn’t have contraindications to abdominal
vibration. massage such as diarrhea, active bleeding,
 Gastrointestinal Function: means spinal cord injury or recent abdominal
decreased gastric residual volume (GRV), surgery.
and absence of vomiting,abdominal Exclusioncriteria:
distension and constipation.  Patients receiving prokinetic medications
Subjects and Methods: as Metoclopramide (Reglan) and
This study was portrayed under the four Cisapride (Propulsid) to avoid interfering
main designs as follows: with the massage effects.
I. Technical design.  Patients with hepatic impairment,
II. Operational design. abdominal aortic aneurysmand ascites
III. Administrative design.  Patients who was receiving radiotherapy
IV. Statistical design.
or chemotherapy.
Technical design:
Tools for data collection:
It included research design, setting,
There were two tool used in this study
subject and tools for data collection.

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1) Patients’ assessment tool: This tool All patients were assessed for defecation
was developed by the researcher after pattern to determine if the patient developing
reviewing related literature (Fareed & constipation or not.
El- Sayad, 2017; Momenfar, Abdi, Application of Abdominal massage: Put
the patient in supine position, straight the legs
Salari, Soroush & Hemmatpour,
and stand on rightside. It started in a left to
2018; Narmadha & Priyanka, 2019; right direction over the intestines on the
El- Feky & Ali, 2020). It included two abdominal wall. The main steps of massage are
parts: superficial effleurage, deep circular stroking,
Part (I): Demographic data: petrissage, and vibration (Uysal, 2017).
It included data such as patient's age, OperationalDesign:
gender, level of education, and occupation. It included preparatory phase, content
Part (II): Clinical data: validity and reliability, pilot study and field
It included data such as patient's history
work.
of GIT problems, reason for ICU admission
The preparatory Phase:
2) Gastrointestinal outcomes assessment
tool: It included reviewing of related
This tool was adapted from Dehghan, literature, and theoretical knowledge of
Mehdipoor& Ahmadinejad, (2018); various aspects of the study using books,
Abdelhafez&AbdElnaeem, (2019) and was articles, internet, periodicals and
modified by the researcher to suite the study magazines to develop data collection tools,
aim. This tool was used to assess gastric the educational guidelines content and
residual volume,abdominal distension, media.
constipation,vomiting through the following
way. Validity andReliability
Gastric residual volume:
Both groups were assessed for GRV
Testing content and face validity of
before each feeding. First, the feeding tube the proposed tools by inspecting the items
position was confirmed by listening to 20 ml of to determine whether the tools measure
injecting air with a stethoscope at the epigastric what supposed to measure. The stage
area. Then, aspirate the stomach content slowly developed by a jury of 5experts from
until no further content. The aspirated content different academic categories (professors
measured by measuring container and and assistant professors) of the medical –
discarded according to the ICU guidelines surgical nursing at the faculty of nursing,
(Warren, 2016). Ain Shams University. The experts
Abdominal distension: reviewed the tools for clarity, relevance,
Both groups were assessed for distension
by palpation and percussion. No distension
comprehensiveness, simplicity and minor
means that the abdomen is soft, moving and not modification was done. Testing reliability
tense. Distended abdomen means hard, tender, of the proposed tools was done statistically
bloating and increase in abdominal diameter. by Crombach alpha test (0.897).
The circumference was measured before the Ethical consideration:
massage (Uysal et al., 2012; El-Feky& Ali, The aim of the research was explained
2020) to the participants. Verbal and written
Vomiting: consent was obtained from each patient to
All patients were assessed for developing participate in the study, after clarifying the
vomiting or not. According to the ICU
guidelines, if the patient vomiting the feeding
procedures of the study. Participants were
was interrupted and the tube feeding was informed about their right to refuse
connecting to urine bagand opened and the participation and to withdraw at any time
patient was observed if vomiting stopped the without any consequences. Confidentiality
patient was re-fed. of data was ensured.
Constipation:

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Original Article Egyptian Journal of Health Care, 2021 EJHC Vol.12 No.1

Pilot Study: before feeding time to avoid aspiration for five

consecutive days at 10,30 am and 4.30 pm.
Pilot study carried out for 6 patients
who admitted to ICU on enterally feeding Abdominal massage was done by the
researcher using four basic steps; stroking,
and meets the inclusion criteria, in the
effleurage, kneading and vibration. Abdominal
previous mentioned setting to test clarity, distension was examined by palpation and the
applicability of tools used in this study measurement of abdominal girth was done by
before performing the actual study. using a 150-cm inflexible. Tape measure was
Based on the result of the pilot study, used to measure abdominal circumference. It
was done before abdominal massage time,
no modifications were done. The patients
GRV was measured before every ryle feeding
who included in the pilot study were by aspiration gastric content then measure this
included in the study sample. amount and take mean for this amount every
Field Work: day are recorded and patient observed for
vomiting and defection pattern to determine if
The actual filed work of this study patient have constipation or not. The
started at the beginning of (August 2020) measurement data were recorded in the
and had been completed at the 15 of parameter questionnaire.
(February 2021). It was conducted in three C. Evaluation phase:
phases:
 The evaluation phase was emphasizing on
A. Assessment and planning phase: determining the effect of the implemented
This phase was carried out through the abdominal massage on gastrointestinal
following steps:Developing tools for data function among enterally fed critically ill
collection after reviewing the related patients.
literature.Obtaining experts opinions to ensure  The evaluation phase was start from the
tools validity and measurement of first day after implementation of
reliability.The researcher was receiving a abdominal massage till the 5 day of the
training course by one of the professional implementation of the abdominal massage.
physiotherapists to be qualified in applying the
correct technique of abdominal massage.An Administrative design:
initial assessment was carried out on the first An official permission was obtained
day for all subjects to confirm that theymet the from the Director of intensive care unit at
inclusion criteria by using the first tool. El Demerdash Hospital affiliated to Ain
Patients who met the inclusion criteria were Shams University. Meeting and
assigned randomly into two groups; the control
discussions were held between the
group and the study group.
researchers and nursing administrative
B. Implementation phase: personnel to make them aware about the
The implementation phase was conducted aims and objectives, as well as to get better
through the following steps:For both groups; cooperation during the implementation
patients’ assessment data were obtained and phase. It was important to have their full
recorded before starting the abdominal massage support, especially to encourage patients to
by using the first tool.Both study and control participate positively in the study.
group was receiving the routine ICU protocol
of the intermittent enteral feeding as the type, A statisticaldesign:
frequency and amount of formula per day Statistical methods for data analysis
according to ICU protocol the patients receive
intermittent enterally feeding it take 300 ml All Data were collected, tabulated and
every 3hrs. at 8am, 11 am, 2pm, 5pm,8pm and subjected to statistical analysis. Statistical
11pm.The study group was receive the analysis is performed by SPSS in general
abdominal massage twice daily for 15 min
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Original Article Egyptian Journal of Health Care, 2021 EJHC Vol.12 No.1
(version 21), also Microsoft office Excel is performed. Using independent samples T
used for data handling and graphical test. For categorical variables Chi squared
presentation. Quantitative variable sare test is used and Fisher exact test in case of
described by the Mean, Standard Deviation small number per cell. Pearson correlation
(SD) and the Range (Maximum– coefficient is used for quantitative
Minimum).Qualitative Categorical variables. Significance level is considered
variables are described by proportions and at P <0.05 (S); while for P < 0.01 was
Percentages. Paired sample T test is used considered highly significant (HS). Two
for testing Pre –post measurements within Tailed tests are assumed throughout the
the same group. Comparison of the mean analysis for all statisticaltests.
changes (Pre-Post) between groups is

Results:
Table (1): Comparison between patients in the control and the study group regarding
their demographic characteristics.
Patients’ Study Group N=30 Control Group
characteristics N=30 Test P value
No % No %
Age ∕ years
< 40 10 33.3% 12 40.0%
40 – 60 11 36.7% 12 40.0% χ2 =0.14 0.7307
Above 60 9 30.0% 6 20.0%
Mean ± SD 43.55 ± 12.14 46.35 ± 12.78 t = 0.30 0.8624
Gender
Male 15 50.0% 20 66.7 % χ2 =1.67 0.1845
Female 15 50.0% 10 33.3%
Education
Illiterate 5 16.7% 3 10.0%
Read and write 8 26.7% 6 20.0% χ2 =0.91 0.7220
Secondary 10 33.3% 13 43.3%
Higher 7 23.3% 8 26.7%
Residence
Rural 7 23.3% 5 16.7% χ2 =0.48 0.4902
Urban 23 76.6% 25 83.3%
Marital status
Widow & divorced 6 20.0% 7 23.3% χ2 =0.10 0.6357
Married 24 80.0% 23 76.6%

Regarding characteristics of patients in the control and study group, table (1) show
that, the mean age of control group was 46.35 ± 12.78, while, the mean age of the study
group was43.55 ± 12.14. Regarding gender, 66.7 % of patients of control group and 50.0 %
of patients of the study group were males. As regards educational level, 10.0% only of the
control group and 16.7% of the study group were illiterate. In relation to residence, 83.3%
and 76.6% of patients in the control and study group resided in urban areas respectively.
Regarding marital status, 76.6%ofthe control group and80.0% of the study group were
married.

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Table (2): Comparison between patients in the study and control groupsaccording to their
admission clinical data
Groups
Items Study (n=30) Control (n=30) X2 P value
No. % No. %
Reason of admissionto ICU
Postoperative care 20 66.67 18 60.00 1.247 0.534
Neurological disorders 6 20.00 3 10.00 3.360 0.067
Infectious disorders 0 0.00 2 6.67 1.156 0.150
Gastrointestinal disorders 1 3.33 0 0.00 1.017 0.313
Endocrine\metabolic
disorders 3 10.00 7 23.33 3.158 0.072
Presence of GIT problems
Yes 10 33.33 12 40.00 =1.67 0.1845
No 20 66.67 18 60.00
GIT problems experienced
Constipation 6 60.00 10 83.33 3.565 0.078
Diarrhea 4 40.00 2 16.67 2.412 0.063
P>0.05 not significant *P<0.05 Significant ** P<0.001 highly significant
Table (2) illustrate that, regarding patient diagnosis during admission, the results reveled that,
66.67% of study group and 60% of control group have post-operative care, also20% of study group
and 10% of control group have neurological disorder. While, regarding presence of GIT problems
there were 33.33% of study group and 40% of the control group have GIT problems and 60% of
them in study group and 83.33% of control group have constipation as GIT problems. In addition,
there was no statistically significant difference between two groups regarding patient clinical data.
Table (3): Gastrointestinal function regarding residual volume among study and control group.

Gastric Residual Study Group Control Group

volume T Test P value
(Mean+ SD) (Mean+ SD)
1st day 0±0 0±0 ---- -----
2 day
nd
4.54±3.2 7.77±14.6 4.256 0.079
3rd day 19.37±5.05 61.43±8.42 26.754 <0.001**
4 day
th
22.2±5.89 74.07±14.08 29.44 <0.001**
5th day 26.1±6.22 86.97±22.45 31.564 <0.001**
Table (3) show that, mean of gastric residual volume is higher among control group
than the study group from the second day to the fifth day with a highly statically
significant differences between them regarding gastric residual volume in 3rd, 4th and 5th
day, while there was no statically significant relation in day 1 and 2.

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Table (4): Gastrointestinal function regarding Abdominal Circumference among study and control
group.
Abdominal distention Study Group Control Group
X2 P value
(palpitation) No % No %
1st day (distended) 0 0.0 0 0.0 ---- ---
2nd day (distended) 0 0.0 2 6.67 1.156 0.150
3rd day (distended) 2 6.67 11 36.67 6.73 0.012
4th day (distended) 2 6.67 16 53.33 12.07 0.0002
5th day (distended) 1 3.33 18 60.00 15.43 <0.001
Table (4) show that, number of patients have abdominal distension is higher among control
group than the study group from the second day to the fifth day with a highly statically significant
differences between them regarding abdominal distension in 4th and 5th day, and there was statically
significant relation between them regarding abdominal distensionin 3rdday while there was no
statically significant relation in day 1 and 2.
Table (5): Gastrointestinal function regarding Abdominal Circumference among study and control
group.

Abdominal Study Group Control Group

T Test P value
Circumference(CM) (Mean+ SD) (Mean+ SD)
1st day 80.17±7.87 93.43±7.8 2.313 <0.001**
2nd day 82.22±7.79 95.5±7.73 2.324 <0.001**
3rd day 81.25±7.83 96.98±7.58 2.335 <0.001**
4th day 81.3±7.76 94.62±7.65 2.377 <0.001**
5th day 80.23±7.85 95.23±7.6 2.561 <0.001**
Table (5) show that, mean of abdominal circumferenceis higher among control group than
the study group from the first day to the fifth day with a highly statically significant differences
between them regarding abdominal circumference in all 5 days.
Table (6): Gastrointestinal function regarding Vomiting among study and control group
Study Group Control Group
Vomiting X2 P value
No % No %
1st day 0 0.0 0 0.0 ---- ---
2nd day 0 0.0 0 0.0 --- ---
3rd day 0 0.0 0 0.0 --- ---
4th day 0 0.0 3 10.00 1.179 0.076
5th day 0 0.0 2 6.67 1.156 0.150
Table (6) show that, none of patients in the study group suffered from vomiting, while only
10,00% and 6.67% of patients in the control group suffered vomiting. Also there were no statically
significant differences between study and control group regarding vomiting in all 5 days.

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Table (7): Gastrointestinal function regarding Constipation among study and control group.
Study Group Control Group
Constipation X2 P value
No % No %
1 day
st
6 20.00 10 33.33 3.564 0.078
2nd day 8 26.67 12 40.00 3.743 0.084
3rd day 5 16.67 15 50.00 6.435 0.003
4th day 5 16.67 14 46.67 6.134 0.008
5th day 4 13.33 16 53.33 10.345 0.001
Table (7) show that, number of patients have constipation in the control group is higher than
number of patient in the study groupfrom the first day to the fifth day with ahighly statically
significant differences between study and control group regarding constipationin 4th and 5th day, and
there were statically significant differencesbetween study and control group regarding gastric
residual volume in 3rdday while there were no statically significant differences in day 1 and 2.
Table (8): Comparison between day one and day five regarding gastrointestinal function among
study and control group.
Items Study group Control group
Gastric residual volume
Day 1 0±0 0±0
Day 5 26.1±6.22 86.97±22.45
Test:12.372 Test: 24.744
P value: 0.001 P value: 0.001
Abdominal circumference
Day 1 80.17±7.87 93.43±7.8
Day 5 80.23±7.85 95.23±7.6
Test: 1.313 Test: 1.643
P value:0.067 P value:0.165
Abdominal Distension
Day 1(distended) 0 0.0 0 0.0
Day 5(distended) 1 3.33 18 60.00
Test:1.017 Test: 5.454
P value: 0.313 P value:0.001
Vomiting No %
Day 1 0 0.0 0 0.0
Day 5 0 0.0 2 6.67
Test: ---------- Test: 1.32
P value:-------- P value: 1.54
Constipation No %
Day 1 6 20.00 10 33.33
Day 5 4 13.33 16 53.33
Test: 2.29 Test: 3.2
P value: 0.297 P value: 0.043
Table (8) show that, this table show comparison between day 1 and day 5 regarding study and
control group , there was better outcome in study group than control group regarding to gastric
residual volume, abdominal distension, abdominal circumference and constipation. There were
highly statically significant differences between day 1 and day 5 in study and control group
regarding gastric residual volume, and abdominal distension in control group. There were statically
significant differences between day 1 and day 5 regarding constipation in control group. While there
were no statically significant differences between day 1 and day 5 regarding abdominal
circumference and vomiting in study and control group.

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Discussion As regards educational level, only less

than one fifth of the study group and minority
Massage therapy began as a sacred system of the control group were illiterate. This result
of natural healing. Nutrition is one of the was in agreement with Warren (2016) whose
essential components of life. Every individual study title was ''Abdominal massage may
requires nutrition for healthy living. However, decrease gastric residual volumes and
for some individuals, nutritional intake abdominal circumference in critically ill
becomes compromised while some benefit patients'' who found that one third of
from oral supplements, others require active intervention group and more than half of
nutritional support. In the hospital setting control group were illiterate.
depending on the disease condition, patients Regarding marital status, majority of the
may need to maintain their nutritional intake study group and more than three quarter of the
through altered routes like enteral tube feeds control group were married. This was in
and parenteral. Critically ill patient can have agreement with Zhou, Yang, Yuan, & He.
issues that can lead to restriction in oral feeding. (2016), whose study title was ''Effect of
In such cases, an option is nasogastric feeding. abdominal massage on recovery of
Nutritional support in intensive care units gastrointestinal function in patients with severe
(ICUs) is an integral part of patient care. It is cranio-cerebral injury with indwelling naso-
an important factor in health maintenance and intestinal tube'' who found that two third of
disease recovery, particularly in critically ill intervention group and half of control group
patients (Narmadha& Priyanka, 2019). were married.
Regarding to demographic characteristics Regarding patient diagnosis during
of patients in the control and study group, table admission, the results reveled that, two third in
(1) show that, the mean age of study group was study group and less than two third in control
43.55 ± 12.14, while, the mean age of the group had post-operative care, alsoone fifth in
control group was 46.35 ± 12.78. This result study group and minority in control group have
was in agreement with Dehghan, Mehdipoor, neurological disorder. This result was in
& Ahmadinejad, (2018). whose study title agreement withTao (2017) whose study title
''Does abdominal massage improve was ''Effect of abdominal massage on vomiting
gastrointestinal functions of intensive care in patients with enteral nutritional crisis'' who
patients with an endotracheal tube?'' who found found that, more than half in study group and
that the mean age in the study group was 42.97 two third in control group have post-operative
± 23.08 and mean age in the control group was care.
40.94 ± 19.44 in the control group. While, this
was not in agreement with Momenfar, Abdi, Regarding presence of GIT problems
Salari, Soroush, & Hemmatpour, there were more than one third in study group
(2018).Whose study title was ''Studying the and two fifth of the control group had GIT
effect of abdominal massage on the gastric problems and less than two third of them in
residual volume in patients hospitalized in study group and majority of control group had
intensive care units'' who found that the mean constipation as GIT problems. In addition,
age was 60.76 ± 17.38 in the study group and there was no statistically significant difference
58.66 ± 14.75in the control group. between two groups regarding patient clinical
data. This result was in agreement with
Regarding gender, half of patients of Etinkaya ,Ovayolu; Ovayolu (2020):whose
study group and more than two third of patients study title 'The Effect of Abdominal Massage
of the control group were males. This result on Enteral Complications in Geriatric Patients'
was not in agreement with Etinkaya, Ovayolu; who found that one fifth of intervention group
Ovayolu (2020): whose study title was 'The and two fifth of control group have GIT
Effect of Abdominal Massage on Enteral problems also found that majority of the study
Complications in Geriatric Patients' who found group and all of the control group have
that two third of intervention group and more constipation.
than half of control group were female.

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Original Article Egyptian Journal of Health Care, 2021 EJHC Vol.12 No.1
Regarding to gastric residual volume, In addition to vomiting, none of patients
mean of gastric residual volume is higher in the study group suffered from vomiting,
among control group than the study group from while minority of patients in the control group
the second day to the fifth day with a highly suffered vomiting. Also there were with a no
statically significant differences between them statically significant differences between study
regarding gastric residual volume in 3rd, 4th and and control group regarding vomiting in all 5
5th day, while there was no statically significant days.This is may be referring to the massage
relation in day 1 and 2. This result was in was effective on preventing occurrence of
agreement with Thomas, Krishna, Das, (2019) vomiting along the study period (5days) and
the study title was ''A study to assess the the massage timing before feeding which
effectiveness of abdominal massage on gastric enhance gastric empty. This result was in
residual volume among patients with disagreement with, Momenfar (2018), who
intermittent naso-gastric tube feeding in a reported that the incidence of vomiting ranged
selected hospital, Bangalore''who found that from 12% to 50 %.
there was statistically significant change in Regarding to constipation, number of
gastric residual volume after the application of patients have constipation in the control group is
abdominal massage. higher than number of patient in the study group
from the first day to the fifth day with a highly
In relation to abdominal distension,
statically significant differences between study
number of patients have abdominal distension
and control group regarding constipation in 4th
is higher among control group than the study
and 5th day, and there were statically significant
group from the second day to the fifth day with
differences between study and control group
a highly statically significant differences
regarding gastric residual volume in 3rd day while
between them regarding abdominal distension
there were no statically significant differences in
in 4th and 5th day, and there was statically
day 1 and 2.This may be due to abdominal
significant relation between them regarding
massage improve defection pattern in study group
abdominal distension in 3rd day while there was
rather than control group. This result was in
no statically significant relation in day 1 and 2.
agreement with Etinkaya, Ovayolu; Ovayolu
This may be due to abdominal massage
(2020) who found that one fifth of intervention
improve peristalsis and make defection better
group and two fifth of control group have GIT
so it lead to decrease abdominal distension.
problems also found that majority of the study
This result was in accordance with Wang,
group and all of the control group have
(2015), who examined the effects of 15-min
constipation.
gentle abdominal massage was administered bi-
Regarding to comparison of gastrointestinal
daily for 3 days showed decrease abdominal
function the result of the present study showed
distension significantly.
that, there was better outcome in study group than
Regarding to abdominal circumference, control group regarding to gastric residual volume,
mean of abdominal circumference is higher abdominal distension, abdominal circumference
among control group than the study group from and constipation. there were highly statically
the first day to the fifth day with a highly significant differences between day 1 and day 5 in
statically significant differences between them study and control group regarding gastric residual
regarding abdominal circumference in all 5 volume, and abdominal distension in control
days.This may be related to the abdominal group. There were statically significant
massage was decrease abdominal distension so differences between day 1 and day 5 regarding
the abdominal circumference not changed in constipation in control group. In addition, while
study group rather than in control group. This there were no statically significant differences
result was in agreement with Dehghan, between day 1 and day 5 regarding abdominal
Mehdipoor&Ahmadinejad,(2018)who found circumference and vomiting in study and control
that who applied 15-minute abdominal massage group. This may be due to abdominal massage
twice a day for three days found a significant improve abdominal peristalsis and it help in
difference in the abdominal circumference improving food absorption and defection pattern
between the intervention and control groups. so it leadto decrease gastric residual volume,
abdominal circumference, abdominal distension

811
Original Article Egyptian Journal of Health Care, 2021 EJHC Vol.12 No.1
and improve defection pattern so decrease El-Feky, H. A. A., & Ali, N. S. (2020). Effect of
constipation. abdominal massage on gastricresidual
volume among critically ill patients at
This result was in agreement with
Cairo University Hospitals.
Etinkaya ,Ovayolu; Ovayolu (2020) who
InternationalAcademic Journal of Health,
found that GRV decreased significantly in the
Medicine and Nursing; 2(1): 36–53.
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Fareed, M.F., &El- Sayad, H.A. (2017). Effect
gentle abdominal massage was administered bi-
of Selected Nursing Intervention on
daily for 3 days showed decrease abdominal
Clinical Outcomesamong Patients with
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Nasogastric Tube in Intensive Care
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Units. Journal of Nursing and Health
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