Effects of Back Massage on Chemotherapy-related Fatigue

This paper is aimed to critique on a quantitative research article. “Effects of back massage on chemotherapy-related fatigue and anxiety: Supportive care and therapeutic touch in cancer nursing” Written by Karagozoglu and Kahve (2013) as part of my assignment.

The Problem

The problem is significant to nursing as noted by Karagozoglu and Kahve (2013) that nurses are directly involved to provide care and deal with patients receiving chemotherapy and their experienced side effects. It is also mentioned that problem is significance to nursing, as nursing interventions intend to improve quality of life by reducing the stress level of the patient with cancer.

Moreover, the purpose of conducting quasi experimental and cross sectional study research was to determine the effectiveness of back massage, a nursing intervention, on fatigue process which develops due to chemo therapy. Furthermore, on the anxiety level which develops, and has been explained explicitly. In my point of view this study can accomplish its purpose as Burns and Grove (2011) mentioned that effects of independent variables on dependent variable can be determined through quasi experimental studies. In addition, quasi experimental; a quantitative approach study design is best fit to determine the effectiveness of back message. In the article research variables back massage independent variable and fatigue as dependent variable has been explained with literature support, whereas I feel the dependent variable anxiety need more elaboration. The investigators promptly introduced the problem statement at the end of the introduction. In my point of view the answer to the problem provide insight into current issues in nursing practice because there was no study found which determine the effects of back massage in decreasing fatigue and anxiety of chemotherapy patients. In addition, the investigators has stated the assumptions very clearly that “back massage providing during chemotherapy reduces fatigue and anxiety” Moreover, limitations are not listed explicitly but reader can infer easily as evident by this statement, small sample size was used therefore, the findings of the study could not be generalized. The limitations of quasi study design are as mentioned in Polit and Beck (2012) noted that in interventional study participants show reluctance to be selected through randomization. Thus these assumptions and limitations are realistic.

Review of the Literature

The literature reviewed by the researchers is comprehensive, critical, and logical. Moreover, the literature was published during the period 1988- 2013 and most of them were not recent but relevant to the problem. The relationship to the research purpose is evident by the literature review. In addition to that the researchers included 21 recent research studies and of these three studies published in 2013 were also used. The investigators paraphrased the reviewed adequately did not use any quotation. The researchers made a case logically for conducting a new study based on the review

Protection of Human Rights

This study was designed to minimize risk and maximize benefits to participants. Moreover, the researchers indicated very explicitly that participants gave voluntary, verbal and written informed consent and no evidence of coercion was found. However, it is not evident in study that participants were invited to consent during periods of high stress. There is no evidence in the study that individuals can be identified and linked to study. The researchers very clearly mentioned that approval to conduct the study has been taken from an independent ethics committee of Cumhuriyet University Faculty of Medicine.

Theoretical / Conceptual Framework

The researchers did not describe any theory or framework to guide their study. Coughlan, Cronin and Ryan (2007) noted that theoretical frameworks tend to be better developed in experimental and quasi-experimental studies. Burn and Grove (2011) noted that a well-developed quantitative study is based on clearly stated framework and quality of frame work needs to be evaluated for practicality. However, in this study the absence of theory or frame work did not detract the researchers from the significance of the research.


The investigators formally stated hypotheses. It is appropriate to have the hypothesis in quantitative study as the investigators were interested to test the effectiveness of back massage. Burns and Grove (2011, p.167) stated that this type of researches are required to have hypothesis in order to predict outcome. Moreover, hypotheses are naturally derived from the research problem and transform the problem into predictable results. In this study hypotheses contain two dependent and independent variables. Furthermore, the investigators stated hypotheses clearly and objectively and the prediction is evident. It is very obvious that these predictions are supported by the literature.


The target population carefully described by the researchers i-e patients who at least underwent for chemotherapy. The target population was appropriate according to the study problem and desirability. However, resource limitations are not mentioned in the study. The investigators described sample selection procedures by giving strict eligibility criteria. However, it would be better if they had clearly mentioned the type of sampling procedure used. Moreover, the sampling method fits with the research design and level of inquiry of study. However, the authors did not describe potential sample biases. According to Polit and Beck (2012) under representation of the sample pertaining to research question should be acknowledge by the researchers. The sample is sufficiently large as Polit and Beck (2012, p.285) propose that small sample size will be adequate if researcher is certain about the strong relationship of the independent and dependent variables and it is described under the subheading of methods p.212.This study can be generalized on the target population and patients receive chemotherapy. The investigators have described the eligibility criteria to enroll participants on ( p.212) to ensure a representative sample. However, sampling error can be minimized by increasing the sample size.

Research Design

The investigators used quasi experimental and cross sectional design to determine the effects of the interventions. The design used for the level of inquiry of research question and purpose of research was appropriate as Burn and Grove (2011, P.151) mentioned that this study design is to determine the effects of back massage on independent variables. The researcher did not discussed potential effects of confounding variables and possible measures to control such effects (validity). Polit and Beck (2012) proposes selection of homogeneous sample to control confounder, however, statistical analysis can also be used for the same purpose. The researchers gave enough information based on which study can be replicated.

Data Collection

The instruments Personal Information Form, The State Anxiety part of Spielberger State- Trait Anxiety Inventry (STAI) Brief Fatigue Inventory (BFI) were used for data collection. Personal Information consists of nine questions for that detail is given under the subheading of Personal Information on p. 212. Moreover, State- Trait Anxiety Inventory (STAI) instruments developed by Spielberger et.al in 1964 has been used by Oner and Le Compte. Cronbach’s alpha coefficient was given that shows validity and reliability. In addition, Brief Fatigue Inventory (BFI) developed by Mendoza et.al. (1999) which consists of 10 questions was used to assess fatigue, and the same scale was used by Cinar, Sezerli,Sarsmaz and Ments. The value of Cronbach alpha reliability coefficient of the scale verifies its validity and reliability. However, rationale for the selection of instruments was not given. Instruments used in this study were congruent with research questions. Are results of these tests sufficient to indicate their use?

The instruments are suitable for use with the study sample.

Quantitative Analysis

Determining the effectiveness of back massage is the third level of inquiry of study question, and for that quasi experimental and cross sectional study design is best fit.

The investigators calculated mean and standard deviation for age. Chi-square test has been used for qualitative ordinal variables. A non-parametric Friedman test that is substitute of ANOVA has been used to analyze mean BFI score for intra group variability. Moreover, a Wilcoxon non-parametric test alternative to paired t-test was used to examine mean STAI scores of patients before, after and right after chemotherapy. Furthermore, Mann-Whitney U test was used for mean STAI and BFI score of patients before and right after chemotherapy. Despite the fact that data were normally distributed, non- parametric test have been used. The link between the analysis and findings are logical, clear, and are evident by statistical rejection of null hypothesis by P-value. The researchers did not go beyond the data during interpretation of the findings, and they presented statistical result both in the narration and in tabulated form. The investigators used inferential statistic that is enough evidence to establish the correctness of the statistical result as Coughlan Cronin, P., & Ryan (2007) noted that statistical significance assist the investigators to rule out threat to validity. The investigator presented findings in a table which is clear, simple, and accurate.

Conclusions and Recommendations

Data analysis clearly explained in reference to research questions and hypotheses.

Since the study sample was small, the researchers made appropriate decision; based on significant findings and did not claim for generalizations beyond the study sample or population. However, the results are applicable on our patients who are planning for chemotherapy. If we will implement this intervention to our context, then it will lead to increase comfort, decrease fatigue, and anxiety. Furthermore, there are no risks of implementing study findings mentioned explicitly or inferred. The authors also recommended that back massage during chemotherapy is effective intervention to be practiced to control the side effects especially fatigue and anxiety and this recommendation is well supported by the others studies. However, the investigators

did not give recommendations for future research studies.

To determine the efficacy of back massage, a nursing intervention is a unique study which is significance for nursing practice. In this study the investigators used quasi experimental and cross sectional study design. Moreover, the study purpose of the study is explicitly stated. The investigators tested hypothesis with instrument which are reliable and valid and they described the instrument very comprehensively. Moreover, sample selection was carried out on strict eligibility criteria. Study findings have been explained in narration and in table. Finally, investigators gave conclusion based on findings that back massage is effective nursing intervention to decrease the fatigue and anxiety of the patients who receive chemotherapy. The investigators also mentioned that study cannot be generalized other than target population.


Burns, N., & Grove, S. K. (2012). Understanding Nursing Research: Building an Evidence-Based Practice. Elsevier Health Sciences.

Polit, D. F., & Beck, C. T. (2012). Nursing Research: Generating and Assessing Evidence for Nursing Practice. Lippincott Williams & Wilkins.

Coughlan, M., Cronin, P., & Ryan, F. (2007). Step-by-step guide to critiquing research. Part 1: quantitative research.British Journal of Nursing,16(11), 658-663

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