1. von Gaudecker, Jane R.

Article Content

In this issue of JNN, Chiu and colleagues1 report the findings of a randomized controlled crossover study to assess the effectiveness of home-based footbath to reduce insomnia among people with traumatic brain injury (TBI). This study is an excellent example of a simple, home-based alternative intervention that can help insomnia among people in their chronic phase of TBI.


Study Purpose

This randomized controlled crossover trial was conducted to examine the effects of home-based footbath to promote sleep in adults with TBI.



Insomnia is a major concern among many people who have experienced TBI. It can affect the person's activities of daily living and sense of well-being and exacerbate cognitive symptoms. Insomnia is characterized by difficulty falling asleep, staying asleep, or waking up too early and being unable to get back to sleep. Pharmacotherapeutics, the mainstay of treatment of insomnia, have adverse effects such as dementia and cancers. Few studies have explored the effects of nonpharmacological treatment of insomnia among people with TBI.



In this feasibility, randomized controlled crossover study, 23 adults who were diagnosed with (first-ever) TBI, more than 1 year since injury, were recruited using convenience sampling from the neurosurgical clinics or rehabilitation departments of 3 hospitals in northern Taiwan. The participants were randomly assigned to either the intervention group, that is, home-based warm footbath (n = 12), or the usual-care group (n = 11). Participants in the intervention group were asked to soak their feet, above ankle in warm water (40[degrees]C) for 30 minutes, 1 to 2 hours before sleep time. These participants maintained a daily log of the intervention. Participants in the usual group maintained their daily activities and received medical as usual for 3 days. After a washout period of 3 days, the participants were administered opposite intervention for 3 days. Sleep data were obtained using the Mini Motionlogger Actigraph. Sleep parameters such as sleep efficiency, sleep onset latency (SOL), total sleep time, and wake after sleep onset (WASO) were collected using the Cole-Kripke algorithm by ActFAST analysis software. The treatment effects of home-based warm footbath on sleep parameters were determined using the linear mixed-effects model.


Presence and degree of depression were assessed using the Chinese version of Beck Depression Inventory, Second Edition. To screen the severity of anxiety symptoms, the Chinese version of Beck Anxiety Inventory was used. Pain intensity was assessed using the Visual Analog Scale of Pain Intensity. Insomnia Severity Scale was used to assess self-perception of insomnia. Berlin Questionnaire was used to assess snoring behaviors, daytime sleeping, body mass index, and hypertension. All these scales were administered at baseline.



The average age of participants was 35.9 years, the average body mass index was 23.5 kg/m2, the major reason for head injury was traffic accidents, and the average time since head injury was 27.6 months. Sixty-five percent of the participants were women. With a Chinese-version Beck Depression Inventory, Second Edition, score of 12.8; a Chinese-version Beck Anxiety Inventory score of 8.4; and a Visual Analog Scale of Pain Intensity score of 3.0, participants were found to be not anxious, depressed, and in pain at the time of the study. There was a significant difference in the SOL (P < .001) and WASO (P = .006), with individuals in the intervention group having a reduced SOL and a suppressed WASO in comparison with the usual-care group, indicating that the home-based footbath therapy was effective.



This feasibility trial shows preliminary evidence of an effective home-based therapy for TBI patients experiencing insomnia. This is an alternative intervention that nurses could suggest for their patients during their chronic phase of TBI.




1. Chiu HY, Lin E, Chiu HT, Chen PY. A feasibility randomized-controlled crossover trial of home-based warm footbath to improve sleep in the chronic phase of traumatic brain injury. J Neurosci Nurs. 2017;49(6):380-385