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Table of Contents
RESEARCH ARTICLE
Year : 2020  |  Volume : 21  |  Issue : 2  |  Page : 181-184

Effectiveness of hot water footbath therapy in reducing body temperature amongst patients with fever


Assistant professor, Hindu Mission College of Nursing, Chennai, Tamil Nadu, India

Date of Submission15-Mar-2018
Date of Decision18-Nov-2019
Date of Acceptance08-Jan-2020
Date of Web Publication19-Feb-2021

Correspondence Address:
Mrs. M Muthupriya
Hindu Mission College of Nursing, Tambaram, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCN.IJCN_19_20

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  Abstract 

Fever has been recognised as a symptom and not a disease in itself. The thermoregulatory centre in the hypothalamus regulates body temperature. Hydrotherapy in the form of cold and tepid applications has been historically used for reducing increased body temperature. Many studies have looked at effect of hydrotherapy over pharmacological measures and have found that tepid or cold sponging reduces body temperature rapidly, but are associated with discomfort for the patients. There is some evidence that hot water soaks to foot reduces body temperature effectively. Hot water footbath is considered as a non-pharmacological, safe, side effect-free, cost-effective and easy-to-administer therapy to reduce fever. The aim of this study was to assess the effectiveness of hot water footbath therapy (HWFBT) in reducing the body temperature in adult patients with fever. Sixty patients were selected by convenient sampling technique, of which thirty patients were allotted to experimental group and thirty to control group by random method. HWFBT was given to experimental group. The control group received the standard care as per practice of the hospital. The findings showed that the difference in the mean body temperature in the post-test was significantly lower in the experimental group (P < 0.001). HWFBT may, therefore, be effectively used as an intervention to reduce the body temperature in patients with fever.

Keywords: Adults, fever, hot water footbath therapy


How to cite this article:
Muthupriya M, Lakshmi R. Effectiveness of hot water footbath therapy in reducing body temperature amongst patients with fever. Indian J Cont Nsg Edn 2020;21:181-4

How to cite this URL:
Muthupriya M, Lakshmi R. Effectiveness of hot water footbath therapy in reducing body temperature amongst patients with fever. Indian J Cont Nsg Edn [serial online] 2020 [cited 2021 Feb 28];21:181-4. Available from: https://www.ijcne.org/text.asp?2020/21/2/181/309855


  Introduction Top


Fever has been recognised as a symptom and not a disease. Fever is a natural response of the body that helps in fighting foreign substances such as microorganisms. Thermoregulatory centre in the hypothalamus regulates body temperature. Once the temperature rises, the person often feels warm, the cellular metabolism increases, oxygen consumption rises and heart and respiratory rate increases to meet the metabolic needs of the body. Increased metabolism uses energy that produces additional heat.

Hydrotherapy is the use of water at any temperature or in any form in the treatment of disease. Hydrotherapy is based on the theory that water with its cooling, warming and/or cleansing properties has healing effects.[1] Warm water therapy, particularly, is a traditional method of treatment that has been used for the treatment of disease and injury in many cultures.

Some of the non-pharmacological measures such as tepid sponging and cold sponging are found to be effective in reducing fever. However, the rapid cooling that occurs with these interventions may cause shivering, which is a discomfort to the patients. Randomised control trials comparing cold or tepid sponging versus oral antipyretics in groups of febrile children have shown that the hydrotherapy measures are effective in rapid reduction of temperature in the first 30 min to 1 h of application versus a gradual reduction of fever with oral antipyretics, effects of both being similar at 2–3 h. Sponging was associated with gross discomfort for children.[2]

Another measure, which has been tried in reducing fever, mainly children, is the hot water footbath. Hot water footbath therapy (HWFBT), one of the hydrotherapeutic measures, improves peripheral blood circulation and provides warmth and comfort for the patients.[3] HWFBT is said to improve immune response which helps in counteracting the underlying infection which causes the fever.[4] As in cold or tepid sponging, rapid cooling is not brought about in HWFBT. Temperature is brought down gradually, so that it allows slow heat loss, thus avoiding rapid cooling and shivering.

The temperature regulatory centre in the hypothalamus has both heating and cooling capabilities. When the body temperature rises above the set point (normal temperature), the temperature-regulating centre attempts to loose heat by increasing the blood flow to the skin and by sweating. When body temperature falls below normal, the physiological reaction of shivering and peripheral vasoconstriction is initiated to increase heat production and reduce heat loss. Hot water footbath is based on this physiology of heat loss.[5] It is a procedure that involves immersing the feet and ankles in hot water at temperature ranging from 39°C to 43°C (102°F to 109°F).[4] The temperature of the water is adjusted to the tolerance of the patients. HWFBT works by initiating skin vasodilatation and inducing sweat through increasing peripheral temperatures. Skin vasodilatation results in small amounts of dry heat loss and is primarily responsible for internal heat transfer, that is, transferring the heat from core (internal organs) to the skin. The sweating causes heat loss and cooling through evaporation (external heat loss). The peripheral blood is cooled before it returns to the internal deeper tissues and organs.[6] Previous studies done in febrile children have shown that HWFBT is beneficial when fever is between 38°C and 39°C (100°F to 102° F). This study was done with an aim to apply hot water footbath in adults with fever.

Objectives

  1. To evaluate the difference in the body temperature between pre- and post-assessments in the experimental group who had hot water footbath and controls who had standard care.
  2. To evaluate the effectiveness of hot water footbath on body temperature in experimental group of patients as compared to those patients who had standard care.


Hypothesis

H1- There will be a significant difference in the body temperature in experimental group and control group after HWFBT as compared to the control group who had standard care at 0.05 level of significance.


  Methodology Top


A quantitative approach with an experimental design was used to assess the effectiveness of HWFBT for reducing the body temperature amongst patients with fever. The study was conducted at the medical ward of a tertiary hospital in Chennai. Conscious patients suffering from fever between 20 and 60 years, including both male and female patients with temperature 100°F–103°F, were included in the study. Patients who had peripheral vascular disorders or peripheral neuropathy or with ulcers or lesions in the legs were excluded from the study. Sixty patients who fulfilled the criteria were selected and randomly allocated to experimental and control groups (30 in each group).

A data profile sheet that included items such as age and gender, body temperature of the patient before and after intervention, duration of fever and associated illness was used as the tool. Axillary temperature was measured using a standard digital thermometer for all study patients. The content of the tool was reviewed and refined by subject experts. After pilot study, reliability of the tool was assessed using inter-rater method and its correlation coefficient (r) value was 0.88. Only footbath was administered to the experimental group. For patients with temperatures ranging from 100° to 103°F, HWFBT was given for 15–20 min duration. For the participants in control group, hospital routine (antipyretics with or without tepid sponging) was carried out. Temperature was checked after 15–20 min of intervention. Approval for the study was obtained from the Institutional Ethical Committee and Head of the Department. Written informed consent was obtained from each study participant after giving full information about the study. Anonymity was assured to each participant and maintained by the researcher.


  Results Top


In the experimental group, there were equal numbers of male and female patients. The control group consisted majority of males (66.7%). Majority of the participants in both experimental (63.3%) and control (50%) groups were between 20 and 30 years of age. About 60% of those in experimental group and 56.7% in the control group had fever of 101°F–102.9°F. The duration of fever was found to be 2 days in 43.3% and 40% of them in experimental and control groups, respectively. However, more number of patients (13, 43.3%) had fever for 1 week in experimental group compared to only 8 (26.7%) in the control group [Table 1].
Table 1: Demographic and clinical profile of participants with fever

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Paired t-test revealed that both experimental and control groups showed a significant reduction in body temperature in the post-assessment. Both hot water foot therapy and standard care were effective in reducing the body temperature in fever patients [Table 2].
Table 2: Comparison of pre and post of mean body temperature in experimental and control groups

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In the pre-test, participants in the experimental group were having a mean temperature of 101.45°F, whereas in control group, it was 101.33°F. The mean difference in temperature before intervention was not statistically different between control and experimental groups.

In the post-assessment, the mean temperature of experimental and control group participants was 99.83°F and 100.8°F, respectively. The mean difference in the temperature was found to be 0.94°F. The difference between experimental and control groups in the post-assessment was found to be statistically significant (P < 0.001) [Table 3]. Hence, it is evident that HWFBT was more effective in reducing the body temperature at specific post-assessment time period when compared to the standard fever care.
Table 3: Comparison of mean body temperature between experimental and control groups in pre- and post-test

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  Discussion Top


The present study evaluated the effectiveness of hot water footbath in reducing the body temperature in adults with fever when compared to routine measures for fever reduction. Majority of the study participants in both groups were between 20 and 30 years of age. The study findings indicate that both experimental and control group participants had a significant reduction in body temperature. The hospital procedure of administering antipyretics and tepid sponging if accepted by patients were the routine measures that were followed for control group participants. The study findings reveal that these measures were effective in controlling body temperature in the control group by showing statistically significant reduction in body temperature at post-assessment. Use of antipyretics and/or cold/tepid sponging for controlling fever has been the general measures to control fever in both adults and children in hospital as well as at home,[7],[8],[9] and the effectiveness of these measures has been reinforced in this study.

Use of alternative methods such as hot water footbath for reducing fever has been studied infrequently. In this study, the experimental group of participants was given only hot water footbath without any other measures for fever reduction. The results showed that there was a significant reduction of body temperature in the experimental group and further showed a higher reduction in body temperature when compared to the control group in the post-assessment. The above findings reveal that hot water footbath was more effective in reducing the body temperature in adult patients with fever. Similar results have been found in other studies. A qualitative study from Iran found that mothers of children used footbath for controlling fever and found that tepid water footbath was effective in reducing the body temperature.[8] Hot water foot therapy was effective in children with fever, and the cooperation to procedure was much better to hot water foot therapy.[10] Another study from India found that there was a significant reduction in the body temperature in adult patients with fever who had hot water foot immersion therapy in addition to standard care compared to the control group. Patients were highly satisfied in hot water immersion group and the therapy was useful in all types of fever.[9] Satisfaction of patients was not measured in this study. Majority of the patients in this study had fever for longer duration (2 days to 2 weeks). Although the association was not known, it is evident that hot water footbath was beneficial even for those with long-term fever. Warming also reduces shivering which is an added advantage and comfort for patients. Therefore, hot water footbath can be effectively used in care of patients with fever.


  Conclusion Top


HWFBT is a simple therapeutic modality which can be carried out in a hospital setting or by the patient themselves in their homes. It is economical. The efficiency of HWFBT on reduction of body temperature found in this study augments other study findings and offers an insight in decision-making process for appropriate intervention. Since this is a non-pharmacological treatment, it is recommended at the right time with prompt duration for fever patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chaurasia G, Patil A, Dighe S. A review on therapeutic aspects of hydrotherapy. Int J Pharm Sci Res 2015;6:2713.  Back to cited text no. 1
    
2.
Aluka TM, Gyuse AN, Udonwa NE, Asibong UE, Meremikwu MM, Oyo-Ita A. Comparison of cold water sponging and acetaminophen in control of Fever among children attending a tertiary hospital in South Nigeria. J Family Med Prim Care 2013;2:153-8.  Back to cited text no. 2
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3.
Thomas S, Vijaykumar C, Naik R, Moses PD, Antonisamy B. Comparative effectiveness of tepid sponging and antipyretic drug versus only antipyretic drug in the management of fever among children: A randomized controlled trial. Indian Pediatr 2009;46:133-6.  Back to cited text no. 3
    
4.
Traditional Hydrotherapy. Hot Foot Bath; 2017. Available from: https://www.traditionalhydrotherapy.com/Techniques/HotFootBath.html. [Last accessed on 2020 Feb 11].  Back to cited text no. 4
    
5.
Hinkle JL, Cheever KH. Study Guide for Brunner & Suddarth's Textbook of Medical-surgical Nursing. USA: Lippincott Williams & Wilkins; 2013.  Back to cited text no. 5
    
6.
Kenny LW. Physiological responses to the thermal environment. Encyclopedia of Occupational Health and Safety. Available from: http://www.ilocis.org/documents/chpt42e.htm. [Last accessed on 2020 Feb 11].  Back to cited text no. 6
    
7.
Lewis SL, Bucher L, Heitkemper MM, Harding MM, Kwong J, Roberts D. Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical Problems, Single Volume. USA: Elsevier Health Sciences; 2016.  Back to cited text no. 7
    
8.
Fallah Tafti B, Salmani N, Afshari S. The maternal experiences of child care with fever: A qualitative study. Int J Pediatr 2017;5:4429-37.  Back to cited text no. 8
    
9.
Sharma K, Kumari R. A study to assess the effectiveness of impact of hot water foot immersion therapy on regulation of body temperature among patients with fever admitted in Sharda Hospital, Greater Noida. Int J Nurs Edu 2019;11:26-9.  Back to cited text no. 9
    
10.
Pereira AC, Sebastian S. Effectiveness of hot water foot bath therapy in reduction of temperature among children (6-12 years) with fever in selected hospitals at Mangaluru. Int J Appl Res 2018;4:86-92.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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