Back massage is a safe and feasible intervention after open-heart surgery, improving objectively measured sleep duration and reducing pain, though cortisol levels decreased over time in both groups without significant between-group differences.
Key Findings
Results
Back massage was associated with significantly longer total objective sleep duration in patients after open-heart surgery.
Sleep duration was measured objectively using smartwatch technology
The between-group difference in total sleep duration was statistically significant (p = 0.037)
The intervention consisted of three standardized sessions of 15-20 minutes each on the first postoperative day
Analysis was conducted in a per-protocol population of 64 patients from an original enrollment of 72
Results
Back massage produced significantly greater reductions in postoperative pain scores compared to routine care with light touch.
Pain was measured using the Numeric Rating Scale-Pain (NRS-Pain)
Significant group effect (p = 0.002), time effect (p < 0.001), and group × time interaction effect (p = 0.048) were observed
The control group received routine care with light touch rather than no touch, serving as an active comparator
Analgesic use declined in both groups with no significant between-group difference
Results
Serum cortisol levels decreased over time in both the massage and control groups, but without significant between-group differences.
Cortisol decrease over time was statistically significant across both groups (p < 0.001)
No significant between-group difference in cortisol reduction was found
Cortisol was included as a biological stress marker to provide novel insight beyond traditionally reported outcomes
This finding suggests the temporal decline in cortisol may reflect natural postoperative recovery rather than a specific massage effect
Results
Subjective sleep quality improved in both the intervention and control groups without a significant difference between groups.
Subjective sleep quality was measured using the Richard-Campbell Sleep Scale
Both groups showed improvement in subjective sleep quality over the study period
No significant between-group variation in subjective sleep quality was reported
This contrasts with the significant between-group difference found in objectively measured sleep duration
Results
No adverse events were observed during the back massage intervention in postoperative open-heart surgery patients.
The study was a prospective randomized controlled trial with 72 patients scheduled for elective open-heart surgery, randomized 1:1
The per-protocol analysis population comprised 64 participants
The intervention was described as 'safe and feasible' following open-heart surgery
Data were analyzed using repeated-measures analysis of variance and Brunner-Langer tests
What This Means
This research suggests that giving patients a back massage after open-heart surgery can help them sleep longer and experience less pain during their recovery. In this study, 72 patients were randomly assigned to either receive three 15-to-20-minute back massage sessions on their first day after surgery or to receive standard care with light touch. Patients who received massage slept significantly longer according to smartwatch measurements, and they reported meaningfully greater reductions in pain compared to the control group. Importantly, no safety concerns or adverse events were observed, suggesting the technique is appropriate even in this medically complex population.
However, not every outcome showed a massage-specific benefit. Levels of cortisol — a hormone associated with stress — fell in both groups over time, indicating this decline is likely part of the normal recovery process rather than a unique effect of massage. Similarly, both groups reported improvements in how they felt their sleep quality was, with no significant difference between them. This gap between objective sleep (measured by smartwatch) and subjective sleep perception is an interesting finding that highlights the value of using multiple measurement methods.
This research matters because open-heart surgery patients often struggle with pain and poor sleep during recovery, and reducing reliance on pain medications is a meaningful goal. The study supports back massage as a practical, low-risk complementary nursing intervention that can be incorporated into routine postoperative care. It also stands out for using a biological marker (cortisol) and objective sleep tracking alongside standard self-reported measures, offering a more complete picture of how massage affects the recovering body.
Özhanlı Y, Güneş A, Akyüz N, Uzun S, Kurt M, Omay O, et al.. (2026). The effect of postoperative back massage on pain, sleep outcomes and serum cortisol after open-heart surgery: A randomized controlled trial.. International journal of nursing studies. https://doi.org/10.1016/j.ijnurstu.2026.105343