Effect of Combined Stress Ball and Lavender Aromatherapy on Cannulation-Related Anxiety in Hemodialysis Patients: A Randomized Controlled Trial
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Objective: This study aimed to evaluate the effect of combined stress-ball squeezing and lavender aromatherapy on arteriovenous fistula cannulation-related anxiety among maintenance hemodialysis patients.
Methods and Materials: A prospective, parallel-group, single-blind randomized controlled trial was conducted in two dialysis centers between December 2025 and February 2026. Eighty hemodialysis patients were randomized to intervention (n = 42) or control (n = 38) groups using dialysis-day cluster allocation. After eight dropouts, 72 participants completed the study and were analyzed per protocol, with 36 patients in each group. The intervention group received lavender oil inhalation and stress-ball squeezing during AVF cannulation across six sessions, while the control group received conventional care. Anxiety was measured immediately before and two minutes after cannulation using the Visual Analogue Scale for Anxiety. Data were analyzed using Mann–Whitney U, Friedman, and related non-parametric tests, with rank-biserial correlation as effect size.
Findings: Baseline sociodemographic and clinical characteristics were comparable between groups. By Session 6, median pre-cannulation anxiety was lower in the intervention group than the control group, 3.3 versus 4.3, respectively, with a between-group difference of 1.0, p < .001, 95% CI [0.81, 1.19], rank-biserial correlation = .82. Median post-cannulation anxiety was also lower in the intervention group, 2.6 versus 4.0, with a between-group difference of 1.4, p < .001, 95% CI [1.15, 1.65], rank-biserial correlation = .86. No intervention-related adverse events were reported.
Conclusion: Combined stress-ball squeezing and lavender aromatherapy safely reduced cannulation-related anxiety in hemodialysis patients.
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