Comparative Study Between Leg Massage and Vibration on Cramps and Comfort for Patients Undergoing Hemodialysis

Muscle cramps are one of the most common and distressing complications experienced by patients undergoing hemodialysis, affecting approximately 33% to 86% of this population. These involuntary, painful muscle contractions, predominantly occurring in the lower extremities, often lead to premature termination of dialysis sessions, sleep disturbances, and significant deterioration in quality of life. While pharmacological interventions such as hypertonic saline, glucose, and carnitine supplements are currently used, their effectiveness remains inconsistent and they may carry adverse effects. Consequently, there is a growing interest in non-pharmacological approaches that are safe, cost-effective, and easily integrated into routine dialysis care. Both leg massage and vibration therapy have shown individual promise in managing muscle cramps and improving patient comfort, yet no large-scale randomized controlled trial has directly compared their relative effectiveness. This study will address this critical knowledge gap by providing head-to-head comparative evidence to guide clinical decision-making.

This study will be designed as a prospective, parallel-group, randomized controlled trial conducted across three outpatient hemodialysis centers. A total of 164 adult patients undergoing maintenance hemodialysis for at least three months who experience lower extremity muscle cramps will be enrolled. After providing informed consent, participants will be stratified based on dialysis session frequency, baseline cramp frequency, age, and gender to ensure homogeneity across groups. Using a computer-generated random sequence, patients will be allocated in a 1:1:1 ratio to one of three groups: the massage group (n=61), the vibration group (n=57), or the control group (n=46). Due to the nature of the interventions, blinding of participants and intervention providers will not be feasible; however, outcome assessors and data analysts will remain blinded to group allocation to minimize detection bias.

Participants in the massage group will receive a standardized 20-minute lower extremity massage during each hemodialysis session, administered three times per week for a total of two weeks (six sessions). The massage protocol will include effleurage (gentle stroking), petrissage (kneading), friction (deep circular movements), and tapotement (rhythmic tapping) applied by trained registered nurses with certification in therapeutic massage. The vibration group will receive 10 minutes of mechanical vibration therapy using a portable device delivering vibration at a frequency of 30-50 Hz with an amplitude of 2-4 mm, applied to the posterior calf, anterior tibial, and quadriceps muscles. The control group will receive standard dialysis care without any additional interventions. The primary outcomes will be cramp frequency (recorded via daily patient diaries during dialysis and at home) and cramp severity measured using a 10-cm Visual Analog Scale (VAS). Secondary outcomes will include sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI), patient comfort scores during dialysis sessions, and documentation of any adverse events.

It is hypothesized that both massage and vibration interventions will demonstrate significant superiority over standard care in reducing cramp frequency and severity, with each intervention showing distinct advantages in specific outcome domains. Specifically, the massage group is expected to exhibit greater improvement in sleep quality and more substantial reduction in home-based cramping episodes compared to both the vibration and control groups. Conversely, the vibration group is anticipated to achieve higher immediate comfort scores during dialysis sessions, reflecting the shorter intervention duration and potentially greater patient tolerability. Both interventions are predicted to be safe, with no serious adverse events expected. The findings from this trial will provide robust evidence to guide personalized, patient-centered care, enabling healthcare providers to recommend either massage or vibration based on individual patient priorities, clinical presentation, and available resources. Ultimately, integrating these evidence-based non-pharmacological interventions into routine hemodialysis protocols has the potential to substantially improve treatment adherence, patient satisfaction, and overall quality of life for the growing population of patients receiving maintenance hemodialysis.

Inclusion criteria

• patients on maintenance HD for ≥3 months who experienced lower extremity muscle cramps.

Exclusion criteria

• Exclusion criteria included acute illness, lower extremity wounds/infections, deep vein thrombosis, severe neuropathy, and cognitive impairment. All participants provided written informed consent.