Effect of Slow Stroke Back Massage on Patients’ Anxiety Level

Anxiety is a feeling of fear or anxiety from negative thoughts and excessive negative emotions that play a role in causing illness. This study aimed to determine the effect of Slow Stroke Back Massage on patient anxiety with various literature. The method used is Literature Review with database searches such as Google Scholar, Sage, and Pubmed. The journals used were 15 consisting of 6 national and 9 international journals. The results of the Literature Review Analysis showed that 15 journals stated there was a significant effect between Slow Stroke Back Massage in reducing anxiety. There is an effect of Slow Stroke Back Massage on reducing patient anxiety.


INTRODUCTION
According to the American Psychological Association, anxiety is an emotional state that arises when individuals are stressed and is characterized by feelings of tension, thoughts that make individuals feel worried, and accompanied by physical responses such as a racing heart, raised blood pressure, and so on (Putri & Wibowo, 2020). Anxiety is a feeling of fear or nervousness from negative thoughts and excessive negative emotions that take a role in causing illness and making the patient's recovery hampered and can worsen the disease (Putri & Wibowo, 2020). Anxiety triggers irregular production of the hormone cortisol so that the hypothalamus increases the production of Corticotropin-Releasing Hormone (CRTH), which in turn causes weakness and decreases endurance (Pujiani and Kristiyawati, 2017).

One of the complementary or non-pharmacological therapies is Slow Stroke Back Massage. Slow Stroke
Back Massage (SSBM) is a massage technique taught in nursing academy by massaging the patient's back using the palm, especially the thumb, in a circular motion. The massage movements were carried out 60 times/minute for 10 minutes in each session and were carried out for 3 consecutive days (Lindquist et al., 2018). Slow Stroke Back Massage (SSBM) activates faster transmission of A-beta sensory nerve fibers as neurotransmitters. The neurotransmitter reduces pain transmission, delivered through small diameter C and A-delta fibers while closing the gate for pain impulse transmission, so anxiety does not occur. Massage will reduce emotions, reduce feelings of nervousness, and provide an outstanding balance to the activity of the parasympathetic nervous system and the sympathetic nervous system. Massage can also increase the pressure on the tissue, then the pressure will increase between the tissue and blood vessels so that it can cause the movement of fluid between the tissues and blood vessels which regulates blood pressure and anxiety can decrease (Peng et al., 2015).
Based on the description, it is interesting to study further, which makes researchers interested in conducting a Literature Review on Slow Stroke Back Massage (SSBM) for Anxiety. The purpose of this study was to analyze and determine whether Slow Stroke Back Massage affects anxiety in patients. using the Inclusion Criteria and Exclusion Criteria. This process found 15 journals (6 National Journals and 9 International Journals). The data obtained will be used in a discussion to answer all the problems in this study. Data obtained from various anxiety patients collected in one document aims to answer the problems that have been formulated.

DISCUSSION
The results showed that 15 journals (100%) stated the effect of Slow Stroke Back Massage on reducing anxiety with a significance value of P-Value <0.05. Based on the 100% percentage results obtained from 6 national and 7 international journals, as many as 9 showed an effect of Slow Stroke Back Massage with decreasing anxiety. Slow Stroke Back Massage (SSBM) will cause A-beta sensory nerve transmission as a neurotransmitter that reduces pain. Massage in the back area will trigger the release of endorphins, make you feel comfortable and calm, and reduce Anxiety (Putri, R. P., & Wibowo, 2020).
Stimulus Slow Stroke Back Massage (SSBM), which affects the peripheral nervous system, will be forwarded to the hypothalamus through the spinal cord pathway. The hypothalamus responds to these stimuli by secreting endorphins and reduces cortisol by releasing corticotropins. The activity reduces sympathetic nerve activity and increases parasympathetic nerve activity. The endorphins production will stimulate the production of hormones, namely serotonin and dopamine, which reduce anxiety and cause a relaxation response.
Massage will reduce emotions, reduce feelings of nervousness, and provide a great balance in the activity of the parasympathetic nervous system and the sympathetic nervous system (Elkheshen, Ahmed and Abdelgawad, 2017). According to the researcher, massage can provide therapeutic benefits in various https://doi.org/10.33086/jhs.v15i02. 2738 Thomas Ari Wibowo -Effect of Slow Stroke Back Massage on Patients' Anxiety Level body systems such as integument, musculoskeletal, cardiovascular, lymphatic and nervous. The implication of this research can be applied to patients because Slow Stroke Back Massage is an easy nonpharmacological action, and minimal complications make SSBM readily accepted by patients because the benefits can immediately be felt.

CONCLUSION
Based on the literature review results of 15 journals consisting of 6 national journals and 9 international journals, it was found that there was an effect of Slow Stroke Back Massage on patient anxiety with pvalue <0.05.