Ask an answerable question (PICO)：
Insomnia is defined as the problems comprising the difficulty of sleep initiation, duration, consolidation, or poor quality by International Classification of Sleep Disorders-Third Edition (ICSD-3). In a survey by the Taiwan Society of Sleep Medicine, "The Trend of the Prevalence of Common Sleep Problems in Taiwan: A 10-year Cross-sectional Repeating Survey" The results showed that the prevalence of chronic insomnia in Taiwan was 11.3%, and the data showed that the rate of insomnia increased to the elderly, 16.7% people in the age 50-59 years old with chronic insomnia, and 22.7% people in the age 60-69 years old with chronic insomnia. Insomnia can easily lead to symptoms of poor mental health during the day, drowsiness, irritability, or depression (Cho & Duffy, 2018), and a foot bath before bedtime has been proven is effective to resolve the long-term chronic insomnia to the elderly.
In clinical practice, many elderly patients need to not only tolerating the pain caused by the disease but also fatigue caused by long-term chronic insomnia. Some patients are even unable to use sleeping drugs due to poor liver and kidney functions. To resolve the problems, the author decides to look for the methods without medicine to alleviate the insomnia problem to the elderly. The title is whether the foot bath before bedtime can improve the sleep quality to the elderly. Hoping find out the appropriate method to help the elderly with clinical insomnia to improve their life quality.
The Method and Analysis of Literature Review：
This study is titled as "A footbath before bedtime can improve the sleep quality to the elderly?" And set PICO keywords: Elderly, Old people, Aging; Poor sleep; Footbath, soak; Sleep quality. Searching keywords by connecting them using “AND” and “OR” in the form of Boolean Logic in the databases of Cochrane, PubMed and Clinical Key. Selecting articles with higher grades and latest publication date which meet PICO to study. In this article we use JBI's "Checklist for Randomized Controlled Trials and Checklist for Quasi-Experimental Studies (non-randomized experimental studies)" to evaluate four literatures.
We select the proper literature according to the PICO. Since the questions from PICO are therapeutic issues, so we choose the latest and the highest graded four research articles to evaluate. We further grading four articles by standard of “JBI 2014 levels of evidence”. Results show that one article belongs to Level 1 and the others belong to Level 2. Three of them use assessment method of the sleep quality by Pittsburgh Sleep Quality Index. One of them uses the actigraphy and a sleep disorder inventory for evaluation.
Conclusions and Recommendations：
Footbath before bedtime is feasible and easy to improve the sleep quality to the elderly. In clinical application, it is recommended to soaking in 10 cm deep in the water with temperature at 41-42 ℃, and maintaining 20 minutes before bedtime. Before the first time footbath, one should be taught by a trained person the footbath skills and checked the correctness and completeness of the activity. Finally, one should checked the improvement of sleep quality by a trained person which is the most effective way to do the activity.