Effects of Contrast Therapy Using Flexible Thermoelectric Devices on Lower Extremity Edema, Pain, Muscle Fatigue, and Stress in Nursing Home ...
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Korean Journal of Adult Nursing eISSN 2288-338X
Vol. 35 No. 1, 61-70, February 2023 https://doi.org/10.7475/kjan.2023.35.1.61
ORIGINAL ARTICLE Open Access
Effects of Contrast Therapy Using Flexible Thermoelectric Devices on Lower
Extremity Edema, Pain, Muscle Fatigue, and Stress in Nursing Home Workers:
A Randomized Controlled Trial
Song, Ji-Ah
Professor, College of Nursing, Konyang University, Daejeon, Korea
Purpose: Contrast therapy, which includes alternately applying cold and heat therapy, is an effective intervention
to increase muscle elasticity and reduce musculoskeletal edema and pain. This study aimed to confirm the effects
of contrast therapy by using flexible Thermoelectric Devices (TEDs)—that not only maintain a constant temperature
but can also change the temperature in a short time—on lower extremity edema, pain, muscle fatigue, and stress
among nursing home workers. Methods: This randomized controlled pre-post experimental study used a flexible
thermoelectric element to administer contrast therapy in nursing home workers to compare its impact on lower
extremity swelling, pain, muscle fatigue, and stress. As an intervention method, 4 minutes of heat therapy and 1
minute of cold therapy were repeated for a total of 30 minutes. Results: The experimental group displayed a
significant difference of -2.53 points, and the control group displayed a significant difference of -0.94 points (t=2.65,
p
Song, J-A
since patients in nursing homes rely heavily on nursing movement, thereby reducing edema and slowing nerve
care for almost all their activities of daily living, workers transmission speed, and finally controlling pain [17]. Heat
caring for nursing home patients may particularly be at therapy is used as an effective intervention to relieve joint
risk of developing musculoskeletal disorders owing to the stiffness by increasing connective tissue elasticity and pro-
nature of their job [6,7]. As a result, workers in nursing moting inflammatory processes and wound healing [18].
homes complain of musculoskeletal symptoms and fati- Previous studies reported that pain and related symptoms
gue, which negatively affect job stress [8]. Some studies were significantly reduced by the contrast applications of
have reported that home care and nursing home workers cold and warm therapy as compared to the single applica-
had more work-related injuries due to tasks than other oc- tion of cold or warm therapy in osteoarthritis patients [19];
cupations, and higher levels of care dependency in pa- additionally, muscle soreness and fatigue significantly re-
tients were associated with a higher incidence of muscu- duced as compared to the control group when athletes
loskeletal disorders in caregiving workers [9,10]. A study were subjected to contrast therapy using water after train-
involving hospital workers reported that the prevalence of ing [20]. However, contrast bath therapy, which is often
musculoskeletal symptoms, back pain, neck and shoulder used as a contrast therapy, has limitations in its applica-
pain, and knee pain among nurses and patient care assis- tion because it requires a large amount of water, mobility
tants in the last three months was 74%, 53%, 42%, and 37%, and usable locations, and maintenance of a constant tem-
respectively [11]. In a previous study on musculoskeletal perature.
symptoms of caregivers, 31.8% of caregivers showed mus- Therefore, this study aimed to investigate the effects of
culoskeletal symptoms, of which 45.2% reported lower ex- contrast therapy using a flexible Thermoelectric Device
tremity pain [8]. Physical exposure causing musculoske- (TED)—that can maintain a constant temperature and
letal pain includes patient transport work requiring pa- change the temperature within a short period of time—on
tient handling out of bed and tasks using strong physical lower extremity edema, pain, muscle fatigue, and stress in
force [11,12]. nursing home workers.
Interventions such as stretching, exercise, cold and heat
therapy, and massage for muscle atrophy and weakness METHODS
are effective in relieving pain and increasing flexibility
[13-15]. Among them, contrast therapy, which includes al- 1. Study Design
ternating heat and cold therapy, is effective in reducing
musculoskeletal edema and pain and is an effective inter- This randomized controlled pretest-posttest experi-
vention to increase muscle elasticity [16]. In general, local mental study aimed to investigate the effects of contrast
cold therapy (or cryotherapy) is used as an intervention to therapy using flexible TED on lower-extremity edema,
reduce skin and tissue temperature to induce vasocon- pain, muscle fatigue, and stress in nursing home workers
striction, reduce blood flow, and prevent tissue fluid (Figure 1).
CT=contrast therapy; L.E.=lower extremities; NRS=numeric rating scale; TED=thermoelectric device; TMG=Tensiomyography; T0=baseline;
T10=10 min after experimental treatment; T20=20 min after experimental treatment; T30=30 min after experimental treatment.
Figure 1. Study design.
62 https://kjan.or.krContrast Therapy Nursing Home Workers
2. Participants and the Controlled Group (CG) two participants from
each group. Therefore, 33 participants, consisting of 15 in
The participants were nursing home workers at S nurs- the CTG and 18 in the CG, were included in the analysis
ing home located in D City, South Korea, who agreed to (Figure 2).
participate in this study. The selection and exclusion cri-
teria for this study were as follows: 1) those who under- 3. Ethical considerations
stood the purpose of this study and voluntarily agreed to
participate in this study; 2) were able to communicate; and To comply with research ethics and protect partici-
3) currently did not have fractures, disabilities, or diseases pants, this study was conducted after receiving approval
in the lower extremities. The exclusion criteria were as fol- from the institutional review board of K University (KYU
lows: 1) those who were currently being treated for a men- -2021-021-01). For data collection, the researcher explained
tal illness, 2) had open wounds or inflammation in the the purpose and method of the study to each subject to
lower extremities, 3) had skin diseases or allergies, 4) had a seek consent and cooperation in data collection and ex-
cardiovascular disease, and 5) currently were musculo- plained that consent could be withdrawn at any time dur-
skeletal medication users (e.g., pain control, NSAIDs). ing the study. The experimental treatment was conducted
To determine the number of participants required for in compliance with safety management regulations, and
this study, we used an effect size (Cohen's d) of 0.29 as data collected for personal protection were coded and
calculated based on a previous study [20] in which con- anonymized.
trast therapy was provided to healthy adults. When the re-
quired number of participants was calculated based on 4. Randomization and Blinding
an effect size (f) of 0.29, significance level (⍺) of .05, power
(1-β) of .80, number of groups of two, and number of re- This was a randomized controlled pretest-posttest ex-
peated measurements of three using the F-test, the appro- perimental study. The researchers divided the partici-
priate sample size obtained was 34. Considering a dropout pants into experimental and control groups using the ran-
rate of 20%, 40 participants were included in the study. Of dom number generation feature on Microsoft Excel pro-
them, 7 dropped out, indicating a dropout rate of 17.5%. gram Version 2016 for each group task. Twenty partici-
For one participant, data collection was not possible ow- pants in the CTG received contrast therapy using a flexible
ing to personal reasons at the time of data collection; two TED and 20 participants in the CG did not receive any
participants refused to participate in this study. Four par- therapy.
ticipants with insufficient pre- and post-test data (general The intervention for the participants was conducted by
characteristics, perceived stress, lower extremities pain) the researcher. The data were collected by three research
were excluded from the Contrast Therapy Group (CTG) assistants who received eight hours of training from the
Figure 2. Flow diagram of the study.
Korean J Adult Nurs. 2023;35(1):61-70 63Song, J-A
principal researcher, through which they became familiar part of the tibia, while each participant sat with the knees
with the contents of the training, including a practical up. For an accurate measurement, two measurements were
course in which they learned about explanation and simul- made, and the average value was used.
ation. And the researcher did not share information about
randomization with the research assistants and did not 2) Lower extremity pain
provide participants with information about their own Lower extremity pain was measured using the Numeric
group after randomization. To prevent the spread risk of Rating Scale (NRS). The participants were asked to in-
experimental results, data collection from CTG was con- dicate their pain level in the lower extremities on a 10 cm
ducted after data collection from CG. After all interven- horizontal line marked with 0 (no pain at all) on the left
tions were completed, contrast therapy was administered end of the tool and 10 points (very painful) on the right
to the participants in the control group who wanted to do end. A higher score indicated higher perceived lower ex-
so. tremity pain.
5. Experimental Treatment 3) Muscle fatigue
Muscle fatigue was measured using Tensiomygoraphy
1) Laboratory preparations (TMG), a muscle function evaluation tool manufactured
The laboratory temperature was set at 25°C, which was by the TMG-BMC Ltd. TMG is a non-invasive neuromus-
optimal for measuring muscle fatigue and stress in the cular evaluation method that can selectively examine spe-
participants, and the laboratory was well ventilated. In ad- cific muscles and is relatively easy and simple to measure
dition, tables, chairs, and beds for measurement were in- muscle function, and it is thus widely used in sports. As
stalled in the laboratory to provide a comfortable environ- for its measurement method, it was reported that the de-
ment for the participants, and a monitoring device was in- gree of muscle stiffness, muscle tone, and muscle fatigue
stalled to measure muscle fatigue and stress. can be determined by evaluating the contractile properties
of the concerned muscle when a single electrical stim-
2) Contrast therapy using flexible TED ulation is applied to muscle to be measured [22]. A varia-
In this study, contrast therapy using a wearable inter- ble that has a high correlation with muscle tone and fa-
vention device with four temperature conduction plates tigue in the TMG is the displacement maximum (Dm),
was performed and flexible thermoelectric devices were which refers to the maximum displacement distance trav-
used as the experimental treatment. Flexible TED is a new eled by muscle contraction caused by electrical stimula-
material developed by TEG way that can maintain a con- tion [22]. A shorter Dm indicates greater muscle fatigue.
stant temperature continuously using electricity, and can
change the temperature between low and high temper- 4) Stress
atures within 3 seconds, and is thus appropriate for con- (1) Stress index
trast therapy [21]. A study by Kim et al., [16] revealed that The stress index was used to objectively measure the
when an intervention using heat therapy for 4 minutes stress. It refers to the autonomic nervous system index val-
and cold therapy for 1 minute was repeated, it was effec- ues measured using Canopy 9 RSA (respiratory sinus ar-
tive in reducing muscle stiffness and relieving muscle rhythmia)(IEMBIO, USA) with a finger sensor, an auto-
pain. Based on these results, one treatment session involv- nomic nervous system measuring device. With this tool,
ing 40 °C heat therapy for 4 minutes and 12°C cold therapy the finger sensor is supposed to be placed on the index fin-
for 1 minute was repeated six times for a total of 30 mi- ger of the left hand, and to continuously measure for 2 mi-
nutes on the right lower extremity. nutes and 30 seconds, and then quantify the ratio of sym-
pathetic nerve and parasympathetic nerve activity values
6. Outcome Measures based on Heart Rate Variability (HRV) through the stand-
ard induction method to yield autonomic nervous system
1) Lower extremity edema index values. The stress index ranges from 1 to 10, with
To measure lower extremity edema, each participant’s higher values indicating exposure to stressful situations.
calf circumference (cm) was measured using a surface mea-
surement method with tape measurement (PIE, BagelLabs (2) Perceived stress
Co., Ltd., Korea). Calf circumference was measured to one Subjective stress is measured using a NRS. Each partic-
decimal place from the thickest part of the calf to the front ipant was asked to indicate the degree of lower extremity
64 https://kjan.or.krContrast Therapy Nursing Home Workers
pain felt on a 10 cm long horizontal line marked with 0 (do RESULTS
not feel stressed at all) on its left end and 10 (feel very
stressed) on its right end. A higher score indicates a higher 1. Pre-homogeneity Test of the Experimental, and Control
level of perceived stress. Groups
7. Data Collection Procedure The results of analyzing the general characteristics and
dependent variables of the participants in the experi-
The data were collected from July 15, 2021, to August 3, mental and control groups are presented in Table 1. The
2021, in a laboratory at S nursing home located in D City, results of the homogeneity test of the general character-
South Korea. Data collection and intervention of study istics between the two groups showed no significant dif-
participants were conducted during breaks at work. A ferences in age, height, weight, drinking status, smoking
questionnaire was distributed to the participants after en- status, and exercise between the two groups. The initial
tering the laboratory, and they were asked to fill out their stress index scores of the participants were 7.13±2.30
general characteristics, current lower extremity pain and points and 6.83±2.15 points in the experimental group
discomfort, and subjective stress. Lower extremity edema, and the control group respectively. The perceived stress
muscle fatigue, and stress index were measured. The par- scores were 4.60±1.81 points, and 5.06±2.10 points, in the
ticipants in the experimental group were provided with experimental group and the control group respectively.
contrast therapy using flexible TED while lying in bed for This indicates that there was no significant difference be-
30 minutes, and the participants in the control group rest- tween the two groups, thus confirming the homogeneity
ed for 30 minutes. To determine the subjective stress re- between the two groups. The lower extremity pain scores
duction time of the experimental group, while the inter- in the experimental and the control groups were 4.87±2.56
vention for 30 minutes was provided to the experimental points, and 4.28±2.32 points, respectively; the degrees of
group, perceived stress and lower extremity pain levels edema in the experimental and the control groups was
were measured three times at 10-minute intervals. To min- 35.42±2.92 cm, and 34.92±2.67 cm, respectively; the mus-
imize extraneous variables, the stress index, lower ex- cle fatigue scores in the experimental and the control
tremity edema, and muscle fatigue were measured after 30 groups were 3.01±0.80 points, and 2.90±1.39 points, re-
minutes of intervention. After data collection, a token of spectively, indicating that there was no significant differ-
appreciation was given to the participants, and all col- ence between the two groups.
lected data were recorded anonymously and input to an
Microsoft Excel program Version 2016 for analysis. 2. The Effects of Contrast Therapy on Stress, Lower Ex-
tremity Pain, Edema, and Muscle fatigue
8. Data Analysis
1) Lower extremity edema
The collected data were analyzed using IBM SPSS After the experimental treatment, the degree of lower
Statistics 24.0. The skewness and kurtosis values were test- extremity edema was 34.41±3.19 cm in the experimental
ed to determine the normality of the data, and the results group, and 34.89±2.60 cm in the control group, indicating
indicate skewness values of -0.10~0.39, and kurtosis val- no significant difference. However, the results of analyz-
ues of -1.28~0.08. They were normally distributed in the ing the difference in lower extremity edema between the
range of skewness absolute value 2 and kurtosis absolute two groups before and after the experimental treatment
value 4 [23]. The general characteristics of the participants found that the degree of lower extremity edema was -1.01
were analyzed using frequency, real number, and percen- ±0.96 cm in the experimental group, and -0.03±0.20 cm in
tage. The pre-homogeneity test for the dependent varia- the control group, indicating a significant difference (t=
bles in the experimental and control groups was perfor- 3.91, p =.001)(Table 2).
med using the x2 test and t-test. The effects of the inter-
vention on stress, lower extremity pain, edema, and mus- 2) Lower extremity pain
cle fatigue were analyzed using independent t-tests and Lower extremity pain scores were measured four times
repeated-measures Analysis of Variance (ANOVA), and in total: before experimental treatment, at 10 minutes (T10),
the mean difference test was analyzed as an independent 20 minutes (T20), and 30 minutes (T30) after the experi-
t-test. mental treatment. The results revealed that there was a
significant difference over time (F=13.11, pSong, J-A
Table 1. Characteristics of the Experimental and Control Groups (N=33)
CTG (n=15) CG (n=18)
Variables Categories x2 or t p
n (%) or M±SD n (%) or M±SD
Age (year) 56.73±5.52 54.89±3.97 -1.11 .274
Height (cm) 156.87±5.72 158.22±5.43 0.70 .491
Body weight (kg) 58.27±9.35 58.00±7.91 -0.09 .930
Drinking alcohol Yes 7 (46.7) 9 (50.0) 0.36 .849
No 8 (53.3) 9 (50.0)
Smoking Yes 1 (6.7) 0 (0.0) 1.24 .266
No 14 (93.3) 18 (100.0)
Exercise Yes 9 (60.0) 7 (38.9) 1.46 .227
No 6 (40.0) 11 (61.1)
Work times 8.73±0.80 9.06±0.64 1.29 .207
Stress index 7.13±2.30 6.83±2.15 -0.39 .701
Perceived stress 4.60±1.81 5.06±2.10 0.66 .514
L.E. pain 4.87±2.56 4.28±2.32 -0.69 .494
L.E. edema 35.42±2.92 34.92±2.67 -0.52 .609
Muscle fatigue 3.01±0.80 2.90±1.39 -0.27 .792
CG=control group; CTG=contrast therapy group; L.E.=lower extremities; M=mean; SD=standard deviation.
was no significant difference in group-by-time interaction, the stress index score in the experimental group had sig-
and there was also no significant difference in repeatedly nificantly decreased (t=2.87, p =.007)(Table 2).
measured stress score results between the groups. The re- The subjective stress scores perceived by the partic-
sults of analyzing the difference between the two groups ipants were measured four times in total: before the ex-
before and after the experimental treatment using differ- perimental treatment, at 10 minutes (T10), 20 minutes (T20),
ence verification revealed that the difference before and and 30 minutes (T30) after the experimental treatment. The
after the experimental treatment was -2.53±2.07 points in results revealed that there was a significant difference
the experimental group, and -0.94±1.16 points in the con- over time (F=12.12, pContrast Therapy Nursing Home Workers
Table 2. Comparison of Stress Index, Perceived Stress, L.E. Pain, L.E. Edema, Muscle Fatigue between the Experimental and
Control Groups (N=33)
CTG (n=15) CG (n=18)
Variables Categories t p F (p)
M±SD M±SD
Stress index T0 7.13±2.30 6.83±2.15 -0.39 .701
T30 5.00±2.00 6.44±2.04 2.05 .049
Difference (T30-T0) -2.13±1.96 -0.39±1.54 2.87 .007
Perceived stress T0 4.60±1.81 5.06±2.10 0.66 .514
Time 12.12 (＜.001)
T10 4.27±1.62 4.67±2.40 0.55 .587
Group 1.52 (.227)
T20 3.33±1.50 4.33±2.17 1.51 .141
G*T 1.76 (.176)
T30 2.67±1.50 4.00±2.22 1.98 .057
Difference (T30-T0) -4.47±2.23 -2.83±3.60 1.53 .137
L.E. pain T0 4.87±2.56 4.28±2.32 -0.69 .494
Time 13.11 (＜.001)
T10 4.27±2.46 4.00±2.35 -0.32 .753
Group 2.46 (.083)
T20 3.33±2.06 3.44±2.12 0.15 .880
G*T 0.01 (.932)
T30 2.33±1.80 3.33±2.17 1.42 .165
Difference (T30-T0) -2.53±2.07 -0.94±1.16 2.65 .015
L.E. edema T0 35.42±2.92 34.92±2.67 -0.52 .609
T30 34.41±3.19 34.89±2.60 0.48 .635
Difference (T30-T0) -1.01±0.96 -0.03±0.20 3.91 .001
Muscle fatigue T0 2.62±0.77 2.90±1.39 0.71 .486
T30 2.82±0.41 2.96±0.94 0.58 .569
Difference (T30-T0) 0.20±0.60 0.06±0.85 -0.55 .590
CG=control group; CTG=contrast therapy group; L.E.=lower extremities; M=mean; SD=standard deviation.
TED had positive effects on care workers and that there group [26]. The authors suggested that warm water ther-
was a statistically significant difference in lower extremity apy might increase the release of proteins from the muscle
pain, edema, and stress index between the groups. The into the blood, and that the increased protein release
results of this study are as follows: might reduce the percentage of muscle components de-
Although the mechanism by which alternating the use graded in the extracellular matrix [27]. Second, cold ther-
of heat and cold treatments affects the recovery of dam- apy with contrast may reduce nerve conduction velocity
aged muscle has not yet been clearly identified, the follow- and decrease nerve transmission [28]. In addition, Greg-
ing three points can be considered. First, heat therapy, son suggested that blood flow to muscles may be lowered
which forms an important part of contrast therapy, might after 8~20°C cold pack application, and stated that this
enhance vasodilation to increase oxygenation and metab- may be because the activation of heat receptors may result
olite excretion [24]. This study indicated that such a phe- in changes in sympathetic activity, thereby decreasing ar-
nomenon occurred to some extent because the contrast terial flow [29]. Therefore, the physiological effects of cold
therapy using a 40°C TED was applied six times for 4 mi- therapy may be partially mediated through a decrease in
nutes per treatment session for a total of 24 minutes. In ad- microvascular blood flow around the injured site, which
dition, heat therapy might increase the immune response in turn can reduce edema and inflammation induction.
to muscle damage, similar to symptoms occurring during Finally, the alternating use of cold and heat therapy can re-
fever, and this response might accelerate muscle recovery sult in drastic changes in muscle perfusion owing to a
[25]. In fact, Viitasalo et al. reported that when applying 37 combination of cold / heat effects, which is called the
°C underwater water jet massage to athletes after training, pumping effect [30]. It has been reported that the pumping
muscle function maintenance was improved, and Creatine effect might cause changes in muscle perfusion through
Kinase (CK) and myoglobin levels were increased in those vasodilation and vasoconstriction, thereby weakening the
receiving warm water therapy compared to the control immune response and reducing muscle cell damage. In
Korean J Adult Nurs. 2023;35(1):61-70 67Song, J-A this study, no vasodilation or constriction was observed; duals’ movement without moving themselves while alter- however, muscle pain and edema were significantly re- nating cold/heat therapy and maintain a constant temper- duced after contrast therapy. Vaile et al. reported in a ature, it is considered an effective intervention method. study examining 15°C / 38°C contrast bath therapy (15°C cold water therapy, and 38°C warm water therapy) that CONCLUSION the 15°C cold water therapy was effective in reducing physiological and functional deficits related to muscle This study was conducted using a randomized control- pain, including muscle recovery and edema reduction, led pretest-posttest experimental design to understand the and 38°C warm water therapy was effective for muscle re- effect of contrast therapy using flexible TED on the muscu- covery, but had no effect on other recovery as compared to loskeletal system and stress of workers in nursing institu- the control group [31]. It can be concluded that contrast tions. In order to confirm the effectiveness of contrast ther- therapy is effective in helping muscle recovery and re- apy using flexible TED, 40°C heat therapy and 12°C cold ducing pain, and edema. Comparative studies with cold therapy were applied to the study participants six times therapy that show similar results are needed to further for 4 minutes and 1 minute, respectively. The results clarify the effects of contrast therapy. showed that contrast therapy using flexible TED had a Stress refers to a state of physical, physiological, and positive effect on leg edema, pain, muscle fatigue, and psychological tension that an individual experiences in stress. Therefore, we believe that the results of this study difficult situations [32]. Excessive stress can have negative provide positive scientific evidence for the application of effects on mental and physical health, cause deterioration contrast therapy using flexible TED and that contrast ther- of work quality, and should be properly relieved [32]. This apy using flexible TED can be used as an intervention to study found a significant difference in the stress index, alleviate musculoskeletal problems in healthcare workers. which measured the autonomic nervous system index However, this study has a risk of performance bias be- based on heart rate variability, before and after the experi- cause the researcher was not blinded by random sequence ment, between the two groups. In addition, perceived generation and intervention, and there is a limit to gen- stress showed no statistically significant difference but de- eralization as a study was conducted at a single nursing creased by 4.47 points in the experimental group and 2.83 institution. points in the control group, showing more reduction ef- Based on the results of this study, I suggest the follow- fects in the experimental group. As studies regarding the ing. First, this study was conducted at a nursing institution effects of contrast therapy on stress could not be identified, in one location, and there are limitations in generalization; a direct comparison between this study and other studies therefore, further studies are needed. Second, in this study, was not feasible. However, it was reported that the use of the effect before and after therapy was verified by apply- 40°C foot bath therapy 4 days per week for 3 weeks in op- ing six on-therapy sessions for 4 minutes and cold therapy erating room nurses was helpful in relieving stress [33], for 1 minute; however, for future studies, I recommend and stress has been reported to have a significantly pos- comparing and verifying the effect on time flow. Third, be- itive correlation with musculoskeletal disorders such as cause the effects of contrast therapy, heat therapy, and back pain [34]. Hence, it is thought that the contrast ther- cold therapy may vary depending on the use of flexible apy used in this study might alleviate lower extremity dis- TED, a comparative study of these effects is suggested. comfort and thus reducing stress. Taken together, the results of this study are significant CONFLICTS OF INTEREST in confirming that contrast therapy using a flexible TED The author declared no conflict of interest. has similar effects to contrast bath therapy using water temperature. In addition, a study by Kim reported that AUTHORSHIP both contrast bath therapy using 38~40℃ hot water and Study conception and design acquisition-SJ-A; Analysis and in- 12~14℃ cold water, and contrast therapy using a 38~40℃ terpretation of the data-SJ-A; Drafting and critical revision of the infrared heating device and a 12~14 ℃ refrigeration de- manuscript-SJ-A. vice was effective in enhancing muscle recovery, confirm- ing that both wet heat therapy using immersion bath and ACKNOWLEDGEMENT dry heat therapy using infrared rays and a refrigeration This work was supported by the National Research Foundation of device can help muscle recovery [16]. Therefore, since con- Korea (NRF) grant funded by the Korean Government (No. 2019 trast therapy using flexible TED can minimize indivi- R1G1A1002538). 68 https://kjan.or.kr
Contrast Therapy Nursing Home Workers
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