The effect of foot reflexology on physiologic parameters and mechanical ventilation weaning time in patients undergoing open-heart surgery: A clinical trial study

Comparing the impact of foot and hand reflexology on anxiety and physiological indices in colonoscopy candidates: A randomized clinical trial

Introduction and objective

Colonoscopy is a standard diagnostic procedure, yet pre-procedural anxiety remains a prevalent concern. While pharmacological interventions are available, non-pharmacological approaches such as reflexology offer a promising alternative. Despite its therapeutic potential, comparative evidence on foot and hand reflexology in this setting is limited. This study aimed to evaluate their effects on pre-colonoscopy anxiety and physiological parameters.

Methods

This randomized clinical study was conducted from November 2022 to August 2023 at the Amir al-Momenin Educational and Therapeutic Center in Arak, Iran. A total of 105 patients were randomly assigned to three equal-sized groups (n = 35) using block randomization: foot reflexology, hand reflexology, and a control group. Patients in the intervention groups received a 30-min reflexology session. Anxiety levels were assessed using the Spielberger State-Trait Anxiety Inventory (STAI-Y1), a validated tool for measuring situational anxiety. Physiological indices, including systolic and diastolic blood pressure, heart rate, and arterial oxygen saturation (SpO2), were measured immediately before and after the intervention.

Results

There were no significant differences in clinical outcomes among the groups at baseline (p > 0.05). However, following the intervention, the mean anxiety scores in both reflexology groups (foot reflexology: 44.39 ± 5.21; hand reflexology: 45.6 ± 4.49) were significantly lower than that of the control group (48.05 ± 4.81) (p = 0.008), as determined by one-way analysis of variance (ANOVA). The anxiety reduction was more pronounced in the foot reflexology group than the hand reflexology group, although this difference did not reach statistical significance (p > 0.05). Additionally, post-intervention assessments revealed significant differences in systolic blood pressure (foot reflexology: 123.48 ± 16.40 mmHg; hand reflexology: 122.65 ± 14.97 mmHg; control group: 132.14 ± 18.48 mmHg) and heart rate (foot reflexology: 78.60 ± 9.54 bpm; hand reflexology: 78.25 ± 11.41 bpm; control group: 85.05 ± 10.82 bpm) across the groups (p < 0.05). However, no significant differences were observed for diastolic blood pressure or arterial oxygen saturation (SPO2) between groups (p > 0.05).

Conclusion

The findings of this study indicate that reflexology, particularly foot reflexology, can significantly reduce anxiety and lead to improvements in physiological parameters, such as systolic blood pressure and heart rate, in patients undergoing colonoscopy. These results highlight the potential of reflexology as an effective complementary method for managing anxiety and enhancing patient comfort during medical procedures.

The Effect of Hand Reflexology Massage on Pain and Anxiety After Coronary Artery Bypass Graft Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial

BACKGROUND

Pain and anxiety are common postoperative problems that impair recovery and quality of life in patients undergoing coronary artery bypass graft (CABG) surgery. Reflexology is a nonpharmacologic method used to control pain and anxiety.

OBJECTIVE

The aim of this study was to examine the effects of reflexology hand massage and stroking massage on pain and anxiety in patients in the immediate postoperative period after CABG.

METHODS

In this double-blind, randomized, placebo-controlled study, we compared the effects of a 20-minute hand-reflexology massage to placebo stroking massage on pain and anxiety in newly extubated patients in the intensive care unit who had undergone CABG surgery. Pain was measured by visual analog scale and anxiety by the State-Trait Anxiety Inventory before and at 5, 30, and 60 minutes post intervention.

RESULTS

A total of 48 patients were enrolled: 24 in the intervention group and 24 in the placebo. Mean pain scores were significantly reduced in the group who received reflexology compared with the placebo group ( F = 36.569, P = .000). Mean anxiety scores were significantly reduced at 60 minutes for the reflexology group compared with the control group ( P = .000).

CONCLUSIONS

We found that hand reflexology massage was effective in reducing pain and anxiety in patients during the immediate postoperative period after CABG.

The Effect of Foot Reflexology on Fatigue, Sleep Quality, Physiological Indices, and Electrocardiogram Changes in Patients with Acute Myocardial Infarction: A Randomized Clinical Trial

Background

Limited evidence is available regarding the effect of reflexology on Acute Myocardial Infarction (AMI). The present study evaluated the effect of foot reflexology on fatigue, sleep quality, physiological indices, and electrocardiogram changes in AMI.

Materials and Methods

This clinical trial was conducted on 80 subjects with AMI. They were divided into an intervention (received reflexology for 3 consecutive days) and a control (received the routine care) group. The Multidimensional Fatigue Inventory, the Pittsburgh Sleep Quality Index, a pain numeric analog scale, a daily physiological indices form, and daily electrocardiogram were used to collect data. The collected data were analyzed in SPSS software. The study was conducted based on CONSORT criteria.

Results

After controlling the covariates, a significant difference was found between the intervention and control groups with regard to the mean scores of fatigue (F5,80 = 16.33; p < 0.001), sleep quality (F5,80 = 16.56; p < 0.001), and chest pain intensity (F5,80 = 6.86; p = 0.010); means of systolic blood pressure (F5,80 = 22.20; p < 0.001), heart rate (F5,80 = 5.86; p = 0.010), respiration (F5,80 = 9.37; p = 0.003), and temperature (F5,80= -4.23; p < 0.001); and incidence of ST-segment (χ2 1,80 = 5.00; p = 0.020) and T-wave changes (χ2 1,80 = 6.05, p = 0.010) on the fourth day of the intervention.

Conclusions

Given the effectiveness of foot reflexology in different aspects of AMI patients, the implementation of this intervention is recommended for these patients in coronary care units.

The Effects of Foot Reflexology on Vital Signs: A Meta-Analysis of Randomized Controlled Trials

Introduction

We evaluated the effects of foot reflexology on bodily vital signs.

Methods

Randomized controlled trials (RCTs) evaluating the effects of foot reflexology on vital signs were collected for a meta-analysis. Statistical analysis was conducted using RevMan5.4 software and pooled estimates of the effects were reported as mean differences (MDs) with 95% confidence intervals (CIs).

Results

Thirteen studies, including 819 patients, met our inclusion criteria. Our results showed that systolic blood pressure (SBP) (MD = -4.62, 95% CI: -5.58 to -3.66; P < 0.00001), diastolic blood pressure (DBP) (MD = -3.32, 95% CI: -4.48 to -2.17; P < 0.00001), heart rate (HR) (MD = -4.76, 95% CI: -6.49 to -3.04; P < 0.00001), respiratory rate (RR) (MD = -0.77, 95% CI: -1.50 to -0.48; P < 0.00001), and pulse oxygen saturation (SpO₂) (MD = 0.95, 95% CI: 0.39 to 1.52; P = 0.0009) showed statistical significance in the foot reflexology group.

Conclusions

Short-term followup results showed that foot reflexology exerted positive effects on vital signs, reduced BP, HR, and RR and increased SpO₂.

Effect of foot reflexology on chest pain and anxiety in patients with acute myocardial infarction: A double blind randomized clinical trial

BACKGROUND AND PURPOSE

The aim of this study was to determine the effect of foot reflexology on chest pain and anxiety in patients with AMI.

MATERIALS AND METHODS

This study was a double blind randomized clinical trial. Stratified random sampling was carried out on 90 patients with AMI in the three groups of treatment, placebo and control. Foot reflexology was done for three consecutive days, each time for 20 min. Chest pain and anxiety were evaluated with Visual Analogue Scale before, immediately and 20 min later.

RESULTS

20 min after the intervention, severity of chest pain in treatment group was significantly lower than control group (p < 0.001) and placebo group (p = 0.002). Severity of anxiety between groups and at different times was not significant.

CONCLUSIONS

Foot reflexology was effective in attenuating chest pain, had the most effect in 20 min after intervention, and can be used to relieve chest pain in patients with AMI.

Effects of foot massage and patient education in patients undergoing coronary artery bypass graft surgery: A randomized controlled trial

BACKGROUND

Anxiety, pain, and fatigue are common postoperative problems that disturb the recovery and quality of life in patients undergoing coronary artery bypass graft (CABG) surgery. These postoperative problems are associated with prolonged recovery and decreased quality of life. This study was aimed at evaluating the combined effects of foot massage and patient education on anxiety, fatigue, pain, self-efficacy, and quality of life in patients undergoing CABG surgery.

MATERIAL AND METHODS

In this randomized controlled trial (RCT), 130 participants were randomly allocated to experimental (n = 65) and control (n = 65) groups. The experimental group received a combination of foot massage and patient education as interventions and the control group received usual care of the hospital.

RESULTS

The experimental group had a significant decrease in anxiety (p = 0.001), fatigue (p = 0.001), pain (p = 0.001), and increased self-efficacy (p = 0.001) and quality of life (p = 0.001).

CONCLUSION

The combined form of foot massage and patient education is effective in decreasing anxiety, fatigue, pain, and increasing self-efficacy and the quality of life. These interventions will support the recovery of patients and reduce their suffering.

Randomized controlled trial of the foot reflexology on pain and anxiety severity during dressing change in burn patients

BACKGROUND

One of the most important problems in burn patients was pain, especially in dressing changes. This pain can lead to anxiety in the patient. The aim of this study was to determine the effect of foot reflexology on pain and anxiety severity in burn patients.

METHODS

This study was a randomized controlled trial, in which 66 patients with burn injuries referred to Vali-e-asr Hospital, Arak, Iran participated. After obtaining written consent, patients were enrolled to study according to inclusion criteria and then, divided into intervention (n = 33) and control (n = 33) groups using simple random allocation. In the intervention group, in addition to standard care, reflexology was performed for one week on Saturday, Monday and Wednesday (three times in a week). The intervention was done one hour before dressing change in a separate room for 30 min. The control group received only standard care during this time (both intervention and control groups were the same in the type of treatment, and reflexology was considered as an extra care in the intervention group). Severity of pain and anxiety in both groups was measured using visual analog scale twice a day (5-10 min before dressing change and 5-10 min after dressing change) for six days. SPSS software ver. 15 was used for statistical analysis. Mean and standard deviation were used for quantitative variables and qualitative variables were reported as frequency and percentage. Data were analyzed using Chi‑square, Mann-Whitney, Fisher's exact tests, and paired t-test. The Kolmogorov-Smirnov test was used to check the normality of data.

RESULTS

The results showed no significant difference in severity of pain (p = 0.25) and anxiety (p = 0.37) between the two groups on the first day, before the intervention. In the following days, the results showed no significant difference between the two groups in the second and third treatments after intervention . However, the mean pain scores showed a significant difference between the two groups in the forth (p = 0.005), fifth (p = 0.001), and sixth (p = 0.001) days after intervention. Anxiety scores also showed a significant difference between the two groups on the fourth (p = 0.01), fifth (p = 0.001), and sixth (p = 0.001) days.

CONCLUSIONS

Our results showed foot reflexology is an appropriate and safe intervention for management of pain and anxiety of burn patients. Therefore, it can be used as a complementary method alongside other methods.

The effect of aromatherapy with rose and lavender on anxiety, surgical site pain, and extubation time after open-heart surgery: A double-center randomized controlled trial

To determine the effect of aromatherapy with rose and lavender on the patient outcomes after open-heart surgery (OHS). In the clinical trial, patients were randomized to four groups. One group received routine care, the placebo group received a cotton swab soaked in water and the other two groups received either a cotton swab containing three drops of rose or lavender essence (0.2 ml). A total of 160 patients were randomized into four groups. Intergroup anxiety was not significantly different; however, the reciprocal time-group effect was significant among the four groups. The extubation time was significant among the four groups which related to rose essence group compared with the control group (p < .001) and placebo group (p = .029). The surgical site pain was significant in the rose essence and lavender groups compared to the control group. Aromatherapy can reduce extubation time, surgical site pain severity, and anxiety in patients undergoing OHS.

A Case Study: Effects of Foot Reflexotherapy in an Infant with Sensorineural Hearing Loss

Sensoryneuronal hearing loss (SNHL) is one type of hearing impairment. The incidence of hearing loss (HL) is 1-3 per 1000 births. Complementary therapies may be effective in addressing the maladies of infants with HL. The aim of this study was to assess the efficacy of foot reflexotherapy in an infant with SNHL. The patient was a 3-month-old infant with SNHL. Pretest and post-test for HL were conducted using an audiologic method (auditory brainstem responses) combined with behavioral audiometry. The subject was treated with foot reflexotherapy for 30 min per session four times per week for a period of 24 weeks. Foot reflexotherapy was effective in auditory recuperation of an infant with SNHL. The results of this novel study suggest that foot reflexotherapy can be an effective complementary treatment for infants with SNHL, especially for those 3 to 9 months of age.

Could complementary health approaches improve the symptom experience and outcomes of critically ill adults? A systematic review of randomized controlled trials

OBJECTIVE

The purpose of this systematic review was to critically evaluate the safety and effectiveness of various complementary health approaches (CHAs) in treating symptoms experienced by critically ill adults.

METHODS

The review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Electronic databases (PubMed, Web of Science, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Education Resources Information Center, Medline, PsychInfo) were searched for studies published from 1997-2017. Randomized controlled trials (RCTs), in English with terms ICU/critical care, music, Reiki, therapeutic touch, healing touch, aromatherapy, essential oil, reflexology, chronotherapy, or light therapy were eligible for inclusion. Studies conducted outside the ICU, involving multiple CHAs, or enrolling pediatric patients were excluded. Data were extracted and assessed independently by two authors and reviewed by two additional authors. The Cochrane risk of bias tool was used to assess study quality.

RESULTS

Thirty-two RCTs were included involving 2,987 critically ill adults. CHAs evaluated included music (n = 19), nature based sounds (NBSs) (n = 4), aromatherapy (n = 3), light therapy (n = 2), massage (n = 2), and reflexology (n = 2). Half of all studies had a high risk of bias for randomization but had low or unclear biases for other categories. No study-related adverse events or safety-related concerns were reported. There were statistically significant improvements in pain (music, NBSs), anxiety (music, NBSs, aromatherapy, massage, reflexology), agitation (NBSs, reflexology), sleep (music, aromatherapy, reflexology), level of arousal (music, massage), and duration of mechanical ventilation (music, reflexology).

CONCLUSIONS

Evidence suggests CHAs may reduce the symptom burden of critically ill adults.

Interpersonal touch interventions for patients in intensive care: A design-oriented realist review

AIM

To develop a theoretical framework to inform the design of interpersonal touch interventions intended to reduce stress in adult intensive care unit patients.

DESIGN

Realist review with an intervention design-oriented approach.

METHODS

We searched CINAHL, MEDLINE, EMBASE, CENTRAL, Web of Science and grey literature sources without date restrictions. Subject experts suggested additional articles. Evidence synthesis drew on diverse sources of literature and was conducted iteratively with theory testing. We consulted stakeholders to focus the review. We performed systematic searches to corroborate our developing theoretical framework.

RESULTS

We present a theoretical framework based around six intervention construction principles. Theory testing provided some evidence in favour of treatment repetition, dynamic over static touch and lightening sedation. A lack of empirical evidence was identified for construction principles relating to intensity and positive/negative evaluation of emotional experience, moderate pressure touch for sedated patients and intervention delivery by relatives versus healthcare practitioners.

Effectiveness of reflexology on anxiety of patients undergoing cardiovascular interventional procedures: A systematic review and meta-analysis of randomized controlled trials

AIM

To appraise the evidence concerning the effect of reflexology on the anxiety in patients undergoing cardiovascular interventional procedures.

BACKGROUND

Anxiety, fear, and other unpleasant emotional experiences are common among patients before and after cardiovascular interventional procedures. The higher anxiety may affect prognosis and recovery of patients.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

The MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Central Register of Controlled Trials (Cochrane Library), EMBASE, PsycINFO, and Web of Science were searched between 2001-2017.

REVIEW METHODS

Randomized controlled trials evaluated the effectiveness of reflexology on anxiety among patients undergoing cardiovascular interventional procedures were included. Meta-analysis was done using Revman 5.3.

RESULTS

Ten trials, representing 760 patients with the mean age of 59, fulfilled the inclusion criteria. Reflexology significantly decreased the anxiety of patients undergoing cardiovascular interventional procedures in the treatment group compared with the control group.

CONCLUSION

Reflexology has some positive effects on anxiety among patients undergoing cardiovascular procedures. It may be a useful complementary therapy and further research is necessary to create reliable evidence.

Complementary Health Approaches Used in the Intensive Care Unit

Intensive care units are care centers where, in order to provide the maximum benefit to individuals whose life is in danger, many lifesaving technological tools and devices are present, and morbidity and mortality rates are high. In the intensive care unit, when classic treatments fail or become unbearable because of side effects, complementary methods have been suggested to be the best alternative. Complementary health approaches are methods that are used both for the continuation and the improvement of the well-being of an individual and as additions to medical treatments that are based on a holistic approach. These applications are especially helpful in the treatment of the stresses, anxieties, and other symptoms of unstable patients in the intensive care unit who do not tolerate traditional treatment methods well, increasing their psychological and physiological well-being, helping them sleep and rest. In intensive care patients, in order to decrease the incidence of postoperative atrial fibrillation, antiemetic and medicine needs, mechanical ventilation duration, and the intensity of the disease as well as to cope with symptoms such as pain, anxiety, physiological parameters, dyspnea, and sleep problems, body-mind interventions such as massage, reflexology, acupressure, aromatherapy, music therapy, energy therapies (healing touch, therapeutic touch, the Yakson method), and prayer are used as complementary health approaches.