The physiological basis of reflexology and its use as a potential diagnostic tool

The Effects of Foot Reflexology for Smoking Cessation on Brain Activities with Functional Magnetic Resonance Imaging (fMRI): A Pilot Study

Background. Foot reflexology is a treatment with the hypothesis that such massage stimulation on the feet may cause a therapeutic effect which should be helpful for smoking cessation. However, its mechanism of action in the brain of smoking people remains unknown. Functional magnetic resonance imaging (fMRI) is helpful for real-time brain activity detection. We aim to compare the brain activity effects of foot reflexology with fMRI between smoking and nonsmoking subjects. Materials and Methods. We divided participants into experimental (smokers) and control groups (nonsmokers). Both groups received similar foot reflexology under the fMRI examination. Then, we compared the mean response score in each brain area before and after foot stimulation among groups and between groups. Results. Five nonsmokers and fifteen smokers had completed the study. All participants were right-handed males, with a mean age of 38.6 years. The fMRI brain response in the areas correlated with foot stimulation, including the precentral gyrus of the frontal lobe and the postcentral gyrus of the parietal lobe, was present for all participants. The fMRI response outside the correlated area, including other parts of the frontal and parietal lobes, the temporal and occipital cortices, and the thalamus, was also found in all participants, but was not consistent. Conclusions. The fMRI of the brain is feasible and safe for demonstrating foot reflexology reactions. The response signal outside the correlated motor-sensory cortical area with foot reflexology may have clinical significance and may be helpful for smoking cessation. We suggest conducting a large-scale, randomized controlled trial to confirm these findings.

Effect of Foot Reflexology Intervention on Depression, Anxiety, and Sleep Quality in Adults: A Meta-Analysis and Metaregression of Randomized Controlled Trials

Objectives

The aim of this study was to conduct a systematic review, meta-analysis, and metaregression to determine the current best available evidence of the efficacy and safety of foot reflexology for adult depression, anxiety, and sleep quality.

Methods

Electronic databases (PubMed, ClinicalKey, ScienceDirect, EMBASE, PsycINFO, and the Cochrane Library) were searched till August, 10, 2020, and the validity of the eligible studies was critically appraised. Randomized controlled trials comparing foot reflexology groups with control groups for adult depression, anxiety, and sleep quality were included. Twenty-six eligible studies were included to assess the effect of foot reflexology intervention on the reducing symptoms of depression and anxiety and improving quality of sleep, respectively, as the primary outcome.

Results

Twenty-six randomized controlled trials involving 2,366 participants met the inclusion criteria. The meta-analyses showed that foot reflexology intervention significantly improved adult depression (Hedges' g = −0.921; 95% CI: −1.246 to −0.595; P < 0.001), anxiety (Hedges' g = −1.237; 95% CI −1.682 to −0.791; P < 0.001), and sleep quality (Hedges' g = −1.665; 95% CI −2.361 to −0.970; P < 0.001). Metaregression reveals that an increase in total foot reflexology time (P = 0.002) and duration (P = 0.01) can significantly improve sleep quality.

Conclusions

Foot reflexology may provide additional nonpharmacotherapy intervention for adults suffering from depression, anxiety, or sleep disturbance. However, high quality and rigorous design RCTs in specific population, along with an increase in participants, and a long-term follow-up are recommended in the future.

The Effect of Hand Reflexology Massage on Pain and Fatigue in Patients after Coronary Angiography: A Randomized Controlled Clinical Trial

Introduction

Coronary angiography can cause pain and fatigue in patients. Hand reflexology as complementary and integrative care approach has been suggested to help with the reduction of patient's pain and fatigue.

Aim

This study aimed to investigate the effect of hand reflexology on pain and fatigue in patients after coronary angiography.

Design

A randomized controlled clinical trial.

Methods

This study was conducted on 90 patients in an angiography department of a referral hospital in an urban area of Iran. The patients were randomly divided into two interventions (n = 45) and control (n = 45) groups. Hand reflexology was performed for 20 minutes in the intervention group. Pain and fatigue in the groups were measured immediately, 4 and 6 hours after the intervention.

Results

Statistically significant differences were observed in pain and fatigue scores between the groups after the intervention (P = 0.001). The intervention had medium to large effects on the patients' pain and fatigue. Hand reflexology as a nonpharmacological and safe technique can be used by nurses along with other pharmacologic interventions in order to reduce patients' suffering related to invasive procedures. The trial is registered with IRCT20110912007529N17.

Effectiveness of breathing exercises, foot reflexology and back massage (BRM) on labour pain, anxiety, duration, satisfaction, stress hormones and newborn outcomes among primigravidae during the first stage of labour in Saudi Arabia: a study protocol for a randomised controlled trial

INTRODUCTION

Labour pain is among the severest pains primigravidae may experience during pregnancy. Failure to address labour pain and anxiety may lead to abnormal labour. Despite the many complementary non-pharmacological approaches to coping with labour pain, the quality of evidence is low and best approaches are not established. This study protocol describes a proposed investigation of the effects of a combination of breathing exercises, foot reflexology and back massage (BRM) on the labour experiences of primigravidae.

METHODS AND ANALYSIS

This randomised controlled trial will involve an intervention group receiving BRM and standard labour care, and a control group receiving only standard labour care. Primigravidae of 26-34 weeks of gestation without chronic diseases or pregnancy-related complications will be recruited from antenatal clinics. Eligible and consenting patients will be randomly allocated to the intervention or the control group stratified by intramuscular pethidine use. The BRM intervention will be delivered by a trained massage therapist. The primary outcomes of labour pain and anxiety will be measured during and after uterine contractions at baseline (cervical dilatation 6 cm) and post BRM hourly for 2 hours. The secondary outcomes include maternal stress hormone (adrenocorticotropic hormone, cortisol and oxytocin) levels, maternal vital signs (V/S), fetal heart rate, labour duration, Apgar scores and maternal satisfaction. The sample size is estimated based on the between-group difference of 0.6 in anxiety scores, 95% power and 5% α error, which yields a required sample size of 154 (77 in each group) accounting for a 20% attrition rate. The between-group and within-group outcome measures will be examined with mixed-effect regression models, time series analyses and paired t-test or equivalent non-parametric tests, respectively.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Ethical Committee for Research Involving Human Subjects of the Ministry of Health in the Saudi Arabia (H-02-K-076-0319-109) on 14 April 2019, and from the Ethics Committee for Research Involving Human Subjects (JKEUPM) Universiti Putra Malaysia on 23 October 2019, reference number: JKEUPM-2019-169. Written informed consent will be obtained from all participants. Results from this trial will be presented at regional, national and international conferences and published in indexed journals.

TRIAL REGISTRATION NUMBER

ISRCTN87414969, registered 3 May 2019.

A pilot study of parents' experiences of reflexology treatment for infants with colic in Finland

Background

Many infants under 4 months suffer from infantile colic. Infants with colic cry a lot, appear to be in pain, and it is difficult to sooth them. Colic is a painful condition for the infant and very stressful to parents. Parents in Finland get advice to try reflexology treatment for their infant, but there are no studies in Finland to support this advice.

Aim

The aim of the pilot study was to treat infants with reflexology and find out parents’ experiences of the effects of the treatment on colic symptoms and parental stress.

Method

A total of 33 parents of 35 infants diagnosed with colic participated to the pilot study. Three certified reflexologists with health care education background and extensive experience in infant reflexology were trained to give the reflexology treatment in a standardised manner. They treated each infant 3–4 times. The whole body reflexology treatment session consisted of gentle pressure treatment of soles and feet, hands, head, face, ears, back, neck and whole stomach area. One treatment session lasted about 20–30 minutes, and treatments were delivered within 8–12 days. The data were collected from the parents with semi‐structured questionnaires.

Results

The series of the treatments helped reduce the suffering of all the babies with infant colic. The colic symptoms disappeared on 43% of infants and decreased on the remaining 57%. The parents reported having pleasant experiences with the treatment, regardless whether the colic symptoms disappeared or continued. Parents stated that the treatment reduced the most typical colic symptoms; infants’ body tension, colic crying and restless movements, poor sleep quality and irregular bowel movements.

Conclusions

Reflexology treatment seems to be a safe and effective way to treat infants with colic when conducted by a health care professional with reflexology training and experience.

The Effect of Foot Reflexology on Hospital Anxiety and Depression in Female Older Adults: a Randomized Controlled Trial

BACKGROUND

Patients with cardiovascular diseases usually suffer from hospital anxiety and depression.

AIM

This study aimed to investigate the effect of foot reflexology massage on anxiety and depression in female older adults suffering from acute coronary syndrome.

PARTICIPANTS

Ninety older women with acute coronary syndrome were randomly assigned into intervention and control groups (n=45 in each group).

RESEARCH DESIGN

A randomized controlled trial.

INTERVENTION

The intervention and control groups received foot reflexology massage and routine care, respectively.

MAIN OUTCOMES MEASURES

The levels of anxiety and depression were evaluated using the hospital's anxiety and depression scale (HADS) before and immediately after foot reflexology massage.

RESULTS

Foot reflexology massage reduced both anxiety (F(1.44)=19.11, p = .001) and depression (F(1.44)=16.76, p = .001) in acute coronary patients relative to control patients. The intervention had a large effect on hospital anxiety and depression.

CONCLUSIONS

Foot reflexology massage is an efficient and safe intervention for alleviating psychological responses among female older adults suffering from acute coronary syndrome during hospitalization.

The medical perspective of cupping therapy: Effects and mechanisms of action

Cupping Therapy (CT) is an ancient method and currently used in the treatment of a broad range of medical conditions. Nonetheless the mechanism of action of (CT) is not fully understood. This review aimed to identify possible mechanisms of action of (CT) from modern medicine perspective and offer possible explanations of its effects. English literature in PubMed, Cochrane Library and Google Scholar was searched using key words. Only 223 articles identified, 149 records screened, and 74 articles excluded for irrelevancy. Only 75 full-text articles were assessed for eligibility, included studies in this review were 64. Six theories have been suggested to explain the effects produced by cupping therapy. Pain reduction and changes in biomechanical properties of the skin could be explained by "Pain-Gate Theory", "Diffuse Noxious Inhibitory Controls" and "Reflex zone theory". Muscle relaxation, changes in local tissue structures and increase in blood circulation might be explained by "Nitric Oxide theory". Immunological effects and hormonal adjustments might be attributed to "Activation of immune system theory". Releasing of toxins and removal of wastes and heavy metals might be explained by "Blood Detoxification Theory". These theories may overlap or work interchangeably to produce various therapeutic effects in specific ailments and diseases. Apparently, no single theory exists to explain the whole effects of cupping. Further researches are needed to support or refute the aforesaid theories, and also develop innovative conceptualizations of (CT) in future.

Effects of foot massage applied in two different methods on symptom control in colorectal cancer patients: Randomised control trial

This randomized controlled clinical study aimed to determine the effect of 2 foot massage methods on symptom control in people with colorectal cancer who received chemoradiotherapy. Data were collected between June 16, 2015, and February 10, 2016, in the Department of Radiation Oncology of an oncology training and research hospital. The sample comprised 60 participants. Data were collected using an introductory information form, common terminology criteria for adverse events and European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 and CR29. Participants were randomly allocated to 3 groups: classical foot massage, reflexology, and standard care control. The classical massage group received foot massage using classical massage techniques, and the reflexology group received foot reflexology focusing on symptom-oriented reflexes twice a week during a 5-week chemoradiotherapy treatment schedule. The control group received neither classical massage nor reflexology. All patients were provided with the same clinic routine care. The classical massage was effective in reducing pain level and distension incidence while foot reflexology was effective in reducing pain and fatigue level, lowering incidence of distension and urinary frequency and improving life quality.

Perspectives on reflexology: A qualitative approach

INTRODUCTION

Reflexology is the systematic practice of applying some pressure to particular points on the feet and hands to impact on health of related parts of the body.

OBJECTIVE

To explore the practitioners' perspectives of reflexology in Malaysia.

METHODS

Data was collected using face-to-face semi-structured interviews with practitioners in Malaysia. The interviews were conducted in the Malay language and recorded. Interview conversations were translated and transcribed verbatim. Responses relating to different themes were identified in each of the interviews and a coding frame was developed. For each theme, the relevant data enabled a description of the range of views and experiences. Data collection and analysis were conducted concurrently and recruitment was stopped when saturation had been reached. All respondents gave written consent for their participation.

RESULTS

The findings show that reflexology treatment nowadays has been accepted as one of the ways to maintain general health. Practitioners believe that reflexology is able to detect some problems in to the body, which can make patients aware of a health condition and seek further treatment. However, if reflexology is not performed correctly, it may cause negative effects such as pain and bruises. Some practitioners voiced concern that illegal activities are taking place in unethical reflexology centers.

CONCLUSIONS

Empowering the practitioner as a professional would help gain the public's trust and confidence in their treatment. Strict enforcement of regulation related to illegal conduct in reflexology centers will improve people's perception of the practice.

The effect of foot reflexology applied to women aged between 40 and 60 on vasomotor complaints and quality of life

PURPOSE

This study aims to identify the effects of foot reflexology applied to women on their vasomotor complaints and quality of life.

METHODS

A randomised controlled study was conducted with 120 women. The experimental group received foot reflexology treatment, while the control group received nonspecific foot massage.

RESULTS

The mean scores for hot flashes, sweats, and night sweats, were lower in the reflexology group than the control group after the practice; and the difference between the groups was statistically significant (p < 0.001). The mean scores for the sub-groups of the MENQOL demonstrated improvements in both groups after the application (p < 0.001). As for the sexual domain, there was a significant improvement in the reflexology group (p < 0.05), but no improvements were found in the control group (p > 0.05).

CONCLUSION

Results showed that reflexology might be effective in decreasing vasomotor problems and increasing quality of life in women in the menopausal period.

Physical and Psychological Effects of Head Treatment in the Supine Position Using Specialized Ayurveda-Based Techniques

Objective: To clarify the physical and psychological effects of head massage performed in the supine position using Ayurveda-based techniques (head treatment).

Design: Twenty-four healthy female students were included in the study. Using a crossover study design, the same participants were enrolled in both the head treatment intervention group and control group. There was an interval of 1 week or more between measurements.

Outcome measures: The physiologic indices measured included blood pressure and heart rate fluctuations (high frequency and low frequency/high frequency). The psychological markers measured included liveliness, depression, and boredom using the visual analogue scale method. State anxiety was measured using the State-Trait Anxiety Inventory method.

Results: The parasympathetic nerve activity increased immediately after head treatment. Upon completion of head treatment, the parasympathetic nerve predominance tended to gradually ease. Head treatment boosted freshness and relieved anxiety.

Conclusions: The results suggest that head treatment has a relaxing and refreshing effect and may be used to provide comfort.

Report on a membership audit of the Association of Chartered Physiotherapists in Reflex Therapy (ACPIRT)

Reflex Therapy (RT), akin to reflexology, is a non-invasive physiotherapy modality approved by the UK Chartered Society of Physiotherapists. One hundred members of the Association of Chartered Physiotherapists in Reflex Therapy (ACPIRT) participated in an audit to establish a baseline of practice. Findings indicate that experienced therapists use RT in conjunction with their professional skills to induce relaxation (95%) and reduce pain (86%) for patients with conditions including whiplash injury and chronic pain. According to 68% of respondents, RT is "very good," "good" or "as good as" orthodox physiotherapy practices. Requiring minimal equipment, RT may be as cost effective as orthodox physiotherapy with regards to duration and frequency of treatment.

The physiological and biochemical outcomes associated with a reflexology treatment: a systematic review

Background. Reflexology is one of the top forms of complementary and alternative medicine in the UK and is used for healthcare by a diverse range of people. However, it is offered by few healthcare providers as little scientific evidence is available explaining how it works or any health benefits it may confer. The aim of this review was to assess the current evidence available from reflexology randomised controlled trials (RCTs) that have investigated changes in physiological or biochemical outcomes. Methods. Guidelines from the Cochrane Handbook of Systematic Reviews of Interventions were followed: the following databases were searched from inception to December 2013: AMED, CAM Quest, CINAHL Plus, Cochrane Central Register of Controlled Trials, Embase, Medline Ovid, Proquest, and Pubmed. Risk of bias was assessed independently by two members of the review team and overall strength of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation guidelines. Results. Seventeen eligible RCTs met all inclusion criteria. A total of 34 objective outcome measures were analysed. Although twelve studies showed significant changes within the reflexology group, only three studies investigating blood pressure, cardiac index, and salivary amylase resulted in significant between group changes in favour of reflexology. The overall quality of the studies was low.

Determination of efficacy of reflexology in managing patients with diabetic neuropathy: a randomized controlled clinical trial

Background. The restricted usage of existing pharmacological methods which do not seem to provide the treatment of diabetic neuropathy may lead to exploring the efficacy of a complementary therapy. In this context, this paper was devoted to evaluate the efficacy of foot reflexology. This health science works on the hypothesis that the dysfunctional states of body parts could be identified by observing certain skin features and be rectified by stimulating certain specific areas mapped on feet. Method. Subjects (N = 58) with diagnosed diabetic neuropathy were randomly distributed into reflexology and control groups in which both group patients were treated with ongoing pharmacological drugs. Reflexology group patients were additionally treated holistically with the hypothesis that this therapy would bring homeostasis among body organ functions. This was a caregiver-based study with a follow-up period of 6 months. The outcome measures were pain reduction, glycemic control, nerve conductivity, and thermal and vibration sensitivities. The skin features leading to the detection of the abnormal functional states of body parts were also recorded and analyzed. Results. Reflexology group showed more improvements in all outcome measures than those of control subjects with statistical significance. Conclusion. This study exhibited the efficient utility of reflexology therapy integrated with conventional medicines in managing diabetic neuropathy.

Noninvasive characterisation of foot reflexology areas by swept source-optical coherence tomography in patients with low back pain

Objective. When exploring the scientific basis of reflexology techniques, elucidation of the surface and subsurface features of reflexology areas (RAs) is crucial. In this study, the subcutaneous features of RAs related to the lumbar vertebrae were evaluated by swept source-optical coherence tomography (SS-OCT) in subjects with and without low back pain (LBP). Methods. Volunteers without LBP (n = 6 (male : female = 1 : 1)) and subjects with LBP (n = 15 (male : female = 2 : 3)) were clinically examined in terms of skin colour (visual perception), localised tenderness (visual analogue scale) and structural as well as optical attributes as per SS-OCT. From each subject, 6 optical tomograms were recorded from equidistant transverse planes along the longitudinal axis of the RAs, and from each tomogram, 25 different spatial locations were considered for recording SS-OCT image attributes. The images were analysed with respect to the optical intensity distributions and thicknesses of different skin layers by using AxioVision Rel. 4.8.2 software. The SS-OCT images could be categorised into 4 pathological grades (i.e., 0, 1, 2, and 3) according to distinctness in the visible skin layers. Results. Three specific grades for abnormalities in SS-OCT images were identified considering gradual loss of distinctness and increase in luminosity of skin layers. Almost 90.05% subjects were of mixed type having predominance in certain grades. Conclusion. The skin SS-OCT system demonstrated a definite association of the surface features of healthy/unhealthy RAs with cutaneous features and the clinical status of the lumbar vertebrae.

Optical, spectroscopic, and Doppler evaluation of "normal" and "abnormal" reflexology areas in lumbar vertebral pathology: a case study

Scientific validation of reflexology requires an in-depth and noninvasive evaluation of “reflexology/reflex areas” in health and disease. The present paper reports the differential properties of “normal” and “abnormal” reflexology areas related to the lumbar vertebrae in a subject suffering from low back pain. The pathology is supported by radiological evidence. The reflexology target regions were clinically assessed with respect to colour and tenderness in response to finger pressure. Grey scale luminosity and pain intensity, as assessed by visual analogue scale scores, differentiated “normal” from “abnormal” skin. Skin swept source-optical coherence tomography recorded their structural differences. Infrared thermography revealed temperature variations. A laser Doppler study using a combined microcirculation and transcutaneous oxygen monitoring system indicated alterations in blood flow and oxygen perfusion. Raman spectroscopy showed differences in chemical signatures between these areas. The present findings may indicate a potential correlation between the reflexology areas and subsurface pathological changes, showing an association with the healthy or unhealthy status of the lumbar vertebrae.

The effect of reflexology on pain intensity and duration of labor on primiparas

BACKGROUND

Reflexology is an ancient, mild and non-invasive technique, used widely as one of the non-pharmacological methods for pain relief. The aim of this research was to determine the effect of reflexology on pain intensity as well as to determine the duration of labor in primiparas.

METHODS

In 2008, a randomized clinical trial study was conducted randomly enrolling 120 parturient women with low risk pregnancy into three groups in Shahid Akbarabadi Hospital, Tehran, Iran. The first group received 40 minutes of reflexology at the beginning of active phase (4-5 cm cervical dilatation). Emotional support was offered for the second group in the same stage of pregnancy and with the same duration. The third group received only routine care during labor. Pain severity was evaluated with visual analogue scale (0 to 10 cm). In all groups, pregnant women were asked to evaluate the severity of pain experienced before and after intervention and also at cervical dilatations of 6-7 cm and 8-10 cm respectively. Data were collected through the numerical pain scale.

RESULTS

Pain intensity at all the three stages of cervical dilatation was significantly lower in the reflexology group. During the 4-5 cm dilatation stage, women in the supported group reported less severe pain compared to those receiving routine care, but no significant differences at the later stages of labor. This indicates that reflexology could decrease the duration of first, second and third stages of labor.

CONCLUSION

Our findings showed that reflexology can be useful to decrease the pain intensity as well as duration of labor.

Structural reflex zone therapy in pregnancy and childbirth: a new approach

This paper is adapted from Denise Tiran's forthcoming new book on pregnancy reflexology, and introduces an innovative new approach which has been termed "structural reflex zone therapy". From a reflexology perspective structural reflex zone therapy (RZT) draws on the Hanne Marquardt system, but is based also on the principles of osteopathy, in which the musculoskeletal system is seen as the main supporting framework of the body and the feet are used purely as a medium through which misalignments can be treated. Structural reflex zone therapy is based on the author's clinical work and research over a 25-year period, and although specifically applied here to maternity care, could easily be adapted for other clinical specialities. In this paper, the way in which structural RZT can be helpful for two particular pregnancy conditions - stress and backache - is considered.

Primer on integrative oncology

At the present time, there is no obvious answer for many of these design difficulties. This problem will continue to constrain ability to determine the efficacy of integrative medical techniques for patients who have cancer. Patients, however, will continue to gravitate toward alternative treatments, especially when standard cancer treatments fail. Therefore oncologists must be aware of alternative medical agents and techniques, and be able to guide their patients, rather than simply being dismissive.