Single-blind trial addressing the differential effects of two reflexology techniques versus rest, on ankle and foot oedema in late pregnancy

The effects of reflexology on symptoms in pregnancy: A systematic review of randomized controlled trials

Objective

This review assessed the effects of reflexology on symptoms in pregnancy.

Methods and analysis

PubMed, Embase, Springer, Web of Science, the Cochrane Library, and reference lists of previous systematic reviews were searched for the eligible randomized controlled trials (RCT) from the inception date of each predefined database up to May 31st, 2023. Data were extracted, and methodological quality was evaluated by the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). The efficacy of treatment was assessed using pooled effect sizes (Hedges' g) and 95% confidence intervals (CI). Meta-analysis was performed using the RevMan 5.4 manager, and publication bias was evaluated by Begg's test.

Results

The included a total of 13 RCTs in this review, of eleven was high risk of bias and two were low, reported the effects of reflexology on low back and/or pelvic pain (LBPP), labor pain, duration of labor, anxiety, fatigue, sleep quality, constipation symptoms, and ankle and foot edema in pregnancy. The effect sizes (Hedges' g) for reflexology in labor pain, duration of labor, anxiety, fatigue, and sleep quality showed statistical significance, which the meta-analysis also confirmed except for fatigue and sleep quality due to insufficient studies.

Conclusion

Reflexology is probably effective and safe for labor pain, duration of labor, and anxiety in pregnancy, while the evidences for reflexology in LBPP, fatigue, sleep quality, constipation symptoms, and ankle and foot edema during pregnancy were insufficient. Based on the low to high quality of included studies, strong supportive evidence is not yet available. Rigorous-design and large-scale clinical trials should be conducted to provide higher-quality, reliable evidence.

Foot Reflexology: Recent Research Trends and Prospects

Foot reflexology is a non-invasive complementary therapy that is increasingly being accepted by modern people in recent years. To understand the research trends and prospects of foot reflexology in the past 31 years, this study used the Web of Science core collection as the data source and two visualization tools, COOC and VOSviewer, to analyze the literature related to the field of foot reflexology from 1991 to 2021. This study found that the number of articles published in the field of foot reflexology has been increasing year by year, and the top three journals with the most articles are Complementary Therapies in Clinical Practice, Therapies in Medicine, and the Journal of Alternative and Complementary Medicine. The top three most prolific authors are Wyatt, Sikorskii, and Victorson, and the core institutions in the field of foot reflexology are Michigan State University, Northwestern University, Tehran University of Medical Sciences, and the University of Exeter. Foot reflexology has been shown to have a moderating effect on anxiety, fatigue, and cancer, and is a topic of ongoing and future research. This study uses this bibliometric analysis of foot reflexology literature to provide an overview of prior knowledge and a reference direction for modern preventive medicine.

Measurement of Skin Thickness Using Ultrasonography to Test the Usefulness of Elastic Compression Stockings for Leg Edema in Pregnant Women

Background: One of the most common treatments for leg edema during pregnancy is the use of compression stockings. The purpose of this study was to evaluate the objective effectiveness in pregnant women, by measuring the changes of skin thickness using ultrasonography. Methods: Pregnant women were diagnosed with leg edema using the pitting edema method at 36 weeks of gestation. Twenty-four pregnant women (48 legs) with leg edema spent time without wearing elastic stockings at 36−37 weeks of gestation. Then, they wore elastic stockings for one week at 37−38 weeks of gestation. We measured the grade of edema (from 0 to 3) and the skin thickness of the lower leg by portable ultrasonography at 36, 37, and 38 weeks of gestation (a before-and-after study). Results: In 24 pregnant women, thigh edema was not detected in any of the 48 legs before or after the use of elastic stockings. All 48 legs in 24 pregnant women had physiological lower leg edema, but not thigh edema. The average grade of pitting edema in each lower leg significantly decreased after using the stockings (36 weeks, 1.77 ± 0.85; 37 weeks, 1.79 ± 0.77; 38 weeks, 1.04 ± 0.74, p < 0.0001). In addition, the skin thickness of the lower legs was significantly decreased after the use of elastic stockings (36 weeks, 7.47 ± 2.45 mm; 37 weeks, 7.93 ± 2.83 mm; 38 weeks, 7.15 ± 2.35 mm, p < 0.0001). Conclusions: The wearing of elastic compression stockings on the lower legs is objectively effective for improving leg edema in pregnant women.

Effects, Side Effects and Contraindications of Relaxation Massage during Pregnancy: A Systematic Review of Randomized Controlled Trials

Healthcare professionals and expecting mothers frequently voice concerns that massages during pregnancy might cause complications or premature labor. This PRISMA review outlines current results on effects, side effects and contraindications of relaxation massage during pregnancy. Inclusion criteria: all randomized controlled trials (RCT) comparing relaxation massage during pregnancy with standard care or standard care plus another intervention (i.e., progressive muscle relaxation). Restrictions were full text availability and English language. Results: 12 RCT were included. Trials had good methodological quality but unknown risk of bias. All women were at least 12 weeks gestation at the start of the study. The main benefits of massage during pregnancy were: reduced stress, back and leg pain, depression and anxiety; increased immune response; increased serotonin and dopamine levels; higher fetal birth weight and reduced risk of preterm delivery. Only 2 RCT reported potential side effects of massage, which were minor and transient. Seven RCT excluded women with difficult pregnancies or preexisting complications, five studies did not report preexisting conditions. Those obstetric or postnatal complications that occurred were most likely unrelated to massage treatments. In healthy pregnant women without complications, relaxation massage has positive effects throughout pregnancy. Precautions for massage during pregnancy (i.e., to prevent pulmonary embolism) are discussed.

Effect of plantar reflexology on labor pain and childbirth experience: A randomized controlled clinical trial

AIM

This study aimed to determine the effect of plantar reflexology on the severity of labor pain and childbirth experience (primary outcomes) and the duration of labor stages (secondary outcomes).

METHODS

This single-blind randomized controlled trial was performed on 90 women in Al-Zahra and Taleghani hospitals in Tabriz-Iran. Participants were randomly assigned into three groups; Intervention 1 (two 30-min massages at the effective point of pain for each sole), intervention 2 (one 30-min massage at the effective point of pain and one 30-min massage at the heel for each sole), and control (two 30-minute heel massages). Massage was performed once in 4-cm dilatation and the second time in 7-cm dilatation. The severity of pain and childbirth experience were measured by Visual Analogue Scale and Labor Agentry Scale, respectively. Partograph chart was used to measure the length of labor stages.

RESULTS

The severity of pain in intervention group 1 was significantly lower than the control group (AMD: -1.7; 9% confidence interval: -2.8 to -0.6; p = 0.001), but there was no significant difference between intervention groups 1 and 2 (p = 0.066) and intervention group 2 and control (p = 0.336). A significant difference was observed between groups in terms of length of the third stage of labor (p = 0.04). There was no significant difference between groups in terms of mean childbirth experience score (p = 0.217), duration of active phase (p = 0.099), and second stage of labor (p = 0.114).

CONCLUSION

The results of the study showed that plantar reflexology can reduce the severity of labor pain and the length of third stage of labor.

Comparing the Effect of Foot Massage with Grape Seed Oil and Sweet Almond Oil on Physiological Leg Edema in Primigravidae: A Randomized Clinical Trial

Background

Leg edema is a prevalent problem in pregnancy causing activity restrictions for pregnant women. This study was performed to compare the effect of foot massage using grape seed oil and sweet almond oil on physiological leg edema.

Methods

A randomized clinical trial was conducted on 90 primigravidae referred to public health centres of Zahedan, Iran. The participants' gestational age was 30–40 weeks. The study was conducted from August 2016 to November 2017. The participants were randomly assigned to three groups (massage with grape seed oil, massage with sweet almond oil, and without intervention). After determining the extent of leg edema, foot massages were done for 20 minutes within 5 days in the two intervention groups. Then, foot circumferences were measured on day 5 after the intervention. Foot circumferences for the control group were measured on days 1 and 5. A nonelastic tape measure was used to measure the circumferences. To analyse the data, SPSS 21 software and statistical tests including one-way ANOVA, Tukey's test, and paired t-test were used.

Results

The results from this study showed a significant difference in the mean score change of foot circumferences between groups (P=0.001). According to the results of Tukey's test, mean score changes of foot circumferences of both intervention groups were significantly different those of the control group. However, this difference was not significant between the two intervention groups (P=0.865).

Conclusion

The findings of this study confirmed the effectiveness of foot massage using grape seed and sweet almond oils to reduce pregnancy physiological edema. Therefore, foot massage with appropriate oils can be used as a useful technique by trained midwives in prenatal care centres or at pregnant women houses. This trial is registered with IRCT2015072723370N1.

A Quantitative Method to Measure Skin Thickness in Leg Edema in Pregnant Women Using B-Scan Portable Ultrasonography: A Comparison Between Obese and Non-Obese Women

BACKGROUND This study aimed to use a portable ultrasound method to quantitatively measure skin thickness and to compare leg edema in obese and non-obese pregnant women. MATERIAL AND METHODS Thirty-six pregnant women (17 primiparas and 19 multiparas) at 27/28 and 37/38 weeks of pregnancy, with and without leg edema, had their lower leg skin thickness measured using a B-scan portable ultrasonography device (72 legs and maximum of 98 measurements). Measurements were compared between women who were obese prior to pregnancy, with a body mass index (BMI) ≥25 kg/m² and non-obese with a BMI <25 kg/m². RESULTS Skin thickness of the legs in pregnant women with edema was significantly increased compared with that in pregnant women without edema (6.4±0.3 mm vs. 4.6±0.4 mm) (p=0.0001). There was a significant correlation between the degree of pitting edema and skin thickness in all edematous legs (r=0.56; n=98; p<0.0001). The cutoff level of edema measured by portable ultrasound in non-obese pregnant women was 4.7 mm (sensitivity 83.9%, specificity 66.7%) and was 7.5 mm in obese pregnant women. Obese pregnant women with edema had a significantly increased leg skin thickness compared with non-obese pregnant women with edema (11.3±1.3 mm vs. 5.7±0.2 mm) (p<0.0001). CONCLUSIONS Portable ultrasonography is a reliable method of quantitatively measuring skin thickness of the lower leg in edema associated with pregnancy. The thickness of the skin in obese pregnant women with edema can be expected to be significantly increased compared with non-obese pregnant women with edema.

Complementary medicine for laboring women: a qualitative study of the effects of reflexology

Background

Despite pharmacological interventions, labor pain and anxiety still remain a challenge, and can carry long-term psychological complications. The goal of this study was to assess the effect of reflexology on these symptoms and to explore the physical and psychological components of women’s experience associated with this treatment.

Methods

This qualitative study was conducted in an Israeli university hospital that offers integrative medicine services. Reflexology was offered to laboring women in the hospital, by the medical staff. In-depth, open interviews were conducted with 36 women, still in hospital, who consented to be interviewed, within 48 h after delivery. Questions referred to their labor experience with reflexology treatment.

Results

Of the 36 participants, 34 (94%) described a positive and empowering experience. They reported reduced pain and anxiety, and an increased sense of self-efficacy brought about by the ability to become active and manage labor.

Conclusions

Using reflexology as one of the complementary medicine treatment available can contribute greatly to the entire labor experience as it empowers women and increases self-confidence and ability to self-manage labor and delivery.

The hemodynamic effects of pregnancy on the lower extremity venous system

OBJECTIVE

Pregnancy has significant effects on the lower extremity venous system. Increasing venous pressure and blood volume, in combination with reduced flow rates within the deep veins, predisposes pregnant women to both primary and secondary chronic venous insufficiency (CVI). This review article highlights the specific physiologic and hemodynamic changes that occur during pregnancy and examines the nonpharmacologic, pharmacologic, and invasive interventions that are appropriate for both prophylaxis and treatment of CVI and venous thromboembolism (VTE).

METHODS

This study is a review article of the key literature related to VTE and CVI in pregnancy.

RESULTS

Significant hemodynamic changes occur in the lower extremities during pregnancy. Although well documented and essential to fetal development, these changes can have a negative impact on the maternal lower extremity venous circulation. Consequences of pregnancy can result in venous disease only during pregnancy or, particularly in the multiparous patient, can progress to CVI. An abundance of literature and guidelines exist for the management of VTE during pregnancy; however, the quality and extent of literature based around the management of primary CVI during pregnancy are modest at best.

CONCLUSIONS

The physiologic changes throughout the arterial and venous systems during pregnancy are well documented. However, there is a paucity of data available to construct guidelines for care, particularly in the pregnant patient with symptomatic superficial venous insufficiency. Further investigation in the form of prospective randomized trials is required to establish appropriate guidelines for treatment.

A pilot randomised controlled trial exploring the effects of antenatal reflexology on labour outcomes

OBJECTIVE

to investigate the effects of antenatal reflexology on labour outcomes.

DESIGN

secondary analysis of a pilot three-armed randomised controlled trial conducted between July 2012 and September 2013.

SETTING

a large UK inner city hospital maternity department.

PARTICIPANTS

ninety primiparous women with a singleton pregnancy experiencing low back and / or pelvic girdle pain.

INTERVENTIONS

six weekly 30-minute reflexology treatments compared to sham (footbath) treatments or usual antenatal care only.

MEASUREMENTS

labour outcome data including labour onset, duration of the second stage of labour, epidural and Entonox usage, and mode of delivery. Participant feedback was collected prior to each treatment.

FINDINGS

labour outcomes were collected for 61 women (95.3%) who completed the study. The second stage of labour duration data, available for 42 women (62.5%) who had vaginal births, showed a mean reduction of 44minutes in the reflexology group (73.56minutes; SD= 53.78) compared to the usual care (117.92minutes; SD=56.15) (p<0.05) and footbath groups (117.4minutes; SD=68.54) (p=0.08). No adverse effects were reported.

KEY CONCLUSIONS

in this trial antenatal reflexology reduced labour duration for primiparous women who had experienced low back and/ or pelvic girdle pain during their pregnancy, compared with usual care and footbaths.

IMPLICATIONS FOR PRACTICE

reflexology is suitable for use during pregnancy, is safe and enjoyable and may reduce labour duration. Midwives may wish to recommend reflexology to promote normal childbirth and facilitate women centred care.

TRIAL REGISTRATION

this trial was listed with the International Standard Randomised Controlled Trial Number Register (ISRCTN26607527).

Factors Affecting Recruitment and Attrition in Randomised Controlled Trials of Complementary and Alternative Medicine for Pregnancy-Related Issues

Background. Randomised controlled trials (RCTs) investigating Complementary and Alternative Medicine (CAM) for pregnancy-related issues have encountered issues with recruitment and attrition. Little is known about the cause of these issues. Methods. Data was gathered from an antenatal CAM randomised controlled trial. During foetal anomaly appointments, women meeting inclusion criteria were invited to participate in the trial. Numbers of women invited and eligible were recorded. Reasons for noninterest were noted and analysed. Focus groups exploring trial experience of participants were also conducted. Findings. Of the 428 women invited to participate, 376 were eligible and just under a quarter participated. Reasons for nonparticipation included concerns about CAM and lack of interest in participation in research. Other factors negatively affecting recruitment included recruitment timing, competition for participants, limited support from staff, and inadequate trial promotion. Factors encouraging recruitment included being interested in research and seeking pain relief. Reasons for dropping out were time constraints, travel issues, work commitments, and pregnancy issues. Several women in the sham and usual care group dropped out due to dissatisfaction with treatment allocation. Conclusion. CAM researchers must explore problems encountered with recruitment and attrition so that evidence-based implementation strategies to address the issues can be developed.

Interventions for varicose veins and leg oedema in pregnancy

BACKGROUND

Pregnancy is presumed to be a major contributory factor in the increased incidence of varicose veins in women, which can in turn lead to venous insufficiency and leg oedema. The most common symptom of varicose veins and oedema is the substantial pain experienced, as well as night cramps, numbness, tingling, the legs may feel heavy, achy, and possibly be unsightly. Treatments for varicose veins are usually divided into three main groups: surgery, pharmacological and non-pharmacological treatments. Treatments of leg oedema comprise mostly symptom reduction rather than cure and use of pharmacological and non-pharmacological approaches.

OBJECTIVES

To assess any form of intervention used to relieve the symptoms associated with varicose veins and leg oedema in pregnancy.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies.

SELECTION CRITERIA

Randomised trials of treatments for varicose veins or leg oedema, or both, in pregnancy.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

MAIN RESULTS

We included seven trials (involving 326 women). The trials were largely unclear for selection bias and high risk for performance and detection bias.Two studies were placebo-controlled trials. The first one compared a phlebotonic (rutoside) with placebo for the reduction in symptoms of varicose veins; the second study evaluated the efficacy of troxerutin in comparison to placebo among 30 pregnant women in their second trimester with symptomatic vulvar varicosities and venous insufficiency in their lower extremities. Data from this study were not in useable format, so were not included in the analysis. Two trials compared either compression stockings with resting in left lateral position or reflexology with rest for 15 minutes for the reduction of leg oedema. One trial compared standing water immersion for 20 minutes with sitting upright in a chair with legs elevated for 20 minutes. Women standing in water were allowed to stand or walk in place. One trial compared 20 minutes of daily foot massage for five consecutive days and usual prenatal care versus usual prenatal care. The final trial compared three treatment groups for treating leg oedema in pregnancy. The first group was assigned to lateral supine bed rest at room temperature, women in the second group were asked to sit in a bathtub of waist-deep water at 32 ± 0.5 C with their legs horizontal and the third group included the women who were randomised to sitting immersed in shoulder-deep water at 32 ± 0.5 C with legs extended downward. We did not include this study in the analysis as outcomes reported in the paper were not pre-specified outcomes of this review.We planned to use GRADE methods to assess outcomes for two different comparisons and assign a quality rating. However, only two out of three outcomes for one comparison were reported and could be assessed. Evidence from one trial (rutoside versus placebo) for the outcomes of reduction in symptoms and incidence of complications associated with varicose veins and oedema was assessed as of moderate quality. Rutoside versus placeboOne trial involving 69 women, reported that rutoside significantly reduced the symptoms associated with varicose veins (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.11 to 3.22; moderate quality evidence). The incidence of complications (deep vein thrombosis) did not differ significantly between the two groups (risk ratio (RR) 0.17, 95% CI 0.01 to 3.49; moderate quality evidence). There were no significant differences in side-effects (RR 1.30, 95% CI 0.23 to 7.28). Women's perception of pain was not reported in this trial. External pneumatic intermittent compression versus restOne trial, involving 35 women, reported no significant difference in lower leg volume when compression stockings were compared against rest (mean difference (MD) -258.80, 95% CI -566.91 to 49.31). Reflexology versus restingAnother trial, involving 55 women, compared reflexology with rest. Reflexology significantly reduced the symptoms associated with oedema (reduction in symptoms: RR 9.09, 95% CI 1.41 to 58.54). The same study showed a trend towards satisfaction and acceptability with the intervention (RR 6.00, 95% CI 0.92 to 39.11). Water immersion versus leg elevationThere was evidence from one trial, involving 32 women, to suggest that water immersion for 20 minutes in a swimming pool reduces leg volume (RR 0.43, 95% CI 0.22 to 0.83). Foot massage versus routine careOne trial, involving 80 women reported no significant difference in lower leg circumference when foot massage was compared against routine care (MD -0.11, 95% CI -1.02 to 0.80).No other primary or secondary outcomes were reported in the trials.

AUTHORS' CONCLUSIONS

There is moderate quality evidence to suggest that rutosides appear to help relieve the symptoms of varicose veins in late pregnancy. However, this finding is based on one study (69 women) and there are not enough data presented in the study to assess its safety in pregnancy. Reflexology or water immersion appears to help improve symptoms for women with leg oedema, but again this is based on two small studies (43 and 32 women, respectively).

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.

Midwives' use of complementary/alternative treatments

BACKGROUND

in recent years, several surveys have suggested that many midwives use some form of complementary/alternative therapy (CAT), often without the knowledge of obstetricians.

OBJECTIVE

to systematically review all surveys of CAT use by midwives.

SEARCH STRATEGY

six electronic databases were searched using text terms and MeSH for CAT and midwifery.

SELECTION CRITERIA

surveys were included if they reported quantitative data on the prevalence of CAT use by midwives.

DATA COLLECTION AND ANALYSIS

full-text articles of all relevant surveys were obtained. Data were extracted according to pre-defined criteria.

MAIN RESULTS

19 surveys met the inclusion criteria. Most were recent and from the USA. Prevalence data varied but were usually high, often close to 100%. Much use of CATs does not seem to be supported by strong evidence for efficacy.

CONCLUSION

most midwives seem to use CATs. As not all CATs are without risks, the issue should be debated openly.

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.

Reflexology: an update of a systematic review of randomised clinical trials

Reflexology is a popular form of complementary and alternative medicine (CAM). The aim of this update is to critically evaluate the evidence for or against the effectiveness of reflexology in patients with any type of medical condition. Six electronic databases were searched to identify all relevant randomised clinical trials (RCTs). Their methodological quality was assessed independently by the two reviewers using the Jadad score. Overall, 23 studies met all inclusion criteria. They related to a wide range of medical conditions. The methodological quality of the RCTs was often poor. Nine high quality RCTs generated negative findings; and five generated positive findings. Eight RCTs suggested that reflexology is effective for the following conditions: diabetes, premenstrual syndrome, cancer patients, multiple sclerosis, symptomatic idiopathic detrusor over-activity and dementia yet important caveats remain. It is concluded that the best clinical evidence does not demonstrate convincingly reflexology to be an effective treatment for any medical condition.

Is reflexology an effective intervention? A systematic review of randomised controlled trials

OBJECTIVE

To evaluate the evidence for and against the effectiveness of reflexology for treating any medical condition.

DATA SOURCES

Six electronic databases were searched from their inception to February 2009 to identify all relevant randomised controlled trials (RCTs). No language restrictions were applied.

STUDY SELECTION AND DATA EXTRACTION

RCTs of reflexology delivered by trained reflexologists to patients with specific medical conditions. Condition studied, study design and controls, primary outcome measures, follow-up, and main results were extracted.

DATA SYNTHESIS

18 RCTs met all the inclusion criteria. The studies examined a range of conditions: anovulation, asthma, back pain, dementia, diabetes, cancer, foot oedema in pregnancy, headache, irritable bowel syndrome, menopause, multiple sclerosis, the postoperative state and premenstrual syndrome. There were > 1 studies for asthma, the postoperative state, cancer palliation and multiple sclerosis. Five RCTs yielded positive results. Methodological quality was evaluated using the Jadad scale. The methodological quality was often poor, and sample sizes were generally low. Most higher-quality trials did not generate positive findings.

CONCLUSION

The best evidence available to date does not demonstrate convincingly that reflexology is an effective treatment for any medical condition.

Interventions for varicose veins and leg oedema in pregnancy

BACKGROUND

Pregnancy is presumed to be a major contributory factor in the increased incidence of varicose veins in women, which can in turn lead to venous insufficiency and leg oedema. The most common symptom of varicose veins and oedema is the substantial pain experienced, as well as night cramps, numbness, tingling, the legs may feel heavy, achy, and possibly be unsightly. Treatment of varicose veins are usually divided into three main groups: surgery, pharmacological and non-pharmacological treatments. Treatments of leg oedema comprise mostly of symptom reduction rather than cure and use pharmacological and non-pharmacological approaches.

OBJECTIVES

To assess any form of intervention used to relieve the symptoms associated with varicose veins and leg oedema in pregnancy.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2006).

SELECTION CRITERIA

Randomised trials of treatments for varicose veins or leg oedema, or both, in pregnancy.

DATA COLLECTION AND ANALYSIS

Both review authors independently assessed trials for eligibility, methodological quality and extracted all data.

MAIN RESULTS

Three trials, involving 159 women, were included. VARICOSE VEINS: One trial, involving 69 women, reported that rutoside significantly reduced the symptoms associated with varicose veins (relative risk (RR) 1.89, 95% confidence interval (CI) 1.11 to 3.22). There were no significant differences in side-effects (RR 0.86, 95% CI 0.13 to 5.79) or incidence of deep vein thrombosis (RR 0.17, 95% CI 0.01 to 3.49). OEDEMA: One trial, involving 35 women, reported no significant difference in lower leg volume when compression stockings were compared against rest (weighted mean difference -258.80, 95% CI -566.91 to 49.31). Another trial, involving 55 women, compared reflexology with rest. Reflexology significantly reduced the symptoms associated with oedema (reduction in symptoms: RR 9.09, 95% CI 1.41 to 58.54). There was no evidence of significant difference in the women's satisfaction and acceptability with either intervention (RR 6.00, 95% CI 0.92 to 39.11).

AUTHORS' CONCLUSIONS

Rutosides appear to help relieve the symptoms of varicose veins in late pregnancy. However, this finding is based on one small study (69 women) and there are not enough data presented in the study to assess its safety in pregnancy. It therefore cannot be routinely recommended. Reflexology appears to help improve symptoms for women with leg oedema, but again this is based on one small study (43 women). External compression stockings do not appear to have any advantages in reducing oedema.

Interventions for leg edema and varicosities in pregnancy

Leg oedema from venous insufficiency is not dangerous but it can cause women symptoms such as pain, feelings of heaviness, night cramps and paraesthesiae. Leg oedema can be a sign of pre-eclampsia when associated with raised blood pressure or proteinuria. The objective of this review was to assess the effects of treatment to relieve the symptoms associated with varicosity in pregnancy and to reduce leg oedema. We searched the Cochrane Pregnancy and Childbirth Group trials register in October 2004 for randomised trials of any form of treatment for varicosity and or leg oedema in pregnancy. Trial quality was assessed and data were extracted. Four trials of three different treatments were included. In one trial, women given rutoside capsules in the last 3 months of pregnancy noted an improvement in symptoms compared with placebo (relative risk 0.54 95% CI 0.32, 0.89). They had a decrease in ankle circumference at 36 weeks' gestation after 8 weeks of treatment, while women given placebo had a small increase. In one trial, women with ankle oedema had a small non-significant reduction in lower leg volume when treated with external pneumatic intermittent compression for 30 min. In another trial compression stockings prophylactically reduced the emergence of leg symptoms but not venous varicosities (relative risk 0.74 95% CI 0.59, 0.93). Lymphatic reflexology was studied in too few women to draw conclusions. In conclusions, rutosides appear to relieve symptoms of venous insufficiency in late pregnancy. However, it is not known if the drug is safe in pregnancy. External pneumatic compression appears to reduce ankle swelling and compression stockings reduce leg symptoms but not varicose veins.

Complementary and alternative medicine in obstetrics

OBJECTIVE

To identify, survey and review randomized controlled studies of the use of complementary and alternative medicine (CAM) for obstetric treatment or health promotion.

METHODS

The MEDLINE database was searched to identify randomized controlled trials of CAM treatment and therapies in obstetrics. Studies examining modalities for treatment or improvement of health status were reviewed.

RESULTS

Fifty-four articles assessing a variety of health modalities met the criteria for inclusion. Acupressure and ginger for prenatal nausea and vomiting, moxibustion for version of breech presentation, sterile water injections for back pain relief in labor, and perineal massage to prevent perineal trauma have three or more studies demonstrating beneficial effect. Other interventions have been studied less, and evidence for them is limited.

CONCLUSIONS

Some CAM interventions have evidence of effectiveness for use in obstetric patients, while others require further investigation before they can be considered for use in practice.