Nursing and Reflexology Research

by Barbara and Kevin Kunz

Touch has always been a part of the nursing mandate and reflexology has become a part of
this reach out to patients. The causal use of reflexology by nurses has now been explored
through research, creating an evidence base for its uses.

The use of reflexology by nurses is easy and practical as noted by one nurse researcher who
writes: "Foot reflexology is a way to enhance the nurse-patient interrelationship. It offers a
strategy to fulfill the goals for human touch and holistic nursing care. It can be performed at
any location, is non-invasive, and does not interfere with patients' privacy."

The following abstracts of sixty-two studies by nurses illustrate the uses, doses and value of
reflexology application. For example, research shows benefits of 10 minutes hand reflexology
applications: a single application provides post-operative pain relief; a 5-day series helps
cancer patients and a 5-day per week/5 weeks course of treatment improves kidney function
for dialysis patients. Whether applied as hand reflexology or foot reflexology or taught for
partner use, research shows reflexology to be a useful adjunct for nursing.

Directory of Study Abstracts

 AIDS, Pain and fatigue
 Anxiety, cortisol and melatonin (Healthy individuals)
 Birthing , Labor outcomes
 Cancer
 Constipation: Children
 Coronary artery bypass graft (Anxiety)
 Dementia
 Depression
 Diabetes
 Encopresis
 Fatigue and sleep states in women (Self reflexology)
 Hemodialysis: Physiologic, emotional & motivational responses and immunity
 Hemodialysis and cancer
 Hospitalized children: Reducing stress for parents
 Hypertension
 Hypertension in the elderly
 Incontinence in middle-aged women
 Insomnia
 Menopausal women
 Mental Health
 Middle-aged women
 Osteoarthritis
 Pain (Surgical ward)
 Peptic ulcers
 Pneumoconosis patients (coal workers)
 Postpartum women
 Post surgical pain
 Post surgical recovery
 Pregnancy (Edema)
 Premenstrual syndrome
 Sleep, Elderly women
 Stroke
 Students: Constipation, anxiety and depression
 Wellness

AIDS: Pain and fatigue

Purpose: A randomized clinical trial with a crossover design was used to test the impact of
foot reflexology or mimic foot reflexology in 28 hospitalized AIDS patients about their
perception of pain and fatigue in Nonthaburee, Thailand.

Sample: The sample was 67.9% (n=19) male with an age range from 22-47 years and a mean
of 30.64 years. The mean score on the Piper Fatigue Scale before intervention was high
(M=95.98; SD=26.73) and the mean Pain Descriptor Intensity Scale was low (M=8.64; SD=-
6.05). Methods: Research nurses were trained in the procedures of true foot reflexology and
mimic foot reflexology. Each procedure required 30 minutes (15 minutes per leg). Patients
had either true or mimic reflexology once a day for four days, each receiving a total of two
session of each procedure in random order. The outcome variables included self-report of
fatigue and pain and vital signs pre and post treatment.

Results: There were significant differences between the true foot and mimic reflexology on
the fatigue and pain descriptive intensity scale, but not on a 1-item numeric pain intensity
scale. The only vital sign difference was lower systolic blood pressure but the difference was
not clinically meaningful.

Conclusion True foot reflexology may offer a low cost, effective nursing intervention to
reduce the symptom of fatigue and pain for hospitalized AIDS patients. The numeric pain
intensity item was reduced in both groups, but not significantly, and this may be due to an
inadequate power in the study to detect a potential difference. Foot reflexology is a way to
enhance the nurse-patient interrelationship. It offers a strategy to fulfill the goals for human
touch and holistic nursing care.
It can be performed at any location, is non-invasive, and does not interfere with patients'
privacy. Foot reflexology can also be taught to family members and become part of family
self-care for people living with HIV/AIDS.

"Effect of foot reflexology on pain and fatigue in HIV/AIDS," Ounprasertpong LA.,

International Conference AIDS. 2004 Jul 11-16; 15: abstract no. ThPeD7743. Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand (http://gateway.nlm.nih.gov?
MeetingAbstracts/102281513.html)

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Anxiety, cortisol and melatonin

This pilot study sought to identify an appropriate methodology to investigate the impact of
reflexology in healthcare settings. The study involved healthy volunteers to prevent
unnecessary intervention to individuals who may already be experiencing health related
trauma. Thirty participants underwent either reflexology or no treatment (control), in a cross-
over experimental design. Selfreported anxiety (Spielberger STAI), cardiovascular parameters
(BP and pulse rate) and salivary cortisol and melatonin concentrations were assessed before
and after reflexology. Control data were obtained at the same time points in identical settings.
Reflexology had a powerful anxietyreduction effect ('state'; P<0.001) but no significant effect
on underlying anxiety ('trait'). Cardiovascular parameters decreased (P<0.001). Baseline
salivary cortisol and melatonin were not significantly correlated with STAI scores and did not
change significantly following reflexology. Reflexology reduced 'state' anxiety and
cardiovascular activity within healthy individuals, consistent with stress-reduction.
Considering the connection between stress/anxiety and well being, the effects of reflexology
may have beneficial outcomes for patients. These findings will be transferred to a study
involving breast cancer patients where effects may be more pronounced particularly since
cancer patients display disregulation of cortisol and melatonin secretion.

McVicar AJ, Greenwood CR, Fewell ''Arcy V, Chandrasekharan S, Alldridge LC,

"Evaluation, of anxiety cortisol and melatonin secretion following reflexology treatment: A
pilot study in healthy individuals," Complementary Therapeutic Clinical Practice 2007
Aug;13(3):137-45 Institute of Health and Social Care, Anglia Ruskin University, Bishop Hall
Lane, Chelmsford, Essex CM1 1SQ, UK. PMID: 17631256

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Birthing
Birthing, Labor outcomes

The objective of this study was to investigate the association of antenatal reflexology with
different outcomes in the intranatal period. A convenience sample of 150 low risk primigravid
women (reflexology group n = 50, control group receiving no reflexology treatment n = 100)
was included. The key variables of interest were onset of labour, duration of labour, analgesia
used and mode of delivery. The findings showed there was no significant difference in the
onset of labour or duration of labour between the two groups. The group who had four or
more reflexology treatments had a reduced length of labour but this was not statistically
significant. There was a significant difference in the use of Entonox between the two groups
with the reflexology group having a lower uptake. Fewer women in the reflexology group had
a normal labour with a higher percentage of women having a forceps delivery. ( On-line
comment: "The findings should not be taken as particularly significant clinical value since
some of the women received only one session of reflexology at 39 weeks." )
(http://www.expectancy.co.uk/docs/expectancyreview.pdf)

McNeill JA, Alderdice FA, McMurray F., "A retrospective cohort study exploring the
relationship between antenatal reflexology and intranatal outcomes," Complementary
Therapeutic Clinical Practice 2006; 12: 11925. (Queen's University, School of Nursing and
Midwifery, Belfast, Ireland)

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Birthing, Labor outcomes

Thirty-seven of 64 pregnant women, who were offered free reflexology, completed the set
course of ten treatments. The effects of reflexology on labor outcomes were perceived as
outstanding. Some had labor times of only 2 hours, some 3 hours. The 20 - 25 year olds had
an average time of First stage labor of 5 or 6 hours. The 26 - 30 year olds seemed to have the
longest labors. In total, the average first stage was 5 hours, second stage 16 minutes, and third
stage 7 minutes. This is compared to textbook figures of 16 to 24 hours' first stage, and, 1 to 2
hour's second stage. "The Effects of Reflexology on Labour Outcome," Dr. Gowri Motha and
Dr. Jane McGrath, Forest Gate, London, England, Nursing Times , Oct. 11, 1989

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Cancer
A review of eighteenteen studies conducted in seven countries (US, Korea, UK, Italy, Japan,
Switzerland, China, and Taiwan) showed that cancer patients experienced significant
improvements with common complaints (pain, anxiety, nausea, vomiting, and fatigue).
Different types of reflexoogy application showed posittive results including foot reflexology,
hand reflexology, self reflexology and partner reflexology. Results were immediate following
a ten-minute session in two studies and a thirty-minute session in another.

Those undergoing palliative care reported results from reflexology work: feeling "relaxed,"
"comforted" and achieving relief from some of their symptoms. All recounted improvements
in quality of life: "appearance, appetite, breathing, communication (doctors), communication
(family), communication (nurses), concentration, constipation, diarrhoea, fear of future,
isolation, micturition, mobility, mood, nausea, pain, sleep and tiredness."

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Cancer, Pain and nausea

Reflexology modifies the distressing symptoms of pain and nausea in patients hospitalized
with cancer. "87 patients participated in the study and each received a 10-minute reflexology
foot massage (5 minutes per foot). The results revealed that the treatments produced a
significant and immediate effect on the patients' perceptions of pain, nausea and relaxation
when measured with a visual analog scale. The use of reflexology foot massage as a
complementary method is recommended as a relatively simpler nursing intervention for
patients experiencing nausea or pain related to the cancer experience. The results were so
positive that the researchers recommend that further research using larger numbers of patients
in controlled clinical trials into its effectiveness of reflexology in alleviating pain, nausea and
anxiety in the management of these symptoms by the family at home is warranted."

Grealish, L. Lomasney, A., Whiteman, B., "Foot Massage: A nursing intervention to modify
the distressing symptoms of pain and nausea in patients hospitalized with cancer," Cancer
Nurse 2000, June;23(3):237-43

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Cancer, Pain and anxiety

Results of study: Foot reflexology alleviated anxiety and pain for twenty-three patients with
breast and lung cancer. Researchers noted a significant decrease in anxiety for patients
diagnosed with breast or lung cancer and a significant decrease in pain for patients with breast
cancer. "This has important implications for nursing practice as both professionals and lay
people can be taught reflexology. Reflexology is a simple technique for human touch which
can be performed anywhere, requires no special equipment, is non-invasive and does not
interfere with patients' privacy." For my dissertation

For my dissertation under the direction of Sally Weinrich, PhD, RN, FAAN, I used a
crossover design to compare reflexology with usual care in 23 inpatients with cancer. In 2001,
I studied 36 patients with cancer as part of my postdoctoral studies at the University of North
Carolina at Chapel Hill under the direction of Dr. Jo Ann Dalton, EdD, RN, FAAN. This
study found a significant decrease in pain and anxiety immediately following the intervention.
I was able to establish a reflexology dosage time of 30 minutes.

"A recent study (Stephenson, Weinrich, & Tavakoli, 2000) examined the effectiveness of a
single reflexology treatment for pain and anxiety. Patients with breast or lung cancer on an
inpatient oncology unit in a 314-bed hospital in the southeastern United States were included
in the study if they were 21 years or older, spoke English, and gave informed consent. A total
of 23 patients participated. Patients received one 30-minute reflexology treatment and a 30-
minute control without reflexology using a crossover design. The researcher administered the
Visual Analogue Scale (VAS) for anxiety and the Short Form-McGill Pain Questionnaire
(SF-MPQ) before and following both reflexology and control condition without reflexology.
The majority of people in the sample were female (62.2%), Caucasian (73.9%), 65 years and
older (78.3%), with 12 years or less education (69.5%), and with $20,000 or more annual
income (47.8%; 8.7% did not report income). All subjects were receiving regularly scheduled
opioids and adjuvant medications on both the control and intervention day (Stephenson,
Weinrich, & Tavakoli, 2000). Eleven of the 13 breast cancer inpatients (10 with metastasis, 1
without metastasis, and 2 unknown) reported pain. The study found a significant decrease in
pain, as measured by the descriptive words of the SF-MPQ in these patients following foot
reflexology (M= ?0.41, SD = 0.71, p = .048). The Gate Control Theory) GCT could explain
the decrease in the patients perceptions of pain. In addition, there was a significant decrease in
anxiety, as measured by the VAS for anxiety, following foot reflexology for both breast-
cancer patients (n = 13, M = ?17.38, \SD = 21.29, p = 0.01) and lung-cancer patients (n =
10,M= ?21.6, SD = 25.49, p = .02). The VAS for pain and the present pain intensity showed
no significant differences between the intervention and control conditions (Stephenson,
Weinrich, & Tavakoli, 2000). From Nancy L. N. Stephenson and Jo Ann Dalton "Using
Reflexology for Pain Management: A Review," 2003; 21; 179 J Holist Nurs, DOI:
10.1177/0898010103021002007

Stephenson, N. L., Weinrich, S. P. and Tavakoli, A. S., "The effects of foot reflexology on
anxiety and pain in patients with breast and lung cancer," Oncology Nursing Forum. 2000,
Jan.- Feb.;27(1):67-72 PMID: 10660924

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Cancer, Pain

Thirty-six oncology inpatients participated in this third pilot study investigating the effects of
foot reflexology in which equianalgesic dosing was calculated. Foot reflexology was found to
have a positive immediate effect for patients with metastatic cancer who report pain, although
there was no statistically significant effect at 3 hours after intervention or at 24 hours after
intervention. Further study is suggested for foot reflexology delivered by family in the homes
for management of cancer pain."

Stephenson N, Dalton JA, Carlson J, "The effect of foot reflexology on pain in patients with
metastatic cancer," Appl Nurs Res. 2003 Nov;16(4):284-6 PMID: 14608562

Cancer: Pain and anxiety (Partner-delivered reflexology)

Purpose/Objectives: To compare the effects of partner-delivered foot reflexology and usual

care plus attention on patients' perceived pain and anxiety.

Design: The experimental pretest/post-test design included patient-partner dyads randomly

assigned to an experimental or control group.

Setting: Four hospitals in the southeastern United States. SAMPLE: 42 experimental and 44
control subjects comprised 86 dyads of patients with metastatic cancer and their partners,
representing 16 different types of cancer; 23% of patients had lung cancer, followed by breast,
colorectal, and head and neck cancer and lymphoma. The subjects had a mean age of 58.3
years, 51% were female, 66% had a high school education or less, and 58% were Caucasian,
40% were African American, and 1% were Filipino.

Methods: The intervention included a 15- to 30-minute teaching session on foot reflexology
to the partner by a certified reflexologist, an optional 15- to 30-minute foot reflexology
session for the partner, and a 30-minute, partner-delivered foot reflexology intervention for
the patient. The control group received a 30-minute reading session from their partners. Main
research variables: Pain and anxiety.

Findings: Following the initial partner-delivered foot reflexology, patients experienced a

significant decrease in pain intensity and anxiety.

Conclusions: A nurse reflexologist taught partners how to perform reflexology on patients

with metastatic cancer pain in the hospital, resulting in an immediate decrease in pain
intensity and anxiety; minimal changes were seen in the control group, who received usual
care plus attention. Implications for Nursing: Hospitals could have qualified professionals
offer reflexology as a complementary therapy and teach interested partners the modality.

Stephenson NL, Swanson M, Dalton J, Keefe FJ, Engelke M., Oncology Nursing Forum.
2007 Jan;34(1):127-32. (School of Nursing, East Carolina University, Greenville, NC, USA.
stephensonn@ mail.ecu.edu) PMID: 17562639

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Cancer (Radiotherapy patients): Fatigue (Hand reflexology)

Purpose: The purpose of this study was to identify the effect of hand reflexology on fatigue
and emotional state in cancer patients receiving radiotherapy.

Method: This study was designed with non-equivalent control group pre and post test.
Subjects were 29 patients who receiving radiotherapy in one hospital. Fifteen patients were
assigned to the experimental group, and fourteen to the control group. The hand reflexology
was applied to both hands for ten minutes each time, five times during five days. For data
collection, questionnaires for fatigue, anxiety, mood, blood pressure, and pulse rate were
measured before and after the program. For data collection, questionnaires for fatigue,
anxiety, mood, blood pressure, and pulse rate were measured before and after the program.
The degree of fatigue, anxiety, and mood state in the experimental group were significantly
lower than that of the control group. The systolic blood pressure and pulse rate in the
experimental group were lower than that of the control group, but diastolic blood pressure in
the experimental group were not significantly lower than that of the control group.

Conclusion: Hand Reflexology could be an effective nursing intervention for cancer patients
suffering from fatigue, emotional states from radiotherapy. And it can help cancer patients to
receive radiotherapy with lower degrees of side effects.

Kim Myung Ae, Kim Su Jung, Kim Su Jin, Kim Yang Ji, (Keimyung University College of
Nursing, Korea) "Effects of Hand Reflexology on Fatigue and Emotional State in Cancer
Patients Receiving Radiotherapy," Article 8 issue of Science nursing commandment No. 1,
2004. pp. 39- 47

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Cancer: Nausea and vomiting (Self-reflexology, bamboo stepping)

Objective: To investigate the bamboo stepping, a self-reflexology technique consisting of

stepping in place on the rounded side of halved bamboo for cancer chemotherapy-induced
nausea and vomiting effect.

Methods: 240 cases of cancer chemotherapy patients were randomly divided into bamboo
stepping group (120 cases) and the control group (120 cases). Bamboo stepping for treatment
of cancer patients undergoing chemotherapy nurses guidance biped barefoot stampede
(stepping) bamboo rolling massage, each 20 to 30 min until Juxin fever, three times daily to
observe nausea, vomiting improve the situation and assess. The physical state of the control
group did not undergo bamboo stepping.
Results: Bamboo stepping effectual 75 cases (62.50%), effective 34 cases (28.33%) and the
overall efficiency of 90.83%, the ?2 test, P=0.05, Bamboo stepping efficacy superior to the
control group group.

Conclusion: Bamboo stepping treatment of cancer chemotherapy-induced nausea and

vomiting significant effect. Bamboo massage for economic, simple, chemotherapy for cancer
patients to accept.

Wang Cui Cheng Rui Dan, Cai Rong-hua, Chin Chu, "Reflexology bamboo massage for the
treatment of cancer chemotherapy-induced nausea and vomiting effect of Š," Modern Nursing
in 2007 , 33

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Cancer, Post-operative pain

Even after receiving analgesia, patients with gastric and liver cancer still report moderate
levels of postoperative pain. The purpose of the study was to investigate the efficacy of foot
reflexotherapy as adjuvant therapy in relieving pain and anxiety in postoperative patients with
gastric cancer and hepatocellular cancer. The study design was a randomized controlled trial.
Data were collected from 4 surgical wards of a medical center in 2005 in Taipei, Taiwan.
Sixty-one patients who had received surgery for gastric cancer or hepatocellular carcinoma
were randomly allocated to an intervention (n = 30) or control (n = 31) group. Patients in the
intervention group received the usual pain management plus 20 minutes of foot
reflexotherapy during postoperative days 2, 3, and 4. Patients in the control group received
usual pain management. Outcome measures included the short-form McGill Pain
Questionnaire, visual analog scale for pain, summary of the pain medications consumed, and
the Hospital Anxiety and Depression Scale. Results demonstrated that studied patients
reported moderately high levels of pain and anxiety postoperatively while patients were
managed with patient-controlled analgesia. Using generalized estimation equations and
controlling for confounding variables, less pain (P < .05) and anxiety (P < .05) over time were
reported by the intervention group compared with the control group. In addition, patients in
the intervention group received significantly less opioid analgesics than the control group (P <
.05). Findings from this study provide nurses with an additional treatment to offer
postoperative digestive cancer patients.

Tsay, Shiow-Luan PhD, RN; Chen, Hsiao-Ling MS, RN; Chen, Su-Chiu MS, RN; Lin, Hung-
Ru PhD, RN; Lin, Kuan-Chia PhD, "Effects of Reflexotherapy on Acute Postoperative Pain
and Anxiety Among Patients With Digestive Cancer," Cancer Nursing . 31(2):109-115,
March/April 2008

Cancer: Nausea, vomiting and fatigue

Purpose: The purpose of this study was to identify the effects of foot reflexology on nausea,
vomiting and fatigue in breast cancer patients undergoing chemotherapy.

Method: The research was a quasi-experimental study using a non-equivalent pre-post design
and was conducted from Jan. 26, to Mar. 20, 2004. The subjects consisted of 34 patients with
18 in the experimental group and 16 in control group. A pretest and 2 posttests were
conducted to measure nausea, vomiting and fatigue. For the experimental group, foot
reflexology, which was consisted of 4 phases for 40 minutes, was given by a researcher and 4
research assistants. The collected data were analyzed by repeated measures ANOVA using the
SPSS WIN 10.0 program.

Results: There was a statistically significant decrease in nausea, and vomiting in the
experimental group compared to the control group over two different times. In addition, there
was a statistically significant decrease in fatigue in the experimental group compared to the
control group over two different times.

Conclusion: Foot reflexology was effective on nausea, vomiting and fatigue in breast cancer
patients receiving chemotherapy in this study. Therefore, foot reflexology can be usefully
utilized as a nursing intervention in the field of cancer nursing for breast cancer patients
receiving chemotherapy."

Yang JH., "The effects of foot reflexology on nausea, vomiting and fatigue of breast cancer
patients undergoing chemotherapy" (Korean), Taehan Kanho Hakhoe Chi . 2005
Feb;35(1):177- 85

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Cancer: Vital signs, general fatigue, mood and foot fatigue

Purpose: This study was done to investigate the effect of foot reflexology on vital signs,
general fatigue, mood and foot fatigue in cancer patients receiving chemotherapy.

Method: Data were collected from a convenience sample of 11 patients who were admitted at
S and E University Hospital. Changes in systolic blood pressure (SBP), diastolic blood
pressure (DBP), pulse rate (PR), general fatigue, mood status, and foot fatigue between pre
and post foot reflexology were analyzed using Wilcoxon signed rank test and Friedman test at
0.05 level of significance.

Results: There were significant differences in the SBP(p=.009), DBP(p=.014), PR(p=.015),

general fatigue (p=.015), mood status(p=.007), and foot fatigue(p=.007) between pre and post
foot reflexology.

Conclusion: Foot reflexology can improve vital signs, general/foot fatigue, and mood status,
therefore we recommend to use foot reflexology as an effective nursing intervention in cancer
patients receiving chemotherapy.

Won JS, Jeong IS, Kim JS, Kim KS.,"Effect of Foot Reflexology on Vital Signs, Fatigue and
Mood in Cancer Patients receiving Chemotherapy," J Korean Acad Fundam Nurs . 2002
Apr;9(1):16-26. Korean. Department of Nursing, Seoul Health College, Korea; Department of
Nursing, College of Medicine, Pusan National University, Korea; Head Nurs of GS Dept,
Dondaemoon Hospital of Ewha Woman's University, Korea; College of Nursing, Seoul
National University, Korea. kimks@snu.ac.kr

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Cancer: Anxiety
Aim: To examine the effectiveness of reflexology foot massage in hospitalized cancer patients
undergoing second or third chemotherapy cycles

Background: Since the late-1970s, studies have been conducted to assess the efficacy of
behavioral and relaxation approaches in controlling nausea/vomiting, anxiety and other side-
effects associated with chemotherapy.

Methods: The study consisted of 30 patients being admitted to the oncology unit at a
Scientific Research Hospital in Italy. Only 15 of the 30 participants received therapeutic
massage. The subjects' self-reports of anxiety (measured by the Spielberger State-Trait
Anxiety Inventory) were recorded before, after and 24 hours after the intervention.

Results: There was an average decrease of 7.9 points on the state-anxiety scale in the
treatment group and of 0.8 points in the control group (P < 0.0001).

Conclusions: Reflexology foot massage can be considered a support treatment used in

combination with traditional medical treatments and executed by an expert, qualified person
to help cancer patients receiving chemotherapy feel better and also cope better with their
disease.

Quattrin, R, Zanini A, Buchini S, Turello D, Annunziata D, Vidotti, C, Colobatti A,

Brusagerro S, "Use of reflexology foot massage to reduce anxiety in hospitalized cancer
patients in chemotherapy treatment: methodology and outcomes," Journal of Nursing
Management 2006 Mar;14(2):96- 105 Chair of Hygiene, DPMSC School of Medicine,
University of Udine, Udine, Italy. r.quattrin@ med.uniud.it; PMID: 16487421

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Cancer, Quality of life

Results of study: 100% of the reflexology group benefited from an improvement in quality of
life: appearance, appetite, breathing, communication (doctors), communication (family),
communication (nurses), concentration, constipation, diarrhoea, fear of future, isolation,
micturition, mobility, mood, nausea, pain, sleep and tiredness. Within the reflexology group,
the participants reported an improvement in all components of the quality of life scale
compared to 67. 5 in the placebo group. Nevertheless, this study would suggest that the
provision of reflexology for palliative patients within the general setting could be beneficial.
Not only did the patients in this study enjoy the intervention, they were also "relaxed,"
"comforted" and achieved relief from some of their symptoms.

Hodgson, H. "Does reflexology impact on cancer patients' quality of life?," Apr. 2000,
Nursing Standard , 14, 31, pp. 33-38

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Cancer: Fatigue (Reflexology, aromatherapy, footsoak)

Fatigue is one of the most distressful symptoms experienced by patients with advanced
cancer. Aroma therapy, footsoak, and reflexology are popular health care modality treatments
in Japan, however, the effectiveness of each treatment for cancer-related fatigue has not been
fully established.

Design and Subjects: To investigate the effectiveness of combined modality treatment

consisting of aromatherapy, footsoak, and reflexology against fatigue, an open study was
performed in 20 terminally ill patients with cancer. After a patch test was performed, patients
received aromatherapy that was accompanied with footsoak in warm water containing
lavender essential oil for 3 minutes, followed by reflexology treatment with jojoba oil
containing lavender for 10 min. Fatigue was evaluated using the Cancer Fatigue Scale (CFS)
before, 1 hour after, and 4 hours after treatment.

Results: Total CFS scores improved significantly after this treatment (from 25.6 +/- 11.0 to
18.1 +/- 10.0, p < 0.001). Among three CFS subscales, physical and cognitive subscale scores
were reduced significantly (11.3 +/- 6.1 to 6.7 +/- 6.1, p < 0.001; 4.5 +/- 3.2 to 2.4 +/- 2.4, p <
0.001). No adverse effects were experienced. Because all patients desired to continue this
treatment, they received treatment eight times on average.

Conclusions: Combined modality treatment consisting of aromatherapy, footsoak, and

reflexology appears to be effective for alleviating fatigue in terminally ill cancer patients. To
confirm safety and effectiveness of this combined modality treatment, further investigation
including randomized treatment assignment is warranted."

Kohara H, Miyauchi T, Suehiro Y, Ueoka H, Takeyama H, Morita T., "Combined modality

treatment of aromatherapy, footsoak, and reflexology relieves fatigue in patients with cancer,"
Journal Palliative Medicine , 2004 Dec;7(6):791-6. (Department of Internal Medicine,
Palliative Care Unit, National Sanyo Hospital, Yamaguchi, Japan. hkohara@bk4.so-net.ne.jp)
PMID: 15684846

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Cancer: Hospice

Complementary therapies are being accessed increasingly by cancer patients. The aims of this
audit were to investigate the impact of reflexology on the quality of life of 20 cancer patients,
to determine their satisfaction with the service provided and to investigate the availability of
this therapy within Scottish hospices. The audit findings suggest that the clients were satisfied
with the service received. Respondents noted that their quality of life was improved through a
reduction in physical and emotional symptoms. It was found that the provision of reflexology
within Scottish hospices varied, with less than half providing this service. The results of this
audit suggest that reflexology may be a worthwhile treatment for other cancer patients and
requires further research to evaluate the benefits

Milligan M, Fanning M, Hunter S, Tadjali M, Stevens E, Int J Oalliat Nurs 2002

Oct;8(10):489- 96 (PMID: 12419988)

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Initiating an Inpatient Cancer Oncology Program for Reflexology

A 2003 Oncology Nursing Forum article details "the step-by-step process of initiating a
program for reflexology and healing touch interns to serve the oncology inpatient population
at Methodist Hospital ( in Minneapolis, Minnesota)." The program addressed goals of
utilizing CAM (Complementary Alternative Medicine); to "offer these therapies along with
traditional treatment in a caring, competent manner that is fiscally responsible." Reflexology
and healing touch were selected because of research showing effectiveness in "relieving
cancer symptoms" and the interest of the nursing staff. "Both the healing touch practitioner
and the reflexologist contacted local schools of complementary therapy to ascertain the
availability of interns and their interest in doing their clinical practicums in the hospital with
patients with cancer."

"A total of 113 patients participated in the program. Sixty-seven percent were female. About
60% of the participants were hospitalized for cancer management, with the remainder
hospitalized for medical and postsurgical diagnoses. Some patients had more than one
treatment over the course of their hospitalization (the certification practicum included treating
patients multiple times). A total of 83 healing touch treatments were given to 48 patients, and
113 reflexology treatments were given to 53 patients. Twelve patients had both healing touch
and reflexology treatments.

"The committee was pleased to find that the patients who received reflexology reported less
pain, nausea, stress, anxiety, and depression; they also expressed increased feelings of well-
being and peacefulness. Every patient reported that he or she would recommend the treatment
to other patients. Patients who received healing touch treatments reported that every symptom
they had experienced before the treatment was lessened after treatment. Following treatment,
they reported that they felt a greater sense of well-being and peacefulness. Both men and
women reported positive benefits." "Leadership and Professional Development" by Ellen
Giarelli, EdD, RN, CS, CRNP and Terry A. Throckmorton, RN, PhD, Associate Editors
"Initiating a Complementary Therapy Internship Program on an Inpatient Oncology Unit,"
Vicki Norton, RN, BSN, OCN®, and Carol P. McPherson, MSW, MPH, Oncology Nursing
Forum, March/April 2003, Volume 30, Number 2 See full report at:
http://www.ons.org/Publications/journals/ONF/Volume30/Issue2/3002213.asp

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Pilot Program: an Outpatient Cancer Oncology Program for Reflexology

A complementary therapy program in oncology was launched by two hospitals in the Cape
Cod HealthCare (CCHC) system in 2001. Two pilot studies using complementary therapies
with chemotherapy outpatients were conducted to evaluate patient benefit. The program has
grown to include three locations, including radiation therapy. Two nurses, trained in
complementary therapies, provide these services.

CCHC executive management decided to explore options for integrating complementary

therapy in oncology in 2000. A consultant provided background information, and the
oncology nurse manager assumed project oversight. The cancer leadership team approved a
three-month pilot offering five to fifteen minutes of gentle massage to interested patients in
the infusion room two days a week. The goal was to offer a voluntary, non-invasive and
holistic opportunity for patients to experience increased comfort and relaxation in the midst of
their treatment experience. The purpose of the study was to assess patient and staff
satisfaction. The findings from the pilot (n = 50) demonstrated an extremely high level of
patient satisfaction with 100% of respondents saying that massage therapy services should
continue to be offered. Trends included reports of decreased pain, nausea, and anxiety, and
increased physical comfort and overall well-being. In addition, staff reported benefit to their
patients, improvement of patient symptoms, no disruption in their job responsibilities, and a
consensus that massage therapy services should continue to be made available to patients.

At the conclusion of the pilot, the cancer leadership team approved expanded services to
medical oncology and the inclusion of radiation therapy. The hours of service were doubled to
20/week. A three-month pilot study was then conducted at the other CCHC outpatient
chemotherapy clinic (n = 47), and included additional modalities (reflexology, aromatherapy,
and therapeutic touch). Findings demonstrated an equally high level of satisfaction with 100%
of patients requesting that services be continued. Services average an additional 10
hours/week at this facility. The hospitals assume the full cost of the program, and hospitals'
complementary therapy committee credentials the holistic nurses. Plans to expand the
program are under consideration and include offering services to oncology inpatients as well
as hospice and palliative care patients.

"Launching a Complementary Therapy Program in Oncology: A Nursing Initiative in Holistic

Care," Judith Kostka, RN, MS, MBA, and Barbara Coughlin, RN, LMT, Cape Cod Hospital,
Hyannis, MA; and Jeanne Jackson, RN, Falmouth Hospital, Falmouth,
MA.http://www.ons.org/ ceCentral/Conferences/abstracts/2003abstracts3.shtml

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Cancer: End of life care

"In Switzerland, many new nurses are taught this approach. When applied skillfully, a
reflexology massage is pleasantly relaxing and able to diminish painful sensations in the
body. Given the number of uncontrollable variables involved in the decrease of pain and the
establishment of a feeling of relaxation, our small study has no scientific value. It was only
intended to motivate nurses to look for ways to integrate aspects of alternative care in the
management of terminal patients.... "Our purpose for using reflexology with these patients
was to decrease their pain but we soon realized the beneficial effect of reflexology on the
morale of patients and families. Something was being done for them. Patients expressed
feelings of being less abandoned and the families expressed satisfaction at seeing that
something painless existed that could aid their relative. In three situations we taught a relative
how to use reflexology and the benefit seemed to have been as important for the relative as for
the patient.... "Patients' comments about reflexology seem to show that it could be one way
for them to feel this support and to have a helping presence near them in their last days."

Dobbs, Barbara Zeller, "Alternative health approaches," Nursing Mirror (England), Vol. 160,
No. 9, Feb. 27, 1985

Dobbs, Barbara Zeller, "Alternative health approaches," Nursing Mirror (England), Vol. 160,
No. 9, Feb. 27, 1985

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Cancer: Feasibility of a randomised clinical trial

Purpose/Objectives: To evaluate patient characteristics to predict selection and maintenance
of a complementary therapy and the feasibility of a randomized clinical trial (RCT) of
complementary therapies.

Design: Quasi-experimental, exploratory study, unblinded and nonrandomized.

Setting: A comprehensive cancer center in Michigan.

Sample: 96 patients undergoing chemotherapy, predominantly Caucasian women.

Methods: Consenting patients with caregivers could choose a reflexology, guided imagery,
guided imagery plus reflexology, or interview-only group. Patients without caregivers were
restricted to guided imagery or interview-only groups. Data on demographics, depression,
anxiety, and functional status were collected using established instruments.

Main Research Variables: Quality of life (QOL) and patient characteristics in relation to
complementary therapy choice

Findings: Patients who chose a complementary therapy rather than an interview only tended
to be older and in worse health and had higher percentages of lung cancer, late-stage cancers,
higher anxiety, depressive symptoms, and physical limitations at baseline. Patients lost from
the guided imagery and guided imagery plus reflexology groups had greater symptom
severity, depressive symptoms and anxiety, and worse physical and emotional well-being than
those lost from the reflexology group.

Conclusions: Patient characteristics influence choice of complementary therapies,

highlighting the need for RCTs to evaluate the true effect of complementary therapies on the
QOL of patients with cancer. Further research on complementary therapies can help
healthcare providers identify patients who are likely to benefit most by addressing nursing-
sensitive outcomes.

Implications for Nursing: An RCT of reflexology as a single therapy for females with breast
cancer is most feasible compared to other complementary therapies

Wyatt G., Sikorskii A, Siddiqi A, Given CW, "Feasibility of a reflexology and guided
imagery during chemotherapy: results of a quasi-experimental study, Oncol Nurs Forum,
2007 May; 34(3):635-42 The College of Nursing, Michigan State University, East Lansing,
MI, USA. gwyatt@msu.edu; PMID: 17573322

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Cancer: Guided imagery, reflexology, reminiscence therapy

The purpose of this observational pre-/post test design was to compare outcomes of patients
undergoing chemotherapy for cancer who received standard care with those who received
standard care plus an eight-week program of complementary therapies, including: (1) guided
imagery (healing images set to music), and/or (2) reflexology (10-minute massage of each
hand or foot)., and/or (3) reminiscence therapy (family storytelling discussions between the
patient and the family caregiver). To be eligible, participants had to be 21 years of age or
older, and be willing to engage in the complementary therapy program during chemotherapy.
Family caregivers participated in the intervention with their family member (patient). An
educational session for the complementary therapies was provided to the family caregiver and
patient at the initial chemotherapy appointment, with 4 reinforcement sessions over an 8-week
period. The Wyatt Quality of Life Model guided this study. The intervention group was
compared on the following variables: depression, anxiety, spirituality, and patients' reports of
quality of life. Findings indicate that: (1) patients who used one or more complementary
therapy experienced lowered levels of depression (<.024) and anxiety (p<.006) over time; and
(2) patients who used one or more complementary therapies experienced increased levels of
spirituality (p<.019), emotional quality of life (p<.000) and total quality of life (p<.000).
Findings from this study will be used as a model for designing future randomizes clinical
trials that utilize complementary therapies with cancer patients who are undergoing treatment.
AN: MN030250

Gwen K. Wyatt, Sharon Kozachik, Charles W. Given, Barbara Given, "Outcomes of

Complementary Therapy Use by Cancer Patients and Family Members," Midwest Nursing
Research Society Conference, 2003

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Constipation in children
184 children (ages 1 to 12) with chronic idiopathic constipation were randomly assigned to
one of three groups: standard care and reflexology; standard care and foot massage; or
standard care. Parents and carers of two groups were taught either foot reflexology or foot
massage. Treatments were followed for twelve weeks. Outcome was measured by a self
reporting constipation questionnaire considering "the increase in the mean number of bowel
movements and improvements in constipation symptoms at 12 weeks: soiling, pain,
medication in use, general health status, and behavior per four week period." Results showed
"significant differences between Reflexology and Control groups in bowel frequency (p,0.05)
and total constipation symptom score at 12 weeks (p,0.05); there was a significant difference
between reflexology and massage for total constipation symptom score (p,0.05) but not for
bowel frequency (p = 0.25). There was no significant difference between control and massage
groups (p = 0.16 and 0.99). "It was concluded that "reflexology is effective in improving
outcomes for children when used as an adjunct to standard treatment."

J. S. Gordon1, E. M. Alder1, G. Matthews-Smith1, I. Hendry1, D. C. Wilson3. "The

effectiveness of reflexology as an adjunct to treatment in childhood idiopathic constipation: A
single blind randomised controlled trial, Archives of Disease in Childhood: Volume 91
Supplement 1 April 2006p A13" 1 Napier University, Faculty of Health & Life Sciences,
Edinburgh, UK; 2 Department of Nursing, Royal Hospital for Sick Children, Edinburgh, UK;
3 Department of Child Life & Health, University of Edinburgh, Edinburgh, UK

Purchase abstract (US$32) at http://bit.ly/8IoN6U

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Coronary Artery Bypass Graft (Anxiety)

Aim. Our purpose was to pilot test whether reflexology may reduce anxiety in patients
undergoing Coronary Artery Bypass Graft Surgery in Iceland. Background. Nurses need to
study the effects of complementary therapies in general and particularly those that may be
beneficial to decrease patients' anxiety. It has been assumed that reflexology lessens anxiety,
but research is needed to substantiate such expectations.

Design. A pilot study using randomized design with experimental and control groups.
Methods. Nine patients were recruited and randomly assigned into groups with five patients
assigned into an experimental group receiving reflexology for 30 minutes and four patients
into control group which rested for 30 minutes. Anxiety and physiological variables were
measured pre- and postreflexology sessions once a day over five days.

Results. The anxiety scores were lower for patients in the control group on all measures.
Systolic blood pressure lowered significantly more in the control group than in the treatment
group. No significant changes were observed for other variables. Patients' comments and
responses overwhelmingly suggested increased well-being due to both experimental and
control intervention. Conclusion. This study showed little evidence to support reflexology as a
mean of reducing anxiety in CABG patients. Several methodological problems were
identified that need to be considered further. Relevance to clinical practice. It is suggested that
reflexology should be tailored to individual needs and research methods used that allow for
capturing its holistic nature. Further scholarly work is warranted to explore several
methodological issues in studying complementary therapies in a highly complex treatment
situation.

Gunnarsdottir TJ, Jonsdottir H. Does the experimental design capture the effects of
complementary therapy? A study using reflexology for patients undergoing coronary artery
bypass graft surgery. Journal Clinical Nursing 2007 Apr;16(4):777-85. School of Nursing,
University of Minnesota, MN, USA and Faculty of Nursing, University of Iceland, Reykjavik,
Iceland. PMID: 17402960

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Dementia
Learning Objective #1: Identify three biomarkers of physiologic stress in the physically and
cognitively frail older population.

Learning Objective #2: Describe the effects of a reflexology intervention in a nursing home
population.

Introduction: Alternative therapies may offer great promise in treating distress in older adults
with dementia without the side effects of pharmaceuticals. A growing body of anecdotal
literature suggests that reflexology may be an effective treatment for older adults with
dementia, appearing to relieve pain and improve psychological well being.

Methods: This experimental repeated-measures study of 80 subjects (40 control and 40

experimental) with mild to moderate dementia randomized to experimental and control groups
was designed to test the efficacy of reflexology as an alternative and complementary therapy
in nursing home residents with mild to moderate dementia. The reflexology sessions and
control group intervention was provided by a trained reflexology therapist once a week for 4
weeks, and lasted 30 minutes each. Physiologic stress was assessed using blood pressure,
heart rate, and salivary measures of cortisol, alpha amyase and DHEA. Measures of pain,
anxiety and depression were assessed using standardized indexes by trained data collectors
blind to subject group assignment. Results: Analysis of variance for repeated measures
demonstrated a significantly greater decrease in symptoms of pain, depression and
physiologic measures of stress for the residents given reflexology treatment than for those in
the control group.

Conclusion: These clinical findings support the use of reflexology in nursing home residents
with mild/moderate dementia.

Nancy A. Hodgson, RN, PhD, CS1, Susan Andersen, BS2, and Heather Felker2. "Efficacy of
Reflexology as a Palliative Treatment in Nursing Home Residents with Dementia: A Pilot
Study" Presented at the 17th International Nursing Research Congress Focusing on Evidence-
Based Practice (19-22 July 2006) (1) Madlyn and Leonard Abramson Center for Jewish Life,
Polisher Research Institute, North Wales, PA, USA, (2) Research, Polisher Research Institute
(formerly the Philadelphia Geriatric Center), Horsham, PA, USA

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Depression
Purpose: The purpose of this study was to evaluate the effect of an Oriental self-help group
program on living-alone elders in rural areas.

Method: A one-group pretest-post test design was used. The subjects of the experimental
group participated in the oriental self-help program, health education, feet bathing in hot
water, cupping therapy, and foot-reflexology. The obtained data were analyzed using the
Wilcoxon signed rank test and Pearson correlation coefficients of SPSS.

Results: 1) The level of blood triglyceride, SGOT and glucose decreased significantly in the
experimental group compared to the control group. 2) The scores of depression and stress
decreased significantly in the experimental group compared to the control group. 3) The score
of Yangsaeng increased significantly in the experimental group compared to the control
group. 4) Depression was higher when the score of stress was high, and the score of
depression and stress were lower when the score of Yangsaeng was high.

Conclusion: Considering the results of this research, the program is effective in improving
physiological indexes partially, emotional indexes and Yangsaeng. Therefore this program
can be implemented as a community-based self-help group program for living-alone elders in
rural areas.

The Effect of Oriental Self-help Group Program for the Living Alone-Aged Inhabiting Rural
Region, Journal of Korean Academy of Community Nursing , Vol. 18, No. 2, 2007 Wang,
Myoung-Ja*?Park, Shin-Ae* Myung, Tae-Ok**?Cha, Nam-Hyun*** * College of Nursing
Science, Kyunghee University.** Public Health Center, Yangju City. *** Department of
Nursing, Kaya University

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Diabetes
Diabetes: Peripheral blood circulation, peripheral neuropathy (Self foot
reflexology)

Purpose: This study was done to investigate the effect of self-foot reflexology on peripheral
blood circulation, peripheral neuropathy and to determine the feasibility of self-foot
reflexology as a nursing intervention.

Method: This was non equivalent control pretest-posttest study with 76 patients with type 2
diabetes mellitus (ages between 40-79) recruited from public health centers in Busan city.
Intervention was a 6 week self-foot reflexology, and outcome variables were peripheral blood
circulation and peripheral neuropathy (tactile response to monofilament, intensity of
symptoms of peripheral neuropathy). ANCOVA was used to do the statistical analysis. A .05
significance level was set for evaluating the effects of self-foot reflexology.

Results: The self-foot reflexology was relatively effective not only in reducing peripheral
neuropathy (especially tingling sensation and pain) but also in improving ability to sense the
10-g force monofilament.

Conclusion: Even though self-foot reflexology was not effective in improving peripheral
circulation, it had good effect on improving peripheral neuropathy. Therefore self-foot
reflexology can be used as a nursing intervention program for promoting foot care for patients
with DM patients. Jeong IS., "Effect of Self-Foot Reflexology on Peripheral Blood
Circulation and Peripheral Neuropathy in patients with Diabetes Mellitus," Journal of Korean
Acad Fundamental Nursing 2006 Aug;13(2):225-234. Korean. College of Nursing, Pusan
National University, Korea. jeongis@pusan.ac.kr

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Diabetes: Vital signs, general fatigue, foot fatigue, mood, and blood glucose
levels

Purpose: This study was done to investigate the effect of foot reflexology on vital signs,
general fatigue, foot fatigue, mood, and blood glucose levels in noninsulin dependent patients.

Method: The Research design of this study was nonequivalent control group quasi-
experimental design. 18 patients were assigned to the experimental group, 24 patients to the
control group. The data were obtained diabetic patients with ambulatory endocrine outpatients
clinic patients from 40 years old to 70 years old. Experimental groups received foot reflex
massage for 30minutes three times/week every other days, and Control groups did not
received foot reflex massage. The dependent variables were blood pressure, pulse rate. visual
analogue scale for general fatigue, foot fatigue, mood. and blood sugar levels. Data were
analyzed with chi2test. t-test and repeated measure ANOVA at .0.05 level of significance.

Results: There were significant difference in the pulse rate, general fatigue. foot fatigue and
mood according to group and time between pre and post foot reflexology. But this research
did not prove to decrease blood sugar levels.
Conclusions: Foot reflexology can improve pulse rate, general and foot fatigue, and mood
status in diabetic patients. So further research need to explore the effect of decreasing of
blood sugar levels.

Kim KS, "Effect of Foot Reflex Massage on Stress Responses, and Glucose Level of Non-
Insulin Dependent Diabetes Mellitus Patients," Korean J Rehabil Nurs. 2003 Dec;6(2):152-
163. Korean.

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Encopresis
Nurses at Ayshire & Arran Acute Hospitals Trust (six hospitals in the National Health System
in Scotland) found that reflexology successfully treated children the condition of encopresis
or fecal incontinence, secondary to constipation / stool withholding. Encopresis is an
"extremely distressing condition." Children are subject to ridicule from other children and
misery is caused to the whole family. Typical treatment includes enemas and laxatives. "An
observational study was carried out of 50 children between three and 14 years of age who had
a diagnosis of encopresis/ chronic constipation. The children received six sessions of 30-
minutes of reflexology to their feet. With the help of their parents they completed
questionnaires on bowel motions and soiling patterns before, during and after the treatment."

Methods: "Detailed histories of frequency of bowel motions and soiling were obtained from
each participant on entering the study to establish a baseline. Existing medications were
unaltered. The questionnaires were designed to record the number of bowel motions and
incidence(s) of soiling in each seven-day period before, during and after the six-week period
of treatment sessions. Parents were surveyed regarding their attitude towards the use of
reflexology before and after the course of treatment."

Results: The incidence of soiling decreased and bowel motions increased following the
application of reflexology:

Soiling before: 78% once daily; 16% once to three times a week; 6% none in a seven day
period

Soiling after: 20% once daily; 30% once to three times a week; 48% none in a seven day
period; 2% (missing data)

Bowel motions before: 36% none in a seven day period; 46% 1-4 motions per week; 18%
daily

Bowel motions after: 2% none in a seven day period; 72% more than 1-4 motions per week;
24%daily

"In the last two years (following the study conducted from June 1998 to July 1999) the
community nurses have ceased giving enemas to children at home. Reflexology for childhood
encopresis and chronic constipation is now an established service with five paediatricians and
two staff grade doctors referring children of all ages for treatment."
"Reflexology in the management of encopresis and chronic constipation," Pedeatric Nursing ,
April 2003, Vol 15 No. 3 http://216.239.53.100/search?
q=cache:ZbjisK7w7igJ:www.nursingstandard.
co.uk/archives/pn_pdfs/pnvol15n3/pnv15n3p2021.pdf+reflexology+ research+
%2Bnursing&hl=en&ie=UTF-8

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Fatigue and sleep states (self reflexology)

Purpose: This study examined the effects of self-foot reflexology (SFR) on fatigue and sleep
states in clinical women nurses.

Method: This study was a nonequivalent pretest-posttest quasi-experimental. Women nurses

were assigned to an experimental group (EG, n=20) or a control group (CG, n=20). The EG
participated in SFR for a total of 40 minutes, 2 times per week during 4 weeks on their right
& left feet. The CG did not receive SFR during the research period. The EG & CG had never
before received SFR, and they had no open wounds or fractures. Data was analyzed using the
chi-square-test, and t-test by the SPSS version 12.0 program at a 5% significant level.

Result: The score of fatigue in the EG was significantly lower than that of the CG and the
score of sleep states in the EG was also significantly higher than that of the CG.

Conclusion: The findings show that the score of fatigue decreased and sleep states increased
in the study. Therefore, we should consider SFR as an intervention on clinical nurses.
However, it is still needed to verify its effects through more intensive study.

Ko YS, Park MK., "Effects of Self-foot Reflexology on Fatigue and Sleep States in Women
Nurses," Korean J Women Health Nurs. 2007 Mar;13(1):21-27. Korean. Department of
Nursing, Kwangyang Health College, 233-1, Dukrye-ri, Kwangyang-eup, Kwangyang-si,
Chonnam, Korea. sook4095@hanmail.net; Department of Nursing, Nambu University, Korea.

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Hemodialysis: Physiologic, emotional & motivational

responses and immunity
The purpose of this study was to identify the Effect of Hand Reflexology on Saeng-chi of
physiologic, emotional & motivational responses and immunity in ESRD patients who
received hemodialysis in two general hospital from June to September, 2001. A two group
quasi-experimental research with pre and post test design was used. The number of
participants in the experimental group was 23, and in the control group, 20. The Hand
Reflexology Intervention was developed by the researcher based on hand reflexology by
Carter & Weber and Chi-massage by Chia. The Hand Reflexology was applied to both hands
for 10 minutes per day, and 5 days by 5 times. To evaluate the effects of the program, pre and
post evaluations were done. In the physiologic response, the PR was decreased at the 1st times
post treatment and at the 5th. In addition BP was decreased at the 1st time, but not the 5th.
After 5 treatments, there were significant increase in Hb and significant decreases in the BUN
and Cr. levels in the experimental group. In the emotional and motivational responses, there
were significant increases in vigor, mood, uplifts and self care agency scores in the
experimental group. but there was no significant difference in the Rosenberg's self esteem
score.In the experimental group, significantly increased CD4, and h/s ratios were found, also
NK cells were significantly decreased, and there was a decrease in the CD8. However, no
significant differences between groups were observed. There were significant increases in
CD32, CD33, CD34 in the experimental group. The self care agency score correlated
negatively with the CD8.

From the above results, Hand Reflexology is shown to be an effective mind-body nursing
intervention for enhancing Saeng-chi responses and affecting some of the immune responses.
However, Immune cell activation and differentiation with hand reflexology will be achieved
with future study.

Oh SY, "The Effects of Hand Reflexology on Saeng-Chi and Immunity in ESRD Patients," J
Korean Acad Fundam Nurs. 2002 Aug;9(2):213-225. Korean. Seoul Women's College of
Nursing, Korea. seiyng5@snjc.ac.kr

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Hemodialysis and Cancer: physiological, emotional

responses and immunity responses of the patients with
chronic illness
PURPOSE: The purpose of this study was to explore the effects of hand reflexology on the
physiological, emotional responses and immunity of the patients with chronic illness. This
study looked specifically at patients with chronic renal failure (CRF) and cancer patients.
METHOD: This study was designed as a quasi-experimental nonequivalent control group pre
and post test. Subjects were 54 patients who received dialysis and chemotherapy in one
hospital. Thirty-one patients were assigned to the experimental group and 23 to the control
group. The hand reflexology was applied to both hands of the experiment group for ten
minutes each time, 5 times during three days. For data collection, physiological lab levels,
immune cells of blood and questionnaires for emotional responses were measured before and
after the program. RESULT: BT of the experiment group was decreased significantly on both
of the 1st and the 5th application. PR and BP were decreased significantly on the 1st times,
but not 5th times. Hb levels of the experimental group were significantly increased. And
emotional responses, vigor and mood scores of the experiment group were significantly
increased. B cell and CD19 were increased significantly on the experiment group. Suppressor
T cell and NK cell showed significant decrease after the program, but no significant
differences between the groups. CONCLUSION: We have found that the hand reflexology
helps the chronic patients to improve physiological emotional responses and the immune
reaction. Through this result, the hand reflexology is effective as a intervention of
psychoneuroimmunologic function.

Lee CH, Oh SY, Park OS, Kwon IG, Jeong MA, Lee EA., "Effects of Hand Reflexology on
Physiological Emotional Responses and Immunity in the Patients with Chronic illness;
Chronic renal failure patients and Cancer patients," Sungkyunkwan University, Korea. Seoul
Women's College of Nursing, Korea. Samsung Medical Center, Korea

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Hospitalized child
http://www.redorbit.com/news/health/226927/
health_support_program_for_family_members_with_hospitalized_child/

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Hypertension in the elderly

Purpose: This study was done to evaluate the effects of foot reflexology on blood pressure,
serum lipids, fatigue and self-efficacy in patients with hypertension.

Methods: The research was done between June 23 and July 31, 2003 and the design was an
experimental treatment design. The thirty-four participants were assigned to either an
experimental group (18) or a control group (16), Foot reflexology was administered twice a
week for 6 weeks to participants in the experimental group.

Results: There was a significant decrease in systolic blood pressure and diastolic pressure in
the experimental group compared to the control group. After the foot reflexology, total
cholesterol and triglyceride levels for the experimental group did not decrease significantly
compared to the control group. High density lipoprotein and low density lipoprotein levels
also did not decrease significantly after foot reflexology. Fatigue in the experimental group
decreased significantly after foot reflexology. Self-efficacy in the experimental group did not
decrease significantly after foot reflexology.

Conclusion: The results show that foot reflexology is an effective nursing intervention to
decrease systolic blood pressure, diastolic blood pressure and to treat fatigue but not serum
lipids. Therefore, blood cholesterol should be further evaluated with a larger group of
participants and for a longer period. Further research is necessary to evaluate and to compare
effects of self-foot reflexology and foot reflexology.

Cho GY, Park HS, "Effects of 6-week Foot Reflexology on the Blood Pressure and Fatigue in
Elderly Patients with Hypertension" J Korean Acad Fundam Nurs. 2004 Aug;11(2):138-147.
Korean. Department of Nursing Research Institute of Nursing Science, Pusan National
University, Korea. gycho677@hanmail.net; College of Medicine, Nursing Department, Pusan
National University, Korea.

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Hypertension
Purpose: This study was to evaluate the effects of foot reflexology on blood pressure, serum
lipids level and life satisfaction in essential hypertension patients.

Method: The research design used was a nonequivalent control group pretest-posttest design.
Foot Reflexology was used as the experimental treatment from June 23rd, 2003 until August
31st, 2003. Thirty-four subjects were assigned to an experimental group(18) and control
group(16). Foot Reflexology was administered twice a week for 6 weeks and self foot
Reflexology was administered twice a week for 4 weeks on the experimental group.
Result: There was a significant decrease in systolic blood pressure but no significant decrease
indiastolic pressure in the experimental group compared to the control group. The total
cholesterol level in the experimental group compared to the control group was not
significantly decreased after foot reflexology. However, the triglyceride level in the
experimental group compared to the control group was significantly decreased after foot
reflexology. On the other hand, high density lipoprotein and low density lipoprotein levels in
the experimental group compared to the control group was not significantly decreased after
foot reflexology. Life satisfaction in the experimental group compared to the control group
was significantly improved after foot reflexology.

Conclusion: The results proved that foot reflexology was an effective nursing intervention to
decrease systolic pressure, and triglyceride but not for the blood cholesterol but did improve
life satisfaction. Therefore, blood cholesterol should be further evaluated in a larger group of
subjects and for a longer period. Further research is regarded as necessary to evaluate and to
compare effects of self-foot reflexology and foot reflexology

Park HS, Cho GY, "Effects of Foot Reflexology on Essential Hypertension Patients," J
Korean Acad Nurs. 2004 Aug;34(5):739-750. Korean. Department of Nursing, Pusan
National University, Korea. Nursing Research Institute of Nursing Science, Pusan National
University, Korea. gycho677@hanmail.net

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Incontinence in middle-aged women

Purpose: This study was to identify the effects of self-foot reflexology on urinary
incontinence symptoms, vaginal contraction and daily life discomfort of middle-aged women.

Method: A quasi-experimental design was used. The subject were 39 middle-aged women
with urinary incontinence, who were composed of 18 women in the experimental group, while
21 were in the control group. In the experimental group, self-foot reflexology was applied for
30 minutes, three times a week for 4 weeks. The obtained data were analyzed by using the
Mann-Whitney U test of SPSS.

Result: 1. Frequency(U=78.00, P=.001), amount(U=65.00, p=.001) and the situation

score(U=81.00, P=.002)of urinary incontinence were reduced significantly in the
experimental group as compared to the control group. 2. Maximum pressure(U=33.50,
p=.000), mean pressure( U=38.00 p=.000) of vaginal contraction were improved significantly
in the experimental group as compared to the control group. 3. Daily life discomfort in the
experimental group was reduced whereas that of the control group was increased(U=63.00,
p=.000) significantly.

Conclusion: These findings indicate that self-foot reflexology is an effective method for
reducing urinary incontinence symptoms and daily life discomfort and for increasing pressure
of vaginal contraction of middle-aged women. Therefore self-foot reflexology can be
considered as a independent nursing intervention for urinary incontinence.

Kang HS, Kim WO, Wang MJ, Cha NH., "The Effects of Self-foot Reflexology on Urinary
Incontinence in Middle-aged Women," J Korean Acad Adult Nurs. 2004 Sep;16(3):482-492.
Korean. College of Nursing Science, Kyung Hee University, Korea.
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Insomnia
Objective: Observation Reflexology Syndrome Nursing combination of the effect of the
treatment of insomnia.

Method: 118 cases of insomnia patients, according to whether or not willing to accept the
reflexology massage area is divided into 60 cases of the treatment group and the control group
of 58 cases. Treatment group Using every means to stimulate the foot with insomnia Visceral
organ at the bottom of the corresponding reflection, and in accordance with TCM type
Nursing control group by conventional Nursing.

Results were the more efficient statistical significance (P <0.01)

Conclusion: Reflexology Syndrome Nursing combination of insomnia patients better efficacy,

safety, no reaction, the patient easily accepted.

Zhou Qingyun, Heng Cai, Chenruwen, "Reflexology with Syndrome Nursing effect on the
impact of insomnia," Influence of suppedaneous massage combined with determining nursing
based on differentiation of symptoms and signs on patients with insomnia Influence of
suppedaneous massage combined with determining nursing based on differentiation of
symptoms and signs on patients with insomnia," (Chinese) Nursing Research, 2007, section
05

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Menopausal women
Purpose: This study was aimed to identify the effect of foot reflexology massage on
climacteric symptom, fatigue and physiologic parameters of middle-aged women.

Method: A non-equivalent pretest-posttest experimental design was used. Participants were

recruited from the Community Health Center in Busan, Korea. Forty participants were
assigned to either an experimental group(20) or a control group(20). Foot reflexology
massage was administered twice a week for 6 weeks in the participant in experimental group.

Results: There were statistically significant differences in climacteric symptom, fatigue, total
cholesterol and cortisol level. However, there were no statistically significant differences in
triglyceride, high density lipoprotein and low density lipoprotein.

Conclusion: These results suggest that foot reflexology massage could be utilized as an
effective nursing intervention to reduce climacteric symptom and fatigue in middle-aged
women.

Lee YM., "Effects of Foot Reflexology Massage on Climacteric Symptom, Fatigue and
Physiologic Parameters of Middle Aged Women," J Korean Acad Adult Nurs. 2006
Jun;18(2):284-292. Korean; Department of Nursing, Inje University, Korea.
lym312@inje.ac.kr
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Mental Health
Boyd, Denise, "Using reflexology: A feasibility study," Mental Health Nursing . Nov/Dec
2001. FindArticles.com. 03 Jan. 2008.
http://findarticles.com/p/articles/mi_qa3949/is_200111/ ai_n9007476

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Middle-aged Women
Middle-aged women: Depression, stress responses and functions of the
immune system

Purpose: This study was aimed to identify the effects of a self-foot reflexology massage on
depression, stress responses and functions of the immune system of middle-aged women.

Method: This study was a one group pretest-posttest experimental design and the data was
collected from August 1st, 2004 to May 31st, 2005. The subjects consisted of 46 middle-aged
women (40 - 64 years) who were recruited from the Community Health Center in Busan city.
Subjects were not treated for 4 weeks, subsequently they were trained in self foot reflexology
massage for 2 weeks, and then they did their own daily for 6weeks (2 days at the research
center, 5 days at home).The outcome variables were measured 4 times, at baseline, pre
training, after training, and after the intervention. The collected data was analyzed using
repeated measure ANOVA by the SPSS/WIN program.

Result: There was a statistically significant difference in depression, perceived stress, systolic
blood pressure, natural-killer cells and Ig G. However, there was not a statistically significant
difference in diastolic blood pressure, pulse or serum cortisol.

Conclusion: These results suggest that a self-foot reflexology massage could be utilized as an
effective nursing intervention to reduce depression and stress responses, and to strengthen
immune systems in middle-aged women.

Lee YM, "Effect of Self-Foot Reflexology massage on Depression, Stress Responses and
Immune Functions of Middle Aged Women," J Korean Acad Nurs. 2006 Feb;36(1):179-188.
Korean. Department of Nursing, Inje University. lym312@inje.ac.kr

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Stress, fatigue and blood circulation in premenopausal middle-aged women

Purpose: This study was to examine the effects of self-foot reflexology on stress, fatigue and
blood circulation in premenopausal middle-aged women.

Methods: A quasi-experimental nonequivalent control group, pretest-posttest design was used.

Participants were 59 premenopausal, middle-aged women in their 40s and 60s living in G
city: 30 in the experiment group and 29 in the control group. Data were collected from May to
August 2008. Self-foot reflexology was performed three times a week for 6 weeks for 40 min
at each session.

Results: The results showed that self-foot reflexology was effective in reducing perceived
stress and fatigue and helped blood circulation in premenopausal middle-aged women.
Conclusion: Self-foot reflexology may be an effective nursing intervention in reducing
perceived stress and fatigue and in improving blood circulation.

Jang SH, Kim KH., "Effects of self-foot reflexology on stress, fatigue and blood circulation in
premenopausal middle-aged women." J Korean Acad Nurs. 2009 Oct;39(5):662-72.
Department of Nursing, Songwon College, Korea (PMID: 19901496)

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Osteoarthritis
Osteoarthritis: Pain and depression

Purpose: This study was to examine the effects of foot reflexology on pain and depression of
middle- aged women with Osteoarthritis.

Method: The subjects were 41 osteoarthritis patients resided in the Jinju city from March to
May, 2005. The foot reflexology was applied to the experimental group 3 times a week for 4
weeks, 30 minutes each. For the data analysis, chi-square-test was conducted to verify the
homogeneity of general characteristics, and t-test was done to verify the homogeneity of pain
and depression. To examine the relative efficacy of the intervention, t-test, paired t-test and
repeated measures ANOVA were conducted.

Results: After foot reflexology, the subjects in experimental group showed significant
improvement in pain (F=155.77, p=.000) and depression (F=20.00, p=.000). Conclusion: The
results suggest that the foot reflexology is effective in relieving of pain and depression.
Therefore, it is necessary to develop foot reflexology as an independent nursing intervention.

Oh HS, Ahn SA., "The Effects of Foot Reflexology on Pain and Depression of Middle-aged
Women with Osteoarthritis," Korean J Rehabil Nurs. 2006 Jun;9(1):25-33. Korean. College of
Nursing, Gyeong-Sang National University, JinJu, Gyeongnam, Korea.
nhsoh@gshp,gsnu.ac.kr Department of Beauty Design, JinJu International University, JinJu,
Gyeongnam, Korea.

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Osteoarthritis: Joint pain

In the U.S., 1 of every 3 people is affected by painful arthritis (CDC and Prevention, 2002).
Arthritic medications have caused adverse reactions e.g. Vioxx recall (U.S. FDA, 2005) and
others may have adverse effects when used long-term. These effects may be minimized by
adjuvant nonpharmacological modalities, such as reflexology, a complementary therapy.
Reflexology is a noninvasive technique of applying topical pressure to specific points on the
feet thought to represent somatic organs. The purpose of the study was to determine the effect
of foot reflexology on self-reported osteoarthritis joint pain. The hypothesis was that
participants with joint pain who received reflexology would have less pain after treatment
than those receiving a placebo massage or control condition. The effect may be explained by
the gate control theory. A power analysis was calculated using G*Power® software computer
program (Faul & Erdfelder, 1992) with .99 Ρ lower for the parameters of alpha =.05, with a
large ES of 1.0408. A convenience sample (N = 119) were randomly assigned to three groups
(n = 41 treatment-foot reflexology, n = 39 placebo- foot massage, and n = 39 control-arthritis
information) for the experimental pretest-posttest controlled clinical trial.

Pain was measured before and after the 15-minute intervention with the Short Form McGill
Pain Questionnaire. A limitation was the researcher administering all interventions and
questionnaires. Multiple regression was used to analyze the hypothesis. The groups receiving
either reflexology or massage had significantly less posttest pain than those receiving arthritis
information. Reflexology, however, did not statistically result in less pain than massage.
Clinical effect was found in the reflexology group who had 8 to 18% improvement (less pain
on all pain scales), compared with those in the massage group. The results generated
knowledge for research, education, and practice regarding adjuncts for joint pain relief.

Laree J Schoolmeesters PhD, RN, "The Effect of Reflexology on Self-Reported

(Osteoarthritis) Joint Pain," Southern Nursing Research Society Proceedings: 2007 Annual
Conference, Feb 22, 2007

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Pain (Surgical ward)

Purpose: This study is aimed to examine the effectiveness on pain, feeling and nursing
practice of hand reflexology applied to in-patient in the clinical setting.

Method: The pre / post test methods using VAS for pain and feeling, physiologic measuring,
and questionnaire of nursing care were conducted. Subjects were selected 45 in-patients from
a surgical ward in hospitals during Nov.-Dec. 2005. 5 minute hand reflexology therapy was
applied to both hands of participant by two research assistants at the same time. Data were
analyzed based on SAS program using frequency, X2-test, paired t-test, ANOVA and Pearson
`s correlation coefficients.

Result: 1. After receiving hand reflexology therapy, the subjects showed significant pain relief
(t =- 4.94, p =. 0001), improvement in feeling (t = 19.44, p = 0001) and an increase in skin
temperature (t = 3.54, p =. 001). 2. The applied skills that the participants preferred were
press-rotate (80.0%), press-walk (35.56%) and press-rolling (31.11%). The effectiveness of
nursing practice scored 3.99 ± 1.97 out of 5. Nurse-Patient Relationship and effective
response of nursing intervention ranked the highest 4.31.

Conclusion: Hand reflexology was considered as an effective nursing intervention in the

clinical settings, but in order to evaluate re-verifies and reliances for this effects, it is
necessary that comparative studies should be conducted.

Caption (Sei Young Oh), hahyejeong (Hyae Chung Ha), yiyoungsun (Young Soon Lee), Kim
DS (Dong Soo Kim), yimyeongsuk (Myung Sook Lee),"The Effect of Hand Reflexology on
Pain, Skin Temperature and Nursing Practice," Korea Journal of Nursing Education, 12, 2
Korea, Overall: 9 pages, start pages: 178 pages, January 2006
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Peptic ulcers
Observation reflexology foot massage on the rehabilitation of peptic ulcer patients.

Method: Of 162 patients with peptic ulcer patients were randomly divided into two groups of
82 cases and the control group of 80 cases, the observation group based in the drug treatment.
Application stomach or duodenum reflexology massage area, two times a day, each for 15
min to 20 min, four weeks for a treatment and control group using only drug therapy Results:
Observer Group 1 after treatment symptoms disappeared 80 cases (97.56%), two cured after
treatment in 78 patients (95.12%), a control group, the symptoms disappeared after treatment
of 65 cases (81.25%), two cured after treatment of 62 cases (77.50%). There was significant
between the two groups (P <0.05)

Conclusion: Stomach or duodenum reflexology massage therapy areas of peptic ulcer patients
can promote rehabilitation.

Ma Dongmei, CAO Hui-min, Duan Feng-lian, "Foot Massage therapy reflection of the impact
of peptic ulcer patients; Influence of foot massage reflection therapy on peptic ulcer patients,"
Nursing Research, 2006 22

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Pneumoconosis patients: Fatigue and insomnia (in Coal

Workers)
"Purpose: The purpose of this study was to determine the effects of foot reflexology on
fatigue and insomnia in patients suffering from coal workers' pneumoconiosis.

"Method: This study was a quasi-experimental study of pre-test and post-test design in a
nonequivalent control group. The subjects of this study consisted of both the experimental
group of twenty-nine and the control group of thirty coal workers' pneumoconiosis patients.
Data was collected from December 10, 2002 to February 15, 2003. Foot reflexology was
performed for 60 minutes twice a week through five weeks in the experimental group, but
none in the control group. To evaluate the effects of foot reflexology, the scores of fatigue and
insomnia were measured before and after the experiment in both groups. Fatigue was
evaluated by Fatigue Symptoms Inventory. Insomnia was measured with the visual analogue
scale (VAS). Data of this experiment was analyzed by Chi-square test, t-test, unpaired t-test
and Repeated Measures ANOVA with the SAS Program.

"Results: The scores of fatigue and insomnia decreased in the experimental group but not in
the control group. There was a significant difference of fatigue and insomnia between the two
groups. "Conclusion: It is suggested that foot reflexology might have beneficial effects on
reducing fatigue and insomnia in patients suffering from coal workers' pneumoconiosis, and
can be recommended as a nursing intervention program for patients with coal workers'
pneumoconiosis." Lee, YM, Sohmg, KY (Dept. of Nursing, Kangwom Tourism College,
ymlee6505@hanmail. net),"The Effects of Foot Reflexology on Fatigue and Insomnia in
Patients Suffering from Coal Workers' Pneumoncomiosis," Taehan Knaho Hakhoe Chi
(Korean language), 2005, Dec;35(7):1221-8, PMID: 16418548

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Pneumoconosis Patients: Depression and Anxiety (in Coal Workers)

Purpose: This study was to evaluate the effects of foot reflexology on depression and anxiety
in coal workers' pneumoconiosis.

Method: The research design used was a non-equivalent control group pretest-posttest design.
The foot reflexology was performed for 60 minutes twice a week through five weeks in the
experimental group, not in the control group. The subjects of this study consisted of both the
experimental group of twenty-nine and the control group of thirty coal workers'
pneumoconiosis. The data were collected from December 10, 2002 to February 15, 2003. To
evaluate the effects of foot reflexology the scores of depression and anxiety were measured
before and after the experiment in both groups. Data of this experiment were analyzed by Chi-
square test, t-test, unpaired t-test, ANCOVA and Repeated Measures ANOVA with the SAS
Program.

Results: The score of depression decreased in the experimental group, not in the control
group. There was a significant difference of depression between the two groups. The score of
anxiety decreased in the experimental group, not in the control group. There was a significant
difference of anxiety between the two groups.

Conclusion: As a summary of the study results, foot reflexology was regarded that it
attributed to the emotional promotion of coal workers' pneumoconiosis. Therefore the foot
reflexology is considered that might be used as an effective skill of nursing intervention
program for coal workers' pneumoconiosis.

Lee YM., "The Effects of Foot Reflexology on Depression and Anxiety in Coal Workers'
Pneumoconiosis.," Korean J Rehabil Nurs. 2005 Jun;8(1):31-37. Korean.(Department of
Nursing, Kangwon Tourism College. ymlee6505@hanmail.net)

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Postpartum women
Post partum women: Body weight, lower extremity edema, and serum lipids

Purpose: This study examined the effects of foot- reflexology massage on body weight, lower
extremity edema, and serum lipids in postpartum women.

Method: This study was a nonequivalent control-group pretest-posttest design. Postpartum

women were assigned to the experimental group (n=16) or a control group (n=15). Foot
reflexology massage was applied 5 times a week, for a total of 2 weeks to the experimental
group. The tool for measuring lower extremity edema was the girth of the thigh, and the calf.
The measuring tool for serum lipids was total cholesterol and TG in blood serum by clinical
process. Data was analyzed by chi-square-test, t-test, and paired t-test, ANOVA using
SPSS/Win PC 14.0. Results: There was a statistically significant decrease in levels of TG in
blood serum in the experimental group compared to the control group.

Conclusion: Foot reflexology massage is a useful nursing intervention that decreases serum
lipids level in postpartum women. Therefore foot reflexology massage is recommended as a
nursing intervention strategy for serum lipids reduction in postpartum women.

Park SH., "Effects of Foot-Reflexology Massage on Body Weight, Lower Extremity Edema
and Serum Lipids in Postpartum Women. ," Korean J Women Health Nurs. 2007
Jun;13(2):105-114. Korean.Department of Beauty Cosmetology, Vision College of Jeonju
Completion of doctor course, Korea. shiningheart@hanmail.net

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Postpartum women: Gastrointestinal function

Zhou Xiaoqing Zhou Xiaoqin, Zhou Xiaoqing, "Foot after cesarean section on the recovery of
gastrointestinal function; the Influence of Foot Soaking and Massage on the Recovery of
Digestive System after Cesarean," Contemporary nurses (Academic Edition) Today Nurse
2004, Section 01

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Post partum women: Sleep quality

Objective: to examine the effectiveness of using foot reflexology to improve sleep quality in
postpartum women.

Design and Setting: randomised controlled trial, conducted at two postpartum centres in
northern Taiwan.

Participants: 65 postpartum women reporting poor quality of sleep were recruited from July
2007 to December 2007.

Interventions: participants were assigned randomly to either an intervention or a control

group. Participants in both groups received the same care except for reflexology therapy. The
intervention group received a single 30-minute foot reflexology session at the same time each
evening for five consecutive days. Sessions were administered by a certified nurse
reflexologist. Measures and Findings: the outcome measure was the Pittsburgh sleep quality
index (PSQI), and this was performed at baseline and post test. Mean PQSI scores for both
groups declined over time between baseline and post test. Using a generalised estimation
equation to control several confounding variables, the changes in mean PSQI were found to
be significantly lower in the intervention group (beta=-2.24, standard error=0.38, p<0.001)
than in the control group. Conclusion: an intervention involving foot reflexology in the
postnatal period significantly improved the quality of sleep.

Implications for Practice: Midwives should evaluate maternal sleep quality and design early
intervention programmes to improve quality of sleep in order to increase maternal
biopsychosocial well-being. Midwives interested in complementary therapies should be
encouraged to obtain training in reflexology and to apply it in clinical settings if it is allowed
Li CY, Chen SC, Li CY, Gau ML, Huang CM, "Randomised controlled trial of the
effectiveness of using foot reflexology to improve quality of sleep amongst Taiwanese
postpartum women,"Midwifery. 2009 Jul 3. (Department of Nursing, Tri-Service General
Hospital, No. 325, Sec.2, Cheng-Gong Rd., Neihu, Taipei 114, Taiwan, ROC)

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Post partum women: Anxiety and depression

Objective: To investigate the maternal mental health promotion effective method: mothers
were randomly divided into four groups, each with 60 cases, a total of 240 cases observed.
After 6 hours in group A respectively to Chinese foot massage with plantar Group B medicine
Footbath, Group C heated foot bath and massage, in Group D after 36 hours does not impose
any factors Results: Chinese foot massage with plantar after the intervention group anxiety,
depression score and the group has significant difference, P < 0.01.

Conclusion: Footbath intervention on the maternal role of promoting mental health, medicine
foot massage with plantar intervention method is the best.

Bangguizhi, hatred snow-sheung, Li Meng Fong, Zhou, Wei Dan He, "Nursing Intervention
on postpartum anxiety and depression impact study," Chinese health Chinese Health Care
2007, 14

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Post surgical pain

Post surgical pain: Frequency of pain medication taking

The purposes of this research were to compare effects of symptom management with
reflexology program on pain and frequency of pain medication taking in elderly patient with
prostatectomy. The quasi-experimental design was used with pretest-posttest control groups.
Sample were 40 elderly patients who received treatment at Suratthanee Hospital which were
equally matched pair and assigned to experimental and control. Groups. The intervention
instrument was the symptom management with reflexology program on pain, consisted of
four sessions: 1) symptom experienced assessment 2) knowledge providing 3) reflexology
and 4) evaluation phases. Data were analyzed by using descriptive statistics and t-test. The
major finding were as follows: 1. The posttest mean score on pain of an experimental group
was significantly lower than of the pretest (X = 7.230, X = 3.75, t=16.335, p<.001) 2. The
posttest mean score of pain of an experimental group was significantly lower than of a control
group0 (X = 3.75, X =6.65, t =-10.627, p<.001) 3. The posttest mean score of frequency pain
medication taking of an experimental group was significantly lower than of a control group
(X = 1.05, X = 1.85, t-=-2.36, p<.05)

Tanyakhanok Pongpiyapibon, "Effects of symptom management with reflexology program on

pain and frequency of pain medication taking in elderly patient with prostatectomy" Thesis,
2005, Chulalongkorn University, Nursing Science, Thailand (Sirphan Sasat, Advisor)

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Post surgical pain: Open heart surgery

To compare the effect of preoperative information, preoperative information combined with

foot reflexology with aromatherapy, and conventional nursing care on unpleasant symptoms
in post opened-heart surgery patients. The subjects were 45 post opened-heart surgery patients
admitted at King Chulalongkorn Memorial Hospital, and were selected by a purposive
sampling. The subjects were arranged into a control group, and two experimental groups. The
groups were matched in terms of age, sex heart disease and type of surgery, regimen of
analgesic and sedative drugs, and type of ward. The control group received conventional
nursing care. The first experimental group received information "Pain relieving after cardiac
surgery" before the surgery. The second experimental group received information "Pain
relieving after cardiac surgery" before the surgery and foot reflexology with aromatherapy on
1st, 2nd, and 3rd day after opened-heart surgery. The instrument was a set of questionnaires
including a demographic data form, and the unpleasant symptoms form. The unpleasant
symptoms questionnaire was tested for the content validity by a panel of experts. Cronbach's
alpha coefficient of the unpleasant symptoms questionnaire was .95. Data were analysed by
descriptive statistics, one way analysis of variance (ANOVA), and pairwise comparison.
Results were as follows 1. Mean of unpleasant symptoms score in opened-heart surgery
patients on 2nd, 3rd, and 4th day after the surgery were statistical different among groups at
the level of .05. Mean of unpleasant symptoms score in the group receiving preoperative
information combined with foot reflexology with aromatherapy was the lowest. Mean of
unpleasant symptoms score in the group receiving conventional nursing care was the highest.
2. Mean of unpleasant symptoms score in opened-heart surgery patients add 3 times were
statistical different among groups at the level of .05. Mean of unpleasant symptoms score in
the group receiving preoperative information combined with foot reflexology with
aromatherapy was the lowest. Mean of unpleasant symptoms score in the group receiving
conventional nursing care was the highest Suthathip Kasedluksame, "The Effect of
preoperative information combined with foot reflexology with aromatherapy on unpleasant
symptoms in post opened-heart surgery patients," Thesis, 2005 Chulalongkorn University,
Nursing Science, Thailand (Chanokporn jitpanya, Advisor) http://bit.ly/75nMaT

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Post surgical recovery

Post surgical recovery: Abdominal operation

The study's goal was to test if foot reflexology (FR) affects the well-being, voiding, bowel
movements, pain, and/or sleep in women who underwent an abdominal operation. 130
subjects were randomised into three groups. For five days they were exposed to fifteen
minutes of FR, foot/leg massage (FM) or talking respectively. Results show that the women in
the FR group were more able to void without problems, after the indwelling catheter had been
removed than did women in the comparison groups. There was also a tendency in the FR-
group for the indwelling catheter to be removed earlier than in the other groups. In
comparison the FR-subjects slept worse than the others. FM showed significant results in the
subjective measures of well-being, pain and sleep."

The aim of this study was to demonstrate effects of foot-reflexology (FR) on operated
women. 130 subjects were randomly assigned to one of three intervention groups: FR, foot-
leg massage (FM) or talking. Interventions were offered on five consecutive days and lasted
15 minutes each. Nurse-reflexologists offered FR, the nurses who cared for the patients did
the control interventions. Data collection was done on five dependent variables: well-being,
pain, sleep, post-operative voiding and bowel movements. Results showed a better ability to
void the bladder after the indwelling catheter was removed in the FR-group (p=0.024).
However, compared to the others, the FR-group slept the worse (p-<0.020). The FM-group
did better than the others in subjective well-being (p<0.006) and experienced less pain
(p=0.011). There were no differences among the groups in the domain of post-operative
bowel movements. We conclude that FR may be effective, if women have problems voiding
after an indwelling catheter was removed. FM may be offered post-operatively as a soothing
nursing intervention.

Kesselring A., Spichiger E., Muller M, "Foot Reflexology: an intervention study, Pflege 1998,
Aug; 11(4):213-8 (PMID: 9775925)

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Post surgical recovery, Gynecological surgery

"The aim of the study was to investigate the possible usefulness of foot reflexology on the
recovery after a surgical intervention. 130 patients participated in the study. They underwent
abdominal surgery under full anesthesia for different, but exclusively gynecological reasons.
Foot reflexology investigated in this study was applied only for a few days for each patient.
The following parameters were recorded: the subjective, self-assessed, general condition, pain
intensity, movement of the bowels, micturition and sleep beginning on the day before the
operation until day 10. Two other treatments served as controls, a simple massage of the foot
or a personal conversation. The simple massage turned out to be a relaxing, positive
experience, whereas foot reflexology had various effects, some of them even negative. The
conclusion was that foot reflexology is not recommended for acute, abdominal postsurgical
situations in gynecology because it can occasionally trigger abdominal pain."

Kesselring A., "Foot Reflexology massage: a clinical study," Forsch Komplementarmed 1999
Feb; 6 Suppl 1:38-40 (PMID: 10077716)

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Pregnancy (Edema)
Fifty-five women in the third trimester (of pregnancy) were randomly assigned to one of three
groups: a period of rest, 'relaxing' reflexology techniques or a specific 'lymphatic' reflexology
technique for 15 minute with pre and post-therapy ankle and foot circumference
measurements and participant questionnaire. There was no statistically significant difference
in the circumference measurements between the three groups; however, the lymphatic
technique reflexology group mean circumference measurements were all decreased. Š A
'perceived wellbeing' score revealed the lymphatic technique group significantly increased
their wellbeing the most, followed closely by relaxing techniques and then the control rest
group. (All groups) had a non-significant oedema-relieving effect. From the women's
viewpoint, lymphatic reflexology was the preferred therapy with significant increase in
symptom relief."
Mollart l., "Single Blind trial addressing the differential effects of two reflexology techniques
versus rest, on ankle and foot oedema in late pregnancy," Complementary Therapeutic
Nursing Midwifery, 2003 Nov;9(4):203-8 See
http://www.midwiferytoday.com/enews/enews0307.as

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Premenstrual syndrome and dysmenorrhea

The purpose of this study was to identify the effect of foot reflexology on premenstrual
syndrome and dysmenorrhea in female college students. The research design of this study was
a quasiexperimental design. Of the forty female college students, twenty were assigned to the
experimental group and, twenty to the control group. The data were obtained over 2 months
(November 26, 2001 to January 31, 2002) from a nursing of C college located in S city. The
instrument used to assess premenstrual syndrome and dysmenorrhea was Keele's VAS (Visual
Analogue Scale) and opening records. Subjects in the experimental group received foot
reflexology for 6 times with 1 hours during 60 days, and subjects assigned to the control
group did not receive foot reflexology. Data were analysed with percentage, mean, standard
deviation, X(2)-test, unpaired t-test, and repeated measure ANOVA, using SAS Program. The
results of the study are as follow, 1.The symptoms which the group of experimental and the
group of control discomforts the most are sensitiveness (35%), abdominal pain (30%), lower
abdominal pain (30%) and lumbago (20%). The method of relieve premenstrual syndrome
and dysmenorrhea by which the subjects employ the most to solve their premenstrual
syndrome and dysmenorrhea is the getting along by enduring (67.5%) and bed rest (32.5%).
2.The mean score of the premenstrual syndromes and dysmenorrhea before foot reflexology
was 8.35, it was 4.16 at the first menstruation after foot reflexology and 3.25 at the second
menstruation for the experimental group.

3.The relieved symptoms after foot reflexology was fatigue (50%), insomnia (40%),
abdominal pain (35%), lower abdominal pain (30%) and constipation (30%). Foot reflexology
was effective in improve the symptoms of the female college students who have the
premenstrual syndrome and dysmenorrhea.

Kim YH, Cho SH, "The Effect of Foot Reflexology on Premenstrual Syndrome and
Dysmenorrhea in Female College Students," Korean J Women Health Nurs. 2002
Jun;8(2):212-221. Korean. Department of Nursing, Sun Cheon Cheong Am College, Korea.

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Sleep, Elderly women

Elderly women: Sleep disturbance, depression and physiological index

"Purpose: This study was to examine the effects of foot reflexion massage on sleep
disturbance, depression disorder, and the physiological index of the elderly in nursing homes.

"Method: The research design was a non-equivalent control group pretest-posttest quasi-
experimental study. The subjects in this study were 50 elderly people who resided in two
different nursing homes in the same region. An experimental group and a control group were
organized with 25 subjects respectively, and foot reflexion massage was provided for 12
sessions, 30 minutes per session. The selected dependent variables were sleep disturbance,
depression disorder, and physiological indices (blood plasma, serum cortisol), which were all
measured before and after foot reflexion massage was offered. Data analysis included chi2-
test, t-test, paired t-test, and ANCOVA, using the SPSS program package.

"Result: 1. The experimental group improved sleep quality more than the control group. 2.
The experimental group had less depression disorder than the control group. 3. The
experimental group had higher serotonin levels than the control group.

"Conclusion: It's necessary to give foot reflexion massage as a successful nursing intervention
to elderly who undergo a change in sleep, and suffer from a depression disorder due to a
deterioration in sleep."

Song RH, Kim do H., "The effects of foot reflexion massage on sleep disturbance, depression
disorder, and the physiological index of the elderly," [Article in Korean], Taehan Kanho
Hakhoe Chi. 2006 Feb;36(1):15-24. (Department of Nursing, Daejeon Health Science
College. rhsong@hit.ac.kr.) PMID: 16520560

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Elderly Women: Sleep

Purpose: To investigate the effects of foot reflexology massage on sleep and fatigue of elderly
women.

Method: The study was performed from April through July of 2004 on the nonequivalent
control group non-synchronized quasi-experimental design. Fifty elderly women were
selected for each group. The foot reflexology massage was performed for 45 minutes every
three days for experimental group. The data were analyzed using the Cronbach's alpha, Chi-
Square test, t-test and Repeated measures ANOVA and Bonferroni.

Result: 1. The sleep score of the experiment group is significantly higher than that of the
control group (t=-5.944, p=.000). 2. For the experiment group, it is seen that the sleep score
increases as the frequency of the foot reflexology massage increases(F=96.362, p=.000). 3.
The fatigue score of the experiment group is significantly lower than that of the control
group(t=4.356, p=.000). 4. For the experiment group, the fatigue is relieved gradually as the
frequency of the foot reflexology massage increases (F= 118.444, p=.000).

Conclusion: Based on the results described above, it is considered that the foot reflexology
massage is effective for elderly women in promoting a good sleep and relieving the fatigue.

Jin SJ, Kim YK, "The Effects of Foot Reflexology Massage on Sleep and Fatigue of Elderly
Women," Journal Korean Academci Adult Nursing 2005 Aug;17(3):493-502. Korean. Masan
Samsung Medical Center. Catholic University of Pusan. ykkim@cup.ac.kr

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Stroke
Stroke is one of the leading causes of death in Korea. Because of their sequelae, strokes are
categorized as a sudden-onset. constant course chronic illness which needs continuous efforts
for rehabilitation. Unfortunately. there are few community based rehabilitation program for
poststroke patients who stay at home. The authors developed a community based self-help
management program for post-stroke patients to enhance their rehabilitation process. The
program consists of five sessions and each session contains health education. ROM exercise,
ADL training, and stress management like foot reflexology. A professor and two graduate
students of nursing college coordinated the program. To test the effects of the program, we
conducted a 5 week program to the 10 conveniently selected post-stroke patients who were
living in Kang-buk district of Seoul. The Questionnaires about ADLs. IADLs, depression and
life satisfaction were asked to the all subjects before and after program. The hand grasp power
and muscle strength of four limbs were measured at the end of each sessions. The analysis of
data revealed that the program was effective to increase the ADLs, IADLs, and muscle
strength and to decrease the depression levels of subjects. However, there was no significant
difference between pre and post hand grasp power and life satisfaction. Because the program
was effective to improve the physical and psychological function of subjects, we suggest
continual development and implementation of community based self-help management
programs.

Kim KS, Sea H, Kang J, "The Effects of Community based Self-help Management Program
on the Activity of Daily Life, Muscle Strength, Depression and Life Satisfaction of Post-
stroke Patients, Korean J Rehabil Nurs. 2000 Jun;3(1):108-117. Korean

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Stroke
Purpose: This study was to examine the effects of foot reflexology on ADL and fatigue in
stroke patients.

Method: The subjects were 31 stroke patients hospitalized in the Oriental Medicine Hospital
of D University from June to November, 2002. Foot reflexology was applied to the
experimental group twice a week for 6 weeks, 40 minutes each. For the data analysis, chi2-
test was conducted to verify the homogeneity of general characteristics and clinical
characteristics, and t-test was done to verify the homogeneity of ADL and fatigue. To
examine the relative efficacy of the intervention, ANOVA and ANCOVA were conducted.

Results: After foot reflexology, the subjects in the experimental group showed significant
improvement in ADL. They also had less physical, psychological, and neurosensory fatigue,
which are three areas of fatigue.

Conclusion: The results suggest that foot reflexology is an effective intervention that helps the
body work efficiently, eases stress and strain, and enhances the homeostasis of the body
through stimulating the reflex zone of internal organs in the body. Therefore, it is necessary to
develop foot reflexology as an unique nursing intervention.

Song MR, Song HM., "The Effects of Foot Reflexology on ADL and Fatigue in Stroke
Patients," Korean J Rehabil Nurs. 2005 Dec;8(2):139-148. Korean.College of Nursing, Seoul
National University, Korea. junhchoi@hanafos.com Nursing Department, Dongshin Oriental
Medicine Hospital, Korea.
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Students: Constipation, anxiety and depression

Purpose: The purpose of this study was to probe the effect of foot reflexology education
program on nursing students with constipation, anxiety and depression. This study was a
quasi-experimental study of pre-test and posttest design on non-equivalent control group.

Method: The data of this study were collected from October 28, to December 14, 2002. The
subjects consisted of 61 nursing students (experimental group: 31, control group: 30) with
constipation, anxiety and depression. 31 out of them were divided into the experimental group
and received foot reflexology education program that was authorized by the World Foot
Reflexology Association and made to suit for the subjects by the author for 6weeks composed
of 2 weeks theory and of 4 weeks practical skill on the program. The effect of the program
was measured by Bowel Function Assessment Form for constipation, State Anxiety
Inventory, and Beck Depression Inventory. Data were analyzed by t-test, X(2)-test, Repeated
measures ANOVA, Bonferroni multiple comparison using SAS/PC 8.12 program.

Result: After all session of treatment, the score of bowel function assessment were
significantly decreased in the experimental group compared to the control group. Outcomes of
6 and 7 weeks were significantly different from those of pre-experiment. After all session of
treatment, anxiety states were significantly decreased in the experimental group compared to
the control group. Outcomes of 7 weeks were significantly different from those of pre-
experiment. After all session of treatment, depression states were significantly decreased in
the experimental group compared to the control group. Outcomes of 6 and 7 weeks were
significantly different from those of preexperiment.

Conclusion: The results are suggested that the foot reflexology education program might
improve the bowel function, anxiety and depression for the nursing students with
constipation, anxiety and depression.

Kim YH, Choi ES, "Effects of Foot Reflexology Education Program on Bowel Function,
Anxiety and Depression in Nursing Students," Korean J Women Health Nurs. 2003
Sep;9(3):277-286. Korean.

Department of Nursing, Suncheon Cheongam College, Korea, College of Nursing, The

Catholic University of Korea, Korea

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Wellness
"Proactive health-care services emphasize health promotion and the prevention of disabling
conditions, Currently in Thai society, the number of elderly with deteriorating health has
increased. Therefore, self-care health promotion activities have become essential in order for
the elderly to maintain their well-being. The purpose of this study was to investigate the
effects of foot massage with biofeedback. Foot massage, a Thai primary self-care custom, has
been found to enhance blood circulation, relaxation, and one's own healing power. In
addition, touch has been found to stimulate secretion of endorphins and reduce pain and
anxiety. It appears therefore that foot massage, or reflexology, promotes a healthy lifestyle for
all age groups.

"An experimental study, utilizing a pilot project in elderly health care, was employed to
investigate the effects of biofeedback using foot massage A pretest/post-test quasi-
experimental design was used. The sample consisted of four men and 16 women (age group
61-69). Four trained researchers massaged the feet of the subjects and measured vital-sign
changes. Biofeedback was also investigated before and after the foot massages. Results
showed that the average biofeedback and temperature were lower before than after the foot
massage (P<0.01). The average pulse rate, respiratory rate and blood pressure, however, were
found to be higher before rather than after the foot massage (P<0.01). It was concluded that
the foot massage provided good circulation, relaxation and comfort. All subjects expressed
positive feelings when they received the foot massage (i. e. "It is very nice that foot massage
can relieve my joint pain, I an happy and comfortable.") These findings appear to indicate that
foot massage is beneficial both for physical and mental conditions. Foot massage, however, is
just one key to achieving a full range of primary health-care services. It needs to no only be
performed by nurses. Families also, can provide foot massage for the elderly, anywhere and
anytime."

Jirayingmongkol P, Chantein S, Phengchomjan N, Bhanggananda N, "The effect of foot

massage (reflexology) with biofeedback: a pilot study to enhance health promotion," Nursing
Health Science, 2002 Aug;4(Suppl):A4 (PMID: 12153420)

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