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Effect of Reflexology on Pain and Quality of Life in a Patient with Rheumatoid Arthritis

Authors:

Abstract

Patients with rheumatoid arthritis (RA) face considerable physical, social and emotional disabilities. In this chronic disease, for which a cure is not yet available, improving patients' health, quality of life and reduce pain is of the utmost concern. The purpose of this work was to measure the effect reflexology has on pain and quality of life (QOL) in a patient with rheumatoid arthritis. Using an 8-week course of reflexology treatments were given to a patient who has RA. A quasi experimental research design was used with 2- month follow-up. The study was conducted in the outpatient clinic of the RA Departments at Zagazig University Hospitals. On 39 female adult patients diagnosed as having RA without deformity of bones or destruction of joints. The exclusion criterion was the presence of any other chronic illness that may affect patient's QOL as diabetes, ischemic heart disease, chronic obstructive pulmonary disease, and stroke. Perceived pain and QOL were assessed using three validated outcome measures: Bio-socio-demographic and disease (RA) characteristics, the Rheumatoid Arthritis Quality of Life (RAQOL) questionnaire, the Pain Assessment Questionnaire (Numerical Rating Scale) and Health assessment questionnaire (HAQ). The study results revealed that, improvements in patients' QOL, pain and health status at the post-intervention phase and at the follow-up phase. Satisfaction QOL scores had moderate statistically significant negative correlations with the duration of illness throughout the study phases, while the scores of the importance of QOL had weak to moderate statistically significant negative correlations with age and duration of illness. On the other hand, the poor health status scores had moderate statistically significant positive correlations with age and duration of illness throughout the study phases, while pain had no correlation with either of them. The study concludes that hands and feet reflexology applied to rheumatoid arthritis patients is effective in reducing their pain, improving their QOL and their total health status, and these positive impacts are not affected by patient's age and duration of illness. Therefore, reflexology must be considered as a complementary treatment modality in rheumatoid arthritis. It should be introduced to nursing and medical students, and in postgraduate staff development programs. Further research is recommended for the long-term effects of this treatment modality in terms of pain and disablement. Research may also extend to assess the effectiveness of as a useful modality in geriatric care and for patients with other chronic conditions.
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Effect of Reflexology on Pain and Quality of Life in a Patient with Rheumatoid Arthritis
1Nadia Mohamed Taha and 2Zeinab Hussain Ali
1Medical Surgical Nursing, Faculty of Nursing, University of Zagazig, Zagazig, Egypt
2Adult Health Nursing, Faculty of Nursing, of Helwan, Helwan, Egypt
dr_nadya_mohamed@yahoo.com
Abstract: Patients with rheumatoid arthritis (RA) face considerable physical, social and emotional disabilities. In
this chronic disease, for which a cure is not yet available, improving patients’ health, quality of life and reduce pain
is of the utmost concern. The purpose of this work was to measure the effect reflexology has on pain and quality of
life (QOL) in a patient with rheumatoid arthritis. Using an 8-week course of reflexology treatments were given to a
patient who has RA. A quasi experimental research design was used with 2- month follow-up. The study was
conducted in the outpatient clinic of the RA Departments at Zagazig University Hospitals. On 39 female adult
patients diagnosed as having RA without deformity of bones or destruction of joints. The exclusion criterion was the
presence of any other chronic illness that may affect patient's QOL as diabetes, ischemic heart disease, chronic
obstructive pulmonary disease, and stroke. Perceived pain and QOL were assessed using three validated outcome
measures: Bio-socio-demographic and disease (RA) characteristics, the Rheumatoid Arthritis Quality of Life
(RAQOL) questionnaire, the Pain Assessment Questionnaire (Numerical Rating Scale) and Health assessment
questionnaire (HAQ). The study results revealed that, improvements in patients' QOL, pain and health status at the
post-intervention phase and at the follow-up phase. Satisfaction QOL scores had moderate statistically significant
negative correlations with the duration of illness throughout the study phases, while the scores of the importance of
QOL had weak to moderate statistically significant negative correlations with age and duration of illness. On the
other hand, the poor health status scores had moderate statistically significant positive correlations with age and
duration of illness throughout the study phases, while pain had no correlation with either of them. The study
concludes that hands and feet reflexology applied to rheumatoid arthritis patients is effective in reducing their pain,
improving their QOL and their total health status, and these positive impacts are not affected by patient’s age and
duration of illness. Therefore, reflexology must be considered as a complementary treatment modality in rheumatoid
arthritis. It should be introduced to nursing and medical students, and in postgraduate staff development programs.
Further research is recommended for the long-term effects of this treatment modality in terms of pain and
disablement. Research may also extend to assess the effectiveness of as a useful modality in geriatric care and for
patients with other chronic conditions.
[Nadia Mohamed Taha and Zeinab Hussain Ali. Effect of Reflexology on Pain and Quality of Life in a Patient
with Rheumatoid Arthritis. Life Science Journal. 2011;8(2):457-365] (ISSN:1097-8135).
http://www.lifesciencesite.com.
Keywords: Reflexology; Rheumatoid arthritis; Quality of life; Pain; Health assessment questionnaire
1. Introduction
Rheumatoid Arthritis (RA) is an ongoing,
progressive auto-immune disease that affects about
1% of the general population (Palferman, 2003;
Helmick et al., 2008; Rheumatoid Arthritis Fact
Sheet, 2010). It affects women three times more than
men (American Medical Women’s Association,
2011). It is mainly a disease of the joints of the body
with episodes of painful inflammation, but may also
affect other organs of the body and can result in the
destruction of joints, disability, and in severe cases,
life threatening complications (Chorus et al., 2003).
The onset of RA can occur at any age and affects
women three time more than men. In general, the
younger a person is when he or she develops
rheumatoid arthritis, the more rapidly that disease
progresses. About 10% of people with the disease
become severely disabled. In addition, life
expectancy may be shortened by about 3 to 7 years,
and those with severe forms of RA may die 10-15
years earlier than expected due to possible life
threatening complications (National Institutes of
Health, 2006; Helmick et al., 2008).
There is no cure for RA, but with early
recognition and treatment, it is possible to minimize
joint damage and complications of the disease. The
main symptoms, disability and pain, the variability of
disease-activity, alternating between improvement
and exacerbation, and the chronic nature of the
disease cause numerous problems which affect the
quality of life. Active participation by the patient in
their therapy can help to improve the disease process
and its impact in terms of health results (Holman and
Lorig, 2004). Because of the progressive chronic
nature of the disease, treatment usually needs to be
continuous, even lifelong in some cases (Jakobsson
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and Hallberg, 2002). The most successful treatment
plans usually use a multipronged approach,
including; pain relief, buffered aspirin, salicylate
medications, hydrotherapy, meditation, and mind-
body exercise (British Medical Association, 2000;
Gharate, 2007).
The use of complementary and alternative
medicines (CAM) has increased in conventional
healthcare settings (Ernst and Fugh-Berman, 2002;
Pagan and Pauly, 2005). The fear of medication side-
effects and desire for symptom relief are possible
reasons for the increasing use of CAM by patients
(Vincent and Furnham, 1999; Ross et al., 2002). With
consumer interest in CAM, nurses have increasingly
incorporated these modalities into their practice. For
example, reflexology has been widely used in fields
such as midwifery, orthopedics, neuroscience and
palliative care (Stephenson et al. 2003). However,
many CAM modalities lack scientific evidence to
support their efficacy and safety.
The supposed theoretical support for reflexology
has been developed since ancient Chinese and
Egyptian times (Wang et al., 2008). It is performed
using the thumb and forefinger to apply pressure to
specific areas on the feet that have been claimed to
correspond to the internal organs, glands and body
parts (Wang et al., 2008). It is different from foot
massage in that it involves more superficial contact,
deeper pressure on certain parts of the foot, and
resembles a caterpillar-like movement (Rose, 2006).
It has been claimed that by pressing the ‘reflex
zones’, energy blocks disturbances such that calcium,
lactate or uric acid crystals are reabsorbed and later
eliminated – a process referred to as ‘detoxification.’
It has also been suggested that reflexology may help
relieve stress and tension, improve blood flow, and
promote homeostasis (Wang et al., 2008).
Anecdotal evidence has shown that reflexology
is beneficial in many conditions such as pre- and
postnatal discomfort, pain, migraine and chronic
obstructive pulmonary disease (Stephenson et al.
2003, Wilkinson et al. 2006). Other therapeutic
effects, such as strengthening the immune system,
improving sleep quality, and wound healing have also
been claimed (Xavier, 2007). Reflexology has also
been offered to cancer patients to improve the
adverse physical and psychological symptoms
associated with the illness or its treatments (Hodgson,
2000; Stephenson et al, 2000; Ross et al., 2002;
Wright et al., 2002; Quattrin et al., 2006). In addition,
the human touch accompanied by reflexology offers
care and attention for patients, and this psychological
comforting has been reported as one of its primary
benefits (Gambles et al, 2002). However, patients’
reports of benefits from reflexology may be
influenced by bias in the lay literature or limited
information about the use and effectiveness of the
intervention (Montbriand, 1994). As reflexology has
become popular in nursing practice, its effects on
pain and quality of life in a patient with rheumatoid
arthritis need to be evaluated.
Significance of the study
The prevalence rate of RA in Egypt is not well
documented. However, by extrapolation using the
worldwide reported prevalence of 1%, about 800000
Egyptians may be affected. Moreover, about 10% of
people with the disease become severely disabled. In
addition, their life expectancy may be shortened due
to possible life threatening complications. Therefore,
the magnitude and severity of the disease are high.
Since there is no cure for RA, early recognition and
treatment are important to minimize joint damage and
complications of the disease. The use of non-
pharmacological treatment modalities as reflexology
may help in reduce pain and improve the quality of
life of these patients.
Aim of the Study
The aim of this work was to measure the effect
reflexology has on pain and quality of life (QOL) in a
patient with rheumatoid arthritis. The research
hypotheses were that the QOL of patients with RA,
their health status, and pain sensation will
demonstrate statistically significant improvements
after application of the reflexology intervention.
2. Subjects and Methods
Research design:
A quasi experimental research design was used
with 2- month follow-up.
Research setting:
The study was conducted in the outpatient clinic
of the RA Departments at Zagazig University
Hospitals.
Subjects:
The subjects of this study consisted of 50
patients. The inclusion criteria were being female
adult patient diagnosed as having RA without
deformity of bones or destruction of joints. The
exclusion criterion was the presence of any other
chronic illness that may affect patient's QOL as
diabetes, ischemic heart disease, chronic obstructive
pulmonary disease, and stroke.
Tools for data collection:
Four different tools were used to collect data
about QOL, health assessment, and pain. These were
included in a structured interview questionnaire form
that included the following sections.
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Section I:
Bio-socio-demographic and disease (RA)
characteristics as age, marital status, level of
education, occupation, residence, monthly income, as
well as the duration of the disease and management.
Section II:
This consisted of the Arthritis Quality of Life
Questionnaire sheet version IV (Ferrans & Powers,
1998). It is the most recent version composed of 70
questions, for assessing health-related QOL. The tool
assesses four subscales of QOL: health and
functioning, social and economic,
psychological/spiritual, and family. Each subscale
has six items on a 6-point scale which are assessed
twice: once for satisfaction with the item, and once
for the importance of the item. The scale for
satisfaction is: very dissatisfied, moderately
dissatisfied, slightly dissatisfied, slightly satisfied,
moderately satisfied, and very satisfied, which are
scored from 1 to 6 respectively. The scale for
importance is: very unimportant, moderately
unimportant, slightly unimportant, slightly important,
moderately important, and very important, also
scored from 1 to 6 respectively. A higher score means
more QOL satisfaction and higher perception of
importance.
Section III:
This section included the Health Assessment
Questionnaire (HAQ-DI), which assesses upper
extremity fine movements, lower extremity
locomotors activities, and other activities of both
upper and lower extremities. Scoring takes into
account the use of aids and devices or assistance from
another person. The tool has 20 items in eight
categories of functional activities during the past
week: dressing, rising, eating, walking, hygiene,
reach, grip, and usual activities. Each category
contains at least two specific sub-category questions.
For example, under the category “walking,” patients
are asked about their ability to walk outdoors on flat
ground and to climb up five steps. Scoring of the
HAQ-DI is modeled after the American Rheumatism
Association/ American College of Rheumatology
functional classes (Hoch Bergm et al., 1992; Bruce
and Fries, 2005). For each item, there is a four-level
response set scored from 0 to 3, with higher scores
indicating more disability (0 = without any difficulty;
1 = with some difficulty; 2 = with much difficulty;
and 3 = unable to do). The highest sub-category score
determines the value for each category, unless aids or
devices are used. The category scores are then
averaged into an overall HAQ-DI from zero to three.
A higher score points to more disability.
Section IV:
This consisted of a Numerical Rating Scale
where the user has the option to verbally rate pain
severity on scale from 0 to 10; zero indicates absence
of pain, while 10 represents the most intense pain
possible (Ware et al., 1988; Kagee, 2001; McGill,
2009).
The reflexology intervention:
Reflexology therapy is not massage, and it is not
a substitute for medical treatment. Source: The
reflexology manipulations in this intervention have
been adapted from the techniques taught in David
Vennells' book entitled Healing Hands: Simple and
practical reflexology techniques for developing good
health and inner peace (David Vennell 2007). A
reflexology session involves pressure treatment that
is most commonly administered in foot therapy
sessions of approximately 20 minutes in duration.
The foot therapy may be followed by a brief 15-
minute hand therapy session and 5 minute for video
film on reflexology treatment. No artificial devices or
special equipment are associated with this therapy. If
the part of the body corresponding to the reflex area
is out of balance then a degree of tenderness will be
felt in the foot when pressure is applied. Treatment to
all of the reflex areas in both feet takes about 40
minutes and during this time the patient is sitting in a
comfortable, reclining position with the feet raised.
Treatment is not applied to inflamed or painful joints.
After receiving a massage treatment, the patient is
instructed to drink water to eliminate toxin and lactic
acids developed during the massage process.
Content validity and reliability:
It was established by a panel of two expertises who
reviewed the instruments translation from English
version to Arabic and back to English the differences
between expertises were calculated and proved high
inter reliability (r=89).
Pilot Study:
A pilot study was conducted on five RA patients
from the study setting to check and ensure the clarity,
applicability, relevance, and feasibility of the tools, to
identify the difficulties that may be faced during the
application, and to estimate the time needed for data
collection. Then modifications of the tools were done
to reach to the finalized form. Subjects who shared in
the pilot study were not included in the main study
sample.
Administrative design and ethical considerations:
To carry out the study, the necessary
approvals were obtained from the Head of outpatient
Department, and from the General Director of the
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Zagazig University Hospitals. Letters were issued to
them from the Faculty of Nursing, Zagazig
University explaining the aim of the study in order to
obtain permission and help. The study protocol was
approved by the pertinent official authorities at the
Faculties of Nursing and Medicine, Zagazig
University. Oral informed consents were secured
from each subject to participate after explaining the
nature, purpose, and benefits of the study.
Participants were informed that participation is
voluntary, with no obligation to continue against will.
Confidentiality and anonymity were ensured. The
study maneuvers would improve participant's health,
with no potentials of harmful effects.
Study maneuver:
The researchers met with participants who gave
their consent and were willing to comply with the
entire study protocol and interviewed them
individually in the outpatient clinic. The researchers
started to apply the intervention and educate the
subjects on how to perform reflexology treatment.
Teaching included giving a good therapeutic foot and
hand massage, massaging own feet and hands for self
healing, and stress management. Also, they were
advised to comply with the medications prescribed by
their physicians. The researchers scheduled times for
attending to the clinic on Saturday, Monday, and
Wednesday of each week (days for females in
outpatient clinic) for physiotherapy, exercises, and
reflexology treatment. They encouraged participants
to attend regularly three times per week for two
weeks these 40-minute sessions. They also ask the
patients to perform these exercises and reflexology
regularly at home. Follow-up assessment was done
after 8 weeks. Data collection extended over a period
of one year from June 2009 to June 2010. Available
patients (39 patients) who fulfilled the inclusion and
exclusion criteria were assigned to implemented
nursing intervention three times per week. While
patients can not received nursing intervention three
times per week excluded from the study.
Statistical analysis:
Data entry and statistical analysis were done
using SPSS 14.0 statistical software package. The
non-parametric Kruskal-Wallis was used for multiple
group comparisons of quantitative data as normal
distribution of the data could not be assumed.
Pearson correlation analysis was used for assessment
of the inter-relationships among quantitative
variables. Statistical significance was considered at
p-value <0.05.
Limitations of the study:
The researchers were faced with many
logistic problems and spent much effort to convince
and promote the objectives of the study. Drop out
cases: the total subjects number at the pre,
intervention and post phases were 50 participants.
While during the follow up phase 11 participants
were dropout from the study for personal reasons and
did not complete the study. The small number of the
study sample of patients doesn't allow generalization
of the result. Patients who suddenly get complications
were excluded.
3. Results:
The study included 39 female patients in the
age range from 19 to 70 years (mean±SD 45.9±11.8
years). As Table 1 shows, the majority were illiterate
(79.5%), married (82.1%), and from rural areas
(74.4%). The duration of their illness ranged between
less than one to 16 years with mean±SD 4.4±4.0
years. About two thirds of them had regular follow-
up (66.7%).
Table 1. Socio-demographic and diseases characteristics
of patients in the study sample
Frequency Percent
Age (years):
<50 24 61.5
50+ 15 38.5
Range 19-70
Mean±SD 45.9±11.8
Marital status:
Single 7 17.9
Married 32 82.1
Education:
Illiterate 31 79.5
Educated 8 20.5
Job:
Unemployed 35 89.7
Working 4 10.3
Living:
Alone 2 5.1
With family 31 79.5
With children 6 15.4
Residence:
Rural 29 74.4
Urban 10 25.6
Income:
Sufficient 20 51.3
Insufficient 19 48.7
Duration of illness (years):
<5 25 64.1
5+ 14 35.9
Range <1-16
Mean±SD 4.4±4.0
Regular follow-up:
No 13 33.3
Yes 26 66.7
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Table 2 show statistically significant
improvements in patients' QOL at the post-
intervention phase. The improvements were also
sustained at the follow-up phase. The only domain
that did not improve was that related to family, both
for satisfaction and importance. As for the poor
health status, the areas of statistically significant
improvements were those related to walking
(p<0.001), self-care (p=0.01), reaching (p<0.001),
and pinching (p=0.003). The improvements also
persisted during the follow-up phase in these areas.
Also, the pain scale scores demonstrated a
statistically significant decline at the post-
intervention phase, with a slight increase at the
follow-up phase (p<0.001).
Figure 1 summarizes the total scores of various
parameters throughout the intervention phase. It
demonstrates significant increase in the scores of
QOL (satisfaction and importance) at the post-
intervention phase, which was sustained at the
follow-up phase. Also, the pain and poor health status
scores showed decline at the post-intervention phase,
which was maintained at the follow-up phase.
Concerning the correlations with patients' age
and duration of illness, Table 3 indicates that scores
of satisfaction with QOL had moderate statistically
significant negative correlations with the duration of
illness throughout the study phases, while the scores
of the importance of QOL had weak to moderate
statistically significant negative correlations with age
and duration of illness. On the other hand, the poor
health status scores had moderate statistically
significant positive correlations with age and duration
of illness throughout the study phases, while pain had
no correlation with either of them.
Table 2. Changes in patients' QOL, health status, and pain scores throughout intervention phases
Time Kruskal
Wallis
Test p-value
Pre (n=39) Post (n=39) FU (n=39)
Mean±SD Median Mean±SD Median Mean±SD Median
QOL satisfaction:
Health/function
ing 2.9±0.9 2.50 4.2±0.4 4.10 4.2±0.4 4.10 55.69 <0.001*
Social/economi
c 2.7±0.8 2.60 3.4±0.6 3.30 3.4±0.6 3.30 36.16 <0.001*
Psychic./spiritu
al 3.4±0.7 3.30 4.7±0.3 4.60 4.7±0.3 4.60 56.82 <0.001*
Family 4.9±0.5 5.00 5.0±0.5 5.00 5.0±0.5 5.00 0.10 0.95
QOL importance:
Health/function
ing 4.2±0.9 4.40 4.9±0.5 4.90 4.9±0.5 4.85 14.50 0.001*
Social/economi
c 3.0±1.0 2.90 3.9±0.6 3.70 3.9±0.6 3.70 26.67 <0.001*
Psychic./spiritu
al 4.2±0.9 4.00 5.0±0.4 4.90 5.0±0.4 4.90 23.21 <0.001*
Family 5.0±0.9 5.20 5.3±0.5 5.40 5.3±0.5 5.40 3.41 0.18
Poor health status:
Clothing/hygie
ne 1.7±0.8 2.00 1.6±0.8 2.00 1.7±0.7 2.00 0.29 0.87
Lifting 1.2±0.9 1.00 1.1±0.9 1.00 1.3±0.8 1.00 0.65 0.72
Eating 2.2±0.7 2.00 2.1±0.6 2.00 2.1±0.6 2.00 1.05 0.59
Walking 2.1±0.9 2.00 1.3±0.7 1.00 1.4±0.6 1.00 20.43 <0.001*
Self-care 1.9±1.0 2.00 1.4±0.6 1.00 1.4±0.6 1.00 8.70 0.01*
Reaching 2.2±0.7 2.00 1.6±0.5 2.00 1.6±0.5 2.00 22.57 <0.001*
Pinching 1.9±0.9 2.00 1.3±0.6 1.00 1.3±0.6 1.00 11.44 0.003*
Outdoor
activities 2.7±0.5 3.00 2.6±0.5 3.00 2.6±0.5 3.00 1.77 0.41
Pain scale 6.7±1.0 7.00 5.3±0.8 5.00 5.5±0.6 5.00 44.75 <0.001*
(*) Statistically significant at p<0.05
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0
1
2
3
4
5
6
7
8
Pre Post FU
scores
QOL satisfaction QOL importance Poor health status Pain
Table 3. Correlations of patients' scores of QOL, pain, and health status and their age and duration of illness
throughout intervention phases
Pearson correlation coefficient
Pre Post FU
Age Duration of
Illness Age Duration of
Illness Age Duration of Illness
QOL satisfaction -.253 -.442** -.166 -.418** -.192 -.419**
QOL importance -.638** -.380* -.561** -.331* -.592** -.455**
Pain -.094 .202 .017 .192 .055 .140
Poor health status .581** .510** .631** .486** .609** .480**
(*) Statistically significant at p<0.05; (**) Statistically significant at p<0.01
Figure 1. Changes in patients' total QOL, health status, and pain scores throughout intervention phases
4. Discussion:
The present study was carried out to test the
research hypothesis that the QOL of patients with
RA, their health status, and pain sensation will
demonstrate statistically significant improvements
after application of the reflexology intervention. The
study findings lead to accepting this research
hypothesis since they point to statistically significant
increases in QOL scores and decreases in poor health
status and pain scores after implementation of the
reflexology intervention. The improvements were
also sustained during the follow-up phase.
In the present study, the researchers used the
Short-Form 36 (SF-36), Rheumatoid Arthritis Quality
of Life (RAQOL) questionnaire, Health Assessment
Questionnaire (HAQ), and visual analog scales for
pain, all of them having high degrees of validity and
reliability. Additionally, their validity was further
confirmed in the study of rheumatoid arthritis in
particular Bansback et al, 2008; (Linde et al, 2008).
The authors compared the measurement properties of
these tools and showed that all of them were able to
discriminate between low, moderate, and severe
rheumatoid arthritis activity as measured by the
Disease Activity Score. These findings add to the
validity of these instruments, and consequently
support the results of the present study.
According to the present study findings, the
application of reflexology had a positive impact on
participants' QOL, health status, and pain scores
throughout intervention phases. These improvements
may be attributed to the process of reflexology as it
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has been claimed that local finger pressure on reflex
points on the hands or feet can influence the function
of corresponding target organs to promote
homeostasis, relaxation, and sense of human touch.
Moreover, the reduction of pain intensity by
reflexology may improve patients' independent
involvement in personal and self-care, as well as
social functioning, with further positive impact on
self-esteem and QOL. Therefore, it has been
recommended as a promising complementary therapy
which can improve quality of life in persons with
rheumatoid arthritis, and other conditions (Lynn,
2010).
The present study revealed improvements in
all QOL domains except that related to family. This
might be attributed to that the scores of this domain
were the highest at the pre-intervention phase and in
all subsequent phases. This implies that the family
domain of QOL is the least affected by the disease.
The finding is expected given the importance of the
family solidarity and values in our community, where
chronic disease patients are provided with more care
in their families. In agreement with this, El-Mansoury
et al. (2008), comparing loneliness among Egyptian
and Dutch women with rheumatoid arthritis found
that the role of the family in perceived loneliness is
greater in Egypt than the Netherlands. The
importance of family relations and functioning in
rheumatoid arthritis has been addressed in previous
studies (Cunha-Miranda et al, 2010; Strand and
Khanna, 2010). Furthermore, Coty and Wallston
(2010) in a study that examined the relationship of
problematic social support and family functioning in
women with rheumatoid arthritis. The study
concluded that subjective well-being in women with
rheumatoid arthritis is related to perceptions of
family functioning and the amount and type of
support received.
As regards health status, the reflexology
intervention had significant positive impacts on
certain areas but did not affect others. The areas that
showed improvements were those of walking, self-
care, reaching, and pinching, whereas the areas of
clothing, eating, lifting, and outdoor activities were
not affected. This might have two different
explanations. The first is related to the severity of
rheumatoid arthritis and the types of joints affected
and their relation to these different activities. The
other explanation is related to the proper application
of reflexology and compliance with the instructions
so that all functions are improved. In line with this
explanation, Somchock (2006) mentioned that most
of the studies addressing reflexology claimed that
reflexology induced general relaxation evidenced by
physiological changes has been reported, but whether
its therapeutic effects were associated with pressure
on specific foot zones remains unanswered because
none of the researchers used an objective indicator to
verify changes in blood perfusion in the foot zones
pressed. Meanwhile, the differential effects of
reflexology on functional aspects of rheumatoid
arthritis patients of the present study are in
congruence with Wang et al. (2008) who reported
variations among reviewed studies regarding the
efficacy of reflexology.
Patient’s age and duration of illness may also
be confounding factors affecting the impact of
reflexology on QOL, and health status, and pain. The
study findings revealed no effect of age or duration of
illness on pain throughout the intervention phases. As
regards QOL, it had statistically negative significant
correlations with the duration of illness in both its
aspects, and with patient's age in its importance
aspect. This means that patient's QOL declines with
increased age and duration of illness. Similarly, the
scores of poor health status increase with age and
duration of illness. The findings are quite plausible
given the added effects of aging, and the progress of
the disease severity with increased duration as
previously reported (Schneider et al., 2008; Collins et
al., 2009). However, all these correlations did not
change throughout the study phases, which means
that patient's age and duration of illness were not
confounding factors, and consequently the observed
positive impact of the intervention was true. In other
words, the intervention was successful in alleviating
pain and improving QOL and health status regardless
patient age and duration of illness.
5. Conclusion and recommendations
The study concludes that hands and feet
reflexology applied to rheumatoid arthritis patients is
effective in reducing their pain, improving their QOL
and their total health status, and these positive
impacts are not affected by patient’s age and duration
of illness. Therefore, reflexology must be considered
as a complementary treatment modality in
rheumatoid arthritis. It should be introduced to
nursing and medical students, and in postgraduate
staff development programs. Further research is
recommended for the long-term effects of this
treatment modality in terms of pain and disablement.
Research may also extend to assess the effectiveness
of as a useful modality in geriatric care and for
patients with other chronic conditions.
Corresponding author:
Nadia Mohamed Taha
Medical Surgical Nursing, Faculty of Nursing,
University of Zagazig, Zagazig, Egypt
dr_nadya_mohamed@yahoo.com
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6. References:
1. American Medical Women’s Association (2011):
Statistics about Rheumatoid arthritis. Retrieved
on 26 Jan 2011 at:
http://www.wrongdiagnosis.com/r/ rheumatoid_
arthritis/ Prevalence
2. Bansback N.J., Anis A.H., and Marra C.A.
(2008): Patient Reported Outcomes for
Rheumatoid Arthritis: Where Are We and Where
Are We Going? The Journal of Rheumatology,
35:8 1482, 1483
3. British Medical Association (2000): Royal
Pharmaceutical Society of Great Britain. British
National Formulary. No 40. NSAIDs
Interactions. Appendix I: Interactions. London:
BMA, RPS, pp. 588-624.
4. Bruce B., and Fries J.F. (2005): The Health
Assessment Questionnaire (HAQ) Clinical and
Experimental Rheumatology; 23 (Suppl. 39):
S14-S18.
5. Chorus A.M.J., Miedema H.S., Boonen A., and
van der Linden S. (2003): Quality of life and
work in patients with rheumatoid arthritis and
ankylosing spondylitis of working age. Ann
Rheum Dis; 62:1178-1184
6. Collins P., Qc AM., and Allbon P. (2009):
Australian Institute of Health and Welfare 2009
A picture of rheumatoid arthritis in Australia.
Arthritis series no. 9. Cat. No. PHE 110.
Canberra: AIHW.1-28.
7. Coty M.B., and Wallston K.A. (2010):
Problematic social support, family functioning,
and subjective well-being in women with
rheumatoid arthritis. Women Health.; 50(1):53-
70.
8. Cunha-Miranda L., Costa L., and Ribeiro J.S.
(2010): Near study: Needs and Expectations in
Rheumatoid ARthritis - do we know our patients
needs? Acta Reumatol Port.; 35(3):314-23.
9. David Vennell (2007): Simple Hands, Foot
Reflexology Techniques. Retrieved on 14 Oct
2007 http://healing.
10. About.com/od/books/ig/Book-of-the-
week/Healing- Hands-Reflexology.htm
11. El-Mansoury T.M., Taal E., Abdel-Nasser A.M.,
Riemsma R.P., Mahfouz R., Mahmoud J.A., El-
Badawy S.A., Rasker J.J. (2008): Loneliness
among women with rheumatoid arthritis: a cross-
cultural study in the Netherlands and Egypt. Clin
Rheumatol.; 27(9):1109-18.
12. Ernst E., and Fugh-Berman A. (2002):
Complementary and alternative medicine: what
is it all about? Occupational & Environmental
Medicine; 59(2): 140–144.
13. Ferrans C. E. & Powers M. J. (1998): Ferrans
and Powers Quality of Life Index (QLI).
Available at http://www.uic.edu/ orgs/ qli/
questionaires/ pdf/ QLI%20 THAI %20 from
%20Suparat%202-07.pdf
14. Gambles M., Crooke M., and Wilkinson S.
(2002): Evaluation of a hospice based
reflexology service: a qualitative audit of patient
perceptions. European Journal of Oncology
Nursing; 6(1): 37–44.
15. Gharate M.K. (2007): Rheumatoid arthritis &
Complementary and Alternative
Medicine.Pharmainfo.net; 5(Issues 5).
16. Helmick C., Felson D., Lawrence R., and Gabriel
S. (2008): Estimates of the Prevalence of
Arthritis and Other Rheumatic conditions in the
United States. Arthritis & Rheumatism;
58(1):15-25.
17. Hoch Bergm C., Chang R.W., and Dwosh I.
(1992): The American College of Rheumatology
1991 revised criteria for the classification of
global functional status in rheumatoid arthritis.
Arthritis Rheum; 35: 498-502.
18. Hodgson H. (2000): Does reflexology impact on
cancer patients’ quality of life? Nursing
Standard; 14(31): 33–38.
19. Holman H., and Lorig K. (2004): Patient self-
management: a key to effectiveness and
efficiency in care of chronic disease. Public
Health Rep; 119:239–243
20. Jakobsson U., and Hallberg I.R. (2002): Pain and
quality of life among older people with
rheumatoid arthritis and/or osteoarthritis: A
literature review. Journal of Clinical Nursing;
11(4): 430–443.
21. Kagee A. (2001): Review of the SF-36 Health
Survey. In Plake BS & Impara, JC. (Eds). The
fourteenth mental measurements yearbook. 2001;
Lincoln NE: Buros Institute of Mental
Measurements.
22. Linde L., Sørensen J., Østergaard M., Hørslev-
Pedersen K., Lund Hetland M. (2008): Health-
related quality of life: validity, reliability, and
responsiveness of SF-36, 15D, EQ-5D, RAQoL,
and HAQ in patients with rheumatoid arthritis. J
Rheumatol; 35: 1528-37.
23. Lynn B. (2010): Reflexology for Chronic
Conditions: A Promising Modality,
Gerontological Nurses Association of British
Columbia Conference and Annual Meeting
“Aging: Honoring the Journey” September 16 –
18, 2010 Coast Inn of the North 770 Brunswick
Street Prince George BC V2L 2C2 Newsletter
(2010) Spring edition March 2010.
24. McGill (2009): Pain Scale for Pain Assessment
McGill Pain Questionnaire, From Erica Jacques,
former About.com Guide Updated September 03,
2009 About.com Health's Disease and Condition
Life Science Journal, 2011;8(2) http://www.lifesciencesite.com
http://www.sciencepub.net/life lifesciencej@gmail.com
365
content is reviewed by the Medical Review
Board.
25. Montbriand M.J. (1994): An overview of
alternate therapies chosen by patients with
cancer. Oncology Nursing Forum; 21(9): 1547–
1554.
26. National Institutes of Health (2006): National
Institute of Arthritis and Musculoskeletal and
Skin Diseases
27. Pagan J.A., and Pauly M.V. (2005): Access to
conventional medical care and the use of
complementary and alternative medicine. Health
Affairs; 24(1): 255–262.
28. Palferman T.G. (2003): Principles of rheumatoid
arthritis control. J heumatol; 67(Suppl):10–13.
29. Quattrin R., Zanini A., Buchini S., Turello D.,
Annunziata M.A., Vidotti C., Colombatti A., and
Brusaferro S. (2006): Use of reflexology foot
massage to reduce anxiety in hospitalized cancer
patients in chemotherapy treatment:
methodology and outcomes. Journal of Nursing
Management; 14: 96–105.
30. Rheumatoid Arthritis Fact Sheet (2010): Arthritis
Foundation news from the arthritis foundation,
1330 west Peachtree Street. Atlanta Georgia,
30309
31. Rose G. (2006): Why do patients with
rheumatoid arthritis use complementary
therapies? Musculoskeletal Care; 4(2): 101–115.
32. Ross C.S., Hamilton J., Macrae G., Docherty C.,
Gould A., and Cornbleet M.A. (2002): A pilot
study to evaluate the effect of reflexology on
mood and symptom rating of advanced cancer
patients. Jan: Eview Paper Efficacy of
reflexology. Palliative Medicine; 16: 544–545.
33. Schneider M., Manabile E., and Tikly M. (2008):
Social aspects of living with rheumatoid arthritis:
a qualitative descriptive study in Soweto, South
Africa – a low resource context, Health and
Quality of Life Outcomes; 6:54.
34. Somchock J. (2006): Effects of foot reflexology
on reducing blood pressure in patients with
hypertension, Master of Science (in Nursing)
School of Nursing and Midwifery Flinders
University Adelaide, Australia January 2006.
35. Stephenson N., Dalton J.A., and Carlson J.
(2003): The effect of foot reflexology on pain in
patients with metastatic cancer. Applied Nursing
Research; 16(4): 284–286.
36. Stephenson N.L., Weinrich S.P., and Tavakoli
A.S. (2000): The effects of foot reflexology on
anxiety and pain in patients with breast and lung
cancer. Oncology Nursing Forum; 27(1): 67–72.
37. Strand V., and Khanna D. (2010): The impact of
rheumatoid arthritis and treatment on patients'
lives. Clin Exp Rheumatol.; 28(3 Suppl 59):S32-
40.
38. Vincent C., and Furnham A. (1999):
Complementary medicine: state of the evidence.
Journal of the Royal Society of Medicine; 92(4):
170–177.
39. Wang M.Y., Tsai P.S., Lee P.H., Chang W.Y.,
and Yang C.M. (2008): The efficacy of
reflexology: systematic review. Journal of
Advanced Nursing; 62(5): 512–520
40. Ware JE, Jr., and Hays RD. (1988): Methods for
measuring patient satisfaction with specific
medical encounters. Medical Care; 26:393-402.
41. Wilkinson I.S., Prigmore S., and Rayner C.F.
(2006): A randomisedcontrolled trail examining
the effects of reflexology of patients with chronic
obstructive pulmonary disease (COPD).
Complementary Therapies in Clinical Practice;
12: 141–147.
42. Wright S., Courtney U., Donnelly C., Kenny T.,
and Lavin C. (2002): Clients’ perceptions of the
benefits of reflexology on their quality of life.
Complementary Therapies in Nursing &
Midwifery; 8: 69–76.
43. Xavier R. (2007): Facts on reflexology (foot
massage). Nursing Journal of India; 98(1): 11–
12.
4/1/2011
... Rheumatoid arthritis (RA) is a chronic, idiopathic, systemic, inflammatory, autoimmune disease characterized by pain in the joints and swelling, loss of function in the joints, morning stiffness and sleep deprivation as well as fatigue accompanying these states [1]. The loss of function due to the disease also leads to poor quality of life [2]. Depending on the prognosis, physical deformities and unbearable pain may become prominent over time [3]. ...
... A limited number of previous studies have also shown that foot reflexology had a pain-reducing effect in RA patients [2,9,16]. It was found that both hand and foot reflexology had a positive effect on pain and quality of life in RA patients [2]. ...
... A limited number of previous studies have also shown that foot reflexology had a pain-reducing effect in RA patients [2,9,16]. It was found that both hand and foot reflexology had a positive effect on pain and quality of life in RA patients [2]. In a study, it was concluded that foot reflexology was a more effective method in reducing pain symptoms compared to aromatherapy [15]. ...
... Autorzy zalecają wprowadzenie tej metody do programu edukacji studentów medycyny i pielęgniarstwa oraz podyplomowych programów rozwoju personelu. Zauważają także potrzebę dalszych badań obejmujących ocenę skuteczności tej metody w leczeniu bólu, u pacjentów geriatrycznych i cierpiących z powodu przewlekłych schorzeń [19]. Badania Movaghar i wsp. ...
... The authors recommend introducing this method into the curriculum and teaching programs of medicine and nursing students as well as postgraduate staff development programs. They also point to the need for further research to evaluate the efficacy of this method in the treatment of pain in the case of geriatric patients and patients suffering from pain due to chronic conditions [19]. Research carried out by Movaghar et al., regarding the evaluation of the effect of reflexology treatments on the reduction in chronic pain of the spinal column, indicate a significant decrease in pain intensity [20][21][22]. ...
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Background: Osteoarthritis (OA) is one of the most common joint disorders and affects a significant percentage of the elderly. Reflexology is a therapeutic method of applying appropriate compression technique to pressure points located, for instance, on feet. The aim of this study was to evaluate the impact of foot reflexology treatment on pain and vitality level in persons with osteoarthritis. Material and Methods: The study was conducted on a group 20 individuals (16 women and 4 men) aged 41-76, who suffered from osteoarthritis. Two questionnaires (surveys), i.e. the NRS scale and the WOMAC questionnaire, were the research tools applied in the study. The study was conducted prior to the therapy and after a series of 8 sessions. Results: After the treatment, the researchers observed an improvement in average results obtained in the WOMAC questionnaire. Moreover, the respondents reported a reduction in pain intensity and improvement in functionality. The applied treatment effectively reduced the intake of pain medications by the surveyed individuals (p = 0.006). The respondents also reported improvement in the quality of sleep. Conclusions: According to the individuals surveyed, reflexology is an effective analgesic method, as a notable reduction in pain severity was observed. Reflexology increases the activity of patients and reduces the intake of pain medications.
... Reflexology is preferred in increasing the quality of life and state of well-being in cases such as reducing the side effects of gynecological diseases, neurological diseases, musculoskeletal disorders, autoimmune diseases, digestive system diseases, and cancer pain and treatments. [2,3,4] The literature indicates that reflexology is mainly used for labor pain6, labor pain and labor duration4, premenstrual distress [7] , premenstrual quality of life [8] , dysmenorrhea [9,10], dysmenorrhea period school performance [11] , menstrual period emotional state [12] , premenopausal vasomotor complaints [13] , multiple sclerosis [14] , rheumatoid arthritis [15] , fibromyalgia [16] , constipation [17] , hypertension [18] , cancer pain [19] , chemotherapy-induced nausea [5] and vomiting as well as for reducing back pain [20] , increasing sleep quality [21] , reducing or eliminating stress-anxiety [2,13] . ...
... The effects of reflexology on blood pressure and quality of life in individuals with hypertension, on alleviating premenstrual distress, on sedation level and vital signs in patients with mechanical ventilation support, on dyspnea and fatigue in patients with copd, on chemotherapy-induced nausea, vomiting and fatigue in patients with breast cancer, on constipation in the elderly, on labor pain and duration, on dysmenorrhea and school performance. Results were examined from various aspects and positive outcomes were obtained [10][11][12][13][14][15][16][17][18] . ...
... The results of the present study showed that foot reflexology significantly reduced pain. The results of the present study are in line with those of previous studies in patients with appendectomy [17], surgical [24], labor [25], and rheumatoid arthritis pain [26], all of which indicate a positive effect of foot reflexology on pain relief. The results also showed that foot reflexology caused significant changes in the physiological indices of HR and blood pressure. ...
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Background: Foot reflexology is a popular complementary medicine method; however, previous studies have shown conflicting results. This study aimed to investigate the impact of foot reflexology on pain and physiological responses caused by intrathecal injection of chemotherapy drugs in children with leukemia. Materials and methods: This clinical trial included 80 children with leukemia. The participants received 20 min foot reflexology (10 min each foot). The primary measured outcomes included pain and physiological indicators (blood pressure and heart rate). Results: The results showed that foot reflexology had a significant effect on reducing pain (p = 0.002) and improving physiological indicators [blood pressure (p = 0.002) and heart rate (p = 0.003)]. Conclusion: Based on the results of the present study, which shows the positive effect of foot reflexology on the improvement of pain and physiological indicators, foot reflexology can be used as a complementary treatment along with conventional therapies.
... [32] Similarly, Taha et al. studied the impact of reflexology on the pain and quality of life of patients with rheumatoid arthritis and reported its positive effects. [33] A study by Cloze et al. also showed the positive impact of reflexology on relieving back pain in 64 pregnant mothers. [34] Furthermore, Shahsavari et al. (2015) indicated that foot reflexology decreased anxiety in candidates for bronchoscopy. ...
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Rheumatoid arthritis (RA) is a chronic, debilitating disease that significantly impacts patients' quality of life and socioeconomic productivity. On a personal level, RA has a significant socioeconomic impact on patients' lives, being ranked among the highest of all chronic diseases for its effect on health-related quality of life (HRQoL), and limitations in physical function as well as increased pain and fatigue affect patients' attendance at paid work, their work performance within and outside the home, and their participation in family, social, and leisure activities. Additional paid or unpaid support, as well as increased flexibility and job modifications from employers, are often required so that patients can meet their role obligations. Disease-related reductions in work and household productivity are not just due to the physical limitations posed by RA; mental/emotional limitations also play a key role in reducing patients' HRQoL and productivity. Newer, effective treatments, such as tumor necrosis factor (TNF) inhibitors, improve the signs and symptoms of disease, inhibit progression of joint damage, and improve physical function and HRQoL. A recently available TNF inhibitor for RA, certolizumab pegol, has been shown to increase productivity outside and within the home and participation in family, social, and leisure activities as well as rapidly improve physical function, fatigue, and pain. Due to the importance of these parameters to patients, new therapies are increasingly assessed based on their ability to improve HRQoL, productivity, and participation. These extend the more traditional measures of efficacy into outcomes that are more central to patients' daily lives.
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Rheumatoid arthritis is a chronic systemic inflammatory rheumatic disease whose characteristics have a clear impact on the life of the patient and his/ her family. Doctor-patient relationship is increasingly based on communication and information transfer. In the case of chronic diseases and especially in RA, that information is fundamental for a better compliance, but also for the prevention of problems and the patient's better management of the disease on a daily basis. To determine in a population of RA patients which are the principal sources of information about the disease, what unmet needs exist and the level of patient involvement in therapeutic decision. We applied a questionnaire in person and by telephone to a population of patients with rheumatoid arthritis fulfilling the criteria of the ACR, which were followed at several departments of rheumatology in mainland Portugal, about their expectations, the degree and type of information they expected, and their unmet needs. A total of 223 RA patients filled in the questionnaire, 82.5% of which were female, mean age 55.13 +/- 14.49 years and whose mean duration of disease was above 5 years in 69.5% of the individuals. Of these, 17.5% found that RA had an impact on quality of life, 15.7% felt that RA affected their ability to enjoy life and 14.3% had difficulties in performing activities of daily living. Some activities were found to be more difficult for a patient with RA (on a scale of 0 to 10), such as gardening (6.36) and practicing sports (5.79). Other basic tasks were also considered difficult, as are the case of household chores (5.76) sleeping (5.08) walking (4.99) and working (4.86). Regarding the clinical impact of RA, as expected pain is almost a universal factor (87.9%), although the majority of patients also refer arthritis (78%), pain when moving (65.5%), fatigue (60.1%) and joint deformities (58.3%) as very common symptoms. Diminishing pain (81.2%), a general improvement of symptoms (73.1%) in a lasting way (57.4%) and reducing arthritis (59.2%) appeared as the main concerns of patients with RA. Regarding quality of information, 68.2% of patients consider they are well informed about the disease, but these numbers decrease if we consider information about treatment options (46.2%), the concept of remission (20.6%) or the recognition of the DAS 28 scale (17%). As preferred sources of information about the disease, 67.7% of individuals indicate their rheumatologist, 31.4% their general practitioner, 17% the Internet and 9% the attending nurse. The same order is obtained when asked about treatment information. As to the need for additional information, the patients refer «more information about therapies/treatments» (26.9%), «new scientific developments and social support» (17.5% each), «how to improve symptoms and live better in everyday life» (16.6%). «What is the disease» (6.7%) is referred last, being that only 8.1% of patients consider they are well informed. In what concerns discussion and participation in the process of clinical decision about medication, 56.1% of patients say that they share it with their doctors during their consultation. These results, which somewhat differ from the existing literature, demonstrate that there are important issues that should be considered in clinical practice, both relating to clinical issues and the unmet needs of our patients. We are unaware of the results coming from a treatment strategy designed to increase the RA patient's perception of their general state of health or of their perception of function. We should, however, keep in mind that pain, wellbeing and disease activity (as well as remission) should be important goals in therapeutic strategies that are to be increasingly shared with our patients.
Article
Many CAM therapies for arthritis are heavily advertised and make attractive claims, often based on personal stories (testimonials). However, it is important to find out whether any high-quality scientific research has been done on a CAM therapy. Some CAM therapies discussed in this review-such as thunder god vine (which is not currently available in a safe American-made product), gamma-linolenic acid, fish oil, and mind-body therapies--have shown some possibility of benefit for RA.The claims for many CAM therapies can be attractive, ranging from enhancing well-being, to helping with difficult chronic conditions, to achieving unbelievable results. It is important to know whether scientific research has proven that a therapy works and, if so, why. It is important for people with RA to have their condition followed by a rheumatologist.