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Perspectives on reflexology: A qualitative approach

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Introduction: Reflexology is the systematic practice of applying some pressure to particular points on the feet and hands to impact on health of related parts of the body. Objective: To explore the practitioners' perspectives of reflexology in Malaysia. Methods: Data was collected using face-to-face semi-structured interviews with practitioners in Malaysia. The interviews were conducted in the Malay language and recorded. Interview conversations were translated and transcribed verbatim. Responses relating to different themes were identified in each of the interviews and a coding frame was developed. For each theme, the relevant data enabled a description of the range of views and experiences. Data collection and analysis were conducted concurrently and recruitment was stopped when saturation had been reached. All respondents gave written consent for their participation. Results: The findings show that reflexology treatment nowadays has been accepted as one of the ways to maintain general health. Practitioners believe that reflexology is able to detect some problems in to the body, which can make patients aware of a health condition and seek further treatment. However, if reflexology is not performed correctly, it may cause negative effects such as pain and bruises. Some practitioners voiced concern that illegal activities are taking place in unethical reflexology centers. Conclusions: Empowering the practitioner as a professional would help gain the public's trust and confidence in their treatment. Strict enforcement of regulation related to illegal conduct in reflexology centers will improve people's perception of the practice.
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Original article
Perspectives on reexology: A qualitative approach
Nurul Haswani Embong
a
, Yee Chang Soh
a
,
b
,
**
, Long Chiau Ming
a
,
c
,
*
, Tin Wui Wong
a
,
d
a
Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
b
School of Pharmacy, Taylor's University (Lakeside Campus), Subang Jaya, Malaysia
c
Vector-borne Diseases Research Group (VERDI), Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
d
Non-Destructive Biomedical and Pharmaceutical Research Centre, iPROMISE, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
article info
Article history:
Received 23 February 2016
Received in revised form
26 July 2016
Accepted 17 August 2016
Available online xxx
Keywords:
Complementary and alternative medicine
Treatment effect
Foot massage
Reexology
Pain management
Professionalism
abstract
Introduction: Reexology is the systematic practice of applying some pressure to particular points on the
feet and hands to impact on health of related parts of the body.
Objective: To explore the practitioners' perspectives of reexology in Malaysia.
Methods: Data was collected using face-to-face semi-structured interviews with practitioners in
Malaysia. The interviews were conducted in the Malay language and recorded. Interview conversations
were translated and transcribed verbatim. Responses relating to different themes were identied in each
of the interviews and a coding frame was developed. For each theme, the relevant data enabled a
description of the range of views and experiences. Data collection and analysis were conducted
concurrently and recruitment was stopped when saturation had been reached. All respondents gave
written consent for their participation.
Results: The ndings show that reexology treatment nowadays has been accepted as one of the ways to
maintain general health. Practitioners believe that reexology is able to detect some problems in to the
body, which can make patients aware of a health condition and seek further treatment. However, if
reexology is not performed correctly, it may cause negative effects such as pain and bruises. Some
practitioners voiced concern that illegal activities are taking place in unethical reexology centers.
Conclusions: Empowering the practitioner as a professional would help gain the public's trust and
condence in their treatment. Strict enforcement of regulation related to illegal conduct in reexology
centers will improve people's perception of the practice.
Copyright ©2016, Center for Food and Biomolecules, National Taiwan University. Production and hosting
by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
Reexology is the systematic practice of applying some pressure
to particular points on the feet and hands to impact the health of
related parts of the body.
1
Each pressure point acts as a sensor on
the feet and hands and is linked with specic parts of the body.
2,3
These sensors will be stimulated by applying the reexology
technique in order to improve the blood and energy circulation,
giving a sense of relaxation and maintaining homeostasis.
4,5
Reexology sessions can be improved with other elements such
as aromatherapy, peaceful music, and good environment settings.
6
There is a term in reexology called reex zone therapy. Reex zone
therapy is where the body is divided into ten longitudinal zones,
from the top of the head down to the feet. In reex zone therapy,
there are ve zones on each side of the body. Each zone diverges off
down the arm and circumscribes one digit on the hand, and also
continuing straight down the body and down the leg to line up with
a toe on the respective foot. Practitioners choose a suitable tech-
nique to be applied to reex zone therapy to gain optimized ef-
ciency and impact.
Instead of an alternative therapy, reexology is a complemen-
tary therapy, linked to other treatments that a patient has already
had based on reexology maps.
4,5
Complementary therapies are
nowadays widely used in palliative care or to alleviate a problem
*Corresponding author. Level 11, FF1, Faculty of Pharmacy, Universit i Teknologi
MARA, 4230 0, Puncak Alam, Selangor, Malaysia. Fax: þ60 3 32584602.
** Corresponding author. Level 11, FF1, Faculty of Pharmacy, Universiti Teknologi
MARA, 42300, Puncak Alam, Selangor, Malaysia. Fax: þ60 3 32584602.
E-mail addresses: nunawanie@gmail.com (N.H. Embong), syc.chris@gmail.com
(Y.C. Soh), ming.long@bath.edu (L.C. Ming), wongtinwui@yahoo.com.my
(T.W. Wong).
Peer review under responsibility of The Center for Food and Biomolecules,
National Taiwan University.
Contents lists available at ScienceDirect
Journal of Traditional and Complementary Medicine
journal homepage: http://www.elsevier.com/locate/jtcme
http://dx.doi.org/10.1016/j.jtcme.2016.08.008
2225-4110/Copyright ©2016, Center for Food and Biomolecules, National Taiwan University. Production and hosting by Elsevier Taiwan LLC. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Journal of Traditional and Complementary Medicine xxx (2016) 1e5
Please cite this article in press as: Embong NH, et al., Perspectives on reexology: A qualitative approach, Journal of Traditional and
Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.08.008
without dealing with the underlying cause in order to improve a
patient's emotional, physiological and spiritual health and increase
the value of their life.
7
Two methods of reexology that are accepted internationally
are the Ingham method and Rwo Shur method. The rst method
does not use any tools in its practice whereas the second method
utilizes tools such as wooden sticks.
4,5
There are ve theories that explain how reexology actually has
impacts on health.
8
The rst and second basic theories are related
to energy. Energy theory advocates that body parts can commu-
nicate using electromagnetic elds,
9
and the communication can be
blocked based on the surrounding elds.
10
The third theory in-
dicates that energy ow can be restored, and the fourth is about a
blocked pathway which can be opened.
9
The last theory proposes
that reexology can break up the lactic acid crystals that are usually
deposited in the feet and allow energy to ow efciently.
8
Modern reexology techniques have been used for the last 60
years and now more scientic and clinical research has been con-
ducted because of its positive effects in reducing and alleviating
symptoms, especially those associated with chronic conditions
such as diabetes mellitus, hypertension and muscular diseases.
Reexology generally does not cause any harmful effects as long as
necessary precautions are taken with patients with special medical
conditions such as blood clot disorder, cancer and heart failure.
Each person has a different body system so results from
reexology treatment could vary from one person to another.
11,12
Based on the latest research conducted, reexology seems to be
effective in helping body systems return to their natural state.
1
One
of the most signicant current discussions in reexology is its
effectiveness in helping to tackle several symptoms of disease.
1
Level of disease conditions and pain are reduced as the patients
receive reexology. It has been suggested by a Swiss study that
patients having reexology sessions show signicant decrease in
the amount of medication they require.
1
As a complementary
therapy, reexology seems to work better together with conven-
tional treatment to treat chronic diseases that alter the normal
physiological functions of the body.
11,12
One of the most signicant current discussions in reexology
practice is around aspects of health, safety and hygiene. Other than
that, the principles and practice of reexology as a complementary
therapy is important to ensure the application of this therapy is
reliable.
Until now, no study has been conducted to understand practi-
tioners' perception of reexology. This study serves to provide
insight from reexology practitioners on the development and
regulation of reexology practice in Malaysia.
The outcome of this study will reveal the perspective of prac-
titioners on reexology and its treatment in Malaysia for the rst
time. We can understand socio-cultural inuences on help-seeking
behavior and reasons for delaying seeking help among symptom-
atic patients with reexology. The ndings of this novel study will
provide the healthcare authorities with an overview on the extent,
barriers to and facilitators of reexology among healthcare pro-
fessionals in Malaysia. Research in this area is very important so
that policymakers can formulate strategies and implement activ-
ities that can monitor the development of reexology.
2. Methodology
Data was collected in face-to-face semi-structured interviews
with practitioners in Malaysia. There is no comprehensive list of
practitioners in Malaysia that could serve as a sampling frame to
obtain a sample including different specialization and position. The
interview focused on development of reexology, perceptions of
effectiveness of reexology, experiences and use of health services
(modern and traditional practices) and respondents' perception.
Interviews were conducted at a time and location convenient for
the respondents. The interviews were conducted in the Malay
language and audiotaped. Voice recording were translated, tran-
scribed verbatim and anonymized to ensure condentiality. In or-
der to ensure consistency, one researcher (NHE) conducted the
whole interviews and then the transcripts were analyzed individ-
ually by all four researchers. The themes and the corresponding
codes were then presented by each researcher. Discussions and
reconciliation of the ideas were done before the nal concepts and
themes were conrmed.
Responses relating to different themes were located in each of
the interviews and a coding frame was developed. For each theme,
the relevant data enabled a description of the range of views and
experiences.
Data collection and analysis were conducted concurrently and
recruitment was stopped when saturation was reached. All re-
spondents provided written consent to participation.
Data was coded and analyzed to identify common descriptive
themes, which were grouped into clusters. Thematic analysis was
used to identify themes and subthemes. Ethical approval was ob-
tained from the Universiti Teknologi MARA Research Ethics Com-
mittee [600-RMI(5/1/6) 19-12-2014].
3. Results
The interview session was stopped at ve practitioners, as it had
already reached the saturation point where all practitioners gave
quite similar answers. The mean age for all respondents involved
was 34. The demographic summary for all respondents is shown in
Table 1.
The outcomes identied were categorized under specic
themes.
3.1. Credentials and training received
All of the practitioners had good qualications in reexology
treatment and have certication from various institutions. None of
them are practicing reexology because of inherited knowledge
from their family but one of them learnt it from senior staff at her
spa. The following answers are typical from the interview session:
I was trained in the arts of reexology at a local massage parlor for
the blind located in Brickelds. I studied for 2½years. (Practitioner 1)
I studied for a diploma in complementary medicine at Aimst. I was
the rst batch for this course. I learnt the origins of foot massage,
Malay massage, and general healthcare management. And then I
pursued reexology at a community college. (Practitioner 3)
Some people conduct classes so we have to attend the class for 18
months. For the whole period of studying, they will teach the theories
Table 1
Demographic summary for all respondents.
Practitioner Gender Age Education Marital
status
Occupation
1 Male 29 Training centre
for disabled
Single Reexology practitioner
2 Female 36 University Married Traditional health care
services practitioner
3 Female 31 eSingle Spa Worker
4 Male 33 eSingle Reexology practitioner
5 Male 42 University Married Reexology practitioner
N.H. Embong et al. / Journal of Traditional and Complementary Medicine xxx (2016) 1e52
Please cite this article in press as: Embong NH, et al., Perspectives on reexology: A qualitative approach, Journal of Traditional and
Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.08.008
and the practice. We will receive a certicate but before that we must
undergo a test to see whether we pass or fail. (Practitioner 4)
In addition, the practitioners also have great experience in
practicing reexology. They have already practiced reexology for
many years:
It was a long time ago when I started to work in this premises and
conducting my own reexology session when I have extra time.
(Practitioner 3)
I have been practicing reexology for 7 years. (Practitioner 4)
I've been practicing this for many years. Last year I was asked to
teach reexology to the inmates in prisons, organized by the prison
administration of Malaysia. (Practitioner 5)
Their knowledge is not limited to theory and practice about
reexology, as they also understand about human anatomy:
I studied a lot including anatomy and physiology of the human
body. (Practitioner 1)
The feet have multiple pressure points and the same goes to our
body. (Practitioner 2)
There I met a lecturer who specialized in this eld; a specialist who
was an expert about nerves and taught me about body systems.
(Practitioner 3)
What is clear from all the data is that most reexology practi-
tioners are qualied to practice on their clients due to their
knowledge and already gained qualications.
3.2. Keeping clients well
Practicing reexology treatment in our life is one of the ways for
us to maintain a good level of health. With all the experiences that
the practitioners had in this eld, they agreed that reexology
treatment is a part of body health care. Here are some of the
statements from the interview session:
[Reexology] helps our body relax after we over-use it. It also helps
to reduce stress and as we know stress may lead to many other health
problems. (Practitioner 1)
[I wholly agree that foot massage] can act as a healthcare practice
because for example the veins of our heart and liver have their own
specic pressure points on the feet. So putting some pressure on the
heart vein's pressure point, with the correct techniques, helps the blood
to ow efciently in the vein. When there is no problem with our blood
ow, many diseases related to our body can be avoided, or at least can
be reduced. (Practitioner 2)
[Reexology is a complementary treatment but] it helps a lot in the
management and cure of many diseases. [In my opinion,] reexology is
a way of maintaining general health and wellbeing, and should] be
practiced routinely. (Practitioner 3)
Based on their experiences and knowledge, they stated that
reexology treatment is helpful to a patient's condition instead of
detrimental:
As long as I've been in this line of work, I've never had a patient
return to complain they are suffering more pain; all of them feel better
after treatment. (Practitioner 1)
[This treatment is] not detrimental to a patient's condition. But
maybe it also depends on customer's condition itself. (Practitioner 3)
If a patient sometimes gets worse after a massage, it is usually
nothing serious. But it normally does not happen. Usually patients feel
better after a session. They feel lighter and more comfortable. (Prac-
titioner 4)
3.3. Diagnostic purpose
When the practitioners discussed how they would know if there
any problem in the body system, most of them stated that they are
able to diagnose a client's health problems, though two said they
did not:
Usually I can detect a patient's problem due to the pain suffered
when suitable pressure is applied to a specic point (Practitioner 1)
When I massaged [a client], I found out there were problems with
his body system. (Practitioner 3)
We can detect if a patient has any abnormalities while doing
this reexology. Sometimes, we do not have to touch the affected
area but we can detect the abnormalities just by looking at the
expression of the patient. This is called the knowledge of diagnostic.
(Practitioner 5)
We only massage specic points but we cannot predict accurately
where the affected area of the body system is. (Practitioner 2)
If there are problems, those are just theories. We can't predict if a
patient has a headache or heart problems. Some people were coinci-
dentally predicted correctly. (Practitioner 4)
The practitioners suggest clients with chronic disease to seek
further treatment with a doctor but do not recommend modern
medicine:
Once I detect the problems I will advise for the patient to consult a
doctor. (Practitioner 1)
Usually if patients have problems, we will recommend for treat-
ment to be done, but if the condition is too serious, we will denitely
recommend they seek treatment from a specialist. (Practitioner 4)
I'll suggested them to see the doctor if their disease is chronic. We as
masseuses have no right to condemn any other practitioners. (Prac-
titioner 5)
Different clients have different body health conditions and the
practitioners must know how to handle such conditions. Based on
the interview session conducted, most of practitioners know how
to handle special conditions:
[I personally think that] if you have fever, you should try massage
rst but if it still does not heal overnight then it would be advisable to
consult a doctor the following day. (Practitioner 4)
There are certain patients for which we can't perform reexology,
for example those with heart problems. Because when we do reex-
ology, the heart will beat faster. It may cause a more serious problem.
This also occurs in patients whose blood sugar level is too high and
pregnant women under 5 months gestation. (Practitioner 4)
For hypertensive patients we can't massage upwards. This will
make the blood pressure shoot up and exacerbate the condition.
(Practitioner 5)
3.4. Regulation and enforcement
Many premises misuse the title 'reexology center' as a cover for
their immoral activities. Practitioners have their own opinion
regarding this matter and mostly agree that stricter regulation is
required and higher authorities should be involved to stop the
problem getting worse. Certications and licenses are the most
important factors:
I admit that there are parties who misuse this license. I think that
the higher authorities need to be stricter in handling this issue.
(Practitioner 1)
[I work for this premise as a reexology practitioner but the]
owner of this premises also has certication for reexology treatment
and [runs another premise in the Kuala Lumpur area.] But both of
these premises have their own licenses. It is important because many
people or premises misuse the title of reexology center. (Practi-
tioner 3)
Here, every practitioner has their own certicate [but the tech-
niques might be different. Before initiating a massage we must rst ask
them about their conditions]. So if the practitioners don't have a
qualication, they might not know about this and put the customer at
risk. (Practitioner 4)
I have negative views on individuals who use reexology as means
of conducting immoral acts. I nd that it is very inappropriate and it
N.H. Embong et al. / Journal of Traditional and Complementary Medicine xxx (2016) 1e53
Please cite this article in press as: Embong NH, et al., Perspectives on reexology: A qualitative approach, Journal of Traditional and
Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.08.008
gives a bad image to certied reexology practitioners like me. It took a
long time to get this certicate. I asked an ofcer at the Klang mu-
nicipalities if I can get a license for my reexology and hijama (cupping
therapy) business. A local council ofcer and another local council
committee member were involved to endorse the license. Both ofcer
and committee member said that they will not endorse or give
approval because too many reexology centers have been involved in
illegal businesses. Due to that, all the application has been put on hold.
(Practitioner 5)
Practitioners seem to agree with the implementation of a form
about a client's background, existing diseases and much more. But
they found it difcult and did not have enough time to do it.
As for this form, I admit that it will be difcult for us to ll in the
forms since we're blind. (Practitioner 1)
Previously, I lled in the forms and put them a proper le, but I do
not have enough assistance to do this any more. So I have stopped
doing it, but personally I really agree that it would be a good approach
to improve reexology treatment. (Practitioner 3)
I agree that the authorities should implement the form-lling
procedure to ease our job and so that we can take extra measures.
Sometimes we need to rush, and there is no time to ll in any forms,
but it is nevertheless a good implementation. (Practitioner 4)
Creating a reexology association in Malaysia may help reex-
ology therapy to become acknowledged,so that people are aware of it
and will take theopportunity to take charge of their health.It also the
safest way to manage any problems that happen related to reex-
ology as it easier for customers or enforcement can trace the practi-
tioner. This is reected in the dialogue from several practitioners:
Maybe it can help us to be recognized as professional practitioners.
(Practitioner 2)
It is actually necessary because in case anything happens related to
reexology treatment, we can refer to the responsible person. Don't
forget that the government needs to make sure all practitioners reg-
ister under this association before treating customers, so if anything
goes wrong, it is easier for customers or enforcement to trace the
practitioner. (Practitioner 1)
3.5. Professionalism
Regarding professionalism, practitioners stated they are pro-
fessional. When asked about it, they gave different personal opin-
ions about why:
I believe that reexology is a professional line of work because we
follow all the steps and procedures. (Practitioner 1)
Yes [we are professional] because we does not practice anything
against the regulation, and we having the certicates and a license to
run this type of practice. All the practitioners that offer this treatment
in our premises have this qualication and this treatment has become
more important in health care nowadays. (Practitioner 3)
Reexology is actually a professional line of work because we are
not just any masseuse; we are trained reexologists and we focus on
massage. (Practitioner 4)
Yes [we are professional] because many studies have shown that
reexology can actually give many benets to our health. (Practitioner
5)
4. Discussion
An exploratory qualitative approach was used because no pre-
vious study had been conducted in this area. A qualitative content
analysis elicited beliefs and values from the respondent that not
normally conveyed in quantitative survey study.
Based on all the data gathered from the interview sessions,
reexologists generally consider that reexology treatment nowa-
days has beenaccepted as one of the ways to maintain general health.
4.1. Credentials and training received
All practitioners have qualied certication, great knowledge
and experience regarding reexology, human anatomy, physiology
and related problems. This enables people to put trust and con-
dence in their treatment. However, reexology is not recognized by
law and so does not require formal training. Practitioners who took
part in the interview were not only procient in massaging tech-
niques on points of reex but also knowledgeable in term of human
physiology and anatomy. There are many education courses avail-
able related to reexology and practiced by many massage thera-
pists. Such courses do not teach any medical practice, and nor do
they replace existing treatment.
13
Practitioners have qualied cer-
tication from various institutions and many years' experiences
practicing reexology. They also have expertise in doing reexology
treatment using various types of apparatus such as stone, horn and
wooden sticks, based on the patients' conditions.
4.2. Diagnostic purpose
Reexology involves differential diagnosis where practitioners
are able to diagnose a patient's body condition. It is impossible to
name the medical condition in simple words, but it is actually the
condition where the practitioners manage to identify any imbal-
ances in the body system.
14
They are able to explain and relate
causes why some problems could happen with our body. This helps
clients be aware of health conditions and so they can seek further
treatment if necessary. Detection of patient's medical conditions in
reexology involves observation, asking, listening and palpation.
Practitioners observe each patient's eyes, skin, hair and facial ex-
pressions, which indirectly shows their physical discomfort and
level of stress.
15
Practitioners can ask about and listen to clients'
general health level, which can be affected by various factors such
as psychological and emotional aspects. It is crucial to build
empathy so that patients can put more trust in the reexologists,
leading to meaningful therapeutic relationships.
15,16
4.3. Keeping clients well
The practitioners also believed that reexology will reduce risk
and help to handle some diseases if synergized with modern
treatment methods.
The collaboration between this complementary therapy, with
correct techniques and procedures, and modern medicine seems
the best way to maintain general health. As reexology is a com-
plement to existing modern medicines, it is a good way to improve
the well-being of patients.
17,18
Based on practitioners' experience,
most clients believed that having routine reexology treatment
(with the correct technique) will enhance their body health and
indirectly increase their quality of life. Routine reexology could
help reduce stress levels, and as we know stress may trigger many
diseases.
19,20
The reexologists did not have any clients complain-
ing that their general health had become worse. They also think
that good practitioners can help the client, based on their level of
body health.
4.4. Regulation and enforcement
Implementation of patients' assessment forms before reex-
ology sessions can help practitioners monitor customers' health
condition after each session. Some people such as pregnant women
in their rst trimester cannot have this treatment. Moreover, if
reexology is not performed correctly it may have adverse effects.
Setting up an association for reexology treatment in Malaysia,
to which all practitioners should register if they want to practice
N.H. Embong et al. / Journal of Traditional and Complementary Medicine xxx (2016) 1e54
Please cite this article in press as: Embong NH, et al., Perspectives on reexology: A qualitative approach, Journal of Traditional and
Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.08.008
reexology professionally, would help patients or responsible au-
thorities trace practitioners if they are not practicing correctly ac-
cording to right techniques and procedures. Some practitioners
voiced concern that some irresponsible reexology centers are
being used for illegal conduct. This can affect other practitioners'
business and make a bad impression about reexology. Responsible
authorities should be stricter, with more frequent monitoring of the
premises that offer reexology treatment. Involvement from
responsible authorities to set up more regulation is crucial to pre-
vent these problems from getting worse.
4.5. Professionalism
Practicing reexology and doing diagnoses would be illegal for
someone that claims they are a practitioner but does not have any
license related. So it is compulsory for each practitioner to have
their own license.
Professional are actually the people who are qualied in the
position. In our study, the practitioners, all of whom have qualied
certication and licenses, considered themselves as professional
since they focus on reexology treatment and practicing it pro-
fessionally with correct techniques and procedures. With world-
wide recognition of Malaysian reexologists, reexology treatment
could increase in scale concomitant with modern medical
development.
21,22
4.6. Limitations of the study
This study was conducted in a small group. For more meaningful
interpretations of practitioners' subjective perceptions, future
studies should be conducted with larger samples and involve more
benecial themes. Furthermore, the interviews should be con-
ducted in a more relaxed environment so that practitioners can
express their opinions more freely. The gap that exists between
facilitator and practitioners can affect each opinion. Spontaneous
interview sessions would facilitate an exploration of practitioners'
perception of their superiors in term of problem diagnosis, the way
they handling customers with different health conditions and the
involvement of responsible authorities in order to focus on their
efforts to maintain people's quality of life.
5. Conclusion and implications for further research
The collaboration between this complementary therapy, with
correct techniques and procedures, and modern medicine seems
the best way to maintain general body health. Involvement of
responsible authorities and strict regulation related to illegal
conduct in reexology centers, which can give a bad name to
practitioners, will improve people's perception of reexology.
Empowering practitioners as professionals can help to improve
people's perception of and condence in reexology treatment.
Conict of interest
None.
Acknowledgement
This work was supported by Synergised Industry-Experimenter
Research Grant Initiative (SInERGI) (COMM-34/1/SInERGI). The
authors would like to express their gratitude to Ministry of Higher
Education, Malaysia and Research Innovation Business Unit, Insti-
tute of Research Management &Innovation (RIBU, IRMI) Universiti
Teknologi MARA, Malaysia for nancial support for this research.
References
1. Embong NH, Soh YC, Ming LC, Wong TW. Revisiting reexology: concept, ev-
idence, current practice, and practitioner training. J Tradit Complement Med.
2015;5(4):197e206.
2. Lu WA, Chen GY, Kuo CD. Foot reexology can increase vagal modulation,
decrease sympathetic modulation, and lower blood pressure in healthy sub-
jects and patients with coronary artery disease. Altern Ther Health Med.
2011;17(4):8e14.
3. Hughes CM, Krirsnakriengkrai S, Kumar S, McDonough SM. The effect of
reexology on the autonomic nervous system in healthy adults: a feasibility
study. Altern Ther Health Med. 2011;17(3):32e37.
4. Song HJ, Son H, Seo HJ, Lee H, Choi SM, Lee S. Effect of self-administered foot
reexology for symptom management in healthy persons: a systematic review
and meta-analysis. Complement Ther Med. 2015;23(1):79e89.
5. Song HJ, Choi SM, Seo HJ, Lee H, Son H, Lee S. Self-administered foot reexology
for the management of chronic health conditions: a systematic review. J Altern
Complement Med. 2015;21(2):69e76.
6. Blunt E. Foot reexology. Holist Nurs Pract. 2006;20(5):257e259.
7. Gambles M, Crooke M, Wilkinson S. Evaluation of a hospice based reexology
service: a qualitative audit of patient perceptions. Eur J Oncol Nurs. 2002;6(1):
37e44.
8. Cade M. Reexology Independent Study. vol. 77. The Kansas Nurse; 2002. No
5e6.
9. Stephenson NL, Weinrich SP, Tavakoli AS. The effects of foot reexology on
anxiety and pain in patients with breast and lung cancer. Paper presented at:
Oncology nursing forum1999.
10. Kunz K, Kunz B. Understanding the science and art of reexology. Altern
Complementary Ther. 1995;1(3):183e186.
11. Nazari F, Soheili M, Hosseini S, Shaygannejad V. A comparison of the effects of
reexology and relaxation on pain in women with multiple sclerosis.
J Complementary Integr Med. 2016;13(1):65e71.
12. Khorsand A, Tadayonfar MA, Badiee S, Aghaee MA, Azizi H, Baghani S. Evalu-
ation of the effect of reexology on pain control and analgesic consumption
after appendectomy. J Altern Complement Med. 2015;21(12):774e780.
13. Martin M. Reexology as a Diagnostic Tool. Available online; 2008. Accessed
10.01.16 http://www.positivehealth.com/article/reexology/reexology-as-a-
diagnostic-tool.
14. Tiran D, Chummun H. The physiological basis of reexology and its use as a
potential diagnostic tool. Complement Ther Clin Pract. 2005;11(1):58e64.
15. Mantle F, Mackereth P. Reexology techniques are not an effective tool for
symptom recognition or the diagnosis of medical conditions. Complement Ther
Nurs Midwifery. 2001;7(1):43e48.
16. White AR, Williamson J, Hart A, Ernst E. A blinded investigation into the ac-
curacy of reexology charts. Complement Ther Med. 2000;8(3):166e172.
17. Mackereth PA, Booth K, Hillier VF, Caress AL. What do people talk about during
reexology? Analysis of worries and concerns expressed during sessions for
patients with multiple sclerosis. Complement Ther Clin Pract. 2009;15(2):
85e90.
18. Yeung WF, Chung KF, Poon MM, et al. Acupressure, reexology, and auricular
acupressure for insomnia: a systematic review of randomized controlled trials.
Sleep Med. 2012;13(8):971e984.
19. Hodgson NA, Lafferty D. Reexology versus Swedish massage to reduce
physiologic stress and pain and improve mood in nursing home residents with
cancer: a pilot trial. Evid Based Complement Altern Med. 2012;2012:456897.
20. Atkins RC, Harris P. Using reexology to manage stress in the workplace: a
preliminary study. Complement Ther Clin Pract. 2008;14(4):280e287.
21. Traditional &Complementary Medicine Division. Good Practice Guideline on
Reexology for Reexologists Practising in Malaysia. Ministry of Health Malaysia;
2011.
22. Traditional &Complementary Medicine Division. Annual Report. Ministry of
Health Malaysia; 2011.
N.H. Embong et al. / Journal of Traditional and Complementary Medicine xxx (2016) 1e55
Please cite this article in press as: Embong NH, et al., Perspectives on reexology: A qualitative approach, Journal of Traditional and
Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.08.008
... BRM is a potential technique that can be used to influence the physiological and psychological factors that affect labor pain and anxiety. 25,26 Touch and support during massage and reflexology improve the psychological status, and is highly appreciated by numerous Arab pregnant women. ...
... It also helps pregnant women to focus on their breathing instead of their uterine contractions, thus helping them to keep calm. 12,25 The mechanical action of reflexology and massage are based on energy theory postulating that an alternating pressure on the reflex points of the feet also stimulate the parasympathetic nervous system that bring about the same effects mentioned above. 12,28 Additionally, serotonin, endorphin, and enkephalin hormones are released that help to reduce labor pain, and suppress the release of stress hormones, such as the cortisol, epinephrine, and norepinephrine hormones. ...
... 26 Touching and pressing during a massage could stimulate the afferent impulses that block pain transmission that are based on the neuro-matrix pain theory. 18,25 Skin-to-skin contact increases energy fluctuation between the pregnant woman and the therapist, and encourages the homeostatic balance posited by the sympathetic resonance theory, 29 whereas the cutaneous mechanoreceptors theory decreases the receptors' responsiveness to pain which increases the production of endorphin, and reduces adrenaline and noradrenaline. 18,30 Labor pain and anxiety have negative consequences for both pregnant women and fetus outcomes. ...
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Background: Labor pain and anxiety are important concerns during labor, especially among the primigravidae. It may increase the duration of labor, increase stress hormones, and affect maternal and new-born related outcomes. This study examined the effectiveness of combined breathing exercises, foot reflexology, and massage (BRM) interventions on labor pain, anxiety, labor duration, stress hormone levels, maternal satisfaction, maternal vital signs, and the new-born's APGAR scores. Participants and methods: This single-blind-parallel randomized controlled trial (RCT) was conducted at the Maternity and Children Hospital (MCH), Makkah, Saudi Arabia, by recruiting primigravidae aged 20 to 35 years, without any medical complications, and who were block-randomized at six-centimeter cervical dilation and stratified by intramuscular pethidine. The intervention is BRM compared to standard care. The labor pain was measured via present behavioral intensity (PBI) and visual analogue scale (VAS), and the anxiety was measured via Anxiety Assessment Scale for Pregnant Women in Labor (AASPWL). The secondary outcomes were duration of labor, maternal stress hormone levels, maternal vital signs, maternal satisfaction, fetal heart rate, and APGAR scores. All outcomes were measured at multiple time-points during and after contraction at baseline, during BRM intervention, at 60, 120, and 180 minutes post-intervention. Generalized linear mixed models were used to estimate the intervention effects over time. Results: A total of 225 participants were randomized for the control (n = 112) and intervention group (113). BRM lowered the labor pain intensity at 60 minutes after intervention during (1.3 vs 3.5, F = 102.5, p < 0.001) and after contraction (0.4 vs 2.4, F = 63.6, p < 0.001) and also lowered anxiety (2.9 vs 4.2, F = 80.4, p < 0.001). BRM correspondingly lowered adrenocorticotropic (ACTH) (133 vs 209 pg/mL, p < 0.001), cortisol (1231 vs 1360 nmol/mL, p = 0.003), and oxytocin (159 vs 121 pg/mL, p < 0.001). It also shortened the labor duration (165 vs 333 minutes, p < 0.001), improved vital signs, which resulted in higher APGAR scores, and increased maternal satisfaction. Conclusion: The labor unit management could consider adopting BRM as one of the non-pharmacological analgesia for healthy women in labor. Trial registration: ISRCTN87414969, registered 3 May 2019.
... Holistik yaklaşımı benimseyen, vücudun istenen bölgelerinin etkilenmesi amacıyla eller ve ayaklardaki belli noktalara uygulanarak tüm vücuda enerji akışını sağlayan bölgesel basınç uygulamasıdır. (41,42) Refreksoloji uygulaması ile kan ve enerji dolaşımını iyileştirmek, gevşeme hissi vermek ve vücudun iç dengesini sürdürmek amaçlanmaktadır. (42) ...
... (41,42) Refreksoloji uygulaması ile kan ve enerji dolaşımını iyileştirmek, gevşeme hissi vermek ve vücudun iç dengesini sürdürmek amaçlanmaktadır. (42) ...
... 3 Reflexology is currently being considered as a complementary therapy, widely used in palliative care to alleviate a problem without necessarily determining its underlying cause in order to improve a patient's emotional, physical, psychological and spiritual health and to upgrade the patient's value of life. 4 Reflexology does not cause any harmful effects as long as necessary preventions are taken for patients with special medical conditions such as blood clot disorders, cancer and heart failure. Therefore, it is imperative that reflexology practitioners take their clients' overall health condition into consideration. ...
... It is still ambiguous regarding the mechanism behind the function of foot reflexology, but it certainly has been shown to have potent physiological and psychological effects, perhaps attributed to the relaxation derived from the placebo effect, the therapeutic communication techniques, and impact of touching behavior. e explication for the mechanism of action in foot reflexology is based on the theory that helps to equilibrate the energy in the whole physical structure [3,4]. Currently, the most promising theory suggests that the benefits of foot reflexology may be caused by modulating our autonomic nervous system [5]. ...
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Objectives: The aim of this study was to conduct a systematic review, meta-analysis, and metaregression to determine the current best available evidence of the efficacy and safety of foot reflexology for adult depression, anxiety, and sleep quality. Methods: Electronic databases (PubMed, ClinicalKey, ScienceDirect, EMBASE, PsycINFO, and the Cochrane Library) were searched till August, 10, 2020, and the validity of the eligible studies was critically appraised. Randomized controlled trials comparing foot reflexology groups with control groups for adult depression, anxiety, and sleep quality were included. Twenty-six eligible studies were included to assess the effect of foot reflexology intervention on the reducing symptoms of depression and anxiety and improving quality of sleep, respectively, as the primary outcome. Results: Twenty-six randomized controlled trials involving 2,366 participants met the inclusion criteria. The meta-analyses showed that foot reflexology intervention significantly improved adult depression (Hedges' g = -0.921; 95% CI: -1.246 to -0.595; P < 0.001), anxiety (Hedges' g = -1.237; 95% CI -1.682 to -0.791; P < 0.001), and sleep quality (Hedges' g = -1.665; 95% CI -2.361 to -0.970; P < 0.001). Metaregression reveals that an increase in total foot reflexology time (P = 0.002) and duration (P = 0.01) can significantly improve sleep quality. Conclusions: Foot reflexology may provide additional nonpharmacotherapy intervention for adults suffering from depression, anxiety, or sleep disturbance. However, high quality and rigorous design RCTs in specific population, along with an increase in participants, and a long-term follow-up are recommended in the future.
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Introduction: Respiratory distress is one of the life-threatening conditions in preterm infants. Sensory deprivation in preterm infants hospitalized in the intensive care units affects their physiological and psychological development. Therefore, this study is an attempt to compare the effects of foot and palm reflexology on respiratory distress in infants subjected to noninvasive ventilation. Methods: In this clinical study, 150 infants hospitalized at Fatemieh Hospital in Hamadan were randomly assigned to 3 groups. In the intervention groups, the reflexology massage to foot and palm was performed for 10 min within 3 days in 6 rounds. In the control group, leg warming was performed. In each group, the personal information checklist, the respiratory distress score, oxygen saturation percentage, and respiratory rate before and after the daily intervention were examined. Data analysis was performed using the standard statistical tests in SPSS. Results: The results mirrored the statistically significant difference between the intervention and control groups 3 days into the intervention with regard to the average oxygen saturation percentage, respiratory rate, and the respiratory distress score (p < 0.05). When eliminating the effect of confounding variables, therapeutic intervention applied to palm compared to foot had a greater effect on reducing respiratory distress score in the studied infants. Conclusion: The reflexology massage method, especially palm reflexology massage, contributes to the mitigation of respiratory distress in preterm infants subjected to noninvasive ventilation. Hence, this low-cost and efficient intervention program can be recommended as a complementary method for preterm infants with respiratory distress.
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Introduction: Neonatal respiratory distress is a life-threatening lung disorder, so it is important to examine the effect of different intervention and care methods on respiratory distress in premature infants. The aim of this study was to determine the effect of foot reflex massage on the reduction of respiratory distress in premature infants in the intensive care unit. Methods: In this study, in 2018, 100 premature infants were randomly assigned to two intervention and control groups by clinical trial method. In the intervention group, reflexive foot massage was performed for three days and the control group received normal care. In both groups, a personal profile questionnaire and a respiratory distress index were completed before and after the intervention. Data analysis was performed using SPSS 16. Results: The results showed that in the intervention and control group, the difference between mean oxygen saturation (Spo2) and respiratory distress rate on the third day after the intervention was statistically significant and in infants who undergone interventional foot massage, the mean respiratory distress is lower than the control group and oxygen saturation is higher than the control group Conclusion: Reflective foot massage is effective on physiological responses and reducing respiratory distress in premature infants. It seems that this easy, cheap and efficient intervention program can be considered in the executive instructions of health care and nurses' intervention and its education to mothers can be included in the country's educational programs.
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Background and purpose The aim of this study was to determine the effect of foot reflexology on chest pain and anxiety in patients with AMI. Materials and methods This study was a double blind randomized clinical trial. Stratified random sampling was carried out on 90 patients with AMI in the three groups of treatment, placebo and control. Foot reflexology was done for three consecutive days, each time for 20 minutes. Chest pain and anxiety were evaluated with Visual Analogue Scale before, immediately and 20 minutes later. Results 20 minutes after the intervention, severity of chest pain in treatment group was significantly lower than control group (p<0.001) and placebo group (p=0.002). Severity of anxiety between groups and at different times was not significant. Conclusions Foot reflexology was effective in attenuating chest pain, had the most effect in 20 minutes after intervention, and can be used to relieve chest pain in patients with AMI.
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Background One of the most important problems in burn patients was pain, especially in dressing changes. This pain can lead to anxiety in the patient. The aim of this study was to determine the effect of foot reflexology on pain and anxiety severity in burn patients. Methods This study was a randomized controlled trial, in which 66 patients with burn injuries referred to Vali-e-asr Hospital, Arak, Iran participated. After obtaining written consent, patients were enrolled to study according to inclusion criteria and then, divided into intervention (n = 33) and control (n = 33) groups using simple random allocation. In the intervention group, in addition to standard care, reflexology was performed for one week on Saturday, Monday and Wednesday (three times in a week). The intervention was done one hour before dressing change in a separate room for 30 minutes. The control group received only standard care during this time (both intervention and control groups were the same in the type of received treatment, and reflexology was considered as an extra care in the intervention group). Severity of pain and anxiety in both groups was measured using visual analog scale twice a day (5 to 10 minutes before dressing change and 5 to 10 minutes after dressing change) for six days. SPSS software ver. 15 was used for statistical analysis. Mean and standard deviation were used for quantitative variables and qualitative variables were reported as frequency and percentage. Data were analyzed using Chi‑square, Mann-Whitney, Fisher’s exact tests, and paired t-test. The Kolmogorov-Smirnov test was used to check the normality of data. Results The results showed that there was no significant difference in severity of pain (p = 0.25) and anxiety (p = 0.37) between the two groups on the first day, before the intervention. In the following, the results showed that there was no significant difference between the two groups in the second and third days after intervention too. But, the mean scores of pain showed that there was significant difference between the two groups in the forth (p = 0.005), fifth (p = 0.001), and sixth (p = 0.001) days after intervention. Anxiety scores also showed there was significant difference between the two groups on the fourth (p = 0.01), fifth (p = 0.001), and sixth (p = 0.001) days. Conclusions our results showed foot reflexology is an appropriate and safe intervention for management of pain and anxiety of burn patients. Therefore, it can be used as a complementary method alongside other methods.
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Background: Fatigue, sleep disorders, and anxiety are common symptoms in multiple sclerosis (MS) patients. MS reduced the quality of life by these symptoms in patients. Studies have shown that foot reflexology may reduce some problems of this disease. Objectives: The present randomized controlled trial study investigated the effect of reflexology on fatigue, sleep quality, and anxiety in patients with multiple sclerosis. Methods: This study included 63 patients with MS referred to Arak MS society in 2018 - 2019. Reflexology and placebo intervention had applied twice a week for 4 weeks, and each session lasted about 30 - 40 minutes. Fatigue Impact scale (FIS), Pittsburgh sleep quality index (PSQI) and state-trait anxiety inventory (STAI) was used for data collection before and after the intervention. A significant statistical level was considered 0.05. Data were analyzed using the SPSS software (V. 16.0). Results: Significant improvement was observed in physical fatigue (P = 0.042), sleep quality (P = 0.001) and anxiety (P = 0.034) in the reflexology group after the intervention. Fatigue Impact Scale (FIS) revealed a decrease in fatigue level in MS patients, but these alterations were not significant (P = 0.134). Conclusions: Reflexology is a non-invasive, simple, affordable, and low-cost nursing intervention that can be helpful in reducing physical fatigue, anxiety, and improving sleep quality of people with MS.
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Reflexology is basically a study of how one part of the human body relates to another part of the body. Reflexology practitioners rely on the reflexes map of the feet and hands to all the internal organs and other human body parts. They believe that by applying the appropriate pressure and massage certain spots on the feet and hands, all other body parts could be energized and rejuvenated. This review aimed to revisit the concept of reflexology and examine its effectiveness, practices, and the training for reflexology practitioners. PubMed, SCOPUS, Google Scholar, and SpringerLink databases were utilized to search the following medical subject headings or keywords: foot massage, reflexology, foot reflex-otherapy, reflexological treatment, and zone therapy. The articles published for the last 10 years were included. Previous systematic reviews failed to show concrete evidence for any specific effect of reflexology in any conditions. Due to its non-invasive, non-pharmacological complementary nature, reflexology is widely accepted and anecdotal evidence of positive effect reflexology in a variety of health conditions are available. Adequate training for practitioners is necessary to ensure the consistency of service provided.
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: Pain is a common and significant symptom in many individuals with multiple sclerosis (MS). The presence and severity of pain in individuals with MS has also been shown to be associated with higher levels of depression, functional impairment, and fatigue. It is common for MS patients and their caregivers to worry about narcotic addiction in the management of chronic pain. Therefore, this study aimed to determine and compare the effects of reflexology and relaxation on pain in women suffering from MS. : This study was a single-blind randomized clinical trial performed on 75 patients with MS referred to the MS Clinic of Ayatollah Kashani Hospital (Isfahan, Iran). After simple non-random sampling, using the minimization method, participants were randomly assigned to the three groups of reflexology, relaxation, and control. In the experimental groups, foot reflexology and relaxation interventions (Jacobson and Benson) were performed within 4 weeks, twice a week for 40 min. The control group received routine care and medical treatment as directed by a doctor. Data were collected using the Numerical Rating Scale before, immediately after, and 2 months after interventions in all three groups. Data analysis was performed using SPSS version 18 and descriptive and inferential statistical tests. : Findings obtained from analysis of variance (ANOVA) showed no significant differences between mean pain intensity scores in the three groups preintervention and 2 months after interventions (p > 0.05). However, this difference was statistically significant immediately after the study (p 0.05). : The results showed that both interventions are effective on relieving pain in women with MS; however, it appears that the effect of reflexology on pain reduction is greater than that of relaxation. Hence, these two methods can be recommended as effective techniques.
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Objective. The purpose of this pilot study was to investigate and compare the effects of reflexology and Swedish massage therapy on physiologic stress, pain, and mood in older cancer survivors residing in nursing homes. Methods. An experimental, repeated-measures, crossover design study of 18 nursing home residents aged 75 or over and diagnosed with solid tumor in the past 5 years and following completion of cancer treatments. The intervention tested was 20 minutes of Swedish Massage Therapy to the lower extremities, versus 20 minute Reflexology, using highly specified protocols. Pre- and post-intervention levels of salivary cortisol, observed affect, and pain were compared in the Swedish Massage Therapy and Reflexology conditions. Results. Both Reflexology and Swedish Massage resulted in significant declines in salivary cortisol and pain and improvements in mood. Conclusions. Preliminary data suggest that studies of Swedish Massage Therapy and Reflexology are feasible in this population of cancer survivors typically excluded from trials. Both interventions were well tolerated and produced measurable improvements in outcomes. Further research is needed to explore the mechanisms underlying the potential benefits of these CAM modalities in this patient population.
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Complementary and alternative medicine (CAM) has long been used by people to postpone the aging process and to reverse disease progression. Reflexology is a CAM method that involves massage to reflex areas in the feet and hands. This study investigated the effect of foot reflexology (FR) on the autonomic nervous modulation in patients with coronary artery disease (CAD) by using heart rate variability analysis. Seventeen people with angiographically patent coronary arteries and 20 patients with CAD scheduled for coronary artery bypass graft surgery were recruited as the control and CAD groups, respectively. The normalized high-frequency power (nHFP) was used as the index of vagal modulation and the normalized very low-frequency power (nVLFP) as the index of vagal withdrawal and renin-angiotensin modulation. In both control and CAD groups, the nHFP was increased significantly whereas the nVLFP was decreased significantly 30 and 60 minutes after FR, as compared with those before FR. The systolic, diastolic, mean arterial, and pulse pressures were significantly decreased after FR in both groups of participants. In the CAD group, the percentage change in heart rate 30 and 60 minutes after FR was smaller than that in the control, and the percentage change in nVLFP 60 minutes after FR was smaller than that in the control. In conclusion, a higher vagal modulation, lower sympathetic modulation, and lower blood pressure can be observed following 60 minutes of FR in both controls and CAD patients. The magnitude of change in the autonomic nervous modulation in CAD patients was slightly smaller than that in the controls. FR may be used as an efficient adjunct to the therapeutic regimen to increase the vagal modulation and decrease blood pressure in both healthy people and CAD patients.
Article
Background and objective: Appendicitis is the most common cause of severe abdominal pain in the world, and the associated postsurgical pain, as occurs with other surgical procedures, is one of the most common problems. Today, there is a growing tendency toward nondrug methods and alternative medicine to reduce the adverse effects of drugs. Reflexology involves applying pressure on certain areas of the palms, feet, and ears in order to reduce stress and pain in certain areas of the body. The aim of this study was to determine the effect of reflexology massage on pain relief after appendectomy. Methods: This clinical trial was conducted at the surgical emergency unit of Imam Reza Hospital of Mashhad, Iran, in 2013. Pain intensity and analgesic consumption were compared between 105 patients before and immediately, 1 hour, 6 hours, and 24 hours after the intervention in three groups of intervention, control, and placebo. Patients in all three groups received analgesics, as required. The experimental group received pressure on a defined area of the right foot for about 10 minutes and the Shen Men point of the ear for 1 minute. This pressure in the placebo group was applied on the left foot and the left earlobe. Patients in the control group received routine care only. The results were evaluated at a 95% confidence level, and data were analyzed using SPSS software version 12 (SPSS, Inc., Chicago, IL). Results: At the beginning of the study, the mean pain intensity in different groups according to analysis of variance was not significantly different (p = 0.439); however, there was a notable difference in pain intensity between the intervention and other groups after reflexology therapy. In addition, methadone consumption was significantly lower in the reflexology group than in the other two groups (p ≤ 0.001). Conclusion: Reflexology is effective for reducing pain after appendectomy surgery.
Article
Objectives: To systematically review the effect of self-administered foot reflexology in patients with chronic health conditions. Methods: Electronic databases were searched for literature published from 1948 to January 2014. The databases included MEDLINE, EMBASE, the Cochrane Library, CINAHL, CNKI, J-STAGE, Koreamed, Kmbase, KISS, NDSL, KISTI, and OASIS. Key search terms were "exp/relaxation therapy," "foot," "reflexology," "zone therapy," and "self." All study designs were included. Two raters independently extracted data and assessed study quality by using the Cochrane risk of bias tool (for randomized controlled trials) and the risk of bias assessment tool for nonrandomized studies (for nonrandomized and before-and-after studies). A qualitative and descriptive analysis was performed because of the clinical diversity associated with chronic health conditions. Results: Of the 224 records assessed, 4 trials met the inclusion criteria: 3 nonrandomized controlled trials and 1 before-and-after study without comparison. Self-administered foot reflexology might have a positive effect in type 2 diabetes, but the low quality of the included study and the lack of adequately reported clinical outcomes obscure the results. Two studies of hypertensive patients and 1 study of patients with urinary incontinence showed that self-performed foot reflexology may exert a beneficial effect on lowering blood pressure and urinary incontinence; however, given the small sample size and the lack of any description of medications and other cointerventions, there was insufficient evidence to conclusively determine whether foot reflexology had any effect. Conclusions: The included studies on self-administered foot reflexology in patients with type 2 diabetes, hypertension, or urinary incontinence provided insufficient evidence to determine a treatment effect. Therefore, a well-designed, large-scale, and randomized controlled trial is needed to confirm the effect of self-administered foot reflexology for chronic conditions.
Article
Objectives: Self-administered foot reflexology is unrestricted by time and space, economical, and practical because it is easy to learn and apply. This study estimated the effectiveness of self-foot reflexology for symptom management in healthy persons through a systematic review and meta-analysis. Methods: The participants were healthy persons not diagnosed with a specific disease. The intervention was foot reflexology administered by participants, not by practitioners or healthcare providers. The comparative studies either between groups or within group comparison were included. Our search utilized core databases (MEDLINE, EMBASE, Cochrane, and CINAHL). We also searched Chinese (CNKI), Japanese (J-STAGE), and Korean databases (KoreaMed, KMbase, KISS, NDSL, KISTI, and OASIS). The search was used MeSH terminology and key words (foot reflexology, foot massage, and self). Results: Analysis of three non-randomized trials and three before-and-after studies showed that self-administered foot reflexology resulted in significant improvement in subjective outcomes such as perceived stress, fatigue, and depression. However, there was no significant improvement in objective outcomes such as cortisol levels, blood pressure, and pulse rate. We did not find any randomized controlled trial. Conclusions: This study presents the effectiveness of self-administered foot reflexology for healthy persons' psychological and physiological symptoms. While objective outcomes showed limited results, significant improvements were found in subjective outcomes. However, owing to the small number of studies and methodological flaws, there was insufficient evidence supporting the use of self-performed foot reflexology. Well-designed randomized controlled trials are needed to assess the effect of self-administered foot reflexology in healthy people.
Article
Previous randomized controlled trials (RCTs) have shown that acupuncture may be efficacious for insomnia. Instead of needling, acupressure, reflexology, and auricular acupressure are procedures involving physical pressure on acupoints or reflex areas. These variants of acupuncture are gaining popularity, perhaps due to their non-invasive nature. A systematic review has therefore been conducted to examine their efficacy and safety for insomnia. Two independent researchers searched five English and 10 Chinese databases from inception to May 2010. Forty RCTs were identified for analysis. Only 10 studies used sham controls, four used double-blind design, nine studies scored three or more by the Jadad scale, and all had at least one domain with high risk of bias. Meta-analyses of the moderate-quality RCTs found that acupressure as monotherapy fared marginally better than sham control. Studies that compared auricular acupressure and sham control showed equivocal results. It was also found that acupressure, reflexology, or auricular acupressure as monotherapy or combined with routine care was significantly more efficacious than routine care or no treatment. Owing to the methodological limitations of the studies and equivocal results, the current evidence does not allow a clear conclusion on the benefits of acupressure, reflexology, and auricular acupressure for insomnia.
Reflexology has been shown to reduce anxiety and stress in various populations. The mechanism by which this occurs may be in modulating autonomic nervous system (ANS) function; however; there is limited evidence available in the area. The aim of the study was to investigate the feasibility of using an experimental model to determine the physiological effect of reflexology on stress. A feasibility study to assess an experimental study design to compare the effect of reflexology and control interventions on heart rate (HR) and blood pressure (BP) following mental stress tests. The Health and Rehabilitation Science Research Institute at the University ofUlster, Northern Ireland, United Kingdom. Twenty-six healthy volunteers. Mental stress was induced before and after intervention. Participants in the reflexology group received 20 minutes of reflexology, and the control group received 20 minutes of relaxation with a therapist holding each participant's feet. The outcome measures, HR and BP, were measured throughout mental stress testing intervention, and a second period of mental stress testing following intervention. The study design was considered feasible. There were significant reductions in systolic blood pressure (SBP) (22%; P = .03) and in diastolic blood pressure (DBP) (26%; P = .01) during mental stress following reflexology compared to the stress period prior to intervention. In contrast, there was a 10% reduction in SBP (P = .03) but a 5% increase in DBP (P = .67) during the period of mental stress following the control intervention compared to results obtained during mental stress prior to this intervention. However, there were no significant differences between reflexology and control groups. This study has demonstrated the feasibility of conducting an experimental study on the effect ofreflexology in stress using BP as the primary outcome measure. Results from such a study would address the lack of high-quality evidence for the physiological effects of reflexology.