Method: Twenty individuals were randomly assigned to either a control group or a treatment group. The intervention group received fifty minutes of reflexology once a week for four weeks.

Conclusion: The data suggest that the reflexology group appeared to become more relaxed throughout the treatment then the control group, however this was only a short-tern effect and did not continue until the next treatment. We cannot make any comment based on our data as tot he effect of an increased frequency of treatment on the longevity of the improvement. There was no evident change in the patients� quality of life when assessed by the quality of life questionnaires, though the evaluation questionnaire does suggest that the patients felt benefits from the study. More research is needed into this areas, since any changes in the quality of life over this short period of time may not have been picked up by the quality of life questionnaires. � Patients felt they had benefited from taking part in this study, indicating that there were changes in sleeping patterns, breathing, and the ability to cope with life. All of these are qualitative results and would need to have further quantitative results and further qualitative analysis (if possible) before an association with the reflexology can be accurately drawn.

Iain S. A. Wilkinson, Samantha Prigmore and Charlotte F. Rayner Corresponding author. (St George's Hospital, Tooting, London SW17, UK; North Hampshire Hospital, Aldermaston Road, Basingstoke RG24 9NA, UK, "A randomised-controlled trail examining the effects of reflexology of patients with chronic obstructive pulmonary disease (COPD)," Complementary Therapies in Clinical Practice, 2005

Why would stepping on a bumpy surface impact health? A study by Mr. Tauro Nakamura of Japan may holds some answers. Mr. Nakamura measured the results of stepping on the Nii-Ichi wooden bead mat, measuring the participants' foot surface temperature, the speed of circulation and electrical potential before and after stepping on the mat. The test participants stepped on the bead mat for 5 minutes followed by a fifteen minute wait before testing. Testing was conducted in a room at 20 degrees Centigrade with a humidity of 60%.

The surface temperature of the foot was tested with thermography. The results of the test showed that the sure temperature of the foot improved. The thermograph measurement following the stimulus of the bead mat showed a more even distribution of temperature over the entire foot when compared to the measurement before the stimulus.

The speed of blood circulation was tested using ultra-sonic measurements before and after exposure to the mat. Improvement was seen with an average "before" measurement of 12.5 centimeters per second followed by an "after measurement of 29.0 cm. per second.

Electric potential was measured as a change in performance of electrical resistance at twelve vital meridian points on the feet and hands. Because cutaneal nerve response represents sympathetic nerve response, the test was taken to show the response to stimulus by the autonomic nervous system. After the stimulation of stepping on the mat, the measurement of electrical current showed improvement in the form of fewer deviations from the mean established before the stimulus.

Nakamura, Teuro, "Using Technical Measuring Machine," Rwo-Shr Health '90 Worldwide Conference Tokyo, Book of Theses, Tokyo, 1990, pp. 45-54)

INTRODUCTION: The aim of the study was to investigate and treat infants with colic by conventional medicine followed by an investigation of the effect of reflexological treatment.

"MATERIAL AND METHODS: The investigation was prospective, followed by a randomised, single-blind, double-controlled, prospective study of reflexological treatment with an interview and diary. Sixty-three infants aged 1-3 months referred by general practitioners with crying for >90 minutes a day were given a pediatric examination and intervention. The cause of crying was discovered in 33 infants: Vitamin D (5), elimination of cow's milk protein (3), and anal stenosis (3); counseling on feeding, sleep, reduction of stimulation, and avoidance of passive smoking (22). Thirty infants without the benefit of pediatric consultation were randomised to three groups for a duration of two weeks: A: Presumed non-effective reflexological treatment vs B: Presumed effective reflexological treatment vs C: No treatment--only observation. The most important parameter was the number of crying hours over 24 hours. Cure was defined as crying for less than or equal to 30 minutes.

RESULTS: Examination by the pediatrician: Thirty-three of 63 infants benefited with a reduction in crying of less than 90 minutes and 13 of these infants were cured. The randomised study: In group C (control), none of the patients was cured. In groups A and B (presumed non-effective reflexological treatment and presumed effective treatment), half the patients were cured, which was significantly better than in group C. There was no significant difference between groups A and B, but B seemed better than group A. B was significantly better than C.

DISCUSSION: Infantile colic had a significant cure rate at pediatric consultation and the children who did not benefit from this intervention had a significantly better outcome after reflexological treatment than had the observation group. Further investigations in reflexological treatment in infants are recommended."

F�rfattare: Bennedbaek O, Viktor J, Carlsen KS, Roed H, Vinding H, Lundbye-Christensen S., "Original title: Infants with colic. A heterogeneous group possible to cure? Treatment by pediatric consultation followed by a study of the effect of zone therapy on incurable colic," Publicerad: Ugeskr Laeger 2001 Jul 2;163(27):3773-8). Article published in Danish.(Institution: Aalborg Universitet, Institut for Matematiske Fag

Forty residents of a "lodging house of the aged people" were studied for effects of foot reflexology on digestive processes. 20 were diagnosed as constipated and 20 were not. Five days before the foot reflexology treatment all were given a carbon tablet and observed for the length of time required to begin and end black stool. All received 10 days of foot reflexology treatment. The carbon tablet was administered again and a comparison was made between the elimination times before the treatment and after. After treatment, the interval between taking the carbon tablet and first black stool for the constipation group changed from an average of 45 hours to an average of 34 hours. The interval until last black stool changed from 77 hours to 51.5 hours. The non-constipation group remained unchanged in average times for first black stool and changed from 57.5 hours to 46 for last black stool after hours after treatment.

Yuru, Yang; Lingyun, Chao; Guangling, Meng; Scuwe, Cao; Jia-Mo, Hao and Suhui, Zhang, "Exploring the Application of Foot Reflexology to the Preventions and Treatment of Functional Constipation," 1994 China Reflexology Symposium Report, China Reflexology Association, Beijing, p. 62

Aim. Our purpose was to pilot test whether reflexology may reduce anxiety in patients undergoing Coronary Artery Bypass Graft Surgery in Iceland.

Background. Nurses need to study the effects of complementary therapies in general and particularly those that may be beneficial to decrease patients' anxiety. It has been assumed that reflexology lessens anxiety, but research is needed to substantiate such expectations.

Design. A pilot study using randomized design with experimental and control groups.

Methods. Nine patients were recruited and randomly assigned into groups with five patients assigned into an experimental group receiving reflexology for 30 minutes and four patients into control group which rested for 30 minutes. Anxiety and physiological variables were measured pre- and post-reflexology sessions once a day over five days. Results. The anxiety scores were lower for patients in the control group on all measures. Systolic blood pressure lowered significantly more in the control group than in the treatment group. No significant changes were observed for other variables. Patients' comments and responses overwhelmingly suggested increased well-being due to both experimental and control intervention.

Conclusion. This study showed little evidence to support reflexology as a mean of reducing anxiety in CABG patients. Several methodological problems were identified that need to be considered further. Relevance to clinical practice. It is suggested that reflexology should be tailored to individual needs and research methods used that allow for capturing its holistic nature. Further scholarly work is warranted to explore several methodological issues in studying complementary therapies in a highly complex treatment situation.

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

58 cases of coronary heart disease were treated with foot reflexotherapy and 67 cases with pharmacotherapy. Four indexes were examined before and after treatment for both groups: (1) clinical symptoms, (2) blood pressure/heart rate, (3) blood fat and (4) ECG. After 30-40 days of treatment, average results were: (1) symptoms, reflexotherapy group: chest distress and angina pectoris disappeared symptoms, pharmacotherapy group: chest distress and angina pectoris disappeared (2) blood pressure/heart rate, reflexotherapy group (before): +185/80 / 86-74 and (after): +160/75 / 72-70 blood pressure/heart rate, pharmacotherapy group (before): +180/80 / 78-72 and (after): +160/80 / 76-70 (3) blood fat, reflexotherapy group (before): high in some and (after): slightly changed blood fat, pharmacotherapy group (before): high in some and (after): slightly changed (4) ECG, reflexotherapy group (before): slight change in T-wave and (after): improved remarkably ECG, pharmacotherapy group (before): change in ST-T wave and (after): certain improvement

Zhongzheng, Li and Yuchun, Liu, "Clinical observation on Treatment of Coronary Heart Disease with Foot Reflexotherapy," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 38 - 41

"Critical care can be considered to be a stressful environment at both physiological and psychological levels for patients. In this article, a research study in which a five-minute foot massage was offered to 25 patients (68 sessions in total) as a stress-reduction intervention is described. A quasi-experimental repeated measures design was used to collect data before, during and after the intervention. Physiological data (heart rate, mean arterial blood pressure, respirations and peripheral oxygen saturation) were obtained from the patient bedside monitoring system. Repeated measures analysis of variance indicated there was no significant effect from the intervention on peripheral oxygen saturation. However, a significant decrease in heart rate, blood pressure and respirations was observed during the foot massage intervention. Results indicated foot massage had the potential effect of increasing relaxation as evidenced by physiological changes during the brief intervention administered to critically ill patients in intensive care."

Hayes J, Cox C, "Immediate effects of a five-minute foot massage on patients in critical care," Intensive Critical Care Nursing 1999 Apr;15(2):77-82. (University of Hertfordshire, Centre for Research in Primary and Community Care, Hatfield, UK) PMID: 10595045

Nancy A. Hodgson, RN, PhD, CS1, Susan Andersen, BS2, and Heather Felker2. (1) Madlyn and Leonard Abramson Center for Jewish Life, Polisher Research Institute, North Wales, PA, USA, (2) Reseach, Polisher Research Institute (formerly the Philadelphia Geriatric Center), Horsham, PA, USA Learning Objective #1: Identify three biomarkers of physiologic stress in the physically and cognitively frail older population. Learning Objective #2: Describe the effects of a reflexology intervention in a nursing home population.

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

METHODS: This experimental repeated-measures study of 80 subjects (40 control and 40 experimental) with mild to moderate dementia randomized to experimental and control groups was designed to test the efficacy of reflexology as an alternative and complementary therapy in nursing home residents with mild to moderate dementia. The reflexology sessions and control group intervention was provided by a trained reflexology therapist once a week for 4 weeks, and lasted 30 minutes each. Physiologic stress was assessed using blood pressure, heart rate, and salivary measures of cortisol, alpha amyase and DHEA. Measures of pain, anxiety and depression were assessed using standardized indexes by trained data collectors blind to subject group assignment.

RESULTS: Analysis of variance for repeated measures demonstrated a significantly greater decrease in symptoms of pain, depression and physiologic measures of stress for the residents given reflexology treatment than for those in the control group.

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

Presented at the 17th International Nursing Research Congress Focusing on Evidence-Based Practice (19-22 July 2006)

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

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

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

Lee YM., Effect of Self-Foot Reflexology massage on Depression, Stress Responses and Immune Functions of Middle Aged Women, [Article in Korean], Taehan Kanho Hakhoe Chi. 2006 Feb;36(1):179-88. (Department of Nursing, Inje University, Korea. lym312@inje.ac.kr) PMID: 16520577

Diabetes*

32 cases of type II diabetes mellitus were randomly divided into two groups. One group was treated with conventional Western medicine hypoglycemic agent plus foot reflexotherapy (FR), the other group with the same medicine only (WM). After 30 days' treatment, fasting blood glucose levels, platelet aggregation, length and wet weight of the thrombus, senility symptom scores and serum lipid peroxide (LPO) were greatly reduced in the FR group (P,0.05-0.01), while no significant change was observed in the WM group. The study suggested that foot reflexotherapy was an effective treatment for type II diabetes mellitus.

Wang, X. M., "Type II diabetes mellitus with foot reflexotherapy," Chuang Koh Chuang Hsi I Chief Ho Teas Chi, Beijing, Vol. 13, Sept. 1993, pp 536-538 (First Teaching Hospital, Beijing) (PMID: 8111210)

Double blind study with a control group. 22 cases with non-insulin dependent diabetes split into two groups. The patients of both groups had taken hypoglycemic agents for a long time. Foot reflexotherapy was applied once a day for thirty days. Results: Indexes of the scores of senility, thrombocyte aggregation rates (TAR), the length and wet weights of thrombosis in vitro, and the serum oxidative lipids were measured to judge curative effect. The foot reflexotherapy group showed a "marked improvement" with a 66.7% "effective rate" in the measured indices. It is termed a "satisfactory curative effect." The non-foot reflexotherapy showed no significant change 20% effective rate.

The study demonstrates that "FRT (foot reflex therapy) can lessen the abnormal hemorrheology, symptoms of senility, concentration of serum oxidative lipids and number of nodes in the main reflex zones. In addition, FRT can enhance the effects of hypoglycemic agents on blood sugar... "Systematic application seems necessary to achieve an effect. The exact mechanism to describe this effect is "waiting further exploration"

Zhi-qin, Duan et. al., "Foot Reflexology Therapy Applied On Patients with NIDDM (non-insulin dependent diabetic mellitus)," 1993 China Reflexology Symposium, p. 24

20 cases of type II diabetes mellitus formed a treatment group and 15 individuals with normal health formed a control group. All were provided with foot reflexotherapy. "Before and after treatment, the blood flow rate, time and acceleration were tested by HP850GP Doppler ultrasonic equipment." Results: The blood flow rate of the 20 cases was improved.

Ying, Ma, "Clinical Observation on Influence upon Arterial Blood Flow in the Lower Limbs of 20 Cases with Type II Diabetes Mellitus Treated by Foot Reflexology," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 97 - 99

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

METHOD: This was nonequivalent control pretest-posttest study with 76 patients with type 2 diabetes mellitus (ages between 40-79) recruited from public health centers in Busan city. Intervention was a 6 week self-foot reflexology, and outcome variables were peripheral blood circulation and peripheral neuropathy(tactile response to monofilament, intensity of symptoms of peripheral neuropathy). ANCOVA was used to do the statistical analysis. A .05 significance level was set for evaluating the effects of self-foot reflexology. RESULTS: The self-foot reflexology was relatively effective not only in reducing peripheral neuropathy(especially tingling sensation and pain) but also in improving ability to sense the 10-g force monofilament.

CONCLUSION: Even though self-foot reflexology was not effective in improving peripheral circulation, it had good effect on improving peripheral neuropathy. Therefore self-foot reflexology can be used as a nursing intervention program for promoting foot care for patients with DM patients.

Jeong IS., "Effect of Self-Foot Reflexology on Peripheral Blood Circulation and Peripheral Neuropathy in patients with Diabetes Mellitus," Journal Korean Academic Fundamental Nursing 2006 Aug;13(2):225-234. Korean. College of Nursing, Pusan National University, Korea. jeongis@pusan.ac.kr

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

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

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

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

A study at the Department of Complementary Medicine, School of Postgraduate Medicine & Health Sciences, University of Exeter in England has resulted in a conclusion that "diagnosis based on reflexology examination is no better than chance." The objective stated: "Reflexologists believe that disease of different organs of the body cause tenderness in corresponding areas of the soles of the feet. We undertook to determine whether reflexology is a valid diagnostic tool.... "Three reflexologists chose six medical conditions which could be detected most easily and reliably. Eighteen adults with one or two of these conditions were examined by two reflexologists, blinded to the patients' condition(s). ...

"Results: There were 72 opportunities to make a correct positive diagnosis. The reflexologists made a definitive diagnosis 9 times. Of these, 3 were correct." Fact: Focus on Alternative and Complementary Therapies 1998; 3(4), Fifth Annual Symposium on Complementary Health Care)

"Three reflexologists took part in the study. Eighteen adults with one or more of six specified conditions were identified from primary care records. Two reflexologists, who were blinded to the patients' conditions and monitored, then examined each patient's feet and rated the probability that each of the of the six conditions was present.

Results: There is little evidence that the distribution of ratings vary with the status of the condition. Receiver operating curves suggest that this diagnostic method is very poor at distinguishing between the presence and absence of conditions. Interrater reliability (kappa) scores were very low, providing no agreement between the examiners.

Conclusion: Despite certain limitations to the data provided by this study, the results do not suggest that reflexology are a valid method of diagnosis."

A. White, J. Williamson, Hart A, Ernst E, "A blinded investigation into the accuracy of reflexology charts, Complementary Therapy Medicine, 8, 2000: 166-7

"We wanted to test the specific theory behind foot reflexology. Three reflexotherapists examined 76 patients of whom they had no previous knowledge. They were to localize the patients' problems and complaints by examination of the foot soles only; they had no other information about the patients. Each patient and the therapist graded problems related to 13 different parts of the body. Interrater agreement, measured by weighted Kappa, ranged from 0.04 to 0.22, and was significantly better than chance (p<0.05) for six parts of the body. the overall kappa was 0.11 (95% ci: 0.08-o.14). a score based on a detailed examination of the 'colon zone' showed no significant difference between patients with many or few data; intestinal complaints. generally the therapists tended to score higher than the patients thus over-diagnosing problems. the statistical agreement may be better than pure chance, but is too low to be of any clinical significance."

Baerheim A, Algroy R, Skogedal KR, Stephansen R, Sandvik H, "Feet - a diagnostic tool?" Tidsskr Nor Laegeforen 1998 Feb 20;118(5):753-5 (PMID: 9528375) (Norwegian)

The reliability and validity of the "reflexological diagnosis method" was tested. "Eighty patients from various clinics and departments of the Hillel Yaffe Medical Center, Hadera, were examined twice by two different reflexologists. The diagnostics were compared with the conventional medical diagnosis of the same patients. In addition, the level of correlation between the two reflexological examinations was tested. Results: Out of 18 body systems in 6 a statistically significant correlation was found between the conventional medical diagnosis and the two reflexological examinations. In body systems, there was a statistically significant correlation between the conventional medical diagnosis and one of the two reflexological examinations. The systems in which correlation was found are characterized by having a defined anatomic region. The examination of the significance of the diagnoses regarding the components of the body systems resulted in statistical significance in only 4 out of the 32 components. Between the two reflexological examinations, a statistically significant correlation was found in 14 out of the 18 body systems and in only 15 out of the 32 system components.

Conclusion: the reflexology method has the ability to diagnose (reliable and valid) at a systematic level only, and this is applicable only to those body systems that represent organs and regions with an exact anatomic location.

Raz I, Rosengarten Y, Carasso R, "Correlation study between conventional medical diagnosis and the diagnosis by reflexology (non conventional," (Article in Hebrew), Harefuah, 2003 Sep;142(8-9):600-5, 646) PMID: 14518162

Dysmenorrhea (See also Amenorrhea)

Thirty six cases of dysmenorrhea showing abdominal pain during menstruation were treated with foot reflexology. Following treatment, those who were cured (showed disappearance of all conceal sometimes with no relapse in 3 months) included (a) 3 of the 4 cases experiencing dysmenorrhea under 1 year (average: 9.4 sessions), (b) 14 of the 22 cases experiencing dysmenorrhea from 1 to 10 years (average 13.1 sessions), (c), 7 of the 11 over 10 years (average: 17.3 sessions). Those who showed marked effectiveness (showed improvement of clinical symptoms, most of which disappear) included (a) 1 under 1 year, (b) 5 from 1 to 10 years and (c) 3 over 10 years. Those who showed effectiveness (amelioration of symptoms, some pain) included (a) 3 from 1 to 10 years and (b) 1 over ten years. All cases showed effect (change after treatment).

Wang Jixizng, "Clinical Observation on the Treatment for 36 Cases with Dysmenorrhea by Foot Reflexotherapy," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 56-57

Foot reflexology was applied to 17 teenagers, 14-17 years old with a history of amenorrhea for 1 to 4 years. Foot reflexology was applied twice for thirty to forty minutes. Application to the 17 during the first menstrual cycle showed a cured rate of 3, a significant rate of 13 and an effective rate of 1. Application to the 14 during the second menstrual cycle, showed a cured rate of 6, a significant rate of 7 and an effective rate of a. Application to the 8 during a third cycle showed 8 cured, 2 significantly effected and 1 effected.

Wang Lan-xian, "Treatment of Amenorrhea by Foot Reflex Therapy during Menstruation," (19)96 Beijing International Reflexology Conference (Report), China Preventive Medical Association and the Chinese Society of Reflexology, Beijing, 1996, p. 36

Two groups of Dyspepsia cases were studied (upper abdominal; discomfort, bloating, satiety, belching, nausea, acid reflux, heartburn) with peptic ulcer, gastric carcinoma, gastritis reflux esophagatitis and hiatal hernia ruled out by barium studies and gastroscopy. Hepatobiliary disease and pancreatic disease were ruled out by ultrasonography. One group of 132 individuals received foot reflexology for 30 minutes once or twice a day for two weeks. One group of 98 individuals received drug therapy for two weeks. The foot reflexology group was found to be: very effective (98 or 74.2%), effective (30 o 22.7%), failure (4 or 0.3%). The drug therapy group was found to be very effective (58 or 60.4%), effective (14 or 14.5%), failure (24 or 25%). Foot reflexology was seen to be effective, simple, and economical.

Zhi-wen, Gong and Wei-song, Xin, "Foot Reflexology in the Treatment of Functional Dyspepsia: A Clinical Analysis of 132 Cases," (19)96 Beijing International Reflexology Conference (Report), China Preventive Medical Association and the Chinese Society of Reflexology, Beijing, 1996, p. 37

"The aim of the study was to describe similarities and differences in health, quality of life, and diagnosed morbidity in 0-6 year-old children whose parents contact either a reflexologist or a general practitioner (GP) due to their child's ear disorder.

MATERIAL AND METHODS: A total of 98 children who received reflexology treatment and 57 children who received treatment by a GP were included. Reflexologists and GPs described the child's symptoms, the parents completed a questionnaire about health status and ear disorders and a specialist examined and diagnosed the child.

RESULTS: The most prevalent symptoms were colds and troubled sleep and the least prevalent were inflammation of the throat and poor spoken language. Parents in the reflexology group considered their children to be more ill than parents in the GP group (measured by number of ear disorders, number of antibiotic treatments, number of sickness days during the past year and the duration of the acute ear disorder). Furthermore, parents in the reflexology group reported that their children had more physical discomfort, more activity limitations and more emotional problems than children treated by GPs and the parents themselves were also more troubled by the ear disorder. The specialist examination showed no differences between the two groups of children, neither according to tympanometry nor according to diagnosis.

DISCUSSION: According to a medical evaluation there was no difference in morbidity between children treated by a reflexologist and a GP. According to the parents' evaluation, children in reflexology treatment were more ill and their health-related quality of life was more affected by the ear disorder than that of children treated by a GP."

Kjoller M, "Children with ear disorders who are treated by reflexologists or general practitioners" [Article in Danish] Ugeskr Laeger. 2003 May 5;165(19):1994-9 (Statens Institut for Folkesundhed, Svanemollevej 25, DK-2100 Kobenhavn o. mk@si-folkesundhed.dk) PMID: 12795075

Reflexology was applied to the feet of 32 cases of eczema daily. 28 cases fully recovered, 2 got better and 2 showed no improvement.

Gu Hanqing, Xu Yazhen, "Treatment of Eczema with Reflexology - Report of 32 Cases," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 66-68

"Fifty-five women in the third trimester (of pregnancy) were randomly assigned to one of three groups: a period of rest, 'relaxing' reflexology techniques or a specific "lymphatic' reflexology technique for 15 minute with pre and post-therapy ankle and foot circumference measurements and participant questionnaire. There was no statistically significant difference in the circumference measurements between the three groups; however, the lymphatic technique reflexology group mean circumference measurements were all decreased.... A 'perceived well-being' score revealed the lymphatic technique group significantly increased their well-being the most, followed closely by relaxing techniques and then the control rest group. (All groups) had a non-significant oedema-relieving effect. From the women's viewpoint, lymphatic reflexology was the preferred therapy with significant increase in symptom relief."

Mollart l., "Single Blind trial addressing the differential effects of two reflexology techniques versus rest, on ankle and foot oedema in late pregnancy," Complementary Therapeutic Nursing Midwifery, 2003 Nov;9(4):203-8

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A recent British study found reflexology to provide beneficial effects on "women experiencing a need for emotional support." Fifteen women received 30-minute reflexology sessions for eight weeks. The findings included: physical improvements, emotional improvements, self-esteem and confidence, motivation, touch, increase in relaxation levels, being heard and taken seriously, concentration improvements.

Trousdale, Peta, "Reflexology meets emotional needs," International Journal of Alternative and Complementary Medicine, November, 1996, p. 9

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

Methods

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

Results

The incidence of soiling decreased and bowel motions increased following the application of reflexology: Soiling before: 78% once daily; 16% once to three times a week; 6 % none in a seven day period Soiling after: 20% once daily; 30% once to three times a week; 48% none in a seven day period; 2% (missing data) Bowel motions before: 36% none in a seven day period; 46% 1-4 motions per week; 18% daily Bowel motions after: 2% none in a seven day period; 72% more than 1-4 motions per week; 24%daily

"In the last two years (following the study conducted from June 1998 to July 1999) the community nurses have ceased giving enemas to children at home. Reflexology for childhood encopresis and chronic constipation is now an established service with five pediatricians and two staff grade doctors referring children of all ages for treatment"

"Reflexology in the management of encopresis and chronic constipation," Pediatric Nursing, April 2003, Vol 15 No. 3 http://216.239.53.100/search?q=cache:ZbjisK7w7igJ:www.nursing-standard.co.uk/archives/pn_pdfs/pnvol15n3/pnv15n3p2021.pdf+reflexology+research+%2Bnursing&hl=en&ie=UTF-8

* The purpose of the study was to clarify whether reflexology is a relevant treatment for enuresis nocturna, and to test a research design applicable to controlled experiments with reflexology. An unblinded method was used comparing a treatment group (1) receiving reflexology to a non-treatment group (2) keeping the same record of symptoms. At the start of the study, the volumes of night urine in the two groups were comparable. By the end of the study, there was no significant decrease in the volume of night urine in either of the groups. Two children in the treatment group and one in the non-treatment group became dry during the night in the course of the study. In conclusion, reflexology given as 14 treatment sessions over a period of four months did not result in a significant fall in enuresis nocturna in children aged seven to eleven years old. It must be concluded that the treatment result can not be distinguished from the conditions in the non-treatment group even though the average night diuresis in group one showed a slightly decreasing tendency while morning diuresis increased, in contrast to group two which exhibited a slight increase in night diuresis. As the total diuresis remained constant, this could be interpreted as an increased urinary bladder capacity, but in both cases the changes were far from significant.

Comment in: Ugeskr Laeger 1999 Apr 12;161(15):2224 Sietam KS, Eriksen L Forenede Danske Zoneterapeuter, Kolding.

Nine cases of epilepsy were treated with foot reflexology in a daily regime ranging from two to three months. Of the 7 males and 2 females, eight "responded well" with one reported as ineffective. The work with a 28 year-old male was detailed. His attacked occurred roughly every 20 days and he was on medication. Reflex areas were very sensitive initially and light pressure was applied. After two weeks of reflexology application, his medication was halved. Two attacks recurred three weeks into treatment. After forty-six days, his reflexology treatments ended. He was advised to apply self-help techniques. He was off medicating. Four years after treatment, no attacks had occurred.

Ji-ming, Lu, "Therapeutic Recording of a Case of Epilepsy Treated with Reflexology," 1994 China Reflexology Symposium Report, China Reflexology Association, Beijing, p. 25 (Ningxia Reflexology Association)

Twelve athletes were divided into two groups: a foot reflexology group and a control group. The test group received daily reflexology sessions. Both groups underwent the same athletic training and were observed for sleeping, appetite and reactions to training. The reflexology group showed better qualities of sleep, better appetite and quicker recovery from fatigue and muscle soreness.

Jianguo, Liu and Jingshun, Zhang, "Foot Reflex Zone Massage in Recovery of Fatigue in Athletes," 1994 China Reflexology Symposium Report, China Reflexology Association, Beijing, p. 98 (Xian City, Shan'xi, China)

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

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

RESULT: The score of fatigue in the EG was significantly lower than that of the CG and the score of sleep states in the EG was also significantly higher than that of the CG. CONCLUSION: The findings show that the score of fatigue decreased and sleep states increased in the study. Therefore, we should consider SFR as an intervention on clinical nurses. However, it is still needed to verify its effects through more intensive study.

Ko YS, Park MK., "Effects of Self-foot Reflexology on Fatigue and Sleep States in Women Nurses," Korean Journal Women Health Nursing 2007 Mar;13(1):21-27. Korean.

Department of Nursing, Kwangyang Health College, 233-1, Dukrye-ri, Kwangyang-eup, Kwangyang-si, Chonnam, Korea. sook4095@hanmail.net Department of Nursing, Nambu University, Korea

"Fetal activity during midgestation (M age=19.8 weeks) was studied in response to vibratory stimulation of the mother's abdomen (at the height of the fetal head), foot massage, hand massage, or control condition (no stimulation). Consistent with previous research conducted during midgestation, the fetuses of mothers who received two trials of 3-sec, 60-Hz vibratory stimulation did not show changes in movement. In contrast, the fetuses of mothers who received a 3-min foot massage showed greater movement than the control fetuses. However, stimulating the mother's hand (another highly innervated area) did not increase fetal activity. By late gestation (M age=35.4 weeks), vibratory stimulation resulted in increased fetal activity. These findings replicate previous research indicating that vibratory stimulation to the mother's abdomen does not elicit fetal activity until later in gestation. Furthermore, our findings indicate that stimulating the mothers' feet, but not the hands, can evoke fetal activity in midgestation.

Diego MA, Dieter JN, Field T, Lecanuet JP, Hernandez-Reif M, Beutler J, Largie S, Redzepi M, Salman FA., "Fetal activity following stimulation of the mother's abdomen, feet, and hands," Developmental Psychobiology 2002 Dec;41(4):396-406 (Touch Research Institutes, University of Miami School of Medicine, Miami, FL 33101, USA.) Copyright 2002 Wiley Periodicals, Inc. Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/dev.10071PMID: 12430163

To consider the mechanism at work, Chinese researchers conducted a controlled study on the impact of foot reflexo-massage on "human antioxidation ability" The control group consisted of twenty medical students with normal health, 10 males and 10 females, ages 20 +1 years (M+SD). The treated group consisted of 56 patients with various disorders, 30 males and 26 females, ages 30 to 70 years.

The control group received a 30 to 40 minute session each day for 10 days. The treated groups received the same treatment but "symptomatic reflexes and related reflexes" were worked for a longer time and with more strength. For both groups, 3 ml. of heparinized venous blood was collected before and after the session. Tests were conducted for measures of antioxidation: superoxide dismutase (SOD), glutathione peroxidase (GP) and malonyl (MDA)

The FRM increased the serum antioxidative enzymes and activities in both control and treated groups. The decrease of MDA, an end product of lipid peroxide, may be the result of physical stimulation of FRM on the nerve fibres and receptors, which relax the local tissue, improve the systemic blood circulation and metabolism, decrease the production of FRs, increase the production of antioxidative enzymes (SOD and GP) and achieve the therapeutic effect. On the other hand, the reduction in FRs can prevent the therapeutic effect on biological membranes, therefore decrease lipid peroxides, and the serum MDA as well. The decrease on FR production and increase in antioxidative enzymatic activity enhance the total antioxidative system (enzymatic and nonenzymatic), this mechanism underlies the increased TSAOA in our subjects. "In generalization, Foot reflexo-massage can decrease the free radicals."

Shouqing, Gui; Changlong, Zhang; Jixai, Dong and Desheng, Luoof, "A Preliminary Study on the Mechanisms of Foot Reflexo-Massage; Its Effect on Free Radicals," 1996 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 128-135

"Fetal activity during midgestation (M age=19.8 weeks) was studied in response to vibratory stimulation of the mother's abdomen (at the height of the fetal head), foot massage, hand massage, or control condition (no stimulation). Consistent with previous research conducted during midgestation, the fetuses of mothers who received two trials of 3-sec, 60-Hz vibratory stimulation did not show changes in movement. In contrast, the fetuses of mothers who received a 3-min foot massage showed greater movement than the control fetuses. However, stimulating the mother's hand (another highly innervated area) did not increase fetal activity. By late gestation (M age=35.4 weeks), vibratory stimulation resulted in increased fetal activity. These findings replicate previous research indicating that vibratory stimulation to the mother's abdomen does not elicit fetal activity until later in gestation. Furthermore, our findings indicate that stimulating the mothers' feet, but not the hands, can evoke fetal activity in midgestation.

Diego MA, Dieter JN, Field T, Lecanuet JP, Hernandez-Reif M, Beutler J, Largie S, Redzepi M, Salman FA., "Fetal activity following stimulation of the mother's abdomen, feet, and hands," Developmental Psychobiology 2002 Dec;41(4):396-406 (Touch Research Institutes, University of Miami School of Medicine, Miami, FL 33101, USA.) Copyright 2002 Wiley Periodicals, Inc. Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/dev.10071PMID: 12430163

A male patient had been bed-ridden for several months due to the impact of gout and pain experienced in the knees ankles and big toes for five years. Foot reflexology was applied in twelve-day courses. After 4 courses of treatment the patient could move on his own. After 6 courses of treatment the patient could walk well with occasional return of symptoms. Following two more courses of treatment, the patient returned to work.

Wen-ying, Xuan, "Treatment of Gout with Foot Reflexomassage," 1994 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 114 - 6 (Yichang Jinguo Foot Massage Clinic of Hubei Province, China)

Results of study: 19% of headache sufferers ceased taking medication following reflexology work. According to a large nationwide research study undertaken in Denmark, reflexology treatment has a beneficial effect on patients suffering from migraine and tension headaches. The study was conducted at the Department of Social Pharmacy, The Royal Danish School of Pharmacy in cooperation with five reflexology associations. 220 patients participated with treatment being given by 78 fully trained reflexologist across the country. in cooperation with five different reflexology societies FDZ (Danish Reflexologists Association), LNF (National Forum for Natural Healing), SFFF, (Association of Scandinavian Reflexologists), SAB (Union of Complementary Therapists) and OZ (Union of Reflexologists). The project description was approved by the National Board of Health's Council concerning complementary treatment and the project was financed by the Ministry of Health, Director and Mrs. E. Danielsens's Fund together with Pool and Lottery Funds distributed by the Ministry of Education." Headaches remain the most common health problem amongst the adult population and it has been estimated that they are the reason for the loss of three million working days every year. Reflexology is renowned for its ability to help relax and calm patients and for this reason it was considered an interesting therapy to study for the treatment of tension headaches and migraine.

Of all the patients who took part in the study, 90 percent said that they had taken prescribed medication for their headaches within the month prior to the commencement of the study and, of them, 36 percent had experienced side effects from the medicines. 81 percent of the prescribed medicine in the acetvlsalicyclic acid and paracetamol group was taken at least twice a week and 72% of the stronger migraine medicines were taken at least once a fortnight which indicates that the majority of the patients were suffering from moderate to severe symptoms. 34 percent had taken medications for ailments other than headaches. Three months after a completed series of reflexology treatments, 81 percent of patients confirmed that reflexology had either cured (16%) or helped (65%) their symptoms. 19 percent of the patients re-ported that they had been able to completely dispense with the medications they had been taking before the study.

The reflexologists also found that there was a strong link between headaches and the gall bladder, stomach, bladder, and endocrine hormone meridians. At the end of the study the patients who benefited from the treatment showed less stress on the reflex points for the ovaries, small intestine, bladder, stomach, liver and kidneys than they had experienced on their first treatment. The likelihood of successful cure was found to be greatest for: a) those patients whom the reflexologist found no stress on the reflex zones of the uterus or gall bladder, and b) younger patients who had suffered from headaches for a short period of time.

Brendstrup, Eva and Launs�, Laila, "Headache and Reflexological Treatment," The Council Concerning Alternative Treatment, The National Board of Health, Denmark, 1997

An electric foot roller was utilized to provide both "reflexologic stimulation" as well as to remove the human element from the application of the stimulation. Heart rate variability (HRV) was measured by electrocardiogram. "HRV is a non-invasive measurement of cardiovascular autonomic regulation. Specifically, it is a measurement of the interaction between sympathetic and parasympathetic activity in autonomic functioning." "Recently, new dynamic methods of HRV quantification have been used to uncover non-linear fluctuation in heart rate that are not otherwise apparent." The researchers speculate that improved circulation of blood from feet to heart creates a situation where "there will be more variation in the heart rate and become more chaotic."

The ECG of twenty individuals was taken for twenty minutes in a relaxed sitting position and then for twenty minutes while being "given reflexological stimulation just below the toes of both feet by a mechanical reflexological device (Massage-scroller type)." The effectiveness of reflexology stimulation on the heart rate variability (HRV) signal was measured by three means: correlation dimension analysis (CD), entropy and Poincare plot geometry (SD2 (m s).""Reflexology being a healing work working on the subtle planes of the human body, we are using subtle tools for investigating the same."

Results: The three parameters of cardiac function were compared and in "most of the cases under study due to the effect of reflexological stimulation have changed significantly."

CD Entropy SD2 (m s)

Without reflexology 4.225 + 0.28 0.491 + 0.07 79.32 + 32.74

With reflexology 4.29 + 0.24 ��0.54 + 0.05 66.37 + 37.89

"Hence, reflexological stimulation could increase the complexity of HRV (heart rate variability) signal which is a better state. Hence, the HRV becomes more chaotic due to reflexological stimulation." Measurement by ECG showed a moderate improvement of cardiac function of the heart's activity.

Paul Joseph, U. Rajendra Acharya, Chua, Kok Poo, Johnny Chee, Lim Choo, S. S. Iyengar, Hock Wei, "Effect of reflexological stimulation on heart rate variability," Science Direct, 4 February 2004

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

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

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

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

A recent study found that reflexology as applied to palliative care cancer patients did not warrant the hiring of a reflexologist to provide services. "While patients greatly enjoyed the treatments, there was no discernible defiance in outcome between those receiving reflexology and those receiving standard foot massage.... "Both treatments were administered weekly for six weeks by any one of three therapist, who had agreed standardised methods."

Cornbleet, Michael A.M "Research in complementary medicine is essential (Letter to the Editor), British Medical Journal, March 24, 2001

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

Milligan M, Fanning M, Hunter S, Tadjali M, Stevens E, International Journal Oalliat Nursing 2002 Oct;8(10):489-96 (PMID: 12419988)

"Complementary therapies are being increasingly used in palliative care in the drive to improve patients' emotional, psychological and spiritual health, and enhance the quality of their lives. The importance of seeking the 'user' perspective when evaluating such services is becoming increasingly acknowledged. However, it is also extremely important that we elicit such perspectives in an ethically sensitive manner. This study used a simple semi-structured questionnaire to elicit the views of a convenience sample of 34 patients receiving palliative care at a specialist palliative core unit in the north of England who had completed a course of 4-6 sessions of reflexology. Patients' comments about the therapy and the service as a whole were overwhelmingly positive. They identified relaxation, relief from tension and anxiety, feelings of comfort and improved well-being as beneficial effects of their course of reflexology. Patients also spontaneously evaluated the experience holistically in terms of the wider therapeutic environment - the centre, the staff and the therapist as well as the therapy itself. The increasing demand for evidence based practice now challenges researchers to provide a relevant holistic assessment of complementary therapies using approaches that are both ethical and sensitive to the needs of this vulnerable patient population

Gambles M, Crooke M, Wilkinson S, "Evaluation of a hospice based reflexology service: a qualitative audit of patient perceptions," European Journal Oncological Nursing 2002 Mar;6(1):37-44. (Marie Curie Cancer Care, Marie Curie Centre Liverpool, Speke Road, Woolton, Liverpool, L25 8QA, UK) PMID: 12849608

Doctors Shou-qing, Xian-qing, Yuna-zhong, and Wan-yan, conducted a study of 72 cases of hyperlipemia with a treated group of 41 and a control group of 31. Before and after the treatment session, 4 ml of "empty stomach blood" was collected. One group received a series of reflexo-therapy sessions of more strength and lasting 30 to 40 minutes. The control group received a 20 minute session with a forehead pillow application of iodineiontophoresis. The reflexo-therapy group showed an improvement of symptoms of 78% as opposed to 32% for the second group with headache, insomnia, palpitation or poor memory. The treatment group showed a reduction in cholesterol and monoglyceride with a marked statistical difference.

Shou-qing, Gui; Xian-qing, Xiao; Yuna-zhong, Li; and Wan-yan, Fu, "Impact of the Massotherapy Applied to Foot Reflexes on Blood Fat of Human Body," 1996 China Reflexology Symposium Report, China Reflexology Association, Beijing, p. 21

186 cases of hyperlipemia were randomly divided into four groups: (A) foot reflexology a 30-40 minute session 5 or 6 times a week), (B) kinesitherapy (4 to 5 times per week: 25 minutes of walking, 20 minutes of slow running, or 6 to 7 minutes 2 or 3 times per day of step aerobics), (C) ion-intorduction therapy (30 minutes per day), and (D) pharmacology (the drug lipunthyl). Groups A, C and D showed remarkable reduction in cholesterol. Group A and D had strong effect on triglyceride. "If one can insist on proper physical exercises and/reflexotherapy plus a balanced diet (low fat, low calorie), it is possible to prevent and treat arteriosclerosis, coronary atherosclerotic cardiopathy, cerebral thrombosis and cerebral apoplexy efficiently."

Shou-qing, Gui; Yuna-zhong, Li; Xian-qing, Xiao; Chen Shengping and Gu Xuejauna (The People's Hospital, Xianning District, Hubei Province), Zhu Shanhan, Liao Enguang (The People's Hospital of Hubei Province) and Luo Desheng (Xianning College of Medicine, Hubei Province), "Impact of the Massotherapy Applied to Foot Reflexes on Blood Fat of Human Body," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 34-37

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

METHOD: The research design used was a nonequivalent control group pretest-posttest design. Foot Reflexology was used as the experimental treatment from June 23rd, 2003 until August 31st, 2003. Thirty-four subjects were assigned to an experimental group(18) and control group(16). Foot Reflexology was administered twice a week for 6 weeks and self foot Reflexology was administered twice a week for 4 weeks on the experimental group.

RESULT: There was a significant decrease in systolic blood pressure but no significant decrease in diastolic pressure in the experimental group compared to the control group. The total cholesterol level in the experimental group compared to the control group was not significantly decreased after foot reflexology. However, the triglyceride level in the experimental group compared to the control group was significantly decreased after foot reflexology. On the other hand, high density lipoprotein and low density lipoprotein levels in the experimental group compared to the control group was not significantly decreased after foot reflexology. Life satisfaction in the experimental group compared to the control group was significantly improved after foot reflexology.

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

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

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

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

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

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

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

Thirty-seven patients with sexual dysfunction (15: impotence, 9: premature ejaculation, 6: emission, and 7: ejaculation deficiens) were randomly assigned to two groups: 19 individuals were treated with foot reflexology and 18 with traditional Chinese medicine. No statistical difference was found between the two groups on age, occupation, education, degree of disease, spirit status, affection between the couple, sexual desire, and sexual intercourse for marital cases. In addition to foot reflex areas, massage was applied to specific acupuncture points of the body in the foot reflexology group. The effective rate of the foot reflexology treatment group was found to be 87.5% for impotence and 100% for the others. The effective rate of the traditional Chinese medicine group was found to be 85.7% for impotence and 100% for the others.

Jianhua, Sun, "The Comparison of Curative Effects Between Foot Reflexology and Chinese Traditional Medicine in Treating 37 Cases with Male's Sexual Dysfunction," 1996 China Reflexology Symposium Report, China Reflexology Association, Beijing, p. 75

Incontinence

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

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

RESULT: 1. Frequency(U=78.00, P=.001), amount(U=65.00, p=.001) and the situation score(U=81.00, P=.002)of urinary incontinence were reduced significantly in the experimental group as compared to the control group. 2. Maximum pressure(U=33.50, p=.000), mean pressure(U=38.00 p=.000) of vaginal contraction were improved significantly in the experimental group as compared to the control group. 3. Daily life discomfort in the experimental group was reduced whereas that of the control group was increased(U=63.00, p=.000) significantly.

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

Kang HS, Kim WO, Wang MJ, Cha NH., "The Effects of Self-foot Reflexology on Urinary Incontinence in Middle-aged Women," Journal Korean Academy Adult Nursing 2004 Sep;16(3):482-492. Korean. College of Nursing Science, Kyung Hee University, Korea.

The aim of this study was to examine whether foot reflexology has beneficial effects on patients with idiopathic detrusor overactivity. One hundred and nine women with symptomatic idiopathic detrusor overactivity were randomized into either foot reflexology treatment group or nonspecific foot massage control group. The primary outcome measure was the change in the diurnal micturition frequency. There was significant change in the number of daytime frequency in the reflexology group when compared with the massage group (-1.90 vs -0.55, p = 0.029). There was also a decrease in the 24-h micturition frequency in both groups, but the change was not statistically significant (-2.80 vs -1.04 p = 0.055). In the reflexology group, more patients believed to have received "true" reflexology (88.9 vs 67.4%, p = 0.012). This reflects the difficulty of blinding in trials of reflexology. Larger scale studies with a better-designed control group and an improved blinding are required to examine if reflexology is effective in improving patients' overall outcome. PMID: 17003953

Mak HL, Cheon, WC, Wong T, Liu YS, Tong, WM, "Randomized controlled trial of foot reflexology for patients with (incontinence) symptomatic idiopathic detrusor overactivity, International Urogynecol Journal Pelvic Floor Dysfunction 2007 Jun;18(6):653-8, Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong, China. mhlj01@yahoo.com

The four women had unsuccessfully tried to become pregnant for 1 to 3 years and were between the ages of 26 and 30. Each received a thirty to forty minute session daily for ten days, one course of treatment. One woman became pregnant after 6 courses of treatment, two after seven course and one after nine courses

Dong Dahai, Xu Ping, Dong Congjun, Wei Lihua, "Treatment of 4 Cases of Infertility with Foot Reflexotherapy," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 58-59

Objective

The aim of this preliminary study was to assess the effectiveness of acupuncture and reflexology on primary insomnia in a pilot RCT.

Materials and methods

Thirteen consenting participants with sleep disturbances were recruited from the University of Ulster�s staff base. Participants were randomly allocated to receive one of three treatments � acupuncture (n = 5), reflexology (n = 4) or music therapy (n = 4) � six times over 3 weeks in the University of Ulster�s clinic. A blind outcome assessor recorded measures at baseline, week 3 (post treatment) and week 5 (follow-up). The primary outcome measure was the Pittsburgh Sleep Quality Index (PSQI); secondary measures included the SF-36 version 2 and a sleep diary. Ethical approval for the study was obtained from the University of Ulster�s Research Ethical Committee.

Results

Ten participants completed the study. In the acupuncture and reflexology groups there was an improvement observed on the PSQI, from baseline scores to post treatment of 2.7 and 1.7 points and a total change at follow-up to 3.4 and 2.0 points, respectively. A change in the PSQI of 2 points is considered to be clinically important. In the music therapy group a small initial improvement was observed (0.7 points), which deteriorated by 1.0 point from the baseline score at follow-up.

Conclusion

The results indicate that treatment with acupuncture and reflexology produces a clinically important improvement in sleep quality in patients with primary insomnia, whereas music therapy does not. A larger suitably powered study is required to confirm and extend these findings.

McCullough CA, Hughes CM, McDonough SM, "The effectiveness of acupuncture and reflexology in primary insomnia," Focus on Alternative and Complementary Therapies 2005; 10: 36

Austrian researchers previously documented that blood flow to the kidneys improved with reflexology technique application. Now, the members of the same group have shown improvement of blood flow to the intestines following reflexology technique application. Once again a controlled, randomized study has demonstrated that application of reflexology technique to reflex areas of the feet has an influence on a reflected body part. Moreover, the researchers are hypothesizing that the mechanism of action at work in reflexology is improved blood flow.

"An influence on organ-associated blood flow is considered as a possible mechanism of action of reflex zone massage of the feet (FRZM) therapy. In the present study we investigated whether changes in intestinal blood flow can be achieved by FRZM. Material and Methods: 32 healthy adults (19 women and 13 men) were randomly assigned to the treatment or the placebo group. Subjects of the treatment group received foot massage on the zones assigned to the intestines and those of the placebo group received massage on zones unrelated to the intestines. Before, during and after FRZM, the blood flow velocity, the peak systolic and the end diastolic velocities in the superior mesenteric artery as well as the resistive index as a parameter of vascular resistance were calculated. Results: During FRZM, in the subjects of the treatment group there was a significant reduction in the resistive index (p = 0.021), suggesting an increase in the blood flow in the superior mesenteric artery and the subordinate vascular system. In contrast, there were no significant changes in the resistive index in the subjects of the placebo group. Conclusion: The reduction in the resistive index observed in the treatment group supports the assumption that FRZM improves blood flow in the organs considered to be associated with the specific foot zones, at least during the therapy process."

J, Egger I, Bodner G, Eibl G, Hartig F, Pfeiffer KP, Herold M., "Influence of reflex zone therapy of the feet on intestinal blood flow measured by color Doppler sonography," [Article in German] Forsch Komplementarmed Klass Naturheilkd. 2001 Apr;8(2):86-9. (Universitatsklinik fur Innere Medizin, Innsbruck, Austria) (Copyright 2001 S. Karger GmbH, Freiburg (Mur E, Schmidseder) PMID: 11340315

"Reflexology does not help patients with Irritable Bowel Syndrome (IBS), a study has found. the complementary therapy, in which points in the feet are massaged in a particular way to ease discomfort in other parts of the body, was assessed in a study published in the British Journal of General Practice."

"Thirty-four patients with IBS were recruited from four GP practices. The study was approved and carried out in consultation with reflexologists. Half the patients received six 30 minute reflexology treatment sessions. The other half saw heath care staff for the same amount of time but received no reflexology treatment. Patients were asked to record symptoms for two weeks before their first session, two weeks after and for a fortnight three months after their treatment had ended. Severity of abdominal pain, constipation or diarrhoea and bloating were measured but the Leeds team, led by Dr. Philip Tovey, said none showed reflexology made no positive difference." Dr. Tovey of the School for Healthcare Studies at the University of Leeds (p.a.tovey@leeds.ac.uk), noted that "While due caution would be exercised in generalising from a single study, the nature of the data is such that clear conclusions can be drawn. However, more research is needed, not only to test these initial findings but also to extend the range of participants to, for instance, those newly diagnosed with IBS Reflexology in particular remains not just under-researched but almost un-researched - something that is quite startling given the extent of its use."

Reported December 31, 2001 at http://news.bbc.co.uk/hi/english/health/newsid_1723000/17232900.stm

Objective

The data collected is used to demonstrate the extent to which (a) symptoms mentioned in the Manning Criteria and those associated with irritable bowel syndrome (IBS) are presented by the client; (b) reflexology ameliorated these symptoms; (c) clients benefited from the course of treatment; (d) client response to reflexology was related to certain factors.

Materials and methods

Clients (28) were asked to assess subjectively on six-point scales, the extent to which they were suffering from ten IBS-related symptoms before and after a course of reflexology (mean of six treatments) and again after 1 month without treatment. Clients were also asked other questions relevant to IBS and about their diet and medication. Practitioners also filled in corresponding confirmatory questionnaires.

Results

(a) All symptoms were presented-most frequent in severe form were abdominal pain, stomach distension and feelings of incomplete evacuation. (b) The means for each symptom before and after treatment were calculated from the aggregated scores. Reflexology had little effect on mild symptoms but the effect on severe symptoms was significant. The reduction in means varied from 72% to 29%. These differences were reduced by less than 10% after a further month. (c) Clients lost 61% of their severe symptoms with a 6% deterioration after 1 month. Some (39%) lost all their severe symptoms, others (21%) lost none. (d) The variation in the effectiveness of treatment on clients� severe symptoms was related to their age, temperament and length of time with IBS.

Conclusion

Reflexology has a significant beneficial effect on clients suffering from IBS, maintained for at least 1 month.

Fisher DG, Berker M, Reflexology for irritable bowel syndrome. Focus on Alternative and Complementary Therapies 2003; 8: 138 British Reflexology Association, Monks Orchard, Whitbourne, Worcester, WR6 5RB, UK

Results of study: Kidney function improves after the application of reflexology work. "Using colour (sic) Doppler sonography blood flow changes of the right kidney during foot reflexology were determine in a placebo-controlled, double blind, randomised (sic) study. 32 healthy young adults (17 women, 15 men) were randomly assigned to the verum or placebo group. The verum group received foot reflexology at zones corresponding to the right kidney, the placebo group was treated on other foot zones. Before, during and after foot reflexology, the blood flow of three vessels of the right kidney was measured using colour Doppler sonography. Systolic peak velocity and end diastolic peak velocity was measured in cm/s, and the resistive index a parameter of the vascular resistance, was calculated. The resistive index in the verum group showed a highly significant decrease during and an increase after foot reflexology. There was no difference between men and women and no difference between smokers and non-smokers. Verum and placebo groups significantly differed concerning alterations of the restive index, both between the measuring points before versus during foot reflexology (p=0.002) and those during versus after reflexology (p=0.031). The significant decrease of the resistive index during foot reflexology in the verum (treatment) group indicates a decrease of flow resistance in the renal vessels and an increase of renal blood flow. These findings support the hypothesis that organ-associate foot reflexology is effective in changing renal blood flow during therapy.

Sudmeier, I., Bodner, G., Egger, I., Mur, E., Ulmer, H. and Herold, M. (Universitatsklinik fur Innere Medizin, Inssbruk, Austria) "Anderung der nierendurchblutung durch organassoziierte reflexzontherapie am fuss gemussen mit farbkodierter doppler-sonograhpie," Forsch Komplementarmed 1999, Jum;6(3):129-34 (PMID: 14060981, UI: 99392031)

In a controlled trial, 96 individuals were followed after receiving lithotrity (externally crushing kidney or ureter stones). 46 cases receiving foot reflexology were compared to 50 cases not receiving foot reflexology. A comparison was made between the beginning time to excrete the fragmented calculus (stones) between the treatment group and untreated group. Results: Members of the treated group experienced less pain, began excretion earlier, and completed the excretion process earlier. (1) 39 of 46 treated cases began excretion in less than 10 days compared to 13 of the 50 in the control group, (2) All members of the treated group completed the excretion process at 20 days, compared to 38 of the 50 in the untreated group.

Xiaojian, Ying, "Foot Reflexology as an Accessory Treatment after External Lithotrity a Clinical Observation of 46 Cases," 1996 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 58 - 59

A few years ago, researchers at Glostrop hospital, Copenhagen, demonstrated that reflexology can help relieve the acute pain suffered by patients with kidney stones. 30 patients participated in the study and were divided equally into three groups: one group received reflexology treatment, one group received placebo treatment and the remaining groups were used as controls.

If no pain relief was experienced within 5 minutes, the treatment would end for analgesic medications, but those who experienced a benefit within 5 minutes, treatment was continued for a further 10 minutes. The results showed that 9 out of the 10 patients in the reflexology group experienced complete pain relief after the treatment which lasted for over an hour and in 5 of the patients pain was relieved for 4 hours.

Medical doctors Niels Baekgaard and Vibe Hansen, who conducted the study, concluded that "Reflexology treatment of acute ureterolithiasis has a pain relieving effect" and when compared to Baralgin (a commonly administered analgesic), the findings revealed that reflexology actually works faster at alleviating pain although the effects last for a shorter duration.

Eriksen, Leila, "Reflexology use in (Pain Caused by) Ureter and Kidney Stone Attacks, Danish Reflexologists Association Research Committee Report, Feb. 1995 (Originally published in Zonetherapeuten, No. 6, 1993

Results of study: Foot reflexology work was found to be more effective than medication in effecting leukopenia, low white blood cell count. (A pathological level of white blood cell count)

Ya-zhen, Xu, "Treatment of Leukopenia with Reflexotherapy," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 32-37

Summary

Objective: The current study was designed as a pilot study for a randomised controlled trial to investigate the effectiveness of reflexology in the management of low back pain (LBP). Materials and methods: Participants suffering non-specific LBP were recruited and randomised into either a reflexology or a sham group. Patients and outcome assessor were blinded to group allocation. Each patient received either a 40�min reflexology treatment or sham treatment (according to group allocation) once per week for six consecutive weeks. The primary outcome measure was pain (visual analogue scale), secondary outcome measures were the McGill pain questionnaire, Roland�Morris disability questionnaire, and SF-36 health survey. Outcome measures were performed at baseline, week 6, week 12 and week 18.

Results: VAS scores for pain reduced in the treatment group by a median value of 2.5�cm, with minimal change in the sham group (0.2�cm). Secondary outcome measures produced an improvement in both groups (McGill pain questionnaire: 18 points in the reflexology group and 11.5 points in the sham group). Results indicate that reflexology may have a positive effect on LBP.

Conclusion: Reflexology appears to offer promise as a treatment in the management of LBP; however, an adequately powered trial is required before any more definitive pronouncements are possible.

Quinna, C.M. Hughesb, , and G.D. Baxter" Reflexology in the management of low back pain: A pilot randomised controlled trial" Complementary Therapies in Medicine, 2007 05 011 aHealth and Rehabilitation Sciences Institute, University of Ulster, Shore Road, Newtownabbey, Co. Antrim BT37 OQB, United Kingdom: bSchool of Life and Health Sciences, University of Ulster, Shore Road, Newtownabbey, Co. Antrim BT37 OQB, United Kingdom

Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand: Corresponding author at: School of Health Sciences, University of Ulster, Shore Road, Newtownabbey, Co. Antrim BT37 OQB, United Kingdom. Tel.: +44 28 9036 6227.

"Seventy-six women between 45 and 60 years, reporting menopausal symptoms. Methods: Women were randomised to receive nine sessions of either reflexology or nonspecific foot massage (control) by four qualified reflexologists over a period of 19 weeks. Main outcome measures: The Women's Health Questionnaire (WHQ), the primary measure s being the subscores for anxiety and depression. Severity (visual analog scale (VAS) a n frequency of flushes and night sweats. Results: Mean (SD) scores for anxiety fell from 0.43 (0.29) to 0.22 (0.25) in the reflexology group and from 0.37 (0.27) to 0.27 (0.29) in the control group over the course of treatment. Mean (SD) scores for depression fell from 0.37 (0.25) to 0.20 (0.24) in the reflexology group and from 0.36 (.023) to 0.20 (0.21) in the control (foot massage) group over the same period. For both scores there was strong evidence of a time effect (P<0.001) but no evidence of a time-group interaction (p>0.2). Similar changes were found for severity of hot flashes and night sweats. In the control group, 14/37 believed they had not received reflexology. Conclusion: Foot reflexology was not shown to be more effective than non-specific foot massage in the treatment of psychological symptoms occurring during menopause."

(Williamson J, White A, Hart A, Ernst E., "Randomised controlled trial of reflexology for menopausal symptoms," British Journal OG, 2002 Sep; 109(9):1050-5)

"We sought to evaluate evidence for the benefits and risks of acupuncture, magnets, reflexology, and homeopathy for menopause-related symptoms. Search strategies included electronic searches of online databases (PubMed, PsycINFO, Medline), direct searches of target journals, and citation-index searches. A total of 12 intervention studies were identified for review. Complementary and alternative medicine (CAM) treatments resulted in few side effects. The design, study populations, and findings across acupuncture studies varied. In uncontrolled studies, acupuncture improved subjective measures of hot flash frequency and vasomotor, somatic, physical, and psychological symptoms; however, improvements were not consistent. Controlled studies of acupuncture yielded even less consistent findings. Overall, controlled studies of acupuncture did not reliably improve hot flashes, sleep disturbances, or mood when compared with nonspecific acupuncture, estrogen therapy, or superficial needling. Homeopathy significantly improved subjective measures of hot flash frequency and severity, mood, fatigue, and anxiety in uncontrolled, open-label studies. Controlled studies of magnets and reflexology failed to demonstrate any increased benefit of treatment over placebo. There is a need for additional investigations of acupuncture and homeopathy for the treatment of hot flashes and other menopausal symptoms. However, existing evidence does not indicate a beneficial effect of magnets or reflexology in the treatment of hot flashes and other menopausal symptoms. Understanding whether, for whom, and how these interventions work is crucial to building the evidence base needed to evaluate any potential for these CAM therapies in the management of menopause-related symptoms."

Carpenter JS, Neal JG , "Other complementary and alternative medicine modalities: acupuncture, magnets, reflexology, and homeopathy." (School of Nursing, Indiana University, Indianapolis, Indiana 46202, USA. carpentj@iupui.edu), American J Medicine 2005 Dec 19;118(12 Suppl 2):109-17 PMID: 16414335

Eighty-two women diagnosed with menopause were randomly divided into two groups. Forty-two women received foot reflexology and forty received foot reflexology with auricular point magnet adhesion. Thirty minute session were provided daily for 60 days.

Among women provided with foot reflexology at the conclusion of the study, 17 (40.48%) of the women had fully recovered, 20 (47.62%) had significantly recovered, 4 (9.25%) had effective results and 1 had ineffective results.

Among women provided with foot reflexology and auricular magnet adhesion at the conclusion of the study, 9 (22.5%) of the women had fully recovered, 16 (40%) had significantly recovered, 9 (22.50) had effective results and 6 (15%) had ineffective results.

Sun Jianhua, "Observation on the Therapeutic Effect of 82 Cases of Climacterium Syndrome (menopause) Treated with Reflexotherapy," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 60-61

"It is clear by the end of the research period that a significant number of participants had experienced many positive effects from the reflexology treatments." The findings of a study of "those in need of emotional support" were reported by Mind Affiliated Local Association Worthing in a publication titled "Making Connections, User Perception of the Effects of Reflexology & Counselling: an evaluation of a complementary health care project at Worthing Mind." Mind Worthing is an affiliate of national charity Mind. The study was conducted at a day centre or a drop-in centre. "The people included in the study were all in need of emotional support." They ranged in age from 18 to 65. Forty-nine individuals participated in the reflexology project and twenty-five in the counselling project between May 1996 and August 1997. "Most of the reflexology sample received reflexology once a week for eight weeks, and each treatment lasted thirty minutes. Qualitative data collection included "Confidential profiles" (individual responses to questions) and "Focus group questions" (responses gathered in groups of four to eight individuals).

Findings from participant responses included: Improvement in physical aspects, significant improvement in emotional state, improvement in ability to concentrate, increase in motivation for a significant number of participants, significant increase in confidence and self-esteem levels, improvement in communication and ability to articulate ideas more effectively and readily, "importance of being touched during treatment in a safe non-intrusive / abusive manner," and reduction of medication by several.

Reports of benefits by the centre's staffs were noted: "Both services (reflexology and counselling), it was reported, have in addition (to positive feedback from members) helped to alleviate pressure on staff and avert crises because some members becoming more relaxed and at ease as a result of having had reflexology and/or counselling."

Assessment of cost-effectiveness included questions related to the cost of not providing reflexology and/or counselling services. At issue were expenses related to the cost of typical interventions such as psychotropic medications or consultation with a GP or Psychiatrist. Adverse outcomes for individual were noted to potentially include "psychiatric breakdown, attempted suicide, physical / sexual abuse of children, and inappropriate health care seeking behaviors."

Trousdale, Peta and Uphoff-Chmielnik, Andrea, Making Connections, User Perception of the Effects of Reflexology & Counselling: an evaluation of a complementary health care project at Worthing Mind, September 1997

Mental retardation*

Results of study: The feet of mentally retarded children were found to be of abnormal color and to show abnormal toe shapes as opposed to other children.

Feng, Gu; Zhao, Lingyun; Yuru, Yang; Jiamo, Hao; Shuwen, Cao and Xiulan, Zhang, "Comparative Study of Abnormal Signs in the Feet of Feebleminded Children," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 9 - 13

Mental retardation*

Results of study: Mentally retarded children were shown to improve significantly in height, weight, health states, social living abilities, and intellectual development when receiving foot reflexology as opposed to those not receiving treatment.

(G)Lingyun, Yuru, Zhao; Yang Yuru, Feng gu; Jiamo, Hao; Shuwen, Cao and Xiulan, Zhang, "Observation on Improvement of Feeble-Minded Children's Social Abilities by Foot Reflexo-Therapy," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 24 - 28

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

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

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

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

Lee YM., "Effect of Self-Foot Reflexology massage on Depression, Stress Responses and Immune Functions of Middle Aged Women," [Article in Korean], Taehan Kanho Hakhoe Chi. 2006 Feb;36(1):179-88. (Department of Nursing, Inje University, Korea. lym312@inje.ac.kr) PMID: 16520577

"Foot reflexology is defined as massage of zones on the feet which correspond to different parts of the body. A medline-search yielded no literature in the field of foot reflexology. Indications for and results of foot reflexology have been extrapolated from case-descriptions and two pilot studies with small samples. One study (Lafuente et al.) found foot reflexology to be as helpful to patients with headaches as medication (flunarizine), yet foot reflexology was fraught with less side-effects than medication. In a second study (Eichelberger et al.) foot reflexology was used postoperatively on gynecological patients. The intervention group showed a lesser need for medication to enhance bladder tonus than did the control group. The literature describes foot reflexology as enhancing urination, bowel movements and relaxation." Foot reflex zone massage (Kesselring A, Institut fur Pflegeforschung, Bern.)

In a blind random trial, (Lafuente) "examined 32 patients between the ages of 15 and 57. There were 25 women and 7 men randomly assigned to two groups. One group was given a placebo and received reflexology treatments two times a week for two or three monthes, The other group received Flunarizin traterment ( a selective calcium entry blocker with calmodulin binding properties and histamine blocking activity that has been effective in preventing migraines) and massage of a non -specific area twice a week for 12 sessions. patients were evaluated at the end of the study and again three months after the study. It was concluded that the reflexology treatment was at least as effective as the Flunarizin treatment and may be classifed as an alternative non-pharmacological therapeutic treatment that would be particularly appropriate to thsoe patients that were unable to follow pharmacological treatment." (Testa, Gail W., "A Study on the Effects of Reflexology on Migraine Headaches" August 2000 (http://members.tripod.com/GTesta/Dissertationall.htm)

Lafuente A et al (1990). Effekt der Reflex zonenbehandlung am FuB bezuglich der prophylaktischen Behandlung mit Flunarizin bei an Cephalea-Kopfschmerzen leidenden Patieten.Erfahrungsheilkunde. 39, 713-715.

Heydenreich A., Institution: Abteilung Neurologie, Wilhelm-Pieck-Universitat, Rostock, "Treatment of migraine with controlled reflex methods and stimulation therapy," Schweiz Med Wochenschr Suppl, 62: 88-93 (1994) Authors:. [Review] [0 refs] [German] Zeitschrift fur Arztliche Fortbildung. 82(24):1247-9, 1988.

Two groups of new mothers were followed for satisfactory lactation. A treated group of 100 was given foot massage within 30 hours after delivery and 17 were given foot massage from 30 to 120 hours after for 10 to 15 minutes a day. No treatment was given to a group of 100 women. In the treatment group, lactation was initiated in 43.47 hours (+12.39 hours). In the control group it was 66.97 hours (+28.16 hours). In 72 hours satisfactory lactation was documented in 98% and 67% respectively in the two groups. Foot massage was found help avoid use of drugs in lactation that may be harmful to the baby.

Siu-lan, Li, "Galactagogue Effect of Foot Reflexology in 217 Parturient Women," (19)96 Beijing International Reflexology Conference (Report), China Preventive Medical Association and the Chinese Society of Reflexology, Beijing, 1996 p. 14

Multiple sclerosis

Following a number of reports by reflexologists of MS patients benefiting from reflexology treatment, a small scale study was initiated backed by the Grampian branch of the Charity Action and Research for Multiple Sclerosis (GARMS) and the Scottish Institute of Reflexology. GARMS provides regular hyperbaric oxygen therapy and physiotherapy for people with MS, and volunteers were asked to participate in reflexology study. Fourteen were assigned to a treatment group to receive a one hour reflexology treatment every week, and 13 patients were selected to act as a control group (one member dropped out leaving twelve who completed the study in the control group)

At the commencement of the study, participants were asked to asses nineteen of the most common symptoms as either minor, major or not applicable. The assessment was repeated after 6 weeks and 12 weeks when the participants also noted whether their symptoms had improved, worsened or not changed. The control were assessed using the same form at the same intervals as the treatment group, and both the treatment and control groups were asked at the time of the assessment whether on not their medication or diet had changed to assess possible external factors. After 6 weeks, a significant number of people in the treatment group showed an improvement in their symptoms, and most of these improvements were maintained. During the second 6 week period, however, many of the participants had lost some of the improvements they had gained in the first 6 weeks; but after 18 weeks, the results revealed that those patients in the treatment group experienced some improvements in 45% of the symptoms compared to a much lower rate of 13% in the control group. The results indicate that reflexology does offer some therapeutic benefit to MS patients especially in the first 6 weeks of treatment, although the treatment sessions need to be regular, and the benefits seem to diminish after twelve weeks.

Joyce M, Richardson R., "Reflexology helps multiple sclerosis." Journal Alternative Complementary Medicine July 1997 10-12 (www.internethealthlibrary) (MS Centre (Glasgow), Unit 16, Chapel Hill Industrial Estate, Maryhill, Glasgow G20 9BD, Tel: 0141 945 3344)

"To evaluate the effect of reflexology on symptoms of multiple sclerosis (MS) in a randomized, sham-controlled clinical trial. METHODS: Seventy-one MS patients were randomized to either study or control group, to receive an 11-week treatment. Reflexology treatment included manual pressure on specific points in the feet and massage of the calf area. The control group received nonspecific massage of the calf area. The intensity of paresthesias, urinary symptoms, muscle strength and spasticity was assessed in a masked fashion at the beginning of the study, after 1.5 months of treatment, end of study and at three months of follow-up. RESULTS: Fifty-three patients completed this study. Significant improvement in the differences in mean scores of paresthesias (P = 0.01), urinary symptoms (P = 0.03) and spasticity (P = 0.03) was detected in the reflexology group. Improvement with borderline significance was observed in the differences in mean scores of muscle strength between the reflexology group and the controls (P = 0.06). The improvement in the intensity of paresthesias remained significant at three months of follow-up (P = 0.04). CONCLUSIONS: Specific reflexology treatment was of benefit in alleviating motor; sensory and urinary symptoms in MS patients."

Siev-Ner I, Gamus D, Lerner-Geva L, Achiron A."Reflexology treatment relieves symptoms of multiple sclerosis: a randomized controlled study," Multiple Sclerosis 2003 Aug;9(4):356-61(Complementary Medicine Clinic, Department of Orthopedic Rehabilitation, Sheba Medical Center, Tel-Hashomer, Israel) PMID: 12926840

Thirty cases of neurodermatitis were divided into two groups of 15 with the treated group receiving foot massage for 10 to 30 days and the other group receiving drug therapy. The effective rate for the treated group was 46.7% very effective and 53.3% effective. In the control group, 33.3% were very effective, 40% were effective and 26.7 were ineffective. Foot massage was seen as simple, effective, economical and lacking the side effects of drugs given the control group (fatigue, sleeplessness, gastrointestinal symptoms, with hormonal dermatitis resulting from long-term use).

Zhi-ming, Liu and Song, Fang, "Treatment of Neurodermatitis by Foot Reflex Area Massage (with a test group of 15 and a control group of 15)," (19)96 Beijing International Reflexology Conference (Report), China Preventive Medical Association and the Chinese Society of Reflexology, Beijing, 1996, p. 16

Recent research from China suggest that reflexology may be particularly helpful for patients suffering from nervous exhaustion. Twenty patients with a history of neurasthenia (nervous exhaustion) which had lasted between 1 & 8 years were given a course of reflexology at the department of physiotherapy, 52884 Military Hospital. The patients' chief symptoms were dizziness, insomnia, memory loss, indigestion and headaches. All had previously received long term medical treatment none of which had helped them. The reflexology treatments focused on the areas of the feet relating to the adrenal gland, kidneys, bladder, sinus, brain and heart. Those patients who suffered from associated digestive problems were also treated to the areas of the feet relating to spleen, stomach, duodenum and celiac, while those patients who suffered from headaches had the areas of the feet relating to the cerebellum and trigeminal nerves treated.

The reflexology treatments were given daily over a period of seven days and the results were quite remarkable: 40% experienced complete 'cure', further 35% had greatly improved, and a further 15% had mildly improved. Only 10% showed no change at all to the treatment.

Duan Shuang-Feng. "Foot reflexology in neurosism: Clinical Observation of 20 cases," Presented at the China Reflexology Symposium in Beijing (July 1993). Reflexology research reports (Association of Reflexologists) 2nd edition

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

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

RESULTS: After foot reflexology, the subjects in experimental group showed significant improvement in pain (F=155.77, p=.000) and depression (F=20.00, p=.000).

CONCLUSION: The results suggest that the foot reflexology is effective in relieving of pain and depression. Therefore, it is necessary to develop foot reflexology as an independent nursing intervention.

Oh HS, Ahn SA., �The Effects of Foot Reflexology on Pain and Depression of Middle-aged Women with Osteoarthritis,� Korean J Rehabil Nurs. 2006 Jun;9(1):25-33. Korean.

College of Nursing, Gyeong-Sang National University, JinJu, Gyeongnam, Korea. nhsoh@gshp,gsnu.ac.kr Department of Beauty Design, JinJu International University, JinJu, Gyeongnam, Korea.

"Background: The use of complementary and alternative medicine (CAM) for the management of chronic low back pain (CLBP) continues to rise. However questions regarding the efficacy of many CAM therapies for CLBP remain unresolved. This study is designed to evaluate the effectiveness of reflexology in this domain.

"Design: Pragmatic RCT. N=243 participants randomised to one of three groups: reflexology, relaxation, or non-intervention (usual care by GP).

"Method: All participants completed a questionnaire booklet before and after the treatment phase. This measured their general health status, pain, functioning, coping strategies, mood and satisfaction with social support. In addition post treatment semi-structured interviews were conducted with a subsample of 22 participants. These were designed to elicit details of participants experience of treatment and its outcome.

"Results: Repeated measures ANOVA found no significant differences between the groups pre and post treatment on the primary outcome measures of pain (F(4, 310)=1.152, p=.332) and functioning (F(4, 318)=2.039, p=.132). There was a main effect of pain reduction, irrespective of group (F(2, 310)=8.185, p=.0005). Conversely thematic analysis of the interview data revealed that the majority of participants reported treatment led to reduction in pain, increased relaxation and an enhanced ability to cope.

"Conclusion: The quantitative data suggest that reflexology is ineffective for managing CLBP, while the qualitative data suggest otherwise. This incongruence between results raises important questions for the design of research studies into the efficacy of CAMs. Should the patients view of efficacy be negated because 'objective' measures showed no effect? or the appropriateness of the scientific parameters questioned because they are in conflict with patients notion of efficacy? Whatever the verdict it is apparent that studies which consider treatment outcome need to define that outcome in terms that have currency for providers and consumers alike."

"Evaluating the efficacy of reflexology for the management of chronic low back pain," Authors: Helen Poole, Peter Murphy, Sheila Glenn, Presented at the Annual Meeting of the American Pain Society

(TREATMENT APPROACHES (Physical) E03 - Holistic/Alternative Medicine Poster #807�), Published as Poole, H. M., Murphy, P., & Glenn, S. (2001) Evaluating the efficacy of reflexology for chronic back pain. The Journal of� Pain, 2(2), 47 http://www.ampainsoc.org/abstract/2001/data/221/

Reflexology was applied to 60 individuals from ages 1 to 73 who were experiencing pain. Sessions lasted 20 minutes to 40 minutes. the pain resulted from Toothache (6), headache (8), sore throat (50), stiff neck (40), shoulder pain/old wound (2), breast pain (2), chest & rib pain (2), dysmenorrhea (3), abdominal pain (5), wrist and leg pain (19), and joint pain in limbs. Following one session 18 of the 60 were healed. 11 were healed following 2 or 3 sessions, 22 were effectively treated after 2 or 3 sessions. Reflexology was ineffective for 9 cases after 1 to 3 sessions.

Jin Hui, "Reflexology Applied as a Pain-Killer - Observation of 60 Cases," 1998 Beijing International Reflexology Conference Report, China Reflexology Association, Beijing, p, 86-88

"Nurses have used complementary therapies for many years to relieve anxiety, promote comfort, and reduce or alleviate pain. The therapies described in this article are examples of the many therapies available for nurses to consider when planning care for patients with chronic pain. The increasing body of scientific knowledge is providing more guidance about the efficacy of specific therapies. As with all interventions, ongoing evaluation about the effectiveness of a therapy for each patient is an important component of quality nursing care. Complementary therapies provide an avenue for nurses to be autonomous in furthering the relief of chronic pain, as many of these therapies fall within the domain of nursing. Incorporating selected therapies into the plan of care provides multiple opportunities for nurses to demonstrate caring, a premier characteristic of nursing. A number of the complementary therapies, such as journaling, hand massage, and imagery, can be taught to patients and their families, thus promoting self-care. Anecdotal evidence and findings from numerous smaller studies provide some support for the use of many complementary therapies to manage chronic pain or their use as adjuncts in the treatment regimen. Still, the nurse must weigh the risks and benefits before suggesting a therapy to a patient. Evaluating the effectiveness of the complementary therapy to promote comfort in patients with chronic pain is essential. Obtaining this information is not only critical to the care of a particular patient, but these data will assist nurses in learning more about specific therapies. Most importantly, nurses need to pursue research to further the scientific basis for many of the complementary therapies."

PMID: 14567205 Snyder M, Wieland J. "Complementary and alternative therapies: what is their place in the management of chronic pain?" Nursing Clinic North America 2003 Sep;38(3):495-508.

School of Nursing and Center for Spirituality and Healing, University of Minnesota School of Nursing, 6-101 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455-0342, USA. snyde002@umn.edu

"Foot reflexology is both a diagnostic technique and therapy. It is an alternative therapy which is considered useful in pain management. Its effectiveness as a therapy has been studied at the Mestre hospital where a clinical study has been undertaken to determine the effectiveness of reflexology in the reduction of pain. A group of 40 persons suffering almost exclusively from a lumbar-sacral disc hernia received three treatments of reflexology massage for a week. The results found that 25 persons (62.5%) reported a reduction in pain, (rating at 0.75 on a scale of 0-4). These results however did not take into consideration the relationship between the effectiveness of foot reflexology and variables such as the persons physicality (Body Mass Index), or their psychological or social status."

Degan M, Fabris F, Vanin F, Bevilacqua M, Genova V, Mazzucco M, Negrisolo A, "The effectiveness of foot reflexotherapy on chronic pain associated with a herniated disk," Prof Inferm. 2000 Apr-Jun;53(2):80-7 [Article in Italian] ULSS 12 Veneziana. (mardeg@libero.it ) PMID: 11272089

Results of study: Reflexology work reduces the pain of those with kidney and ureter stones.

A few years ago, researchers at Glostrop hospital, Copenhagen, demonstrated that reflexology can help relieve the acute pain suffered by patients with kidney stones. 30 patients participated in the study and were divided equally into three groups: one group received reflexology treatment, one group received placebo treatment and the remaining groups were used as controls.

If no pain relief was experienced within 5 minutes, the treatment would end for analgesic medications, but those who experienced a benefit within 5 minutes, treatment was continued for a further 10 minutes. The results showed that 9 out of the 10 patients in the reflexology group experienced complete pain relief after the treatment which lasted for over an hour and in 5 of the patients pain was relieved for 4 hours.

Medical doctors Niels Baekgaard and Vibe Hansen, who conducted the study, concluded that "Reflexology treatment of acute ureterolithiasis has a pain relieving effect" and when compared to Baralgin (a commonly administered analgesic), the findings revealed that reflexology actually works faster at alleviating pain although the effects last for a shorter duration.

Eriksen, Leila, "Clinical Trials of Acute Uretic Colic and Reflexology," Reflexology: Research and Effect Evaluation in Denmark, Danish Reflexologists Association, Kolding, Denmark, 1993, p. 10

Results of study: Post surgical patients who receive foot massage and medication report "significantly less" agony than those on painkillers alone.

"Foot Rubs Easing Pain," Third Age. com, December 4, 1998

Method: Sixty patients of general surgery were randomly assigned to a control group or a reflexology group. All were given the required quantity of standard drugs such as NSAID (Diclofenac and Opioids (Pethidine and Fentanyl). Fifteen to twenty minutes of foot reflexology work was applied to the treatment group.

Results: This study show a decrease of the quantity of pain killers in Group I (foot reflexology) to less than 50% in comparison with Group II (control).

Shweta Choudhary PhD (Dept of Biophysis), Dr. Guresh Kumar, Dr. Kulwant Singh (Dept. of Biostatistics), All-India Institute of Medical Science, New Delhi, India

Post-operative pain is routinely poorly controlled by pharmaceutical means. Complementary strategies based on sound research findings are needed to aid in post-op pain relief. Foot and hand massage provides potential mechanisms to aid in pain relief. Massage stimulates receptors that activate non-nociceptive neurons. They release enkephalin and GABA, which inhibit neurotransmitters released from the primary nociceptive neurons and evoke depressive reactions within the receptive field in the pain pathway. Both reactions block receptor activation of the second transmission neurons, which prevents nociceptive activities from reaching consciousness. The purpose of the pretest-posttest design study was to investigate whether a 20-minute foot and hand massage (five minutes to each extremity) could produce reductions of pain perception and sympathetic responses among post-operative patients. A convenience sample of 16 patients completed the modified Brief Pain Inventories (mBPIs). The subjects reported a 56% decrease in pain intensity from 4.5 to 2.3 (t=7.18, p<0.001). pain distress decreased from 3.7 to 1.9 (t=4.96, p<0.001). the heart rates also significantly decreased. the foot and hand massage appears to an effective, inexpensive, low risk, flexible, and easily applied strategy for pain management.

http://www.nursinglibrary.org/Portal/main.aspx?pageid=4024&sid=19949

Physiological responses to pain create harmful effects that prolong the body's recovery after surgery. Patients routinely report mild to moderate pain even though pain medications have been administered. Complementary strategies based on sound research findings are needed to supplement postoperative pain relief using pharmacologic management. Foot and hand massage has the potential to assist in pain relief. Massaging the feet and hands stimulates the mechanoreceptors that activate the "nonpainful" nerve fibers, preventing pain transmission from reaching consciousness. The purpose of this pretest-posttest design study was to investigate whether a 20-minute foot and hand massage (5 minutes to each extremity), which was provided 1 to 4 hours after a dose of pain medication, would reduce pain perception and sympathetic responses among postoperative patients. A convenience sample of 18 patients rated pain intensity and pain distress using a 0 to 10 numeric rating scale. They reported decreases in pain intensity from 4.65 to 2.35 (t = 8.154, p <.001) and in pain distress from 4.00 to 1.88 (t = 5.683, p <.001). Statistically significant decreases in sympathetic responses to pain (i.e., heart rate and respiratory rate) were observed although blood pressure remained unchanged. The changes in heart rate and respiratory rate were not clinically significant. The patients experienced moderate pain after they received pain medications. This pain was reduced by the intervention, thus supporting the effectiveness of massage in postoperative pain management. Foot and hand massage appears to be an effective, inexpensive, low-risk, flexible, and easily applied strategy for postoperative pain management. PMID: 15297952

Wang HL, Keck JF, "Foot and hand massage as an intervention for postoperative pain, Pain Management Nursing, 2004 Jun;5(2):59-65Clarian Health Partners, Methodist Hospital, Indiana University School of Nursing, Indianapolis, IN 46202, USA. hswang@iupui.edu

The 39 cases of shoulder pain ranged in age from 49 to 58 years old. At the completion of reflexology treatment, 32 had been cured (pain disappeared, the arm and shoulder could move freely) and 17 had received an effect (pain reduced, the movement of the arm and shoulder obviously improved).

Yu Baofu, Han Houngling, Yang Huaiqing, Li Caixia, "Treatment of Shoulder-Joint Pain with Foot Reflexology," 1998 Beijing International Reflexology Conference Report, China Reflexology Association, Beijing, pp. 69-70

A pilot study of the effects of foot and hand reflexology applied to paralyzed clients began in 1980. Foot and hand reflexology techniques were applied to a quadriplegic client and two paraplegic clients. The work consisted of 220 hours of sessions, 338 hours of sessions and 358 hours of sessions applied over a time period of three to five years.

From this work it was concluded: (1) A possible mechanism within the existing nervous system explains the workings of reflexology: the integration of autonomic-somatic information by the body. Such a mechanism allows the body to coordinate the involuntary internal reactions of the autonomic nervous system with the actions of the musculo-skeletal system for the purposes of survival. (2) The application of pressure, stretch and movement technique to the feet can effect a physical change within the body. (3) An interruption of the body's imaging process occurs in paralysis. The imaging can be changed by the exercise of locomotive components, pressure, stretch and movement.

A major observation was that pressure techniques applied to the feet elicited (1) what we came to recognize as a segment of the stride mechanism and (2) a direct response of the autonomic nervous system. Specifically, the spasming of paralyzed limbs in response to pressure applied to the feet of the paraplegic clients came to be conditioned into a series of sophisticated movements consistent with the positioning of hips, legs, ankles, and feet for walking. Pressure technique applied to one foot elicited movement of both limbs, each appropriate for a segment of stride in opposition to the other.

The response of the quadriplegic client differed from that of the paraplegic clients. Pressure technique applied to the sole of the foot, base of the toes of the left foot elicited movement of particular digits of the right hand, as if the client was playing a guitar. Responses were elicited from left foot to right foot and vice versa but paled in contrast to the left foot/right hand response.

Secondly, a stereotypical internal organ response was elicited in all three clients from general work on feet. The response varied from client to client but seemed to be internal body adjustments. One client shivered and her teeth chattered, yet when asked, she would report no sensation of being cold. One client perspired on one side of the head. One client perspired below the level of spinal cord injury and experienced intestinal tract grumbling. The responses developed over time and were extinguished over time.

Aside from immediate responses to reflexology work, none of the three clients experienced a bladder or kidney infection, a common occurrence, during the course of the work. In addition, the quadriplegic client experienced a gradual return of the ability to sense pain, heat, cold, light touch, and deep pressure. This ability varied over his body seemingly from dermatome to dermatome. The pain sensation developed into discrete localization of pain. He reported the ability to sense fullness in the stomach next followed by sensation of the need to empty the bladder.

Kunz K, Kunz B, "The Paralysis Project," Reflexions, Vol. 8, No. 1, J/F/M 1987

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

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

�Results: The scores of fatigue and insomnia decreased in the experimental group but not in the control group. There was a significant difference of fatigue and insomnia between the two groups.

�Conclusion: It is suggested that foot reflexology might have beneficial effects on reducing fatigue and insomnia in patients suffering from coal workers' pneumoconiosis, and can be recommended as a nursing intervention program for patients with coal workers' pneumoconiosis

Lee, YM, Sohmg, KY (Dept. of Nursing, Kangwom Tourism College, ymlee6505@hanmail.net),�The Effects of Foot Reflexology on Fatigue and Insomnia in Patients Suffering from Coal Workers� Pneumoncomiosis,� Taehan Knaho Hakhoe Chi (Korean language), 2005, Dec;35(7):1221-8, PMID: 16418548

Pneumonia (Infantile)*

122 cases of infantile pneumonia were divided into two groups: 58 cases received medication and foot massage and 64 cases were treated with medication only. The results showed that those treatment group required 7.8 days average time of treatment with a course of the disease as 10.2 days. The curative rate was 96.5% with improvement in the other 2 cases. Those in the control group required an average treatment time of 9.7 days with the total course of the disease at 12.3 days. The curative rate was 92% with 5 cases improved. It was concluded that the treatment course is shorter and effect better in combined medication and foot massage group.

Liang-cai, Pei, Observation of 58 Infantile Pneumonia by Combined Method of Medication with Foot Massage, A Clinical Analysis of 132 Cases," (19)96 Beijing International Reflexology Conference (Report), China Preventive Medical Association and the Chinese Society of Reflexology, Beijing, 1996, p. 34

Three different methods were used to work with pneumonia and bronchitis in children. Foot reflexology was utilized in 103 cases, antibiotics in 40 cases and antibiotics with Chinese herbs in 68 cases. Foot reflexology was found to be more effective than either of the others.

Hui-ming, Wu, "Perspectives of foot reflex based on foot massage for treatment of pneumonia and bronchitis in childhood," (19)96 Beijing International Reflexology Conference (Report), the China Preventive Medical Association and the Chinese Society of Reflexology, Beijing, p. 42

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

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

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

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

Post surgical care

"This randomized-controlled study examined the effects of foot massage on patients' perception of care received following surgery. The sample of 59 women who underwent laparoscopic sterilization as day case patients were randomly allocated into two groups. The experimental group received a foot massage and analgesia post-operatively, whilst the control group received only analgesia post-operatively. Each participant was asked to complete a questionnaire on the day following surgery. This examined satisfaction, memory and analgesia taken. The 76% response rate was comparable with other patient satisfaction studies following day-case surgery. Statistical analysis showed no overall significant difference in the pain experienced by the two groups; however, the mean pain scores recorded following surgery showed a significantly different pattern over time, such that the experimental group consistently reported less pain following a foot massage than the control group. This study has attempted to explore the use of foot massage in a systematic way and is therefore a basis for further study."

Hulme J, Waterman H, Hillier VF, "The effect of foot massage on patients' perception of care following laparoscopic sterilization as day case patients," Journal Advanced Nursing 1999 Aug;30(2):460-8 (Stockport Acute Services NHS Trust, Anaesthetic Department, Stepping Hill Hospital, Stockport, England) PMID: 10457249

"Because of the widely presumed association between heart disease and psychological wellbeing, the use of so-called 'complementary' therapies as adjuncts to conventional treatment modalities have been the subject of considerable debate. The present study arose from an attempt to identify a safe and effective therapeutic intervention to promote wellbeing, which could be practicably delivered by nurses to patients in the postoperative recovery period following coronary artery bypass graft (CABG) surgery. Aim. To investigate the impact of foot massage and guided relaxation on the wellbeing of patients who had undergone CABG surgery.

METHOD: Twenty-five subjects were randomly assigned to either a control or one of two intervention groups. Psychological and physical variables were measured immediately before and after the intervention. A discharge questionnaire was also administered.

RESULTS: No significant differences between physiological parameters were found. There was a significant effect of the intervention on the calm scores (ANOVA, P=0.014). Dunnett's multiple comparison showed that this was attributable to increased calm among the massage group. Although not significant the guided relaxation group also reported substantially higher levels of calm than control. There was a clear (nonsignificant) trend across all psychological variables for both foot massage and, to a lesser extent, guided relaxation to improve psychological wellbeing. Both interventions were well received by the subjects.

CONCLUSIONS: These interventions appear to be effective, noninvasive techniques for promoting psychological wellbeing in this patient group. Further investigation is indicated."

Hattan J, King L, Griffiths P, "The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial," Journal Advanced Nursing 2002 Jan;37(2):199-207 (Institute of Nursing and Midwifery, University of Brighton, East Sussex, UK. jenniehattan@netscapeonline.co.uk) PMID: 1185178

Post surgical nausea and vomiting

To investigate the effectiveness of prophylactic Korean hand acupressure in the prevention of postoperative vomiting in women scheduled for minor gynecological laparoscopic surgery, we conducted a double-blinded, randomized, placebo-controlled study. In one group (n = 40), acupressure was performed 30 min before the induction of anesthesia by using special acupressure seeds, which were fixed onto the Korean hand acupuncture point K-K9 and remained there for at least 24 h. The second group (n = 40) functioned as the Placebo group. The treatment groups did not differ with regard to demographics, surgical procedure, or anesthetic administered. In the Acupressure group, the incidence of nausea and vomiting was significantly less (40% and 22.5%) than in the Placebo group (70% and 50%). We conclude that Korean hand acupressure of the acupuncture point K-K9 is an effective method for reducing postoperative nausea and vomiting in women after minor gynecological laparoscopic surgery. IMPLICATIONS: This randomized study was performed to investigate the antiemetic effect of the Korean hand acupuncture point K-K9. Acupressure of K-K9 reduces the incidence of postoperative nausea and vomiting in female patients after minor gynecological laparoscopic surgery.

Boehler M, Mitterschiffthaler G, Schlager A. "Korean hand acupressure reduces postoperative nausea and vomiting after gynecological laparoscopic surgery," Anesth Analg. 2002 Apr;94(4):872-5, University Department of Anesthesiology and Critical Care Medicine, University of Innsbruck, Innsbruck, Austria. PMID: 11916788

A double-blind, randomized, placebo-controlled study was conducted to investigate the effectiveness of Korean hand acupuncture in preventing postoperative vomiting in children scheduled for strabismus surgery. In one group, acupressure was performed 30 min before induction of anaesthesia by applying an acupressure disc onto the Korean hand acupuncture point K-K9; the disc remained in situ for at least 24 h. The second group functioned as placebo group. The treatment groups did not differ with regard to patient characteristics, surgical procedure and anaesthetic administered. In the acupressure group, the incidence of vomiting was significantly lower (20%) than in the placebo group (68%). We conclude that Korean hand acupressure of the acupuncture point K-K9 is an effective method for reducing postoperative vomiting in children after strabismus repair.

Post surgical recovery

Reports that Eichelberger et. al. demonstrated that reflexology enhances urination, stimulates bowel movements and so aids recovery. Patients who received reflexology also showed a much less need for medication than patients in the control group.

(Eichelberger G (1993) Study of foot reflex zone massage. Alternatives to tablets. Krankenpfiege - Soins Infirmiers. 86, 61-63) Kesselring, A. Fussrelszonemassage. Schweiz med Won\chenschr suppi (Switzerland) 1994, 62, pp. 88-93

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

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

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

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

Pre-menstrual syndrome

Results of study: Reflexology improves the symptoms of 46% of those suffering from PMS.

OBJECTIVE: To determine whether reflexology therapy--the application of manual pressure to reflex points on the ears, hands, and feet that somatotopically correspond to specific areas of the body--can significantly reduce premenstrual symptoms compared to placebo treatment.

METHODS: Thirty-five women who complained of previous distress with premenstrual syndrome (PMS) were randomly assigned to be treated by ear, hand, and foot reflexology or to receive placebo reflexology. All subjects completed a daily diary, which monitored 38 premenstrual symptoms on a four-point scale. Somatic and psychological indicators of premenstrual distress were recorded each day for 2 months before treatment, for 2 months during reflexology, and for 2 months afterward. The reflexology sessions for both groups were provided by a trained reflexology therapist once a week for 8 weeks, and lasted 30 minutes each. RESULTS: Analysis of variance for repeated measures demonstrated a significantly greater decrease in premenstrual symptoms for the women given true reflexology treatment than for the women in the placebo group.

CONCLUSION: These clinical findings support the use of ear, hand, and foot reflexology for the treatment of PMS.

Oleson, Terry and Flocco, William, "Randomized Controlled Study of Premenstrual Symptoms Treated with Ear, Hand, and Foot Reflexology," Obstetrics and Gynecology, 1993;82(6): 906-11

The purpose of this study was to identify the effect of foot reflexology on premenstrual syndrome and dysmenorrhea in female college students. The research design of this study was a quasi-experimental design. Of the forty female college students, twenty were assigned to the experimental group and, twenty to the control group. The data were obtained over 2 months(November 26, 2001 to January 31, 2002) from a nursing of C college located in S city. The instrument used to assess premenstrual syndrome and dysmenorrhea was Keele's VAS(Visual Analogue Scale) and opening records. Subjects in the experimental group received foot reflexology for 6 times with 1 hours during 60 days, and subjects assigned to the control group did not receive foot reflexology. Data were analysed with percentage, mean, standard deviation, X(2)-test, unpaired t-test, and repeated measure ANOVA, using SAS Program. The results of the study are as follow, 1. The symptoms which the group of experimental and the group of control discomforts the most are sensitiveness (35%), abdominal pain (30%), lower abdominal pain (30%) and lumbago (20%). The method of relieve premenstrual syndrome and dysmenorrhea by which the subjects employ the most to solve their premenstrual syndrome and dysmenorrhea is the getting along by enduring(67.5%) and bed rest (32.5%). 2. The mean score of the premenstrual syndromes and dysmenorrhea before foot reflexology was 8.35, it was 4.16 at the first menstruation after foot reflexology and 3.25 at the second menstruation for the experimental group. 3. The relieved symptoms after foot reflexology was fatigue(50%), insomnia(40%), abdominal pain(35%), lower abdominal pain (30%) and constipation(30%). Foot reflexology was effective in improve the symptoms of the female college students who have the premenstrual syndrome and dysmenorrhea.

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

90 cases of hyperplasia of the prostate were divided into 3 groups: in 30 cases foot reflex area was used, in 30 cases drug therapy was used, in 30 cases massage foot massage was combined with drug. "Ultrasonographic examinations were performed pre and post first course of treatment. Comparison is summation of sizes in three dimensions pre and after treatment. Criteria for effectiveness: significant effect - the differences >1.5cm., effective -difference=1-1.4cm. It is indicated that foot reflex area health promoting method may be used as a useful method in treatment for hyperplasia especially when combined with drug therapy."

Xiao-li, Chen, "Hyperplasia of Prostate Gland Treated by Foot Reflex Area Health Promoting Method (with a group of 90 study participants)," 1996 China Reflexology Symposium Report, China Reflexology Association, Beijing, October 1996, pp. 32 - 33

50 cases were treated with foot reflexology. All were above 55 years old and experienced frequent, urgent, difficult and nocturnal urination. Thirty minute sessions were applied once or twice a day. Among the 50 cases: (1) 10 were cured, all symptoms disappeared,(2) 5 showed markedly effective, main symptoms disappeared, (3) 30 were effective, symptoms alleviated and (4) 5 were ineffective, no improvement. Effectiveness was achieved within ten to 21 days.

Zhou Xin, Zhou Gengye, "Treatment of Prostatic Hypertrophy with Reflexotherapy," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 50-5

A 21 year-old college student had experienced a widely spreading skin lesions over 14 years. Numerous Western and traditional Chinese medicines had failed to effect the psoriasis. One to two treatments a week were applied for 50 minutes. After 14 treatments change was evident in the four largest lesions. After 15 courses of treatment all lesions disappeared.

Xi-guang, Xu and De-zhao, Liu, "Treatment of Psoriasis with Foot Reflexology," 1994 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 91-92 (Tianjin, China)

Reflexology is an ancient holistic healing technique that has been practiced as far back as the Egyptian Era and is currently used throughout the world. It�s basic premise is that specific reflex points on the hands and feet correspond to different glands and organs in the body. When stimulated, the body�s own healing abilities are engaged resulting in improved health and feelings of well being. The purpose of this project was to examine how these positive changes, resulting from a single reflexology session, would manifest in the EEG of 14 volunteers (adults ranging in age from 23 to 63).

We used an 8 channel multi-modality biofeedback system in which 2 channels were dedicated to the EEG measurement. Electrode placement was at C3 and C4 where sensory input is registered. Other measures used were temperature, skin conductance and heart rate. The EEG measures taken were amplitude, power, % power and % synchrony. Bandwidths examined were theta (3.5- 7.4 Hz), alpha (7.4- 12.1 Hz) and beta (12.2 -42 Hz) with subsequent bandwidth redefinition in order to check for trends in narrower bands.

All but 2 of the subjects found reflexology to be a very pleasant experience. Of the 14 subjects, 11 had useable data. (Combining EEG with "hands on" treatment techniques brings with it a particular set of liabilities with respect to artifacts), Of these 11 persons, 10 showed significant increases, over the course of the session, in one or more of the following measures: alpha amplitude, theta amplitude, % alpha synchrony and % theta synchrony. All increases in amplitude were bilateral. Only one person showed no increases. Additionally, and perhaps more importantly, there was a substantial drop in these measures immediately following the baseline period when the hands on portion of the session began. This may have important implications with respect to the role of healing touch in cortical stimulation.

John A. Putman and Merle Sunde, EEG Spectrum Encino, CA

OBJECTIVES: Over the past few years, a considerable increase in complementary and alternative medicine (CAM) has been observed, particularly in primary care. In contrast little is known about the supply of CAM in Swiss hospitals. This study aims at the investigation of amount and structure of CAM activities of Swiss hospitals.

MATERIALS AND METHODS: We designed a cross-sectional survey using a 2-step, questionnaire- based approach acquiring overview information form hospital managers in a first questionnaire leading to detailed information on CAM usage at medical department level (head of department). This second questionnaire provides data of physician-based and non-physician-based CAM supply.

RESULTS: The size of hospitals was significantly associated with the provision of CAM. 33% of the hospital managers indicated 1 or more medical doctor (MD) using CAM in their hospital compared to 37% of confirmation on department level (Kappa value 0.5). Mostly different CAM methods were applied. Acupuncture was used most frequently. However only 13 hospitals (11%) occupied more than 3 CAM MDs and only 5 hospitals had more than 2 full-time equivalents for MDs. Furthermore, 74.7% of these personnel resources were dedicated for outpatient care. In terms of CAM methods anthroposophic medicine accounted for more than half of the total personnel costs. On the other hand usage of non-physician based CAM accounted for 41% according to hospital managers compared to 64% of CAM usage according to medical departments (Kappa values 0.31). Reflexology of the foot was used most frequently.

Widmer M, Donges A, Wapf V Busato A, Herren S "The supply of complementary and alternative medicine in Swiss hospitals," Institute for Evaluative Research in Orthopaedic Surgery, University of Bern, Switzerland. marcel.widmer@MEMcenter.unibe.ch PMID: 17200610

Accuracy of the widely used organ representation areas, currently used in different schools of foot and hand reflexology was evaluated using Bi-Digital O-Ring test resonance phenomenon. Our previous study indicated that mapping organ representation areas of the tongue using Bi-Digital O-Ring Test resonance phenomenon between 2 identical substances often provided more reliable clinical information for both diagnosis and treatment than the 2 widely used, but crude, traditional schools of Chinese tongue diagnosis. This same method was applied for the mapping of the organ representation areas on the feet and hands.

We succeeded in mapping the following areas on human feet: 1) Middle (3rd) toe on the sole side represents the following starting from the tip: A) Head, B) Face with eye, ear, nose, and mouth (1st Digit) C) Neck and organs within the neck (narrow band of space between 1st crease after the 1st digit and crease at the junction of the beginning of the sole); 2) 2nd and 4th toe represent upper extremities, the beginning tip being fingers and hands. The crease at the base of these toes represents the shoulder. The 2nd toe represents right upper extremity, and the 4th toe represents left upper extremity; 3) 1st and 5th toes in both the right and left feet represent lower extremities with the tip being the toes and soles of feet. The crease at the base of these toes represents the inguinal area. The 1st toe of each foot represents right lower extremity, and 5th toe represents left lower extremity. The sole of the foot is divided into the following 3 distinctive sections. 1) Upper (1st) section represents organs in the chest cavity including 2 thymus glands, trachea, 2 lungs, with the heart between them, and with the esophagus appearing as a narrow band outside of the lung near and below the 1st and 2nd toe depending upon the individual. Chest section occupies the first 1/3 to 1/5 (on a relatively long foot) of the entire sole. The boundary between the chest and G.I. system can be approximately estimated by extending the length of the entire toe or up to 25% longer to the sole, but it can be accurately determined using a diaphragm tissue microscope slide as a reference control substance. 2) Middle (2nd) section represents Gastrointestinal system, including lower end of the esophagus, liver, stomach, spleen, gall bladder, pancreas, duodenum, jejunum, ileum, appendix, colon, and anus.(ABSTRACT TRUNCATED AT 400 WORDS)

Omura Y. , Acupunct Electrother Res. 1994 Jun-Sep;19(2-3):153-90. "Accurate localization of organ representation areas on the feet & hands using the bi-digital O-ring test resonance phenomenon: its clinical implication in diagnosis & treatment--Part I." Heart Disease Research Foundation, New York. PMID: 7863839 [PubMed] http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7863839

Relaxation

In a study of eight individuals, an EEG was taken during a normal resting condition and then under reflexological stimulation of the brain reflex area of the hand, the upper one-third of the thumb. "In this work nonlinear techniques have been used to assess the complexity of EEG with and without reflexological stimulation. We prefer the nonlinear approach, as we believe that the effects (of reflexological stimulation) are taking place in a subtle way, since there is no direct correlation between reflexological points and modern neuroanatomy." Specifically, "we conclude that reflexological stimulation, from the signals and systems point of view bring the brain-mind mechanism to a lower dimensional chaos indicating a state of 'order out of disorder.'... "We expected this, as reflexology claims to de-stress and bring relaxation to the brain."

In one study the EEG's of 30 subjects were measured (1) in a resting state, (2) with subject listening to classical music followed by rock music and (3) "with subjects under foot reflexologic stimulation." Results "suggests that when the subjects are under sound (music) or reflexologic stimuli, the number of parallel functional processes active in the brain is less and the brain goes to a more relaxed state. This gives rise to the increase in alpha frequencies in the brain waves."

Kannathal Natarjan, Rajendra Acharya U, Fadhilah Alias, Thelma Tiboleng and Sadasivan K. Puthusserypady, "Nonlinear analysis of EEG signals at different mental states," BioMedical Engineering OnLine, 3:7, 16 March 2004: PMID: 15023233

Rhinitis

Foot reflexology was applied daily to three cases of rhinitis for 30 minutes. After three sessions symptoms had subsided even for a patient experiencing rhinitis for 20 years. A course of 10 sessions was applies to "consolidate the effect. Symptoms had not returned two years later for this patient.

Xiu, Ma, "Observation on the Treatment of Rhinitis with Foot Reflexology," 1994 China Reflexology Symposium Report, China Reflexology Association, Beijing, p. 139 (Tianjin, China)

Thirty-seven patients with sexual dysfunction (15: impotence, 9: premature ejaculation, 6: emission, and 7: ejaculation deficiens) were randomly assigned to two groups: 19 individuals were treated with foot reflexology and 18 with traditional Chinese medicine. No statistical difference was found between the two groups on age, occupation, education, degree of disease, spirit status, affection between the couple, sexual desire, and sexual intercourse for marital cases. In addition to foot reflex areas, massage was applied to specific acupuncture points of the body in the foot reflexology group. The effective rate of the foot reflexology treatment group was found to be 87.5% for impotence and 100% for the others. The effective rate of the traditional Chinese medicine group was found to be 85.7% for impotence and 100% for the others.

Jianhua, Sun, "The Comparison of Curative Effects Between Foot Reflexology and Chinese Traditional Medicine in Treating 37 Cases with Male's Sexual Dysfunction," 1996 China Reflexology Symposium Report, China Reflexology Association, Beijing, p. 75

"Reflexology massage" was found to be as effective as nasal irrigation for alleviation of chronic sinusitis in a University of Wisconsin School of Medicine study. Dr. Andrew Weil's Self Healing reports that "After two weeks of daily treatment, more than 70 percent of those who practiced either form of nasal douching reported improved symptoms. But surprisingly, the group that practiced reflexology massage - where pressure is applied to the feet or hands but may produce changes elsewhere in the body - appeared to fare equally well. The unexpected results for this technique may prompt further research." ("The Saline Solution?," Self Healing, January 2002, page 2) � "Reflexology massage" was utilized as a control in the testing of two nasal irrigation study groups, nasal irrigation with a bulb syringe and nasal irrigation with a nasal irrigation pot. One hundred fifty individuals were randomly assigned to one of the three groups. "Groups one and two performed daily hypertonic saline irrigation for two weeks with one method (bulb syringe or nasal irrigation pot) and then switched to the other method for the following two weeks. Irrigation devices were collected and cultured after two weeks of use. Group three (the control) performed reflexology massage daily for two weeks. Data was collected prospectively including pre-treatment Medical Outcomes Study Short Form, pre and post-treatment Rhinosinusitis." � "Overall, 36 percent of subjects reported decreased use of sinus medication (decongestants, antihistamines, pain relievers, and nasal sprays) during the study with no measurable difference between the three groups.

Conclusions: The study demonstrated that daily nasal irrigation with hypertonic saline offers patients an inexpensive treatment protocol that improves chronic sinusitis symptoms. During the study, a number of patients decreased or eliminated medication. The choice of preferred irrigation protocol was likely linked to the randomization among patient subjects. It is unclear whether the improvement found in patients in the reflexology massage group reflects a therapeutic, placebo, or combination of effects. All the findings highlight the complex interactions of managing chronic sinusitis symptoms."

Diane G. Heatley MD, Glen E. Leverson PhD, Kari E. McConnell RN, and Tony L. Kille (the University of Wisconsin School of Medicine, Madison, WI) "Nasal Irrigation for the Alleviation of Sinonasal Symptoms," presented Monday, September 25, 2000, at the American Academy of Otolaryngology--Head and Neck Surgery Foundation Annual Meeting/Oto Expo, being held September 24-27, 2000, at the Washington, DC Convention Center

(http://www.askdrbob.com/archives/reference/sinus.htm) (Published in Otolaryngol Head Neck Surg. 2001 Jul;125(1):44-8)

"BACKGROUND: Attempts at smoking cessation have been correlated with severe withdrawal symptoms, including intense cigarette cravings, anxiety, and depressed mood. Massage therapy has been shown to reduce anxiety and stress hormones and improve mood.

"METHOD: Twenty adult smokers (M age = 32.6) were randomly assigned to a self-massage treatment or a control group. The treatment group was taught to conduct a hand or ear self-massage during three cravings a day for 1 month. RESULTS: Self-reports revealed lower anxiety scores, improved mood, and fewer withdrawal symptoms. In addition, the self-massage group smoked fewer cigarettes per day by the last week of the study.

"CONCLUSIONS: The present findings suggest that self-massage may be an effective adjunct treatment for adults attempting smoking cessation to alleviate smoking-related anxiety, reduce cravings and withdrawal symptoms, improve mood, and reduce the number of cigarettes smoked."

Hernandez-Reif M, Field T, Hart S. "Smoking cravings are reduced by self-massage." Preventive Medicine 1999 Jan;28(1):28-32. Touch Research Institute, University of Miami, School of Medicine, Florida 33101, USA. PMID: 9973585

Stroke

Foot reflexology was applied once a day for ten days, every other day for ten days, and once or twice a week for ten days. A review of 38 cases of cerebrovascular accident patients showed a 95% effectiveness rate. Results were evaluated as (1) effective if the "functions of palsy lower limbs got recovered to enable the patient to walk independently in the room and" and (2) remarkably effective if the "function of lower limbs got recovered, digital meticulous action partially recovered, Babinski's sign turned negative" Results: among the 28 patients of the cerebral thrombosis groups (a) 9 cases showed effect in the first course of treatment and 15 in the second course and (b) 3 cases showed remarkably effective in the second course of treatment and 3 cases in the third course. Among the cerebral infarction group (a) 2 cases showed effective in the first course of treatment and 2 cases in the second and (b) 2 cases showed remarkably effective in the third course of treatment.

Wu Zhen-sheng, Li Xue-zhen, "Treatment of 38 Cases of Ischemic Apoplexy," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, p. 1

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

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

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

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

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

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

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

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

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

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

Department of Nursing, Suncheon Cheongam College, Korea, College of Nursing, The Catholic University of Korea, Korea.

Surgery: Anxiety during

PURPOSE: This study was to examine the effects of hand massage and hand holding as nursing interventions on the anxiety in patients with local infiltration anesthesia.

METHOD: The design of this study was a nonequivalent, control group, non- synchronized design. The subjects of this study consisted of 15 patients for the hand group, 15 patients for the hand holding group and 17 patients for the control group awaiting surgery in the operation room of a general hospital in Daegu. As an experimental treatment, hand massage was carried out by the Hand Massage Protocol developed by Snyder (1995) and interpreted by Cho (1998) and hand holding developed by Cho (1998). The data were analyzed by SPSS/WIN, T-test, ANOVA, Cronbach's alpha, and the Scheffe test.

RESULTS: The hand massage group and hand holding group were more effective than the control group in reducing anxiety, VAS score, systolic blood pressure and pulse rate.

CONCLUSION: Hand massage and hand holding are effective nursing interventions that alleviates the psychological and physiological anxiety of patients with local infiltration anesthesia. In particular, the simple contact of hand holding is regarded as an effective and easily accessible nursing intervention in the operating room.

PMID: 15613828 Oh HJ, Park JS Effects of hand massage and hand holding on the anxiety inpatients with local infiltration anesthesia," Taehan Kanho Kajhoe Chi, 2004 Oct;34(6):924-33; Kwak's Hospital Operating Room, Dague 700-734, Korea. ohj28@hanmail.net

METHODS: This study comprised 59 patients having cataract surgery from December 11, 1996, to February 12, 1997. The patients were divided into those having a hand massage 5 minutes before surgery (experimental group, n = 29) and those not receiving a hand massage (control group, n = 30). Patients' anxiety levels were measured using the Visual Analog Scale and by assessing the systolic blood pressure, diastolic blood pressure, and pulse rate before and after the hand massage and 5 minutes before the end of surgery. Epinephrine, norepinephrine, cortisol, blood sugar levels, neutrophil, and lymphocyte percentages in white blood cells were also measured.

RESULTS: After the hand massage, the psychological anxiety levels, systolic and diastolic blood pressures, and pulse rate were significantly lower than before the massage. The hand massage significantly decreased epinephrine and norepinephrine levels in the experimental group. Epinephrine, norepinephrine, and cortisol levels increased in the control group. The differences between groups were significant. There were no significant between-group differences in blood sugar levels or neutrophil and lymphocyte percentages in white blood cells.

CONCLUSION: The findings indicate that hand massage decreases the psychological and physiological anxiety levels in patients having cataract surgery under local anesthesia."

Kim MS, Cho KS, Woo H, Kim JH, "Effects of hand massage on anxiety in cataract surgery using local anesthesia," J Cataract Refract Surg. 2001 Jun;27(6):884-90 (Department of Ophthalmology, Kangnam St. Mary's Hospital, Medical College, The Catholic University of Korea, Seoul, South Korea) PMID: 11408136

Results of study: Reflexology reduced the pain of 66% toothache patients and eliminated the symptoms of 26%.

Xue-xiang, Wang, "Relieve (150 Cases of) Toothache with Foot Reflexotherapy," 1994 China Reflexology Symposium Report, China Reflexology Association, Beijing, October 1994, p. 132 - 135

Urinary tract stones

Foot reflexology was applied to 46 cases of lithotrity and compared to the results of 50 cases not treated with foot reflexology. The process of excreting the calculi broken by external lithotrity begins within one week of the procedure and finishes approximately after a month of pain experienced by the patient. Reflexology was applied to the treatment group daily for 30 minutes. Thirty cases in the reflexology group had begun excretion of fragmented calculus in seven days or less compared to 5 of the untreated group. Forty-three had begun in fifteen days or less compared to 22 in the untreated group. All forty-six of the untreated group had completed excretion in less than 20 days compared to 38 in the untreated group.

Xiaojian, Ying, "Foot Reflexology as an Accessory Treatment after External Lithotrity a Clinical Observation of 46 Cases," 1996 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 58-59

"Foot reflex area massage" was applied to 34 individuals with a diagnosis of calculi of the urinary tract. A cure rate of 71% was achieved. Results were achieved by application of 3-5 times for three individuals, 6-8 times for eight individuals, 10-12 times for eight individuals and more than 20 times for 5 individuals.

Yue-jin, Zhang; Jing-Fang, Chung and Bao-rong, Ju, "Observation of the Effect of Foot Reflex Area Massage on 34 Cases of Calouli of Urinary Tract," (19)96 Beijing International Reflexology Conference (Report), 1996, China Preventive Medical Association and the Chinese Society of Reflexology, Beijing, 1996, p. 46

24 cases of urinary tract infection were divided into two groups. In the treated group norfloxin and foot massage were used. In the control group only norfloxin was used. Of the treated group, 5 showed immediate amelioration of disappearance of symptoms with 7 showing amelioration or disappearance on the second day. Of the control group 4 showed amelioration or disappearance on the second day and 8 showed amelioration or disappearance on the third day. Foot massage was found to be effective in treating urinary tract infection.

Yu-lian, Zao, "Clinical Observation on Treatment of Infection of Urinary Tract by Foot Massage," (19)96 Beijing International Reflexology Conference (Report), China Preventive Medical Association and the Chinese Society of Reflexology, Beijing, 1996, p. 17

Forty cases were divided into two groups randomly. Of the forty, 34 could not urinate 3 to 4 hours after surgery on the cranium or brain and 6 could not urinate in 5 hours. Those of the control group listened to the sound of flowing water, massage was applied to the urinary bladder and other conditional reflexes were applied. Foot Reflexotherapy was applied for thirty minutes to those in the observation group. Results of study: 65% of the control group could excrete urine within 10 minutes of treatment as opposed to 30% of the control group. 25% of those in the observation group could excrete urine but not completely within 10 to 30 minutes of treatment as opposed to 45% of the control group. 10 of the observation group were unable to urinate 30 minutes after treatment as opposed to 25% of the control group.

Cailian, Lin, "Clinical Observation on Treatment of 40 Cases of Uroschesis with Reflexology," 1998 China Reflexology Symposium Report, China Reflexology Association, Beijing, pp. 52 - 53

Teruo, Nakamura, "Using Technical Measuring Machine," RWO-SHR Health '90 Worldwide Conference Tokyo, Best Care, Tokyo, pp. 45 - 54

Cho, Z. H., Chung, S. C., Jones, J. P., Park, J. B., Park, H. J., Lee, H. J., Wong, E. K., and Min, B. I., "New findings of the correlation between acupoints and corresponding brain cortices using functional MRI," Proceedings of the National Academy of Sciences USA, Vol. 95, pp. 2670-2673, March 1998, Physiology

Oz, Mehmet C., Whitworth, Gerard C., and Liu, Eric C., "Complementary Medicine in the Surgical Wards (at Columbia-Presbyterian Hospital in New York City)," Journal of the American Medical Association, Vol. 279, pp. 710-711, March 4, 1998

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