Studies
Senior Citizens
Biofeedback assessment (Pulse rate, respiratory rate, blood pressure for senior citizens)
"Proactive health-care services emphasize health promotion and the prevention of disabling conditions, Currently in Thai society, the number of elderly with deteriorating health has increased. Therefore, self-care health promotion activities have become essential in order for the elderly to maintain their well-being. The purpose of this study was to investigate the effects of foot massage with biofeedback. Foot massage, a Thai primary self-care custom, has been found to enhance blood circulation, relaxation, and one's own healing power. In addition, touch has been found to stimulate secretion of endorphins and reduce pain and anxiety. It appears therefore that foot massage, or reﬂexology, promotes a healthy lifestyle for all age groups.
"An experimental study, utilizing a pilot project in elderly health care, was employed to investigate the effects of biofeedback using foot massage A pretest/post-test quasi-experimental design was used. The sample consisted of four mean and 16 women (age group 61-69). Four trained researchers massaged the feet of the subjects and measured vital-sign changes. Biofeedback was also investigated before and after the foot massages. Results showed that the average biofeedback and temperature were lower before than after the foot massage (P<0.01). the average pulse rate, respiratory rate and blood pressure, however, were found to be higher before rather than after the foot massage (p<0.01). it was concluded that the foot massage provided good circulation, relaxation and comfort. all subjects expressed positive feelings when they received the foot massage (i.
e. "It is very nice that foot massage can relieve my joint pain, I an happy and comfortable.") These ﬁndings appear to indicate that foot massage is beneﬁcial both for physical and mental conditions. Foot massage, however, is just one key to achieving a full range of primary health-care services. It needs to no only be performed by nurses. Families also, can provide foot massage for the elderly, anywhere and anytime."
Jirayingmongkol P, Chantein S, Phengchomjan N, Bhanggananda N, "The effect of foot massage (reﬂexology) with biofeedback: a pilot study to enhance health promotion," Nurs Health Sci, 2002 Aug;4(Suppl):A4 (PMID: 12153420)
Agitated elderly (Hand massage and calming music)
BACKGROUND: Agitated behavior is a widespread problem that adversely affects the health of nursing home residents and increases the cost of their care. OBJECTIVE: To examine whether modifying environmental stimuli by the use of calming music and hand massage affects agitated behavior in persons with dementia. METHOD: A four group, repeated measures experimental design was used to test the effect of a 10-minute exposure to either calming music, hand massage, or calming music and hand massage simultaneously, or no intervention (control) on the frequency and type of agitated behaviors in nursing home residents with dementia (N = 68). A modiﬁed version of the Cohen-Mansﬁeld Agitation Inventory was used to record agitated behaviors. RESULTS: Each of the experimental interventions reduced agitation more than no intervention. The beneﬁt was sustained and increased up to one hour following the intervention (F = 6.47, p<.01). the increase in beneﬁt over time was similar for each intervention group. when types of agitated behaviors were examined separately, none of the interventions signiﬁcantly reduced physically aggressive behaviors (f = 1.93, p=.09), while physically nonaggressive behaviors decreased during each of the interventions (F = 3.78, p< 01). No additive beneﬁt resulted from simultaneous exposure to calming music and hand massage. At one hour following any intervention, verbally agitated behavior decreased more than no intervention. CONCLUSION: Calming music and hand massage alter the immediate environment of agitated nursing home residents to a calm structured surrounding, offsetting disturbing stimuli, but no additive beneﬁt was found by combining interventions simultaneously. PMID: 12352780 [PubMed] Remington R. ,"Calming music and hand massage with agitated elderly," Nurs Res. 2002 Sep-Oct;51(5):317-23, University of Massachusetts, Lowell 01854, USA. rem@rem.ultranet.com
Cancer Patients
Symptoms of Pain and Nausea
“Ten minute reﬂexology treatments can provide relief from pain, nausea and anxiety according to a report from the School of Nursing, Division of Science and Design, University of Canberra, Australia. Nurses at the school conducted an empirical study on the use of foot massage as a nursing intervention in patients hospitalised with cancer. The study was developed from the earlier work of Ferrell-Torry and Glick (1992)
“87 patients participated in the study and each received a 10-minute reﬂexology foot massage (5 minutes per foot). The results revealed that the treatments produced a signiﬁcant and immediate effect on the patients’ perceptions of pain, nausea and relaxation when measured with a visual analog scale. The use of reﬂexology foot massage as a complementary method is recommended as a relatively simpler nursing intervention for patients experiencing nausea or pain related to the cancer experience. The results were so positive that the researchers recommend that further research using larger numbers of patients in controlled clinical trials into its effectiveness of reﬂexology in alleviating pain, nausea and anxiety in the management of these symptoms by the family at home is warranted.” (“Reﬂexology Used for Cancer Patients,” Internet Health Library, October 11, 2000; Review of “Foot Massage: A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer,” Grealish, L. Lomasney, A., Whiteman, B., Cancer Nurse 2000, June;23(3):237-43)
Symptoms of Anxiety and Nausea
Researchers at the School of Nursing, East Carolina University, Greenville, North Carolina found that foot reﬂexology alleviates anxiety and pain for twenty-three patients with breast and lung cancer. Researchers noted a signiﬁcant decrease in anxiety for patients diagnosed with breast or lung cancer and a signiﬁcant decrease in pain for patients with breast cancer. “This has important implications for nursing practice as both professionals and lay people can be taught reﬂexology. Reﬂexology is a simple technique for human touch which can be performed anywhere, requires no special equipment, is non-invasive and does not interfere with patients’ privacy. The patients were given a 30 minute session by a certiﬁed reﬂexologist. (Stephenson, NL, Weinrich, SP and Tavakoli, AS, “The effects of foot reﬂexology on anxiety and pain in patients with breast and lung cancer,” Oncol Nurs Forum 2000, Jan-Feb;27(1):67-72)
Quality of Life
• The use of reﬂexology improved the quality of life for twelve British hospitalized cancer patients. Six patients with different types of tumors were randomly assigned to a reﬂexology group and six to a placebo reﬂexology group during research conducted for the Master’s dissertation of nurse H. Hodgson.
The placebo group was given “gentle foot massage that does not stimulate reﬂexology points.” Patients completed a visual analogue scale (VAS) 24 hours before commencement of the intervention and within 24 hours of completion. Placebo and reﬂexology groups received three 40 minute sessions, every other day over a ﬁve-day period. The VAS measured quality of life components: appearance, appetite, breathing, communication (doctors), communication (family), communication (nurses), concentration, constipation, diarrhoea, fear of future, isolation, micturition, mobility, mood, nausea, pain, sleep and tiredness.
“From the results it was concluded that all participants received some comfort from the intervention, be it reﬂexology or placebo reﬂexology. However, only 33% of the placebo group beneﬁted from an improvement in quality of life compared to 100% of the reﬂexology group. Within the reﬂexology group, the participants reported an improvement in all components of the quality of life scale compared to 67 5 in the placebo group. However, despite there being an improvement reported in 67% of the components, the frequency of improvement was greater in the reﬂexology group compared to the placebo group.”
“Should reﬂexology be available for palliative care patients within a general hospital setting? The researcher recognized that this was indeed a small-scale study with limitations. Nevertheless, this study would suggest that the provision of reﬂexology for palliative patients within the general setting could be beneﬁcial. Not only did the patients in this study enjoy the intervention, they were also ‘relaxed,’ ‘comforted’ and achieved relief from some of their symptoms. Furthermore they demonstrated an improvement in their quality of life.” (Hodgson, H., “Does reﬂexology impact on cancer patients’ quality of life?”, Nursing Standard (England). 14, 31, 33-38)
* (Hand massage) Vomiting, nausea, anxiety in children underoging chemotherapy
"The purpose of study was to determine the effects of hand massage on nausea, vomiting and anxiety in acute lymphocytic leukemia children with high dose chemotherapy. The subjects of this study consist of 15 in experimental group and 15 in control group. All subjects were diagnosed as acute lymphocytic leukemia and admitted for high dose chemotherapy at the C University Medical Center in Seoul, Korea. The hand massage was performed for 10 minutes twice a day through three days in the experimental group, not in the control group. To evaluate the effects of hand massage, the Index of Nausea, Vomiting by Rhodes et al and State-Trait Anxiety Inventory for children by Spielberger were measured before and after the experiment in both groups. Also, the level of anxiety as measured by blood pressure, pulse rate were measured before and after hand massage therapy.
"Result of the study were as follows;1. The score of nausea, vomiting decreased in the experimental group, not in the control group. There was a signiﬁcant difference of nausea, vomiting between the two groups. 2. The score of state anxiety decreased in the experimental group and increased in the control group. After hand massage, the state anxiety of the experimental group was signiﬁcantly more positive than the control group at the 2nd measurement 3. There was no signiﬁcant difference of pulse rate between the two groups. 4. systolic blood pressure decreased in the experimental group and some increased in the control group. There was a signiﬁcant difference of systolic blood pressure between the two groups. 5. The level of diastolic blood pressure in the two groups was signiﬁcantly decreased over time. "In conclusion, hand massage could be effective in decreasing nausea, vomiting, state anxiety, pulse rate and blood pressure of acute leukemia children receiving high dose chemotherapy." Ji-Eun Han, Master, RN, Young-Im Moon, PhD, and Ho-Ran Park, PhD. College of Nursing, Catholic University of Korea, Seoul, none, South Korea, "Effect of Hand Massage on Nausea, Vomiting and Anxiety of Childhood Acute Lymphocytic Leukemia with High Dose Chemotherapy," Presented at Back to Evidence-Based Nursing: Strategies for Improving Practice, Sigma Theta Tau International, July 21, 2004
End of life
In a paper given at the Nursing Mirror-Royal Marsden Hospital Advanced Nursing Practice Conference by Barbara Zeller Dobbs. Two studies about work with cancer patients are reported. The original purpose of one study was to decrease patients' pain with the use of reﬂexology, but the researchers “soon realized the beneﬁcial effect on the morale of patients and family. Something was being done for them.…” “In another study we carried out on cancer patients' needs, 85 percent of them said they wanted to keep, increase, restore or modify their support system. They attached much importance to communication with loved ones, to receiving proof of support such as visits, letters, and ﬂowers. Patients' comments about reﬂexology indicated that could be one way to feel this support and to have a helping presence near them in their last days.”
“In Switzerland, many new nurses are taught this approach. When applied skillfully, a reﬂexology massage is pleasantly relaxing and able to diminish painful sensations in the body. Given the number of uncontrollable variables involved in the decrease of pain and the establishment of a feeling of relaxation, our small study has no scientiﬁc value. It was only intended to motivate nurses to look for ways to integrate aspects of alternative care in the management of terminal patients. …
“Our purpose for using reﬂexology with these patients was to decrease their pain but we soon realized the beneﬁcial effect of reﬂexology on the morale of patients and families. Something was being done for them. Patients expressed feelings of being less abandoned and the families expressed satisfaction at seeing that something painless existed that could aid their relative. In three situations we taught a relative how to use reﬂexology and the beneﬁt seemed to have been as important for the relative as for the patient. … “Patients’ comments about reﬂexology seem to show that it could be one way for them to feel this support and to have a helping presence near them in their last days.“(Dobbs, Barbara Zeller, “Alternative health approaches,” Nursing Mirror (England), Vol. 160, No. 9, Feb. 27, 1985)
Hospice
Hospice
"Complementary therapies are being accessed increasingly by cancer patients. The aims of this audit were to investigate the impact of reﬂexology on the quality of life of 20 cancer patients, to determine their satisfaction with the service provided and to investigate the availability of this therapy within Scottish hospices. The audit ﬁndings suggest that the clients were staisﬁed with the service received. Respondents noted that their quality of life was improved through a reduction in pahysical 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 tratment for othwer cancer patients and requires further research to evaluate the bneﬁts." Milligan M, Fanning M, Hunter S, Tadjali M, Stevens E, Int J Oalliat Nurs 2002 Oct;8(10):489-96 (PMID: 12419988)
Hospice
"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 wellbeing 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," Eur J Oncol Nurs. 2002 Mar;6(1):37-44. (Marie Curie Cancer Care, Marie Curie Centre Liverpool, Speke Road, Woolton, Liverpool, L25 8QA, UK) PMID: 12849608
Hospice
"Complementary therapies are being accessed increasingly by cancer patients. The aims of this audit were to investigate the impact of reﬂexology on the quality of life of 20 cancer patients, to determine their satisfaction with the service provided and to investigate the availability of this therapy within Scottish hospices. The audit ﬁndings suggest that the clients were satisﬁed with the service received. Respondents noted that their quality of life was improved through a reduction in physical and emotional symptoms. It was found that the provision of reﬂexology within Scottish hospices varied, with less than half providing this service. The results of this audit suggest that reﬂexology may be a worthwhile treatment for other cancer patients and requires further research to evaluate the beneﬁts." Milligan M, Fanning M, Hunter S, Tadjali M, Stevens E. "Reﬂexology audit: patient satisfaction, impact on quality of life and availability in Scottish hospices," In
Pain, Chronic (Hand massage)
"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?" Nurs Clin North Am. 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
Critical care (Foot massage)
"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 Crit Care Nurs. 1999 Apr;15(2):77-82. (University of Hertfordshire, Centre for Research in Primary and Community Care, Hatﬁeld, UK) PMID: 10595045 Post surgical pain
* 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

Surgery
* Post surgical care (Foot massage)
"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," J Adv Nurs. 1999 Aug;30(2):460-8 (Stockport Acute Services NHS Trust, Anaesthetic Department, Stepping Hill Hospital, Stockport, England) PMID: 10457249
* Post surgical care (Foot massage)
"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," J Adv Nurs. 2002 Jan;37(2):199-207 (Institute of Nursing and Midwifery, University of Brighton, East Sussex, UK. jenniehattan@netscapeon-line.co.uk) PMID: 11851788
*Post surgical nausea and vomiting (Hand acupressure)
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 [PubMed]
*Post surgical nausea and vomiting (Hand acupressure)
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. Schlager A, Boehler M, Puhringer F., "Korean hand acupressure reduces postoperative vomiting in children after strabismus surgery," Br J Anaesth. 2000 Aug;85(2):267-70. Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens-University of Innsbruck, Austria. PMID: 10992837 [PubMed]
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
Post surgical recovery
* 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)

Post surgical recovery
*"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)
* Surgery, anxiety during (Hand massage)

"To evaluate the effects of hand massage on patient anxiety during cataract surgery. SETTING: Kangnam St. Mary's Hospital, Seoul, Korea. 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 Ophthalmol- ogy, Kangnam St. Mary's Hospital, Medical College, The Catholic University of Korea, Seoul, South Korea) PMID: 11408136

Children

Encopresis

Nurses at Ayshire & Arran Acute Hosptials Trust (six hospitals in the National Health System in Scotland) found that reﬂexology successfully treated children the condtion of encopresis or fecal incontinence, secondary to constipation / stool withholding. Encopresis is an "entremely 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 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 Bowel motions before: 36% none in a seven day period; 46% 1-4 motions per week; 18% daily Bowel motions after: 2% none in a seven day period; 72% more than 1-4 motions per week; 24%daily "In the last two years (following the study conducted from June 1998 to July 1999) the community nurses have ceased giving enemas to children at home. Reﬂexology for childhood encopresis and chronic constipation is now an established service with ﬁve paediatricians and two staff grade doctors referring children of all ages for treatment" "Reﬂexology in the management of encopresis and chronic constripation, Pedeatric 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

Birthing, Obstetrics and Gynecology

Birthing

Nurses and midwives utilize reﬂexology for birthing and complications of birthing. Reﬂexology can be used “to increase strength of contractions, to calm down contractions if they’re extremely painful or to regulate them if the muscles of the womb are not working harmoniously” (www.babyworld.co.uk/information/birth/pain_relief/complementary_therapies.asp)

It is reported that labor can be induced by reﬂexology more effectively than rupturing the membranes and the length of labor can be shortened with the patients frequently sleeping between contractions. Reﬂexology is seen an excellent way to deal with many problems including to help expel the retained placenta and to help relieve urinary retention after delivery. Such results are reported at the Reﬂexology Department of the National Maternity Hospital in Dublin, Ireland Started in 1995 following demands by doctors, patients and midwife practitioners, all now ﬁnd reﬂexology use totally positive and the beneﬁts enormous. Reﬂexology uses include obstetric and gynecological, pre and post natal depression, endometritis, and PMS. Reﬂexology is also used in various other departments at the hospital by at least 50 of the staff who are trained reﬂexologists. (2002)

Birthing, Pain killing; Alternative to labor stimulating and inducing drugs

Of 593 women who gave birth at Gentofte County Hospital (Great Britain) in 1988, 103 chose reﬂexology as an alternative to both pain killing drugs and to labor stimulating and inducing drugs. Of sixty-eight women who chose reﬂexology with no analgesic drugs, sixty one (89.71%) stated that reﬂexology had helped reduce pain., six (8.82%) felt no effect, and, one had increased pain in spite of reﬂexology treatment. Four of the sixty-one women who were helped by reﬂexology also required pain medication. Of forty-nine women who chose reﬂexology to stimulate labor, twenty-four gave birth without additional drug treatment. Fourteen women who were candidates for surgical delivery, received reﬂexology treatment between 30 and 60 minutes of birth. Eleven (78.57%) were then able to discharge the placenta. The other three had it surgically removed. All participants, except one, found the reﬂexology treatments extremely pleasant. "Easier Births Using Reﬂexology." by Gabriella Bering Liisberg, "Tidsskrift for Jordemodre," No. 3, 1989.

Birthing, Labor outcomes

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

Birthing, Delivery; Retention of placenta

"90% of 68 women had a positive effect of reﬂexology as a pain killer during delivery. 11 out of 14 with retention of the placentea avoided operation." (http://www.fdz-intranet.dk/english/ research/results.htm) Sorrig, Kirsten, "Easier Births Using Reﬂexology, "Danish Reﬂexologists Association, Research Committee Report, Feb., 1995 (Originally published in the Danish daily newspaper "Berlingske Tidende," July 15, 1988

Milk Secretion in New Mothers

* 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

Lactation in New Mothers

“The focus of this paper is to consider whether reﬂexology can have an effect on homeostasis to establish and maintain lactation. This complementary therapy encompasses the theory of holism to nurture the whole body, mind and spirit (Crane 1997). Parents experience many stressful emotions when their baby is admitted to a neonatal intensive care unit (NICU), which in turn can affect the body, mind and spirit, often contribution to the reduction of lactation for the mother. This paper will utilize a concept analysis approach (Chinn & Jacobs 1987) to provide a focus and source of direction to the discussion and exploration of the topic.”

Tipping, L. Mackereth, (St. Mary’s Hospital, Manchester, UK, liz@tipping seinternet.co.uk), “A concept analysis: the effect of reﬂexology on homeostasis to establish and maintain lactation,” Compl Ther Nurs Midfery 2000 Nov;6(4):189-98 (PMID: 11858502)

Edema in Pregnant Women

Midwives of the Central Coast of New South Wales in Australia “are conducting a randomised single-blind controlled trial on the effect of reﬂexology on foot and ankle in late pregnancy (over 32 weeks). A total of 80 women are randomised into” one of three groups: normal pregnancy visit (control), relaxation reﬂexology (placebo) or lymphatic drainage reﬂexology (treatment.). The sessions are 15-20 minutest at least once a week. The information gathered are pre- and post-treat-ment measurement of the ankle and instep, and blood pressure. The women answer a questionnaire at each session about comfort, changes in mood/feelings, and changes in relationship with midwife.” ("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 wellbeing' score revealed the lymphatic technique group signiﬁcantly increased their wellbeing the most, followed closely by relaxing techniques and then the control rest group. (All groups) had a non-signiﬁcant oedema-relieving effect. From the women's viewpoint, lymphatic reﬂexology was the preferred therapy with signiﬁcant increase in symptom relief." Mollart l., "Single Blind trial addressing the differential effects of two reﬂexology techniques versus rest, on ankle and foot oedema in late pregnancy," Complement Ther Nurs Midwifery, 2003 Nov;9(4):203-8)

“Our teacher was Susanne Enzer, a retired midwife and reﬂexologist, originally from England and now living in Australia. Susanne facilitates seminars, workshops and the accredited course “Maternity Reﬂexology.” She is also the co-author of Maternity Reﬂexology: a guide for reﬂexologist (1997) and author of Reﬂexology: a tool for midwives (2000).

“Reﬂexology is a therapeutic system of pressure-oriented massage to feet, hands or ears in the belief that all organs and glands have corresponding reﬂex points to the body. Reﬂexology elicits painful or tender areas with actual or potential disorder. It is a gentle, nonthreatening, noninvasive effective therapy. It has the potential to balance and maintain equilibrium, relax and increase vitality, and balance energy and move blockages.

“A complementary therapies working party (3 midwives, 1 pharmacist, 1 midwifery childbirth educator) forged a policy which has been accepted by the hospital ethics committee to practice reﬂexology at work.

We use reﬂexology in our antenatal clinics and midwife clinics for various discomforts of pregnancy like leg and ankle odema, constipation, anxiety, and prolonged pregnancy. In childbirth, reﬂexology is useful to help enhance contractions, increase relaxation, retained placenta. Postnatally, reﬂexology can assist after epidural, forcep or LSCS and urinary retention. Difﬁculties relating to breastfeeding can be helped with reﬂexology. Also, with exhaustion, postnatal depression. There are few contraindications- severe PE, APH, severe PPH.

“We are conducting a randomised single-blind controlled trial on the effect of reﬂexology on foot and ankle oedema in late pregnancy (over 32 weeks pregnancy). All women who met the criteria and are attending the clinics are invited to participate in the trial. The women are randomised (after informed consent obtained) into one of the three groups: normal pregnancy visit (control), relaxation reﬂexology (placebo,) or lymphatic drainage reﬂexology (treatment). The sessions are 15-20 minutes at least once a week. The information gathered are pre- and post-treatment measurements of ankle and instep, and blood pressure.

“The women answer a questionnaire at each session about comfort, changes in mood/feelings, and changes in relationship with midwife. The study commenced in August 1999 and is due for completion in August 2001. Unfortunately we will fall short of the 120 women needed as we have had only 80 women enrolled. The difﬁculty of the study is the midwives do not always have the time to give the reﬂexology as it is within work time and there is no research assistant.

“In a separate part of the trial, 12 women were treated with lymphatic drainage reﬂexology and refused randomisation but wanted reﬂexology. The characteristics of the women were mostly primigravidas (91.6%), 24-39 years old (mean of 30 years), at 33-39 weeks gestation (mean of 37.5 weeks). The results show all measurements decreased after lymphatic drainage reﬂexology. The women's blood pressure decreased (42%), increased (21%) and/or remained unchanged (35%).

“On a scale of 0 to 5, The women found a decrease in stress, tension, anxiety, pain, tiredness, discomfort and irritability. The majority felt “very relaxed” or “relaxed” during and after the reﬂexology. Most noticed a difference in their feet after the reﬂexology: “more movement,” “not as tight,” “less swelling.” Additional comments made by the women included “more at ease with midwives,” “feel better about myself,” and “relaxed whole body.”

“Although this sample is small, the many midwives have had similar comments from women receiving reﬂexology. It demonstrates that reﬂexology has a place in midwifery practice.”

-L.M.

One quarter of the midwifery staff at the hospital are trained in reﬂexology, a 40-hour certiﬁcate course on reﬂexology and uses in midwifery practice endorsed by the national midwifery board. The staff trained with Susanne Enzer, author of Maternity Reﬂexology (1997) and Reﬂexology; A Tool for Midwives (2000). (“Midwifery around the World, Midwives of the Central Coast of New South Wales, Australia, Midwifery Today E-News, Vol. 3, Issue 7, February, 14, 2001) (http//mid-wiferytoday.com/enews3n7.asp)

Reﬂexology & Nursing: Studies, Articles & Uses

Senior Citizens

Biofeedback assessment (Pulse rate, respiratory rate, blood pressure for senior citizens)

Agitated elderly (Hand massage and calming music)

Cancer Patients - End of Life - Hospice

Symptoms of Pain and Nausea Symptoms of Anxiety and Nausea Quality of Life

* (Hand massage) Vomiting, nausea, anxiety in children undergoing chemotherapy

Pain, Chronic (Hand massage)

Critical care (Foot massage)

Surgery

* Post surgical care (Foot massage, Perception of care)

*Post surgical care (Foot massage, Quality of life)

*Post surgical nausea and vomiting (Hand acupressure, Nausea and vomiting)

Post surgical recovery

Post surgical recovery

* Surgery, anxiety during (Hand massage)

Children

Encopresis

Birthing Birthing, Pain killing; Alternative to labor stimulating and inducing drugs Birthing, Labor outcomes Milk Secretion in New Mothers Edema in Pregnant Women

Birthing Birthing, Pain killing; Alternative to labor stimulating and inducing drugs Birthing, Labor outcomes Milk Secretion in New Mothers Edema in Pregnant Women

Studies

Senior Citizens

Biofeedback assessment (Pulse rate, respiratory rate, blood pressure for senior citizens)

Agitated elderly (Hand massage and calming music)

Cancer Patients

Symptoms of Pain and Nausea

Symptoms of Anxiety and Nausea

Quality of Life

End of life

Hospice

Hospice

Hospice

Hospice

Pain, Chronic (Hand massage)

Critical care (Foot massage)

Surgery

Post surgical recovery

Post surgical recovery

Post surgical recovery

Children

Encopresis

Birthing, Obstetrics and Gynecology

Birthing

Birthing, Pain killing; Alternative to labor stimulating and inducing drugs

Birthing, Labor outcomes

Birthing, Delivery; Retention of placenta

Milk Secretion in New Mothers

Lactation in New Mothers

Edema in Pregnant Women

Articles

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