Findings in Research: Can Reflexology Help in the Management of Ventilator Dependent or Hospitalized Covid19 Patients

Some of the challenges of caring for ventilator-dependent Covid19 patients are cited in recent news articles. Included is the time consuming task of monitoring and adjusting oxygen levels (1) as well as the increased use of painkillers and sedatives leading to potential shortages of the drugs (2). 

In one example of reflexology research, ventilator dependent ICU patients showed statistically significant differences in sedation and patient-ventilator syncrony following 30 minutes of targeted reflexology work for each of five days. Also improved were other signs of sedation assessment agitation, anxiety, and sleep. In addition physiological parameters of anxiety improved: significantly lower heart rate, systolic blood pressure, diastolic blood pressure and respiratory rate. (3)

Reflexology was seen by multiple researchers as a non-pharmacological treatment option for nursing care to address physiological and psychological problems presented by ventilator dependent patients: reducing anxiety, preventing physiological reactions caused by anxiety, stabilizing vital signs and managing pain. (4) Such goals are of interest in the management of the sickest of all Covid19 patients, those on a ventilator. While less urgent these goals are also important to those hospitalized with Covid19.

A single round of reflexology work applied to specific reflex areas of the feet was found to create significant differences from control group patients for ventilator-dependent patients recovering from open-heart surgery. (5) In addition significant differences were found when a single bout of reflexology work was applied to hospitalized patients. (9-18) Significant differences were reported in physiologic parameters as well as anxiety and pain. 

Two (5) (6) of four studies of ventilator-dependent patients found significantly improved physiology parameters. Noted in parentheses is the number of studies finding differences from the control group in: oxygen saturation [2], heart rate [1], respiratory rate [2], mean arterial pressure [2], systolic and diastolic blood pressure [2]. One study found anxiety and agitation was significantly reduced following 30 minutes of reflexology work (6) while another found anxiety was not reduced following 20 minutes of reflexology work (7). Three of three studies found reduced time spent weaning patients from the ventilator, important following recovery from open heart surgery, by 39 minutes (4), 100 minutes (8) and 165 minutes (5).

Significant differences in physiologic parameters were found for hospitalized patients in nine ((9) through (18) in References) of ten ((19) in References) studies. Noted in parentheses is the number of studies finding differences from the control group in: heart rate [3], pulse rate [3], respiratory rate [6], breathing [1], mean arterial pressure [2], temperature [1], blood pressure [4], systolic [3] and diastolic [2] blood pressure. Significant differences in level of anxiety were found in two of the three studies that looked at the issue.

References

1. Bernstein, Lenny, “Ventilator use is helping save lives,” Albuquerque Journal, July 14, 2020, p. B-3
2. Hopkins, Jared S., “Hospital Stockpiling Sparks Drug Shortage,” Wall Street Journal, p. A-1

(3) Akin Korhan, Esra PhD; Khorshid, Leyla PhD; Uyar, Mehmet MD, “Reflexology: Its Effects on Physiological Anxiety Signs and Sedation Needs,” Holistic Nursing Practice: January/February 2014 - Volume 28 - Issue 1 - p 6–23 doi: 10.1097/HNP.0000000000000007

(4) Abbas Ebadi, Parasoo Kavei, Seyyed Tayyeb Moradian, Yaser Saeid, “The Effect of Foot Reflexology on Physiologic Parameters and Mechanical Ventilation Weaning Time in Patients Undergoing Open-Heart Surgery: A Clinical Trial Study” Complement Ther Clin Pract 2015 Aug;21(3):188-92. PMID: 26256138

(5) Elsayed, Amira, Kandeel, Nahed, El-Aziz, Wafaa, “The Effect of Foot Reflexology on Physiological Indicators and Mechanical Ventilation Weaning Time among Open-Heart Surgery Patients” American Journal of Nursing Research. 2019, 7(4), 412-419 DOI: 10.12691/ajnr-7-4-2

(6)Yaser Abbaszadeh, Atefeh Allahbakhshian, Alehe Seyyedrasooli, Parvin Sarbakhsh, Sakineh Goljarian, Naser Safaei, Yaser Abbaszadeh , Atefeh Allahbakhshian, Alehe Seyyedrasooli, Parvin Sarbakhsh, “Effects of Foot Reflexology on Anxiety and Physiological Parameters in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Clinical Trial,” Complement Ther Clin Pract. 2018 May;31:220-228. PMID: 29705459

(7) Kavei, P, Ebadi, A, Saeed Y, Moradian S. T., Sedigh Rahimabadi M, “Effect of Reflexology on Anxiety and Agitation in patients Under Mechanical Ventilation after Open Heart Surgery: A Randomized Clinical Trial Study, Journal of Clinical Nursing and Midwifery, Spring 2015, Volume 4, Number 1; Pages 16-26

(8)Didem Kandemir, “How Effective Is Reflexology on Physiological Parameters and Weaning Time from Mechanical Ventilation in Patients Undergoing Cardiovascular Surgery?,” European Journal of Integrative Medicine 26 · February 2019 DOI: 10.1016/j.eujim.2019.01.008

(9) Arash Khalili, Negin Masoudi Alavi, Davoud Mardani, Nastoor Bekhradiani Pour, Akvan Paymard, Mehdi Daraei, Shapour Yaripoor, Saba Bashiri and Mehdi Molavi Vardanjani, “The effect of foot reflexology on physiological parameters,” International Journal of Medical Research & Health Sciences, 2016/09/01

(10) Mahin Moeini, Leila Sadat Kahangi, Mahboobeh Valiani, Reza Heshmat, “The Effect of Reflexotherapy on Patients’ Vital Signs Before Bypass Graft Surgery,” Iran J Nurs Midwifery Res, Winter 2011;16(1):8-12 PMID: 22039373 PMCID: PMC3203304

(11) Khosrow Hashemzadeh, Marjan Dehdilani, Mehdi Khanbabayi Gol, “Effects of Foot Reflexology on Post-sternotomy Hemodynamic Status and Pain in Patients Undergoing Coronary Artery Bypass Graft: A Randomized Clinical Trial” Published 2019, Corpus ID: 211201347

(12) Fatemeh Rigi, Aram Feiz, Zainab American, Mohsen Naseri, Shahyad Salehi, “The Effect of foot reflexology massage on physiological parameters in patients undergoing coronary artery bypass,” Complementary Medicine Journal of (Arak University) Faculty of Nursing and Midwifery, 2014; 4 (3) :865-875 Corpus ID: 110819484

(13) Vinaya Anjaly Thomas,  Shweta Pattnaik, “Effect of Foot Reflexology on Vital Parameters of Hypertensive Patients” Published 2017 Corpus ID: 195746695

(14) Quattrin R., Zanini A., Buchini S., Turello D., Annunziata M. A., Vidotti C., Colmbatti A. & Brusaferro S. “Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: methodology and outcomes,” (2006) Journal of Nursing Management 14, 96–105

(15) Fatemeh Heidari, Nahid Rejeh, Majideh Heravi-Karimooi, Kamran Ghodes, Mehrdad Karimi, Davood Tadrissi, “The effect of stress on foot reflex zone therapy on anxiety, hemodynamic parameters of patients waiting for cardiac catheterization,”Avicenna Journal of Nursing and Midwifery Care Summer 2015 Volume 23 Number 2 (49) #G00167; Pages 63 to 73

(16) M. Torabi, M. Salavati, A. Ghahri Sarabi, "Effect of Foot Reflexology Massage and Benson Relaxation Techniques on Anxiety and Physiological Indexes of Patients Undergoing Coronary Heart Angiography," Iran Avicenna Journal of Nursing and Midwifery Care Volume 20, Issue 1 (5-2012)

(17) Khosrow Hashemzadeh, Marjan Dehdilani, Mehdi Khanbabayi Gol, “Effects of Foot Reflexology on Post-sternotomy Hemodynamic Status and Pain in Patients Undergoing Coronary Artery Bypass Graft: A Randomized Clinical Trial,” Crescent Journal of Medical and Biological Sciences, Vol. 6, No. 4, October 2019, 517–522 eISSN 2148-9696

(18) Hassani, S., & Hassani, K. (2015). “The Effect of Foot Reflexology on Physiologic Indices and Pain Severity Following Cesarean Delivery.” Research Journal of Medical Sciences, 9(3), 114-117
(19) Mehrnoosh Khoshtarash, Atefeh Ghanbari Mohammad Reza Yegane, Ehsan Kazemnejhad, Parvine Rezasoltani, “Effects of foot reflexology on pain and physiological parameters after cesarean section,” Iran Koomesh Autumn 2012, 14 (1): 109 - 116

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Less Pain for Post-operative Patients: Benefits of Reflexology Use in a Hospital Setting

Medical Applications for Reflexology Part 2

Less pain is the result for post-operative patients who receive reflexology and other integrative therapies. At least that’s the finding from one Minneapolis hospital.

Use of reflexology meets the needs of medical facilities. Such benefits are noted in a study of post-operative pain and integrative therapies including reflexology applied to “1,837 cardiovascular, medical, surgical, orthopedics, spine, rehabilitation, oncology, and women’s health patients” by the Penny George Institute for Health and Healing at Abbott Northwestern Hospital (Minneapolis, MN). (17) 

The study found the various therapies reduced patients’ pain by as much as 50% “in an environment where pain management continues to be a major challenge, and traditional medications can have negative consequences.... “‘Roughly 80 percent of patients report moderate to severe pain levels after surgery,’ says Gregory Plotnikoff, M.D., one of the study’s authors .... “‘We struggle to provide effective pain control while trying to avoid the adverse effects of opioid medications, such as respiratory depression, nausea, constipation, dizziness and falls.’” 

“‘Our real-world study broadly shows that these therapies ... can be clinically implemented in real time, across, and under the operational and financial constraints within an acute care hospi- tal.’”... “‘I think we will find that integrative approaches to pain management during the hospital stay will improve patient satisfaction and outcomes, and we will see cost savings from patients using fewer drugs and experiencing fewer adverse events,” said Lori Knutson, RN, BSN, HN-BC, executive director of the George Institute.” (http://www.abbottnorthwestern.com/ahs/news.nsf/newspage/Non-drugPainRelief) 

Why Reflexology Improves Post-Operative Care

                                        Medical Applications for Reflexology Part 2

Research demonstrates the benefits of reflexology use with post operative patients: lessening pain, decreasing anxiety, speeding recovery as well as providing comforting touch. Explanation for such benefits is found in the impact on the nervous system by reflexology pressure technique application to the hands and feet.

Lessening of pain
The lessening of pain in response to reflexology work is documented in six post operative care studies. Similar results have been demonstrated in twenty-five studies with reflexology applied in areas such as birthing, phantom limb and the elderly. 

Such results find explanation in what researcher Dr. Nancy Stephenson of Eastern North Carolina University considers as affect on the neuromatrix of the brain, an expansion of the Gate Control Theory of Pain. According to Wikipedia: “Gate control theory asserts that activation of nerves which do not transmit pain signals, called non-nociceptive fibers, can interfere with signals from pain fibers, thereby inhibiting pain.” Stimulating nerves that sense touch, heat, and cold as well as pressure such as pressure sensors of the feet and hands affected by reflexology use overcomes the action of the pain nerves.

Decrease in anxiety
Decrease in anxiety for post surgical patients in response to reflexology work is demonstrated in two studies. Explanation is found in some twenty studies with individuals ranging from healthy individuals to senior citizens to menopausal women using a variety of measurements show that reflexology relaxes the body. The stimulation of reflexology’s pressure techniques creates change in the body’s basic level of tension as demonstrated by research using measurement of: brain waves (EEG), blood pressure, systolic blood pressure, diastolic blood pressure, pulse rate, and anxiety. 

Speeding recovery
Speedier recovery of gastrointestinal and urinary functions is noted in five studies of post operative recovery as well as six studies in post-partum women. Explanation may be found in improved blood circulation to the kidneys and intestines due to reflexology work as found in previous research using Doppler sonogram measurement. 

Additional studies have found reflexology to impact functions of the digestive system and the kidneys. Improvements in bowel movement and constipation was found in multiple studies with a variety of individuals: the elderly, healthy individuals, children (2 studies), cancer patients, hospice care (2 studies), cerebral hemorrhage patients, coronary heart disease patients, women (3 studies), and college students. In two studies hand reflexology applied to hemodialysis patients found reflexology work improved multiple function of the kidneys. 

Comforting touchFinally, the comforting touch of a concerned care giver or professional cannot be over-looked in the responses of patients to reflexology work. Study after study notes the response of the reflexology’s human to human non-invasive touch.