Wednesday, August 26, 2020

Reflexology Research with Ventilator-Dependent Patients: Methods for Positive Results

Brian Hall / Public domain
How to get results. This is always a topic of interest to reflexologists. The discussion centers around where to apply technique, how frequently and for how long a period of time to apply technique. 

The same issue is important for researchers working with patients in a hospital setting. Setting such parameters is a part of establishing Method for a study. Defining Method in a study is critical to ascertain a potential future protocol that will create results. This is a part of evidence-based medicine. Here we consider the reflex areas and amount of time utilized in research with ventilator-dependent patients.

Following are synopses of research with ventilator-dependent patients. Some studies found positive results, others did not. As common with research, researchers cite and consider methods in similar studies seeking to understand reported results. Study (1), for example was criticized for using different reflexologists. As you look through the synopsis, consider the Method and positive or negative results.

Multiple studies show that reflexology helps in the treatment of patients on mechanical ventilators. Patients experience: Improved physiological parameters (positive results in (2) and (5), negative results in (1) and (3)); Lessened anxiety and agitation (positive results as well as better sleep and patient-ventilator synchrony (5), negative results (4); less use of drugs for sedation (5); shorter length of time on the ventilator (weaning time) (Positive results for all three studies1, 2, 3) and increased level of consciousness for those in a coma (6). Five of the six studies, noted  use of reflexology as “an effective nursing intervention,” recommended training in and use of foot reflexology for patients on mechanical ventilators. (1, 2, 3, 5, 6,7)

(1) Researched: Physiological parameters (Pulse rate, respiratory rate, systolic and diastolic blood pressures, mean arterial pressure, percutaneous oxygen saturation); Weaning time

Researchers Abbas Ebadi et al noted the method implemented in their research: Following open heart surgery (OHS), transfer to an OHS-ICU and placement on a mechanical ventilator (MV), 31 patients who had been randomly assigned to the study’s reflexology group received on each foot 7 to 10 minutes of reflexology work applied to the lung and heart reflex areas. Work was applied by same-gender nurses. Measured were pulse rate, systolic and diastolic blood pressure, mean arterial pressure and oxygen saturation. 

Results were reported as: “Study findings also showed that although reflexology had no significant effect on physiological parameters, it significantly reduced the length of MV weaning time. The mean of weaning time in the reflexology group was 39.11 min shorter than the control group.…

“Conclusion: Study findings indicate that foot reflexology is an effective nursing intervention for facilitating MV weaning after OHS. Given the simplicity, safety, and cost-effectiveness of foot reflexology, we recommend the development and implementation of reflexology training programs for both nursing and practicing nurses.”

(1) 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 DOI: 10.1016/j.ctcp.2015.07.001

(2) Researched: Physiological parameters (Heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, oxygen saturation), Weaning time, Sedation and analgesic drug use

Researchers Amira Elsayed et al noted the method implemented in their research. Monitored six times were: (a) heart rate, (b) respiratory rate, (c) systolic and (d) diastolic blood pressure, (e) mean arterial pressure and (f) oxygen saturation. Following open heart surgery and within 60 minutes of being admitted to the cardio-thoracic ICU, 40 patients who had been randomly assigned to the study’s reflexology group received on each foot 15 to 30 minutes of reflexology work applied to the lung and heart reflex areas. 

Results demonstrated reflexology work positively affects stabilization of physiological parameters. were reported. Compared to the patients in the control group patients in the reflexology group experienced a: (a) statistically significant decrease in heart rate,  (b) significantly lower respiratory rate, (c) statistical significant reduction in the systolic blood pressure, (d) statistically significant lower diastolic blood pressure, (e) statistically significant drop in mean arterial pressure and (f) statistical significant elevation in the oxygen saturation level. Weaning time from the mechanical ventilator for those in the reflexology group was 270 minutes while in the control group it was 435 minutes. 

“Based on the results of our study, we conclude that foot reflexology massage can significantly enhance the physiological indicators, and shorten MV weaning time in patients undergone OHS (Open Heart Surgery). Therefore, foot reflexology massage can be incorporated into daily patient care in cardiothoracic ICU. Training programs on applying foot reflexology for critical care nurses are needed. Future large scale studies on different patient population are also required in order to obtain a strong evidence to support this approach and enrich the body of knowledge in this area. … 

“Conclusion: Foot reflexology is an effective method for stabilizing physiological indicators and decreasing ventilator dependence among patients undergoing OHS. Therefore, it can be introduced as an adjunct to daily care of OHS patients in ICU.” 

(2) 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

(Full study

(3) Researched: Heart rate, oxygen saturation; Weaning time

Researcher Kandmire noted the method of the study: a twenty-thirty-minute foot reflexology session was applied post operatively to 42 non-randomly selected open heart surgery patients.

Results: “(As compared to those in the control group) Reflexology did not have a significant effect on physiological parameters in patients receiving mechanical ventilation support. Shortening the weaning time from mechanical ventilation suggests that it might be applied effectively in patients receiving mechanical ventilation support in intensive care unit.”

(3) 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 2019DOI: 10.1016/j.eujim.2019.01.008

(4) Researched: Anxiety, Agitation

Researchers Kavei et al describe a double blind three group randomized study. Following open heart surgery: “Foot reflexology massage for 20 minutes was provided to patients in the experimental group on the reflection points in the heart and lungs. The rate of anxiety and agitation based on Faces of Anxiety Scale (FAS) and the Richmond Agitation Scale (RSAS) were recorded in 6 stages.”

“Conclusion: Foot reflexology massage in reflection points of the heart and lung in patients after surgery did not reduce anxiety and agitation in patients.”

(4) 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

(5) Physiological anxiety signs (Heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate) and Sedation Needs

Researchers Akin Korhan et al note their method: “… a single blinded, randomized controlled design with repeated measures was used in the intensive care unit of a university hospital in Turkey. Patients (n = 60) aged between 18 and 70 years and were hospitalized in the intensive care unit and receiving mechanically ventilated support. Participants were randomized to a control group or an intervention group. The latter received 30 minutes of reflexology therapy on their feet, hands, and ears for 5 days. …”

Results: “The reflexology therapy group had a significantly lower heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate than the control group. A statistically significant difference was found between the averages of the scores that the patients included in the experimental and control groups received from the agitation, anxiety, sleep, and patient-ventilator synchrony subscales of the American Association of Critical-Care Nurses Sedation Assessment Scale. … “Reflexology can serve as an effective method of decreasing the physiological signs of anxiety and the required level of sedation in patients receiving mechanically ventilated support. Nurses who have appropriate training and certification may include reflexology in routine care to reduce the physiological signs of anxiety of patients receiving mechanical ventilation.”

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

(6) Researched: Conscious level

“Methodology: The study group constituted (50) patient (adult mechanically ventilated patients hospitalized in ICU), who was received two reflexology session on feet and the control group constituted (50) patient who was received the routine care, GCS (Glasgow Coma Scale) measured before session, immediate after, post 2 hours and post 4 hours.” A 30-45 minute session was applied including “a mild massage will be done to the all feet and then pressure will be applied once to specified reflex points related to brain, heart, renal and respiratory systems.”

Result: No statistical difference was found in time on mechanical ventilator or days in ICU.  “The findings of the study revealed that there was effect of foot reflexology on the conscious level after the second session … “There was significant increase in GCS (Glasgow Coma Scale). So, because of the positive results of the intervention, the nurse practitioners may be trained about the technique of foot massage and reflexology.”

Maha Salah Abdullah Ismail, Manal S. Ismail, Amir M. Saleh “Effect of Foot Reflexology Treatment on Glasgow Coma Scoring Among Mechanically Ventilated Patients,”IJBPAS International Journal of Biology, Pharmacy and Allied Science), July, 2017, 6(7): 1384-1394, ISSN: 2277–4998; (Full Study available:

(7) Researched: Systolic and diastolic blood pressure, mean arterial pressure, heart rate, respiratory rate, percutaneous oxygen saturation, and anxiety

“Results showed a statistically significant difference between intervention and control groups in terms of the level of anxiety (p < 0.05). Also, results showed a statistically significant effect on all physiological parameters except heart rate (p < 0.05).”

“Today,  it  seems  that  non-pharmaceutical therapies such as complementary and alternative medicine (CAM) may be used to reduce anxiety [21,37e 40], prevent physiological reactions caused by anxiety [37, 40, 41], stabilize vital signs [42], and manage pain [43]. Since nurses play a key role in predicting psychological and physiological needs of patients and reducing their level of anxiety and stress [25], it seems that nurses can practice some CAMs to reduce stress, pain, and improve the health conditions of patients [44]. As a result, in addition to helping patients relax, nurses can lower the chance of complications by actively reducing the anxiety levels of their patients.””

Kavei, P, Ebadi, A, Saeed Y, Moradian S. T., Sedigh Rahimabadi M,, “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 DOI: 10.1016/j.ctcp.2018.02.018.

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