The Physiological and Biochemical Outcomes Associated with a Reflexology Treatment: A Systematic Review

Table 4

Table of study characteristics.

Study	Participants	Intervention	Comparison	Dropouts	Outcome measure	Adverse effects	Results	Comments
Jones et al., 2013 [30]   (Scotland, UK) Double-blind RCT	12 patients with stable chronic heart failure	4.5 mins reflexology to heart reflex area (active heart point) (Ingham Method)	4.5 mins reflexology on gross heel area	No dropouts; occurred	Beat-to-beat cardiovascular parameters HR, BP, stroke index (SI), cardiac output (CO), cardiac index (CI), total peripheral resistance (TPR), baroreceptor up/down events (BarUpEv)/barDwEv), and heart rate variability (HRV)	None	No sig. difference for any outcome for either group	The authors state that participants medication may have masked any potential benefit
Hodgson and Lafferty, 2012 [31] (USA) Pilot crossover RCT with one week’s washout	18 older cancer survivors in nursing homes	4×20 mins reflexology (Ingham Method)	4×20 mins Swedish massage to feet	No dropouts; occurred	Salivary cortisol	None reported	Sig. change for both groups,; no sig. difference between group	No details regarding whether cortisol levels returned to baseline during the washout period were given
Jones et al., 2012 [3] (Scotland, UK) Double-blind RCT	16 healthy volunteers	4.5 mins reflexology to heart reflex area (active heart point) (Ingham method)	4.5 mins reflexology on gross heel area	1 due to data collection issue	Beat-to-beat cardiovascular parameters HR, BP, stroke index (SI), cardiac output (CO), cardiac index (CI), total peripheral resistance (TPR), baroreceptor up/down events (BarUpEv)/(BarDwEv), heart rate variability (HRV)	None reported	Sig. decrease in CI for intervention group,; sig. change in CO from baseline for intervention group,; no other sig. results,; sig. between group difference for CI	Suggests a link between reflexology stimulation to the heart reflex area and cardiac blood flow and circulation
Ruiz-Padial et al., 2012 [32] (Spain) RCT	41 healthy volunteers	3×40 mins reflexology (Ingham Method)	3×40 mins; (1) Non-professional foot massage; (2) Seated in a darkened room	None reported	BP, BRS, HRV, Inter-beat interval (IBI)	Some pain reported for reflexology group	Increases in interbeat interval, HRV and BRS in all groups. Sig. increase in BP in reflexology group as a function of time	The authors state that the increase in BP in the reflexology group suggest a “co-activation of the two branches of the ANS,” namely, the sympathetic and parasympathetic pathways
Sliz et al., 2012 [26] (Canada) RCT	40 healthy volunteers used a mental stress test to increase stress levels	1×8.5 mins reflexology to right foot only	1×8.5 mins; (1) Swedish foot massage; (2) Foot massage with a wooden object to mimic Swedish massage; (3) Rest	None reported	fMRI, blood oxygen level dependent (BOLD) response (indicated blood flow to areas of activation)	None reported	Positive BOLD response in ACC and PCC brain region for reflexology, Swedish massage and control,; no sig. difference between groups	The ACC and PCC regions of the brain are thought to be linked to emotional response, learning, and memory and are also involved in major depressive disorders (Dervets et al., 2008)
Hughes et al., 2011 [25] (Northern Ireland, UK) Feasibility RCT	25 healthy volunteers using a mental stress test to increase stress levels	1×20 mins reflexology	1×20 mins relaxation and foot hold	No dropouts occurred	BP, HR	None reported	Sig. reduction in SBP for intervention and control groups,; sig. reduction in DBP in intervention group,; no sig. change in HR,; no sig. difference between groups
Lu et al., 2011 [33] (Taiwan) RCT	37 participants	1×60 mins reflexology (Father Josef Method) CAD patients	1×60 mins reflexology (Father Josef Method) healthy patients	None reported	ECG, BP, HRV, PP, RRI	None reported	Sig. reduction in BP and PP for both groups, sig increase in RRI in reflexology group.; Sig. change in HRV in both groups,; no sig. difference between groups	HRV benefits lasted longer for CAD patients (60 mins) compared with controls (30 mins)
Moeini et al., 2011 [34] (Iran) RCT	50 CABG patients	1×30 mins reflexotherapy pre-surgery	Usual care	None reported	BP, HR, respiratory rate	None reported	Sig reduction in SBP and DBP in reflexology group,; nonsignificant reduction in HR and respiration rate for reflexology,; sig. between groups difference in SBP and DBP
Green et al., 2010 [35] (UK) RCT	183 Early stage breast cancer (6 weeks post-surgery)	8 × treatment (weekly session duration unknown)	(1) Self-initiated support; (2) 8 treatments at weekly intervals of SIS with head massage	Full data sets were obtained for 87 participants,; intention to treat was carried out	Blood lymphocytes (CD profiles) cytokine production (Th1, Th2), prolactin, cortisol, growth hormone	None reported	Sig. increase in CD25 + cells in reflex and massage group compared with baseline. Sig. increase in CD25 + cells between massage and SIS,; no other sig. results,; no sig. difference between groups	Results for only 47.5% of the participants were reported due to a loss of blood sample in the analysis process
Holt et al., 2009 [36] (UK) RCT	49 Women with anovulation	7×60 mins reflexology	Sham reflexology	9 dropouts	Serum progesterone	None reported	Ovulation occurred in intervention (42%) and sham groups (46%), Pregnancy occurred in intervention (15%) and sham groups (9%),; no sig. difference between groups	The authors stated that the rate of ovulation in this trial was double that expected giving rise to an idea that the sham treatment may also have had an effect on the outcome measures
Mackereth et al., 2009 [37] (UK) Crossover RCT with 4-week washout	53 MS patients	6×40 mins weekly reflexology (Ingham Method)	Progressive muscle relaxation (PRM) training	3 dropouts	HR and BP, salivary cortisol	None reported	Sig. decrease before and after treatment and before and after weeks 1–6 for cortisol within reflexology group,; sig. decrease in SBP and HR for both groups,; no sig. change in DBP,; no sig. difference between groups	The variable of interest failed to return to initial levels resulting in problems relating to the ordering of the treatments and these interactions made analysis very difficult to determine
Hodgson and Andersen, 2008 [38]; (USA); Crossover RCT with no washout period	21 dementia sufferers in nursing homes	4×30 mins weekly hand or foot reflexology	4×30 min weekly friendly visit	Not stated	BP, pulse, salivary 𝛼-amylase	None reported	Sig. decrease in salivary 𝛼-amylase in reflexology group,; no other sig. results,; significant between groups difference in amylase	The authors did not consider the impact of the absence of a washout period on results. Also, no details or numbers of patients receiving hand or foot reflexology were given
Gunnarsdottir and Jonsdottir, 2007 [39] (Iceland) Pilot RCT	9 Coronary artery bypass graft patients	5×30 mins reflexology (Ingham Method) pre and post-surgery	Cream application to feet (1 min) + 30 mins rest	2 due to post surgery complication	BP, HR, respiration rate	None reported	Sig reduction in SBP in control group,; no sig. difference between groups	Anxiety levels in the control group were consistently lower in the control group and authors attribute higher anxiety scores to a potential lack of validity of SAI to the Icelandic population
Mc Vicar et al., 2007 [40] (UK) Pilot crossover RCT with 3-day washout	30 healthy volunteers	3×60 mins pragmatic reflexology	Sitting as a group in a quiet room	Not stated	Salivary melatonin & cortisol, BP, pulse rate	None reported	Significant reduction in pulse and SBD in reflexology group,; no sig. change in DBP,; no sig. change in cortisol or melatonin,; no sig. difference between groups	Authors stated that carry over effects and order of treatments due to study design may have affected results. They also, suggest that sitting in a room as a group may have resulted in anxiety for some control participants
Wilkinson et al., 2006 [41] (UK) RCT	20 Chronic Obstructive Pulmonary Disease (COPD) patients	4×50 min sessions	Friendly visits	19 participants did not complete all of the study	BP, HR, respiration rate, oxygen saturation, FVC, FEV, vital capacity, peak flow	None reported	Significant pre-postdecrease in HR within reflexology group,; no sig. improvement in HR and PEF in control group,; no sig, difference between groups	Peak flows were self-reported and as only one participant completed all of the study, these results are open to bias
Mollart, 2003 [10] (Australia) Single-blind RCT	69 Pregnant women 30 weeks + gestation with foot oedema	3×15 mins session lymphatic reflexology	(1) Relaxing reflexology; (2) Rest	Only 20 participants completed all 3 sessions	BP, ankle, and foot circumference measurements	None reported	Nonsignificant reduction in BP for all groups, nonsignificant decreases in ankle and foot measurements	Results from the first treatment session only were analysed due to dropouts
Frankel, 1997 [42] (UK) Pilot RCT	24 healthy participants	1×45 mins reflexology (Ingham Method)	(1) Foot massage; (2) No intervention	None reported	Baroreceptor reflex sensitivity (BRS), BP, sinus arrhythmia (SA)	None reported	Nonsignificant reduction in BRS for reflexology and FM (60%) compared with no treatment (50%),; nonsignificant increase in SA frequency for reflexology and FM,; nonsignificant difference between groups	Author suggests a “Neuro theory” may explain the mechanism of action as BRS is under ANS control

ACC: anterior cingulate cortex; ANS: autonomic nervous system; BarDwEv: baroreceptor down events; BarUpEv: baroreceptor up events; BOLD: blood oxygen level dependent; BP: blood pressure; BRS: baroreceptor reflex sensitivity; CABG: coronary artery bypass graft; CAD: coronary artery disease; CHF: chronic heart failure; CI: cardiac index; CO: cardiac output; COPD: chronic obstructive pulmonary disease; DBP: diastolic blood pressure; ECG: electrocardiogram; FEV: forced expiration volume; FM: foot massage; fMRI: functional magnetic resonance imaging; FVC: forced vital capacity; HR: heart rate; HRV: heart rate variability; IBI: interbeat interval; PCC: posterior cingulate cortex; PEF: peak expiratory flow; PMR: progressive muscle relaxation; PP: pulse pressure; RCT: randomised controlled trial; RRI: R-R interval; SA: sinus arrhythmia; SAI: Spielbergers State Anxiety Inventory; SBP: systolic blood pressure; SI: Stroke Index; SIS: self-initiated support; TPR: total peripheral resistance.