Evidence-Based Complementary and Alternative Medicine / 2020 / Article / Tab 1

Research Article

Effect of Foot Reflexology Intervention on Depression, Anxiety, and Sleep Quality in Adults: A Meta-Analysis and Metaregression of Randomized Controlled Trials

Table 1

Characteristics of included studies.

Authors, year, countryMain characteristics of studied populationSample characteristics (sample size, mean age)Sex differenceIntervention group. vs. comparison groupOutcome measurement toolsOutcomes

Valizadeh et al., 2015, IranParticipants between the age of 60–75 y/o independently performing daily activities and having mental health based on health records available in the health center69, G1 = 23, G2 = 23, G3 = 23 mean age: G1 = 66.82 y/o (SD = 4.80), G2 = 67.69 y/o (SD = 4.28), G3 = 66.82 y/o (SD = 3.84)Male: 69 Female: 0G1 = foot reflexology G2 = footbath G3 = control groupPittsburgh Sleep Quality Index (PSQI)The total score of PSQI improved: no statistically significant finding G1 vs. G3 ( < 0.05) G1 = 6.08 (5.27), G1 = 3.91 (4.04) G3 = 4.69 (0.51), G3 = 5.69 (3.08)

Lee et al., 2011, TaiwanPostpartum women have given birth vaginally without postpartum complications and concurrent medical conditions with poor sleep condition (PSQI ≥ 5)68, G1 = 34, G2 = 34 mean age: G1 = 32.0 y/o (SD = 2.8), G2 = 31.2 y/o (SD = 2.8) (3 drop out)Male: 0 Female: 68G1 = foot reflexology G2 = control groupPittsburgh Sleep Quality Index (PSQI)The total score of PSQI improved: G1 vs. G2 ( < 0.001) G1 = 9.94 (2.61), G1 = 3.97 (1.26) G2 = 9.45 (2.59), G2 = 6.24 (1.68)

Bakir et al., 2018, TurkeyVoluntary participants aged ≥18 y/o diagnosed with rheumatoid arthritis, at least, 1 year with VAS-Pain (visual analogue scale for pain) of 4 or greater60, G1 = 30, G2 = 30 mean age: G1 = 50.83 y/o (SD = 12.0), G2 = 49.50 y/o (SD = 16.4) (5 drop out)Male: 14 Female: 46G1 = foot reflexology G2 = control groupPittsburgh Sleep Quality Index (PSQI)The total score of PSQI improved: G1 vs. G2 ( = 0.001) G1 = 16.20 (3.70), G1 = 13.16 (3.57) G2 = 16.75 (3.64), G2 = 19.03 (3.05)

Unal et al., 2016, TurkeyPatients between the age of 18–60 y/o who received hemodialysis therapy twice a week without any communication problems105, G1 = 35, G2 = 35, G3 = 35 mean age: G1 = 51.74 y/o (SD = 12.2), G2 = 53.89 y/o (SD = 13.1), G3 = 54.33 y/o (SD = 12.9)Male: 55 Female: 50G1 = foot reflexology G2 = back massage G3 = control groupPittsburgh Sleep Quality Index (PSQI)The total score of PSQI improved: G1 vs. G3 ( < 0.05) G1 = 11.09 (3.18), G1 = 5.54 (2.15) G3 = 9.20 (2.42), G3 = 11.88 (2.47)

Zengin et al., 2018, TurkeyParticipants with cancer have received at least their first session of chemotherapy and have no diagnosis of sleep disorder167, G1 = 84, G2 = 83 mean age: G1 = not mentioned G2 = not mentioned (9 drop out)Male: 78 Female: 89G1 = foot reflexology G2 = control groupPittsburgh Sleep Quality Index (PSQI)The total score of PSQI improved: G1 vs. G2 ( < 0.001) G1 = 12 (2.7), G1 = 5.5 (2.1) G2 = 11.3 (1.9), G2 = 13 (2.4)

Rambod et al., 2019, IranPatients with lymphoma aged ≥18 y/o, being able to speak Persian and being willing to participate in the study72, G1 = 36, G2 = 36 mean age: G1 = 41.47 y/o (SD = 13.70), G2 = 46.90 y/o (SD = 15.40)Male: 52 female: 20G1 = foot reflexology G2 = control groupPittsburgh Sleep Quality Index (PSQI)The total score of PSQI improved: G1 vs. G2 ( < 0.05) G1 = 10.11 (3.26), G1 = 8.41 (2.98) G2 = 11.80 (3.83), G2 = 11.83 (3.26)

Malekshahi et.al., 2018, IranPatients between the age of 18–65 y/o who have sleeping problems on the basis of the Pittsburgh questionnaire, undergoing hemodialysis in the evening and night shifts80, G1 = 40, G2 = 40 mean age: G1 = not mentioned G2 = not mentionedMale: 53 female: 27G1 = foot reflexology G2 = control groupPittsburgh Sleep Quality Index (PSQI)The total score of PSQI improved: G1 vs. G2 ( < 0.05) G1 = 11.79 (3.13), G1 = 6.32 (1.93) G2 = 10.94 (4.10), G2 = 12.47 (3.94)

Oshvandi et al., 2014, IranPatients between the age of 30–80 y/o who have ischemic heart disease hospitalized in the critical care unit60, G1 = 30, G2 = 30 mean age: G1 = 64.17 y/o (SD = 12.04), G2 = 50.50 y/o (SD = 11.40)Male: 34 Female: 26G1 = foot massage G2 = control groupSt. Mary’s Hospital Sleep Questionnaire (SMHSQ)The total score of SMHSQ improved: G1 vs. G2 ( < 0.05) G1 = 19.67 (6.25), G1 = 15.33 (4.87) G2 = 18.93 (5.87), G2 = 18.90 (5.66)

Samarehfekri et al., 2020, IranPatients undergoing kidney transplantation surgeries suffer from postoperative pain, fatigue, and sleep disorders50, G1 = 25, G2 = 25 mean age: G1 = 38.12 y/o (SD = 12.87), G2 = 38.56 y/o (SD = 12) (3 drop out)Male: 34 Female: 16G1 = foot massage G2 = control groupThe Verran and Snyder-Halpern Sleep ScaleThe total score of the Verran and Synder-Halpern Sleep Scale improved: G1 vs. G2 ( < 0.05) G1 = 41.98 (SD = 13.92), G1 = 60.60 (SD = 10.75) G2 = 42.15 (SD = 11.78), G2 = 52.23 (SD = 11.76)

Toygar et al., 2020, TurkeyAged 18 years and above, who are the primary informal caregivers of cancer patients (without any professional help)66, G1 = 33, G2 = 33 mean age: G1 = 41.52 y/o (SD = 13.88), G2 = 39.02 y/o (SD = 12.80)Male: 10 Female: 56G1 = foot reflexology G2 = control group (shame intervention)Richard–Campbell Sleep Questionnaire (RCSQ) state-trait anxiety inventory (STAI)The total score of RCSQ improved: G1 vs. G2 ( < 0.05) G1 = 430.3 (SD = 43.46), G1 = 441.8 (SD = 35.51) G2 = 441.2 (SD = 35.18), G2 = 409.5 (SD = 50.08) the total score of STAI improved: G1 vs. G2 ( < 0.05) G1 = 46.67 (SD = 7.21), G1 = 38.91 (SD = 5.63) G2 = 47.94 (SD = 10.62), G2 = 46.30 (SD = 11.29)
Bahrami et al., 2019, IranA female patient aged ≥60 y/o diagnosed with acute coronary syndrome consisting of angina pectoris and myocardia infraction, no anxiolytics and sedative medications in the last four hours before the intervention90, G1 = 45, G2 = 45 mean age: G1 = 72.86 y/o (SD = 7.98), G2 = 72.62 y/o (SD = 7.93)Male: 0 Female: 90G1 = foot reflexology G2 = control groupHospital depression scale (HADS-D) hospital anxiety scale (HADS-A)The total score of HADS-D improved: G1 vs. G2 ( < 0.05) G1 = 13.66 (SD = 4.64), G1 = 8.42 (SD = 3.62) G2 = 11.74 (SD = 4.29), G2 = 11.11 (SD = 3.42) the total score of HADS-A improved: G1 vs. G2 ( < 0.05) G1 = 13.77 (SD = 4.39), G1 = 8.53 (SD = 3.71) G2 = 11.66 (SD = 4.24), G2 = 11.06 (SD = 3.19)

Noh et al., 2019, South KoreaGynaecologic cancer patients receiving chemotherapy and hospitalized in the gynaecological ward, who received short-term chemotherapy (at least 2 weeks chemotherapy)63, G1 = 32, G2 = 31 mean age: G1 = 56.34 y/o (SD = 9.04), G2 = 55.36 y/o (SD = 9.96) (1 drop out)Male: 0 Female: 63G1 = self-foot reflexology G2 = control groupHospital depression scale (HADS-D); hospital anxiety scale (HADS-A)The total score of HADS-D improved: G1 vs. G2 ( < 0.01) G1 = 9.31 (SD = 4.47), G1 = 8.03 (SD = 4.28) G2 = 8.58 (SD = 4.36), G2 = 9.48 (SD = 4.14) the total score of HADS-A improved: G1 vs. G2 ( < 0.01) G1 = 7.25 (SD = 4.05), G1 = 5.69 (SD = 3.46) G2 = 6.48 (SD = 3.06), G2 = 7.39 (SD = 3.23)

Mahdavipour et al., 2019, IranWomen during their menopausal period, aged 40–60 y/o, diagnosis of depression by a psychiatrist based on DSM-IV, and the total depression score >14 based on the Beck Depression Inventory90, G1 = 45, G2 = 45 mean age: G1 = 54.18 y/o (SD = 3.90), G2 = 52.23 y/o (SD = 11.6) (10 drop out)Male: 0 Female: 90G1 = foot reflexology G2 = control groupBeck Depression Inventory-second edition (BDI-II)The total score of BDI-II improved: G1 vs. G2 ( < 0.001) G1 = 26.97 (SD = 4.47), G1 = 22.55 (SD = 5.18) G2 = 26.15 (SD = 5.01), G2 = 26.22 (SD = 5.14)

Soheili et al., 2017, IranFemale patients aged 18–75 y/o, with a definite diagnosis of multiple sclerosis by a medicine specialist75, G1 = 25, G2 = 25, G3 = 25 mean age: G1 = 34.4 y/o (SD = 6.6), G2 = 33.9 y/o (SD = 5.6) G3 = 34.0 y/o (SD = 7.7)Male: 0 Female: 75G1 = foot reflexology G2 = relaxation G3 = control groupDepression, anxiety and stress scale‐21 (DASS‐21)The total score of DASS-21 depression improved: G1 vs. G3 ( = 0.03) G1 = 20.72 (SD = 7.56), G1 = 13.20 (SD = 6.16) G3 = 19.52 (SD = 6.06), G3 = 18.64 (SD = 6.99) the total score of DASS-21 anxiety improved: G1 vs. G3 ( = 0.03) G1 = 16.72 (SD = 6.66), G1 = 10.40 (SD = 7.37) G3 = 16.80 (SD = 6.90), G3 = 14.88 (SD = 6.50)

Vardanjani et al., 2013, IranThe patients were candidates for their first elective coronary angiography without the symptoms of myocardial infarction100, G1 = 50, G2 = 50 mean age: G1 = 52.6 y/o (SD = 7.8), G2 = 54.8 y/o (SD = 5.6)Male: 100 female: 0G1 = foot reflexology G2 = control groupState-Trait Anxiety Inventory (STAI)The total score of STAI improved: G1 vs. G2 ( = 0.0001) G1 = 53.24 (SD = 4.29), G1 = 45.24 (SD = 3.32) G2 = 49.62 (SD = 5.31), G2 = 43.70 (SD = 5.06)

Bagheri-nesami et al., 2014, IranVoluntary participants participate in the study for first nonemergency cardiac surgery by using a heart-lung machine80, G1 = 40, G2 = 40 mean age: G1 = 58.75 y/o (SD = 8.69), G2 = 58.90 y/o (SD = 9.58)Male: 40 female: 40G1 = foot reflexology G2 = control groupVisual Analogue Scale of Anxiety (VAS-A)The total score of VAS-A improved: G1 vs. G2 ( < 0.05) G1 = 1.93 (SD = 2.81), G1 = 1.45 (SD = 2.90) G2 = 1.78 (SD = 2.11), G2 = 2.00 (SD = 2.44)

Khaledifar et al., 2017, IranParticipants aged ≥18 y/o, candidate for coronary angiography in hospital, absence of acute psychological disorders, or use of antistress drugs within recent 48 hours75, G1 = 25, G2 = 25, G3 = 25 mean age: G1 = 67.2 y/o (SD = 11.8), G2 = 67.0 y/o (SD = 11.1) G3 = 64.7 y/o (SD = 12.1)Male: 38 female: 37G1 = foot reflexology G2 = massage therapy G3 = control groupState-Trait Anxiety Inventory (STAI)The total score of STAI improved: G1 vs. G3 ( < 0.05) G1 = 60.60 (SD = 7.20), G1 = 34.70 (SD = 4.70) G3 = 47.80 (SD = 9.60), G3 = 46.50 (SD = 9.20)

Saatsaz et al., 2016, IranFemale, aged 20–35 y/o, being primiparous, giving birth to a living and healthy child, being conscious, and having junior high school or higher degree of education to comprehend the numerical pain scale106, G1 = 52, G2 = 52, G3 = 52 mean age: G1 = 27.04 y/o (SD = 2.77), G2 = 26.73 y/o (SD = 3.81), G3 = 27.75 y/o (SD = 3.22)Male: 0 Female: 106G1 = foot massage G2 = foot and hand massage G3 = control groupState-Trait Anxiety Inventory (STAI)The total score of STAI improved: G1 vs. G3 ( < 0.05) G1 = 31.52 (SD = 9.93), G1 = 28.23 (SD = 8.88) G3 = 30.17 (SD = 6.98), G3 = 30.38 (SD = 6.93)

Pasyar et al., 2018, IranPatients who had undergone tibial shaft fracture surgery; aged ≥18 y/o; an open reduction and internal fixation surgery for a tibial fracture, hospital admission for at least 1 day after surgery66, G1 = 33, G2 = 33 G1 = not mentioned G2 = not mentionedMale: 53 female: 13G1 = foot reflexology G2 = control groupState-Trait Anxiety Inventory (STAI)The total score of STAI improved: G1 vs. G2 ( < 0.05) G1 = 54.72 (SD = 7.36), G1 = 42.84 (SD = 6.50) G2 = 57.48 (SD = 9.14), G2 = 58.36 (SD = 10.37)

Koras et al., 2019, TurkeyPatients age ≥18 y/o who underwent laparoscopic cholecystectomy without any complication with pain severity greater than 4 on VAS (visual analogue scale) after surgery167, G1 = 85, G2 = 82 mean age: G1 = not mentioned G2 = not mentionedMale: 50 female: 117G1 = foot massage G2 = control groupState-Trait Anxiety Inventory (STAI)The total score of STAI improved: G1 vs. G2 ( < 0.05) G1 = 49.74 (SD = 13.54), G1 = 28.67 (SD = 9.12) G2 = 43.67 (SD = 8.11), G2 = 51.84 (SD = 6.61)

Eguchi et al., 2016, JapanMen and women aged 20 to 70 who lived in or near Matsuyama, Ehime Prefecture, Japan55, G1 = 27, G2 = 28 mean age: G1 = 49.0 y/o (SD = 13.6), G2 = 48.8 y/o (SD = 11.4)Male: 5 female: 50G1 = foot reflexology G2 = control groupState-Trait Anxiety Inventory (STAI)The total score of STAI improved: G1 vs. G2 ( < 0.05) G1 = 41.1 (SD = 11.2), G1 = 38.0 (SD = 9.4) G2 = 40.6 (SD = 10.0), G2 = 40.0 (SD = 9.2)

Ozturk et al., 2018, TurkeyVoluntary participants who have undergone abdominal hysterectomy operation and reported postoperation pain of 3 or above according to visual analog scale63, G1 = 32, G2 = 31 mean age: 47.23 y/o (SD = 4.71)Male: 0 female: 63G1 = foot reflexology G2 = control groupState-Trait Anxiety Inventory (STAI)The total score of STAI improved: G1 vs. G2 ( < 0.05) G1 = 58.87 (SD = 4.81), G1 = 45.75 (SD = 4.25) G2 = 57.32 (SD = 4.81), G2 = 55.96 (SD = 3.85)

Ramezanibadr et al. 2018 IranMale candidates for undergoing coronary angiography, aged 40–80 y/o, had neither health problems nor arterial line in the feet, received no anxiolytic agent during the past 48 hours before the intervention150, G1 = 50, G2 = 50, G3 = 50 mean age: 66.5 y/o (SD = 4.6)Male: 150 Female: 0G1 = foot reflexology G2 = placebo group G3 = control groupState-Trait Anxiety Inventory (STAI)The total score of STAI improved: G1 vs. G3 ( < 0.05) G1 = 61.68 (SD = —), G1 = 45.58 (SD = —) G2 = 60.52 (SD = —), G2 = 59.14 (SD = —)

Shahsavari et al., 2017, IranPatients between the age of 18–60 y/o, no lesion or disorder on the feet and other conditions affecting the feet, no previous history of bronchoscopy, or participation in similar studies80, G1 = 40, G2 = 40 mean age: G1 = 45.55 y/o (SD = 1.78), G2 = 48.23 y/o (SD = 1.72)Male: 41 female: 39G1 = foot reflexology G2 = control groupVisual Analogue Scale of Anxiety (VAS-A)The total score of VAS-A improved: G1 vs. G2 ( < 0.05) G1 = 4.35 (SD = 2.08), G1 = 2.83 (SD = 1.45) G2 = 3.78 (SD = 1.83), G2 = 4.88 (SD = 2.15)

Abbaszadeh et al., 2018, IranParticipants who had been diagnosed with coronary artery disease and were candidates for nonurgent CABG (coronary artery bypass graft)120, G1 = 40, G2 = 40, G3 = 40 mean age: G1 = 55.90 y/o (SD = 8.31), G2 = 57.32 y/o (SD = 8.62) G3 = 56.30 y/o (SD = 7.11)Male: 120 female: 0G1 = foot reflexology G2 = placebo group G3 = control groupShort-form of Atate-Trait Anxiety Inventory (short-form of STAI)The total score of STAI improved: G1 vs. G3 ( > 0.05) G1 = 8.25 (SD = 2.71), G1 = 6.21 (SD = 0.82) G2 = 10.81 (SD = 2.16), G2 = 7.80 (SD = 2.31)

Levy et al., 2020, IsraelWomen aged over 18 years, hospitalization in obstetrics ward during labor, primiparity, with moderate to severe anxiety at admission Visual Analogue Scale (VAS) ≥4189, G1 = 99, G2 = 90 mean age: G1 = 28.6 y/o (SD = 4.4), G2 = 27.9 y/o (SD = 4.5)Male: 0 female: 189G1 = foot reflexology G2 = control groupVisual Analogue Scale of Anxiety (VAS-A)The total score of VAS-A improved: G1 vs. G2 ( < 0.05) G1 = 7.9 (SD = 1.8), G1 = 5.5 (SD = 2.4) G2 = 7.9 (SD = 2.0), G2 = 8.6 (SD = 2.4)

BDI-II = Beck Depression Inventory-second edition; CABG = coronary artery bypass graft; DASS‐21 = depression, anxiety, and stress scale‐21; DSM-IV = Diagnostic and Statistical Manual of mental disorders, 4th edition; G1 = group 1, G2 = group 2, G3 = group 3; HADS-A = hospital anxiety and depression scale-anxiety; HADS-D = hospital anxiety and depression scale-depression; PSQI = Pittsburgh Sleep Quality Index; SMHSQ = St. Mary’s Hospital Sleep Questionnaire; STAI = State-Trait Anxiety Inventory; RCSQ = Richard–Campbell Sleep Questionnaire; VAS-A = visual analogue scale for anxiety.

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