Reflexology in Primary Care What is the evidence? Patricia H. Cox, - - PDF document

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Reflexology in Primary Care What is the evidence?

Patricia H. Cox, DNP, MPH, FNP‐BC Assistant Professor

I have no conflict of interest to disclose Objectives

• Define reflexology and history
• Identify clinical areas where reflexology is

being used

• Discuss the use, benefits and evidence of

reflexology

• Explore the use of self‐reflexology as a self

care measure

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What is reflexology?

Whoa….what does that all mean?

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Reflexology

• The entire body is reflected on the feet, hands

and ears.

• Non‐invasive complementary discipline

employing alternating pressure on body maps

• n the feet, hands and ears.
• Reduces stress which causes physiological

changes in the body.

• Provides relaxation which may help the body

balance.

Foot Reflexology Hand Reflexology

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Brief History Brief History

• Believed to have started in Egypt, Tibet, China

and/or with Native American Indians.

• There is no proof but art and sculptures of

indigenous cultures do indicate working on the feet.

• The first use of the word ‘reflex’ with reference to

motor reactions was by the German physiologist Johann August Unzer in 1771.

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Brief History

• Fitzgerald, the father of ‘zone therapy’, divided

the body into ten zones—five on each side of the sagittal plane.

• Doctors and dentists used as a form of pain relief
• r analgesia.
• Riley, began reflexology as known today, reflexes

found on feet and hands follow the anatomy of the body.

• In 1930 Eunice Ingham contributed that

alternating pressure stimulated healing.

What is reflexology used for?

• Anxiety
• Asthma
• Cancer treatment
• Cardiovascular issues
• Diabetes
• Headaches
• Kidney function
• PMS
• Sinusitis
• Palliative care & Hospice

What are the benefits of reflexology?

• It promotes stress reduction throughout

the entire body, bringing about relaxation

• It naturally promotes balance and

normalizations of the body through the relaxation process

• It stimulates circulation and the delivery
• f oxygen and nutrients to the cells.

10/12/2016 6 What is the evidence?

Kunz & Kunz (2008) summarized 168 research studies and abstracts from journals and meetings from around the world. Many in peer‐reviewed journals in China and Korea. All had information about the frequency and duration of the reflexology application. They concluded that reflexology may:

• Impact specific organs (e.g., fMRI readings demonstrated an increase in

blood flow to kidneys and to the intestines)

• Be associated with an amelioration of symptoms (e.g., positive changes

were noted in kidney functioning with kidney dialysis patients)

• Create a relaxation effect (e.g., EEGs measure alpha and theta waves,

blood pressure was decreased, and anxiety was lowered)

• Aid in pain reduction (27 studies demonstrated a positive outcome for

reduction in pain; e.g., AIDS, chest pain, peripheral neuropathy of diabetes mellitus, kidney stones, and osteoarthritis)

What is the evidence?

Other systematic reviews are cautious:

• reflexology may have a positive effect on type 2

diabetes

• may exert a beneficial effect of lowering blood

pressure and incontinence(Song, 2015)

• may have a positive impact on blood pressure

(McCullough, 2014)

• may be effective for tingling in MS(Yadav, 2015).

These reviews note that the quality of research studies on reflexology is generally low.

What is the evidence?

Ernst, Posadzki & Lee (2011) conducted a systematic review. They evaluated the effectiveness

• f reflexology in the treatment of human

conditions. Twenty‐three RCTs met their inclusion criteria:

• 8 suggested that reflexology had beneficial effects
• 14 showed no effectiveness
• one was equivocal.

The authors note that the quality of the studies was

• ften poor.

10/12/2016 7 The Bottom Line

Studies in the U.S. and around the world indicate possible benefits of reflexology for various conditions:

• as an intervention to reduce pain
• enhance relaxation
• reduce psychological symptoms, such as anxiety

and depression. However, reviewers of the research have noted that the quality of reflexology studies is mixed and more high‐quality research is needed.

Is reflexology safe?

Reflexology is a safe healing practice however there are a few contraindications:

• foot fractures, unhealed wounds, or active gout in the foot.
• osteoarthritis of the foot or ankle
• vascular disease of the legs or feet
• current thrombosis or embolism
• women in early pregnancy (the first 6 weeks). Caution should

be exercised during pregnancy because of reports that stimulation may cause contractions.

• allow at least 48 hours between touch therapy sessions to

avoid an overload on your system.

What are the guiding principles in reflexology?

• Reflexologists do not heal clients; the body

repairs itself.

• Reflexology is offered to help bring the person

back into balance so that the body can nurture and repair itself.

• A relaxed body can induce calm emotions, a

serene mind, and an integrated spirit.

• The body responds to touch, which can

facilitate healing on all levels.

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Self‐reflexology as self‐care

https://www.youtube.com/watch?v=VIiO7WOw rgk

Finally

"If you're feeling out of kilter. Don't know why or what about. Let your feet reveal the answer. Find the sore spot work it out."

Eunice D. Ingham

The Law & Reflexology

Oregon

• 851‐050‐0005 Nurse Practitioner Scope of Practice

(8) The nurse practitioner will only provide health care services within the nurse practitioner's scope of practice for which he/she is educationally prepared and for which competency has been established and maintained. Educational preparation includes academic coursework, workshops or seminars, provided both theory and clinical experience are included.

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The Law & Reflexology

Oregon

• Board of Massage Therapists‐“Effective January 1,

2008, there has been a specific exemption for the practice of Reflexology in Oregon. The exemptions is as follows per ORS 687.031 (1)(i): Practitioners of reflexology who do not claim expressly or implicitly to be massage therapists and who limit their work to the practice of reflexology through the application of pressure with the thumbs to reflex points on the feet, hands and ears for the purpose of bringing the body into balance, thereby promoting the well‐being of clients”.

References

Dalal, K., Maran, V. B., Pandey, R.M. & Tripathi, M. (2014). Determination of Efficacy of reflexology in Managing patients with diabetic neuropathy: A randomized controlled clinical trial. Evidenced‐based Complementary & Alternative Medicine, 1‐11. Ear map [Photograph]. Retrieved from http://reflexology‐map.com/wp‐content/uploads/2013/03/REFLEXOLOGY‐ear.jpg Egyptian picture [Photograph]. Retrieved from http://static.wixstatic.com/media/be5eed_2f81c79d20e34f57bbc8853d337a5fdb.gif_srz_498_221_85_22_0.50_1.20_0.00 _gif_srz Ernst, E., Posadzki, P., Lee, M.S. (Feb 2011). Reflexology: an update of a systematic review of randomised clinical trials. Maturitas. 68 (2): 116–20. Feet [Photograph]. Retrieved from http://i.dailymail.co.uk/i/pix/2009/05/30/article‐1189708‐051F57BC000005DC‐ 33_468x417.jpg Foot map [Photograph]. Retrieved fromhttp://enjoyrelaxingmoments.abmp.com/footreflexology.jpg http://clairemariemiller.com/product/85x11‐foot‐chart Guven, S.D. & Karatas, N. (2013). The effect of foot reflexology applied to patients with hypertension on blood pressure, cholesterol levels and quality of life. Turkish Journal of Research & Development in Nursing, 15 (3): 56‐67 Hand map [Photograph]. Retrieved from http://reflexology‐map.com/wp‐content/uploads/2013/03/hands.jpg Hodgson H. (2000). Does reflexology impact on cancer patients’ quality of life? Nursing Standard, 14(31): 33‐38. Hodgson, N.A., Andersen, S. (2008). The clinical efficacy of reflexology in nursing home residents with dementia. The Journal of Alternative & Complementary Medicine, 14(3): 269‐275. Hughes, C.M., McCullough, C.A., Bradbury, I., Boyde, C., Hume, D., Yuan, J., Quinn, F., & McDonough, S.M. (2009). Acupuncture and reflexology for insomnia: a feasibility study. Acupuncture in Medicine, 27 (4): 163‐168. Jones, J., Thomson, P., Lauder, W., & Leslie, S.J. (2013). A proposed reductionist solution to address the methodological challenges

• f inconsistent reflexology maps and poor experimental controls in reflexology research: a discussion paper. The Journal of

Alternative & Complementary Medicine, 19(3): 232‐234.

References

Jones, J., Thomson, P., Irvine, K. & Leslie, S.J. (2013). Is there a specific hemodynamic effect in reflexology? A systematic review of randomized controlled trials. The Journal of Alternative & Complementary Medicine, 19 (4): 319‐328. Kunz, B. & Kunz, K. (2008). Evidence‐Based Reflexology for Health Professionals and Researchers: The Reflexology Research Series. Lakasing, E. & Lawrence, D. (2010). When to use reflexology. Primary Health Care, 20 (1): 16‐19. McCullough, J.E.M., Liddle, S.D., Sinclair, M., Close, C. & Hughes, C.M. (2014). The physiological and biochemical

• utcomes

associated with a reflexology treatment: a systematic review. Evidenced‐based Complementary & Alternative Medicine, 1‐ 16. Ozdemir, G., Ovayolu, N. & Ovayolu, O. (2013). The effect of reflexology applied on haemodialysis patients with fatigue, pain and cramps. International Journal of Nursing Practice, 19: 265‐273. Song, H.J., Choi, S.M., Seo, H., Lee, H., Son, H., & Lee, S. (2015). Self‐administered reflexology for the management of chronic health conditions: a systematic review. The Journal of Alternative & Complementary Medicine, 21 (2): 69‐76. Wang, M., Tsai, P., Lee, P., Chang, W. & Yang, C. (2008). The efficacy of reflexology: systematic review. Journal of Advanced Nursing, 62 (5): 512‐520. Wyatt, G., Sikorskii, A., Rahbar, M.H., Victorson, D. & You, M. (2012). Health‐related quality of life outcomes: a reflexology trial with patients with advanced‐stage breast cancer. Oncology Nursing Forum, 39 (6): 568‐577. Yadav , V., Bever , C., Bowen, J., Bowling , A., Weinstock‐Guttman ,B., Cameron , M., Bourdette , D., Gronseth ,G.S., Narayanaswami , P. (2014). Summary of evidence‐based guideline: complementary and alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology.

• Neurology. 82(12):1083‐92.

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