Abstract
Background: Reflexology is a non-invasive, inexpensive, and simple technique that can be employed for pregnant women.
Objective: This study aimed to determine the effects of reflexology on anxiety during labor (primary outcome) and its side effects (secondary outcome).
Methods: In this systematic review, the Cochrane Library, PubMed, Google Scholar, Scopus, Web of Science, SID, Science Direct, and ProQuest databases were searched systematically and without time constraints until 20 April 2021. The quality of the selected articles was assessed using Cochrane Handbook and the meta-analysis was performed utilizing RevMan 5.3. Heterogeneity was evaluated by the I2 statistic and as there was heterogeneity between the studies, subgroup analysis was carried out based on the control group. Since the anxiety assessment tools in the included studies were identical, the mean difference (MD) was reported. The quality of the evidence was assessed using the GRADE approach.
Results: Six studies that included 643 pregnant women were investigated in this systematic review. The results of the meta-analysis using five of the studies revealed that reflexology significantly lowered the mean scores for maternal anxiety compared to routine care or simple massage (MD: -11.34; 95% CI: -16.28 to -6.40). None of the studies reported any specific side effects after reflexology treatment.
Conclusion: Reflexology can decrease maternal anxiety during labor. However, given the small number of studies and the high or unclear bias risk in most of them, no definitive conclusions can be drawn, and it is recommended that further research with stronger methodologies be conducted on this subject.
Keywords: foot reflexology, anxiety, childbirth, systematic review, pregnancy, meta-analysis
Graphical Abstract
[1]
Maier B. Women’s worries about childbirth: Making safe choices. Br J Midwifery 2010; 18(5): 293-9.
[http://dx.doi.org/10.12968/bjom.2010.18.5.47859]
[http://dx.doi.org/10.12968/bjom.2010.18.5.47859]
[2]
Hall WA, Hauck YL, Carty EM, Hutton EK, Fenwick J, Stoll K. Childbirth fear, anxiety, fatigue, and sleep deprivation in pregnant women. J Obstet Gynecol Neonatal Nurs 2009; 38(5): 567-76.
[http://dx.doi.org/10.1111/j.1552-6909.2009.01054.x] [PMID: 19883478]
[http://dx.doi.org/10.1111/j.1552-6909.2009.01054.x] [PMID: 19883478]
[3]
Madhavanprabhakaran GK, D’Souza MS, Nairy KS. Prevalence of pregnancy anxiety and associated factors. Int J Afr Nurs Sci 2015; 3: 1-7.
[http://dx.doi.org/10.1016/j.ijans.2015.06.002]
[http://dx.doi.org/10.1016/j.ijans.2015.06.002]
[4]
Leach LS, Poyser C, Fairweather-Schmidt K. Maternal perinatal anxiety: A review of prevalence and correlates. Clin Psychol 2017; 21(1): 4-19.
[http://dx.doi.org/10.1111/cp.12058]
[http://dx.doi.org/10.1111/cp.12058]
[5]
Ding X-X, Wu Y-L, Xu S-J, et al. Maternal anxiety during pregnancy and adverse birth outcomes: A systematic review and meta-analysis of prospective cohort studies. J Affect Disord 2014; 159: 103-10.
[http://dx.doi.org/10.1016/j.jad.2014.02.027] [PMID: 24679397]
[http://dx.doi.org/10.1016/j.jad.2014.02.027] [PMID: 24679397]
[6]
Grigoriadis S, Graves L, Peer M, Mamisashvili L, Tomlinson G, Vigod SN, et al. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: Systematic review and meta-analysis. J Clin Psychiatry 2018; 79: 5.
[http://dx.doi.org/10.4088/JCP.17r12011]
[http://dx.doi.org/10.4088/JCP.17r12011]
[7]
Misri S, Kendrick K. Treatment of perinatal mood and anxiety disorders: A review. Can J Psychiatry 2007; 52(8): 489-98.
[http://dx.doi.org/10.1177/070674370705200803] [PMID: 17955910]
[http://dx.doi.org/10.1177/070674370705200803] [PMID: 17955910]
[8]
McNeill JA, Alderdice FA, McMurray F. A retrospective cohort study exploring the relationship between antenatal reflexology and intranatal outcomes. Complement Ther Clin Pract 2006; 12(2): 119-25.
[http://dx.doi.org/10.1016/j.ctcp.2005.11.004] [PMID: 16648089]
[http://dx.doi.org/10.1016/j.ctcp.2005.11.004] [PMID: 16648089]
[9]
Ernst E, Posadzki P, Lee MS. Reflexology: An update of a systematic review of randomised clinical trials. Maturitas 2011; 68(2): 116-20.
[http://dx.doi.org/10.1016/j.maturitas.2010.10.011] [PMID: 21111551]
[http://dx.doi.org/10.1016/j.maturitas.2010.10.011] [PMID: 21111551]
[10]
Tiran D, Chummun H. The physiological basis of reflexology and its use as a potential diagnostic tool. Complement Ther Clin Pract 2005; 11(1): 58-64.
[http://dx.doi.org/10.1016/j.ctnm.2004.07.007] [PMID: 15984227]
[http://dx.doi.org/10.1016/j.ctnm.2004.07.007] [PMID: 15984227]
[11]
Lee J, Han M, Chung Y, Kim J, Choi J. Effects of foot reflexology on fatigue, sleep and pain: A systematic review and meta-analysis. J Korean Acad Nurs 2011; 41(6): 821-33.
[http://dx.doi.org/10.4040/jkan.2011.41.6.821] [PMID: 22310867]
[http://dx.doi.org/10.4040/jkan.2011.41.6.821] [PMID: 22310867]
[12]
Yılar Erkek Z, Aktas S. The effect of foot reflexology on the anxiety levels of women in labor. J Altern Complement Med 2018; 24(4): 352-60.
[http://dx.doi.org/10.1089/acm.2017.0263] [PMID: 29474093]
[http://dx.doi.org/10.1089/acm.2017.0263] [PMID: 29474093]
[13]
Mahdavipour F, Rahemi Z, Sadat Z, Ajorpaz NM. The effects of foot reflexology on depression during menopause: A randomized controlled clinical trial. Complement Ther Med 2019; 47: 102195.
[http://dx.doi.org/10.1016/j.ctim.2019.102195] [PMID: 31780002]
[http://dx.doi.org/10.1016/j.ctim.2019.102195] [PMID: 31780002]
[14]
McCullough JEM, Close C, Liddle SD, Sinclair M, Hughes CM. A pilot randomised controlled trial exploring the effects of antenatal reflexology on labour outcomes. Midwifery 2017; 55: 137-44.
[http://dx.doi.org/10.1016/j.midw.2017.09.006] [PMID: 29024881]
[http://dx.doi.org/10.1016/j.midw.2017.09.006] [PMID: 29024881]
[15]
Kim Y-H, Cho S-H. The effect of foot reflexology on premenstrual syndrome and dysmenorrhea in female college students. Korean J Women Health Nurs 2002; 8(2): 212-21.
[http://dx.doi.org/10.4069/kjwhn.2002.8.2.212]
[http://dx.doi.org/10.4069/kjwhn.2002.8.2.212]
[16]
Sehhatti F, Hughes C, Mirghafourvand M, Azan ZA. The effect of short-term foot reflexology in improving constipation symptoms during pregnancy: A two-armed, randomized controlled trial. Int J Women’s Health Reprod Sci 2020; 8(3): 303-10.
[http://dx.doi.org/10.15296/ijwhr.2020.49]
[http://dx.doi.org/10.15296/ijwhr.2020.49]
[17]
Moghimi-Hanjani S, Mehdizadeh-Tourzani Z, Shoghi M. The effect of foot reflexology on anxiety, pain, and outcomes of the labor in primigravida women. Acta Med Iran 2015; 53(8): 507-11.
[PMID: 26545996]
[PMID: 26545996]
[18]
Higgins J, Green S. Cochrane handbook for systematic reviewsof interventions version 5.1. 0: The cochrane collaboration. 2011.
[19]
Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ 2004; 328(7454): 1490.
[http://dx.doi.org/10.1136/bmj.328.7454.1490] [PMID: 15205295]
[http://dx.doi.org/10.1136/bmj.328.7454.1490] [PMID: 15205295]
[20]
Baljon KJ, Romli MH, Ismail AH, Khuan L, Chew BH. Effectiveness of breathing exercises, foot reflexology and back massage (BRM) on labour pain, anxiety, duration, satisfaction, stress hormones and newborn outcomes among primigravidae during the first stage of labour in Saudi Arabia: A study protocol for a randomised controlled trial. BMJ Open 2020; 10(6): e033844.
[http://dx.doi.org/10.1136/bmjopen-2019-033844] [PMID: 32540887]
[http://dx.doi.org/10.1136/bmjopen-2019-033844] [PMID: 32540887]
[21]
Akköz Çevik S, Incedal İ. The effect of reflexology on labor pain, anxiety, labor duration, and birth satisfaction in primiparous pregnant women: A randomized controlled trial. Health Care Women Int 2021; 42(4-6): 710-25.
[http://dx.doi.org/10.1080/07399332.2020.1800014] [PMID: 32877317]
[http://dx.doi.org/10.1080/07399332.2020.1800014] [PMID: 32877317]
[22]
Navaee M, Khayat S, Abed ZG. Effect of pre-cesarean foot reflexology massage on anxiety of primiparous women. J Complement Integr Med 2020; 17(3): 2019-0229.
[http://dx.doi.org/10.1515/jcim-2019-0229]
[http://dx.doi.org/10.1515/jcim-2019-0229]
[23]
Mirzaee F, Kaviani M, Jafari P. Effect of reflexology on anxiety level in nuliparous women. Hayat (Tihran) 2010; 16(1): 15-71.
[24]
Levy I, Attias S, Stern Lavee T, et al. The effectiveness of foot reflexology in reducing anxiety and duration of labor in primiparas: An open-label randomized controlled trial. Complement Ther Clin Pract 2020; 38: 101085.
[http://dx.doi.org/10.1016/j.ctcp.2019.101085] [PMID: 32056811]
[http://dx.doi.org/10.1016/j.ctcp.2019.101085] [PMID: 32056811]
[25]
Spielberger CD. State-Trait anxiety inventory. The Corsini encyclopedia of psychology 2010.
[http://dx.doi.org/10.1002/9780470479216.corpsy0943]
[http://dx.doi.org/10.1002/9780470479216.corpsy0943]
[26]
Williams VS, Morlock RJ, Feltner D. Psychometric evaluation of a visual analog scale for the assessment of anxiety. Health Qual Life Outcomes 2010; 8(1): 57.
[http://dx.doi.org/10.1186/1477-7525-8-57] [PMID: 20529361]
[http://dx.doi.org/10.1186/1477-7525-8-57] [PMID: 20529361]
[27]
Hornblow AR, Kidson M-A. The visual analogue scale for anxiety: A validation study. Aust N Z J Psychiatry 1976; 10(4): 339-41.
[http://dx.doi.org/10.3109/00048677609159523] [PMID: 1071419]
[http://dx.doi.org/10.3109/00048677609159523] [PMID: 1071419]
[28]
Wang W-L, Hung H-Y, Chen Y-R, et al. Effect of foot reflexology intervention on depression, anxiety, and sleep quality in adults: A meta-analysis and metaregression of randomized controlled trials. Evid Based Complement Alternat Med 2020; 2020: 2654353.
[http://dx.doi.org/10.1155/2020/2654353] [PMID: 33014101]
[http://dx.doi.org/10.1155/2020/2654353] [PMID: 33014101]
[29]
Anjoman Azari Z, Mirghafourvand M, Hughes C, Havizari S. Effect of Foot Reflexology on Constipation: A Systematic Review and Meta-Analysis. Shiraz E Med J 2021; 22(1): 1-11.
[http://dx.doi.org/10.5812/semj.100585]
[http://dx.doi.org/10.5812/semj.100585]
[30]
Yeung W-F, Chung K-F, Poon MM-K, et al. Acupressure, reflexology, and auricular acupressure for insomnia: A systematic review of randomized controlled trials. Sleep Med 2012; 13(8): 971-84.
[http://dx.doi.org/10.1016/j.sleep.2012.06.003] [PMID: 22841034]
[http://dx.doi.org/10.1016/j.sleep.2012.06.003] [PMID: 22841034]
[31]
Hasanpour M, Mohammadi MM, Shareinia H. Effects of reflexology on premenstrual syndrome: A systematic review and meta-analysis. Biopsychosoc Med 2019; 13(1): 25.
[http://dx.doi.org/10.1186/s13030-019-0165-0] [PMID: 31673284]
[http://dx.doi.org/10.1186/s13030-019-0165-0] [PMID: 31673284]
[32]
Chandrababu R, Rathinasamy EL, Suresh C, Ramesh J. Effectiveness of reflexology on anxiety of patients undergoing cardiovascular interventional procedures: A systematic review and meta-analysis of randomized controlled trials. J Adv Nurs 2019; 75(1): 43-53.
[http://dx.doi.org/10.1111/jan.13822] [PMID: 30109722]
[http://dx.doi.org/10.1111/jan.13822] [PMID: 30109722]
[33]
Oliver JS. Reflexotherapy of the Feet. Physiotherapy 2000; 86(10): 556.
[http://dx.doi.org/10.1016/S0031-9406(05)60994-7]
[http://dx.doi.org/10.1016/S0031-9406(05)60994-7]
[34]
McCullough JEM, Liddle SD, Close C, Sinclair M, Hughes CM. Reflexology: A randomised controlled trial investigating the effects on beta-endorphin, cortisol and pregnancy related stress. Complement Ther Clin Pract 2018; 31: 76-84.
[http://dx.doi.org/10.1016/j.ctcp.2018.01.018] [PMID: 29705485]
[http://dx.doi.org/10.1016/j.ctcp.2018.01.018] [PMID: 29705485]
[35]
Embong NH, Soh YC, Ming LC, Wong TW. Perspectives on reflexology: A qualitative approach. J Tradit Complement Med 2016; 7(3): 327-31.
[http://dx.doi.org/10.1016/j.jtcme.2016.08.008] [PMID: 28725628]
[http://dx.doi.org/10.1016/j.jtcme.2016.08.008] [PMID: 28725628]
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