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Med. J. Cairo Univ., Vol. 79, No.

2, September: 193-202, 2011


www.medicaljournalofcairouniversity.com

Effect of Nursing Interventions Using Foot Reflexology on


Blood Pressure and Quality of Life of Hypertensive Patients
at Mansoura University Hospitals: Preliminary Results
KARIMA ELSHAMY, D.N.Sc.* and EMAN ELSAFETY, M.D.**
The Departments Adult Nursing* and Cardiovascular Medical**, Faculty of Nursing, Mansoura University, Egypt

Abstract defined as a condition in which individuals have


The aim of this study was to investigate the effect of foot a systolic pressure of equal to or greater than
reflexology on blood pressure and quality of life among 140mmHg and a diastolic pressure of equal to or
hypertensive patients. A quasi-experimental study was con- greater than 90 mmHg on at least three occasions,
ducted for patients with hypertension attended the outpatient or individuals who require medication to remain
clinic of the Specialized Medical Hospital at Mansoura Uni-
normotensive [3-5] .
versity, Egypt, enrolled in this study during six months,
between 15 May and 14 October 2010 were randomly allocated
into two equal groups (40 in the foot reflexology group
Hypertension is one of the conditions purported
(intervention), and 40 in the control group. to be improved by complementary therapies such
as foot reflexology [1,2] . Pressure techniques applied
Two tools were used for data collection:
on the feet are believed to help unblock nerve
I : Demographic and medical interview schedule.
supply and improve blood flow, which may help
II: Quality of Life Questionnaire. the body to function at its peak 1. It is claimed
Systolic blood pressure decreased significantly in inter- that reflexology relieves stress and tension by
vention group from 160.2mmHg to 136.5mmHg compared to inducing relaxation [1,6] . By doing this, it brings
(162.5mmHg to 155.2mmHg) in controls. There was a statis-
tically significant decrease in means of diastolic blood pressure
about vasodilatation, blood pressure, improved
between pre and post intervention (102.0mmHg –87.5mmHg) blood flow and provision of oxygen-rich nutrients
within the intervention group ( p<0.05), Change in control to cells [1,7,8] . Some authors suggest that 70 to
group was not proved to be statistically significant 80% of all diseases and illnesses come from stress
(100.1mmHg –96.4mmHg pre and post readings respectively, including hypertension, migraine, headaches, the
p>0.05). There was no evidence for improvement in Quality
of Life in either group (pre levels was 42.2, 47.1 and post
common cold, ulcers and coronary heart disease
levels was 45.9, 47.4 in the 2 groups respectively). This study [1,9] .
supported that foot reflexology can reduce blood pressure
levels in patients with hypertension, it did not support that Although not yet widely used, relaxation tech-
foot reflexology could improve quality of life in these patients. niques are potentially valuable nonpharmacological
Future research is needed to support these findings specially treatments to lower blood pressure. Such techniques
the negative ones. It is recommended that qualitative research include progressive muscle relaxation, etc ... [10] .
might be used in combination with quantitative research to
determine details of patients' feelings, interactions, attitudes, Complementary therapies such as massage and
cultural influences and satisfaction after intervention. reflexology are claimed to help reduce symptoms
of stress and tension resulting in a decrease in
Key Words: Nursing Intervention – Foot reflexology – Hyper-
tension – Blood pressure – Quality of life. blood pressure, and an adjustment of body, mind
and spirit to a state of harmony [11] ; they can also
Introduction help improve quality of life [12] .
HYPERTENSION is one of the conditions pur- Reflexology is believed to be used for more
ported to be improved by complementary therapies than 4,500 years in Egypt, as pictograph evidence
such as foot reflexology [1,2] . Hypertension is was found in the tomb of an Egyptian physician;
Correspondence to: Dr. Karima Elshamy, Adult Nursing some claim that it originated in India and China
Department, Faculty of Nursing, Mansoura University, [2,6] . During intervention, the therapist inserted
Email: Karima_elshamy2002@yahoo.com pressure on reflexology areas of plantar surface of

193
194 Effect of Nursing Interventions Using Foot Reflexology on Blood Pressure

the feet or palm of the hands using his fingers the disease and any treatment side effects but may
(specially the thumbs) which were related to each also, be worried and frustrated about their disease,
part of the body. This caused health restore and may be open to complementary therapies as an
had made a balance throughout the body [13,14] . adjunct to conventional treatments.
Reflexology, as a comprehensive approach and The aim of this study was to: Investigate the
a nursing intervention that supports traditional effect of foot reflexology on decreasing blood
care; can be used in the medical treatments [15,16] . pressure and the improvement in mean quality of
Many studies have investigated reflexology as a life among hypertensive patients.
noninvasive and non-pharmacological nursing
intervention in its various aspects such as: The Hypotheses:
impact of reflexology on hypotension without any 1- There will be a decrease in mean blood pressure
known reasons, reducing triglyceride and blood level in foot reflexology group (intervention)
sugar, improving nausea and vomiting in cancer relative to the control group (no intervention)
patients undergoing chemotherapy, reducing de- by the end of four weeks of implementation.
pression and improving immune system function, 2- There will be an improvement in mean quality
improving pain and anxiety of the cancer patients of life scores in foot reflexology group (inter-
and decrease the fatigue in pregnant women [17] . vention) relative to the control group (routine
However, in a pilot (small) study conducted on the management) by the end of four weeks of im-
anxiety of patients before and after the coronary plementation.
artery bypass graft surgery, this method has a
significant effect on the physiological parameters Subjects and Methods
of the patients [11] .
Research design: A quasi-experimental, pro-
It has been found that health care professionals spective study was conducted for patients with
have increased their use of complementary therapies hypertension enrolled in this study. Two groups
to help relieve uncomfortable symptoms and suf- were studied; foot reflexology group (intervention)
fering of patients with chronic diseases [18] . Foot and control group (routine management). All pa-
reflexology is a well known complementary therapy tients continued their usual medical treatment
which claims to help the body achieve homeostasis. throughout the duration of the study.
It is believed that pressing specific areas on the
feet related to specific glands or organs of the body Subjects and setting: The subjects of this study
can help these glands and organs to function at consisted of 80 consecutive eligible patients with
their peak, allowing the body to heal itself [1,2] . hypertension who attended the outpatient clinic of
The principal difference between massage and the Specialized Medical Hospital at Mansoura
touch and foot reflexology is that foot reflexology University, Egypt; Subjects were matched and
provides not only the relaxation effect obtained similar in gender, age, educational background,
from massage or touch but is said to also improve economic factors, marital status, duration of hy-
body immunity contributing to healing process pertension, medical history and treatments, lifestyle
[1,2] . Foot reflexology has been scientifically re- characteristics, and co-morbidities. Patients were
searched in many studies to explore the claimed randomly allocated and divided to equal numbers.
benefits [19,20] . Some studies have supported its into 40 patients in intervention and control group.
ability to reduce anxiety and pain [21-23] . However, Data collection was undertaken during six months,
there has been little scientific evidence to support between May and October 2010. Subjects were
the claim that foot reflexology can reduce blood eligible for inclusion in the study if they were:
pressure and serum lipids, and can improve the Adult males and females, aged 18 years and above,
quality of life in patients with hypertension [21- had hypertension (systolic blood pressure greater
24] . The purpose of this study was to begin to fill than or equal to 140mmHg, and diastolic blood
this gap by investigating the influence of foot pressure greater than or equal to 90mmHg) with
reflexology on blood pressure, serum lipids and or without hyperlipidaemia, had two feet, gave
quality of life in hypertensive patients. informed consent to be involved in the study and
fully conscious. Subjects were excluded from the
The role of nursing staff is to care for patients study if they had thrombotic disease of the lower
as a whole, encompassing body, mind and spirit extremities, foot ulcers, foot infections/diseases,
[24] . Demonstrating concern for patients’ needs or had undergone foot surgery, and pregnant women
helps to achieve holistic care [25] . Patients with a were excluded. Other criteria of exclusion were:
chronic disease, who are suffering not only from recent major surgery such as open heart surgery,
Karima Elshamy & Eman Elsafety 195

lesions or fractures in foot, sprains or bruises of experts and minimal modifications were made
the lower extremities, hemorrhage, epilepsy, dia- based on the given suggestion.
betic foot complication, thrombosis, kidney stone
or gallbladder, irregular heart rate and hypotension Reliability of the tool: A new standardized
[26,27] . Patients with open skin wounds on their sphygmomanometer and stethoscope were used to
feet, a foot tumor or foot metastasis, or radiation check the blood pressure. The reliability of the
treatment to the feet was also excluded [28] . sphygmomanometer and stethoscope were checked
with other standardized sphygmomanometer and
Tools of the study: stethoscope. The readings were matched with the
Two tools were used in the study: comparative devices used for the reliability testing.
Tool I: Demographic and medical interview sched- Pilot study: A pilot study was conducted in the
ule: previously mentioned setting, from 5 May 2010
A demographic data questionnaire was written to 10 May 2010. The investigator obtained formal
in Arabic language, This tool was developed by permission from the concerned authority prior to
Soliman H. (2007) in a pervious study which in- the study. The study was conducted on 10 hyper-
cluded questions on gender, age, marital status, tensive patients who fulfilled the inclusion criteria
educational background, economic factors (specif- for the selection of the sample. The purpose of the
ically, whether patients had financial problems), study was explained to the subjects and consents
duration of hypertension, medical history and were obtained after assuring privacy and confiden-
treatments, co-morbidities, and top medical treat- tiality. Baseline information was collected; and
ments. It also included questions about lifestyle blood pressure was checked after intervention. The
modification such as fat/salty foods intake, exercise, tools were found feasible and practical. No further
smoking, alcohol intake, recreation and relaxation. changes were made in the tool after the pilot study
This questionnaire was completed by participants and the investigator proceeded for the main study.
at the first day of the study [29] .
Before taking part in the study, all potential
Tool II: Quality of life questionnaire: participants were provided with information about
the study topic; the study objectives, study meth-
The World Health Organization Quality of Life-
odology, potential risks, and treatment benefits,
BREF, Arabic version (WHOQOL-BREF) ques-
privacy and confidentiality were assured. Patients
tionnaire was used. The WHOQOL-BREF is a 26-
who accepted to participate were assured that their
item, self-administered, generic questionnaire that participation was entirely voluntary and informed
is a short version of the WHOQOL-100 scale. The
of their rights as research subjects. The investigator
response options range from 1 (very dissatisfied/
clarified this information verbally and provided
very poor) to 5 (very satisfied/very good). It consists further details upon request. Patients who wished
of domains and facets (or sub-domains). The items to participate in the study were asked to give
on “overall rating of QOL” (OQOL) and subjective consent to confirm their willingness to be involved
satisfaction with health constitute the general facet in the study. They were also informed that they
on OQOL and health. The more popular model for could withdraw from the study at any time without
interpreting the scores has four domains, namely, any impact on their treatment.
physical health (seven items), psychological health
(six items), social relations (three items) and envi- Prior to randomization, participants were asked
ronment (eight items). Participants completed this to complete a demographic data questionnaire and
questionnaire at the start of the study and following the World Health Organization Quality of Life-
four weeks of intervention [30] . BREF (WHO QOL BREF) questionnaire. Revision
of their laboratory data for: A blood sugar, kidney
Methods: function, lipids and gout. Electrocardiogram was
Official permission to conduct the study was also done for all participants in the study to exclude
taken from the hospital responsible authorities patients with irregular heart rate.
after explaining study’s aims.
Eligible participants were randomly allocated
Content validity: The content validity of the into two equal groups 40 participants in the foot
first tool along with the including and excluding reflexology group (intervention) and 40 in the
criteria was submitted to 10 experts in the field of control group (routine management). Immediately
medical surgical nursing, medicine and physiother- prior to each treatment session, patients were
apy for their opinion on the items in the tool and provided with 10-minute rest. Following this rest
the criteria. There was complete agreement by time, their blood pressure level was measured by
196 Effect of Nursing Interventions Using Foot Reflexology on Blood Pressure

trained nurses in the outpatient clinic using a lumbar, sacral-coccyx zone. 7. Spinal stretch and
standard mercury sphygmomanometer and stetho- metatarsal knead [32] .
scope before and after each treatment.
Working the lungs: 1. Diaphragm relaxer then
The researchers worked to decrease factors toe walks from medial metatarsal upwards from
affecting blood pressure such as emotion, exercise, diaphragm to base of toes. 2. Do five plantar zones
respiration, meals, tobacco, alcohol, temperature, in between metatarsals; repeat other hand, back to
pain, bladder distension based on the protocols for start metatarsal knead. 3. Finger walk dorsal five
taking blood pressure [31] . The sphygmomanometer zones in between metatarsals with thumb in fist
was calibrated before use. medial to lateral. 4. Change hands, repeat lateral
to medial.
The process of reflexotherapy was explained
to the intervention group. Participants in the foot Working the toes: 1. Toe walk sideways over
reflexology group received their usual medical throat-thyroid reflex both ways. 2. Finger walk
treatment and a 30-minute foot reflexology treat- cervical while stretching toe with holding fingers.
ment (15m for each foot) twice a week for four 3. Toe walk down large toe plantar side latched
weeks. Participants in the control group received onto fingers, work medial to lateral. All toes latched
their routine usual medical treatment which includ- onto fingers, work medial to lateral all toes to their
ed physical examination of feet. roots. 4. Repeat other coming back to start (use
other hand). 5. Hook in and back up on pituitary
The research assistant conducted the reflexo- with medial thumb. 6. Working the brain. 7. Toe
therapy; first of all, the relaxation technique was walk the ridge (eye and ear reflexes) both ways
used from the footstalk toward the sole (plantar using lateral aspect or edge of thumbs pulling down
surfaces) at the beginning of the session. Then, padding. 8. Side to side relaxer. 9. Metatarsal
four major plantar reflexology points (solar plexus, kneads [32] .
pituitary, heart and liver) were put under pressure
using the thumbs. The other reflexology areas of Working the digestive system: 1. Toe walk waist-
the plantar surface of the foot were also massaged line to diaphragm, cross hatch in both direction
and finally intervention was put to an end with with foot in dorsiflexion. 2. Wring out with thumbs.
massaging the solar plexus by the researcher. 3. Toe walk waistline to heel line, cross hatch in
both directions with foot in dorsiflexion and wring
At the end of the study (4 weeks), immediately out with thumb. 4. Work the adrenal gland. 5. Work
after the intervention, blood pressure level was the ileocecal valve reflex hook in and back up right
measured again by the by the research assistant in foot. 6. If on left foot cross hatch plantar heel zone
the clinic. Participants were asked to complete the working the sigmoid flexor three ways with thumb
WHO QOL-BREF again. After data collection, then hook in and back up. 7. Side to side relaxer
patients in the control group received the same [32] .
foot reflexology to avoid depriving them from a
potentially valuable technique. Working the lateral and medial heel areas: 1.
Finger walk lateral hip, knee, leg reflex zone. 2.
Foot reflexology procedure: Change hands and finger walk same reflex from
dorsal side to plantar side. 3. Finger walk hip,
Prior to the study the investigator underwent
sciatic reflex around external malleolus. 4. Change
2-hours training on foot massage under an expert
hands and finger walk same reflex going opposite
in the Physiotherapy Department of Faculty of
direction underneath. 5. Change hands pin point
Medicine, Mansoura University.
with index finger rotate clockwise on lateral repro-
The researcher follows Farnsworth’s method; the ductive reflex. 6. Ankle loosening. 7. Dorsiflex
researcher starts at the right foot as follows: foot, toe walk medial Achilles tendon three times.
8. Reflex rotate using thumb as a fulcrum on medial
Relaxing techniques: 1. Ankle stretch ‘under’. reproductive reflex. 9. Ankle loosening. 10. Finger
2. Ankle stretch ‘over’. 3. Ankle loosening. 4. Side walk across ankle medial to lateral and lateral to
to side. 5. Spinal stretch. 6. Metatarsal knead. 7. medial. 11. Finish with full range of relaxing
Diaphragm relaxer. 8. Toe rotation [32] . techniques [32] .
Working the spine: 1. Toe walk up sacral-coccyx
zone. 2. Toe walk up lumbar zone. 3. Toe walk up Statistical methods:
thoracic zone. 4. Finger walk up cervical zone. 5. Random number tables were used to allocate
Toe walk down thoracic zone. 6. Toe walk down consecutive eligible patients to either group.
Karima Elshamy & Eman Elsafety 197

Descriptive statistics included numbers and control group. These results may be related to
percentages for qualitative variables and means Egyptian culture and religion. Most of participants
and standard deviations for quantitative variables. (67.5%) in the foot reflexology group and 70.0%
Comparison of means was achieved using 2-tail t- of participants in the control group had a sedentary
test for independent samples. Chi-square test was lifestyle, exercising less than once a week. More
used to compare percentages. The threshold of than 80% of participants in each group had recre-
significance was fixed at the 5% level [33,34] . ation or relaxation time more than once a week
90.0% in the foot reflexology group, 87.5% in the
Results control group (Table 2).
Demographic characteristics of participants: Top six co-morbidities of the two study groups:
For this study, the 80 participants were randomly There was no difference in both groups related to
allocated into two groups: (40 in the foot reflexol- the top six co-morbidities and also other co-
ogy group (intervention), and 40 in the control morbidities. Some participants had more than one
group (routine management). of co-morbidity, thus the total does not equal 100%.
The most co morbid was diabetes 75.0% and 72.5
Demographic data for the participants was (Table 3).
collected and then analyzed for gender, age, marital
status, educational background, economic factors,
duration of hypertension, medical history, period Table (1): Demographic and clinical characteristics of the
of treatment for hypertension, and co-morbidities. studied groups N=80.
Lifestyle data such as fat/salty foods intake, smok- Foot Control
ing, alcohol intake, exercise and recreation / relax- Reflexology Group N=40
ation was also determined. The data is presented Characteristic Group N=40 (Routine
in Tables (1-6). (Intervention ) management)

N % N %
Demographic data of control and intervention
groups were similar without statistically significant Gender:
differences in gender, age, educational background, Male 27 67.5 26 65.0
Female 13 32.5 14 35.0
economic factors, lifestyle characteristics, co-
morbidities and medical treatments, marital status, Age/year:
the length of time experiencing hypertension and 30-40 years 10 25.0 10 25.0
40-50 years 12 30.0 12 30.0
the length of time having treatment for hyperten- 51-60 years 19 47.5 18 45.0
sion.
Marital status:
Demographic characteristics of the studied Single 4 10.0 5 12.5
Married 31 77.5 30 75.0
groups (n=80): Most of patients were married in Divorced/separated/ 5 12.5 5 12.5
foot reflexology and control group (77.5%) and widowed
(75.0%). Both groups reported achieving similar
Level of education:
levels of university education 53.7% and 52.5% No education 5 12.5 5 12.5
of in the foot reflexology group and control group Primary school 1 2.5 2 5.0
respectively. The majority of participants in both Secondary school 13 32.5 13 32.5
groups had financial problems – 90.0% in the foot College/university 22 55.0 21 52.5
reflexology group, 87.5% in the control group. Economic/financial
There was no difference between the groups in the difficulties:
length of time that participants had been diagnosed Yes 36 90.0 35 87.5
No 4 10.0 5 12.5
with hypertension, and the duration having treat-
ment for hypertension (Table 1). Duration of hypertension/
year:
Lifestyle characteristics of the studied groups 1-5 years 20 50.0 21 52.5
(n=80): Almost more than 70% of participants in 6-10 years 10 25.0 9 22.5
10-15 years 3 7.5 3 7.5
the two groups ate fat/salty foods more than 1- More 15 years 8 20.0 7 17.5
6/wk – 82.5 % in the foot reflexology group, 85.0%
Treatment of hypertension/
in the control group. Most participants did not year:
smoke – 55.0% and 55.0% in the foot reflexology 1-5 years 19 47.5 18 45.0
and control groups respectively. The majority of 6-10 years 11 27.5 12 30.0
participants did not drink alcohol at all – 98.0% 10-15 years 5 12.5 4 10.0
in the foot reflexology group and 99.0% in the More 15 years 5 12.5 6 15.0
198 Effect of Nursing Interventions Using Foot Reflexology on Blood Pressure

Table (2): Lifestyle characteristics of the studied groups N=80. and post intervention (160.2mmHg versus 136.5
Foot Control mmHg) within the intervention group respectively
Reflexology Group N=40 (p<0.05). Change in control group was not proved
Characteristic Group N=40 (Routine to be statistically significant (162.5mmHg-155.2
(Intervention ) management) mmHg pre and post readings respectively) ( p>0.05).
N % N %
There was a statistically significant decrease
Fat/salty foods intake: in means of diastolic blood pressure between pre
Never 0 0.0 0 0.0
and post intervention (102.0mmHg versus 87.5
<1/wk 2 5.0 0 0.0
1-6/wk 33 82.5 34 85.0
mmHg) within the intervention group (p<0.05),
Daily 5 12.5 6 15.0 Change in control group was not proved to be
statistically significant (100.1mmHg versus 96.4
Smoking: mmHg pre and post readings respectively, p>0.05).
Yes 18 45.0 18 45.0
No 22 55.0 22 55.0
There was a little difference in means of quality
Alcohol intake: of life scores between groups before treatment.
Never 38 95.0 39 97.0 Differences was not proved to be statistically
<1/wk 2 5.0 1 2.5 significant (p>0.05).
1-6/wk 0 0.0 0 0.0
Daily 0 0.0 0 0.0
Mean of quality of life and health satisfaction
Exercise: scores were slightly higher for participants in the
Never 27 67.5 28 70.0 foot reflexology group than for participants in the
<1/wk 5 12.5 5 12.5 control group. Mean of physical health, psycho-
1-6/wk 6 15.0 6 15.0
logical health, social relationships and environment
Daily 2 5.0 1 2.5
scores for participants in the control group were
Recreation/relaxation: slightly higher than for participants in the foot
Never 1 2.5 1 2.5 reflexology group. Quality of life scores pre-post
<1/wk 36 90.0 35 87.5 intervention was neither statistically nor clinically
1-6/wk 3 7.5 4 10.0
significant. Differences were not proved to be
Daily 0 0.0 0 0.0
statistically significant (p>0.05).

Table (3): Top six co-morbidities of the studied groups N=80. There was a significant increase in all patients
comments before and after intervention in the foot
Foot reflexology group, (75.0%) of patients in the foot
Control
Reflexology
Group N=40 reflexology group feel satisfied after the interven-
Characteristic Group N=40
(Routine management) tion, compared to (52.5%) before intervention.
(Intervention )
Patients comments indicated that they felt comfort-
N % N %
able, relaxed, and believed that treatment could
Dyslipidaemia 25 62.5 25 62.5 relieve fatigue, numbness and cramps in their feet.
Diabetes Mellitus 30 75.0 29 72.5 p<0.05. Regarding the control group, all patients
Heart Disease 7 17.5 6 15.5 'comments before and after routine care indicated
no significant differences p>0.05 (Table 6).
Gout 11 27.5 12 30.0
Kidney 4 10.0 4 10.0 Post intervention results:
Stroke 2 5.0 3 7.5
There was a decrease in systolic blood pressure
of 23.7mmHg in the reflexology group compared
Top ten medical treatments of the two study with a decrease of 7.3mmHg in the control group.
groups: There was no difference in both groups There was a decrease in diastolic blood pressure
related to the top ten medical treatments and also of 14.5mmHg in the reflexology group compared
other treatments. Some participants had more than with a decrease of 3.7mmHg in the control group
one medical treatment, thus the total did not equal (Table 5).
100% (Table 4).
The findings showed that foot reflexology lower
Results of blood pressure and the quality of blood pressure in patients with hypertension, but
life: There was a statistically significant decrease it had little impact on the quality of life in these
in means of systolic blood pressure between pre patients (Table 5).
Karima Elshamy & Eman Elsafety 199

Table (4): Top ten medical treatments of the studied groups N=80.

Foot
Control
Reflexology
Group N=40
Medical treatments Group N=40
(Routine management)
(Intervention )

N % N %
Antihyperlypidaemic agents 25 62.5 24 60.0
Beta-blockers 16 40.5 19 47.5
ACE inhibitors 15 37.5 13 32.5
Diuretics 15 37.5 16 40.5
Anticoagulants, antithrombolytics & 14 35.0 11 27.5
fibrinolytics
Anti-anginal drugs 10 25.0 10 25.0
Antidiabetic drugs 10 25.0 9 22.5
Angiotensin II antagonists 5 12.5 6 15.0
Calcium antagonists 5 12.5 6 15.0
Other antihypertensive 2 5.0 3 7.5

Table (5): Pre and Post intervention results of blood pressure and the quality of life of the studied groups N=80.

Foot Reflexology Group Control Group


N=40 N=40
(Intervention ) (Routine management)
Pre Post Pre Post
intervention interventions p-value intervention interventions p-value
Mean SD Mean SD Mean SD Mean SD
Systolic blood pressure 160.2 2.6 136.5 2.0 162.5 2.5 155.2 2.4
Diastolic blood pressure 102.0 1.2 87.5 1.1 p<0.05 100.1 1.2 96.4 1.2 p>0.05
Quality of life:
Quality of life general score 3.8 0.1 3.9 0.1 p>0.05 3.6 0.1 3.7 0.1 p>0.05
Health satisfaction 3.3 0.1 3.4 0.1 3.1 0.1 3.3 0.1
Physical health 64.3 1.7 65.0 1.3 66.1 1.6 66.0 1.5
Psychological health 65.8 1.8 66.7 1.6 p>0.05 67.1 1.9 68.9 1.9 p>0.05
Social relationships 70.1 1.8 70.1 1.7 75.0 2.1 74.3 2.2
Environment 66.2 1.5 66.5 1.5 67.8 1.9 68.0 1.8

Table (6): Patients' comments of pre and post intervention of the two groups N=80.

Foot Reflexology Group Control Group


N=40 N=40
(Intervention ) (Routine management)
Pre Post Pre Post
intervention interventions p-value intervention interventions p-value
N % N % N % N %
Satisfaction:
Satisfied 21 52.5 30 75.0 19 47.5 15 37.5
Average 4 10.0 10 25.0 6 15.0 4 10.0
Not satisfied 15 37.5 4 10.0 p<0.05 15 37.5 14 35.0 p>0.05
Feel comfortable 10 25.0 19 47.5 8 20.0 8 20.0
Feel relaxed 10 25.0 18 45.0 9 22.5 10 25.0
Relieves fatigue, numbness, 5 12.5 11 27.5 6 15.0 8 20.0
cramps
200 Effect of Nursing Interventions Using Foot Reflexology on Blood Pressure

Discussion Our study showed that foot reflexology was


more likely to reduce diastolic and systolic blood
Hypothesis one: There is a decrease in mean pressure than control group. Previous studies sup-
blood pressure level between the foot reflexology porting these results were a study by Hayes & Cox
and control groups at the end of four weeks of [36] and another by Jirayingmongkol et al. [37] .
treatment. Analyses of data in this study indicated However, these two studies used different measure-
that there was a statistically significant difference ment and foot massage procedures to test blood
in mean blood pressure between the foot reflexol- pressure. Hayes and Cox [36] used mean arterial
ogy group and control group at the end of four blood pressure as an indicator of measurement of
weeks of treatment. The mean diastolic blood physiological and psychological stress in patients
pressure in the foot reflexology group was statis- in a critical care unit. They found that there was
tically significantly lower than in the control group a significant decrease in heart rate, mean arterial
(p<0.05). blood pressure and respirations during the foot
Frankel [35] explored the effects of foot reflex- massage intervention in participants in the foot
ology on the baroreceptor reflex, which controls massage group compared to those in the control
blood pressure. He found that baroreceptor reflex group who received no intervention. Jirayingmon-
sensitivity was significantly lowered in the inter- gkol et al. [37] used Thai foot massage which is
vention groups (foot reflexology and foot massage), quite different in style and procedure from the
compared with the control group. Baroreceptor current study to measure vital signs in older sub-
reflex sensitivity was measured using sinus arrhyth- jects. They found that Thai foot massages signifi-
mia and phase IV of the Valsalva maneuver, a cantly decreased blood pressure, pulse rate and
period in the Valsalva maneuver during which respiratory rate in these people. Given the differ-
blood pressure is substantially raised above the ences in measuring, procedures and samples, we
baseline. These blood pressure results are different can not conclude that foot massage can lower blood
to those outlined by Frankel [35] who found that, pressure in patients with hypertension.
between foot reflexology and foot massage, there
Hypothesis two: There is an improvement in
was no significant difference in resting blood
mean quality of life between the foot reflexology
pressure after intervention.
and control groups at the end of four weeks of
The results of our study supported the hypoth- treatment p>0.05. Results from this study showed
esis that foot reflexology decreases blood pressure no significant difference in mean quality of life
in patients with hypertension. In this study, the for both groups. These results differed markedly
results in relation to blood pressure are comparable from study results of Park & Cho [24] and Hodgson
to those of Park and Cho [24] who found in their [12] . Park & Cho [24] showed that foot reflexology
research that there were no significant differences significantly improved life satisfaction in 34 pa-
in diastolic blood pressure and LDL cholesterol tients with hypertension. This study did not support
between the foot reflexology group and the control Park and Cho’s [24] conclusions.
group (who received no intervention). In contrast
with this study, however, Park and Cho found that Similarly, Hodgson [12] found that foot reflex-
systolic blood pressure and triglyceride levels ology could improve quality of life. However,
significantly decreased in their foot reflexology Hodgson’s study was based on cancer patients and
group compared to their control group. In addition, is difficult therefore to compare with the effects
life satisfaction was significantly improved in the of foot reflexology on quality of life in patients
foot reflexology group. with hypertension. In addition, the sample size in
her study was small-only twelve subjects including
Compared to Park and Cho’s [24] study (2004), six in the foot reflexology group, and six in the
our study was performed using a bigger sample gentle foot massage group. Hodgson used the visual
size and with control as a comparison intervention analogue scales for cancer patients to measure
(Park and Cho [24] , provided foot reflexology only quality of life, as contrasted from the current study’s
in a small group of 34 hypertensive patients-18 in use of the WHOQOLBREF World Health Organi-
the foot reflexology group and 16 in the control zation [30] which is suitable for use with people
group who received no intervention). From both who have a general chronic disease. There is a
studies, we can conclude that foot reflexology has little difference in mean quality of life between
been proved to lower diastolic and systolic blood the foot reflexology and control groups at the end
pressure. However, its effects on quality of life or of four weeks of treatment. The evidence relating
life satisfaction in patients with hypertension are to foot reflexology, quality of life and patients with
ambiguous. hypertension did not indicate that foot reflexology
Karima Elshamy & Eman Elsafety 201

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