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Burns
Volume 46, Issue 8, December 2020, Pages 1942-1951

The effect of foot reflexology massage on burn-specific pain anxiety and sleep quality and quantity of patients hospitalized in the burn intensive care unit (ICU)

Reza Alinia-najjar (a), Masoumeh Bagheri-Nesami (b,c), Seyed Afshin Shorofi ( b,d), Seyed Nouraddin Mousavinasab (e), Kiarash Saatchi (f)

a Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
b Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
c World Federation of Acupuncture-Moxibustion Societies (WFAS), Beijing, China
d Flinders University, Adelaide, Australia
e Department of Biostatistics, Health Sciences Research Center, School of Public Health, Mazandaran University of Medical Sciences, Sari, Iran
f Member of the Board of Directors of Acupuncture Society of Iran, Tehran, Iran

Abstract

Background: Burn-specific pain anxiety and sleep disorders are common factors in burned patients that affect wound healing process, as well as the severity of burn pain. This study aimed to investigate the effect of foot reflexology massage on burn-specific pain anxiety and sleep condition of patients hospitalized in the burn ICU.
Method: In this randomized controlled clinical trial, 52 patients were assigned by permuted block randomization 1:1 to the intervention (n = 26) and control (n = 26) groups. The intervention group received 20 min of foot reflexology massage during 3 days on their third, fourth and fifth days of hospitalization and 15 min before changing wound dressings. Patients in the control group merely received routine care. The Burn-Specific Pain Anxiety Scale (BSPAS) was completed for three consecutive days before and after changing wound dressings, and St. Mary's Hospital Sleep Questionnaire (SMHSQ) was filled out for four consecutive days before changing wound dressings for patients in both groups. The data were analyzed by IBM SPSS 16 software, Chicago, independent t, Chi-square, Friedman, Mann–Whitney and Wilcoxon tests.
Findings: We found no significant difference between pain-anxiety in the two groups before the intervention. The trend of different days in each groups were compared with Friedman test and showed that pain anxiety (p < 0.001), sleep latency (p < 0.001), duration of the last day's sleep (p < 0.001) and satisfaction of the last night sleep (p < 0.001) had a significant difference. In addition, Mann–Whitney test results showed that there were significant differences between the two groups at different times in terms of the above variables (p < 0.05). The effect size was = 0.82 for pain anxiety between group after the intervention.
Conclusion: Based on the results, foot reflexology massage can effectively reduce pain anxiety levels and improve sleep quality and quantity of patients with burn injuries; therefore, this non- pharmacological therapeutic method is recommended to be used in the burn ICUs. (Clinical trial’s registration code: IRCT20110906007494N27)

Free full text:
https://www.sciencedirect.com/science/article/pii/S0305417920303466

Excerpts:

"Foot reflexology massage is a branch of complementary therapies. Foot reflexology massage is based on the notion that it stimulates energy flow within the body from the feet to the head, which can decrease sympathetic nervous system arousal, relieve anxiety and promote relaxation [16]. Foot reflexology massage serves various functions; it alleviates physical problems (e.g. pain and physiological indicators) and enhances psychological dimensions (sleep, anxiety, depression and stress) of individuals; thereby, it improves physical, psychological, and social aspects of pain [17]. However, some studies have emphasized positive effect of foot reflexology massage in reducing anxiety levels [16], [18] and some studies had rejected its effect [19]. A review of literature confirmed the effects of reflexology on sleep in various persons, such as elderly [20] and hemodialysis patients [21]. However, no study has so far been conducted to investigate the effect of foot reflexology massage on burn-specific pain anxiety and sleep condition of patients hospitalized in the burn ICUs."

"Patients in the intervention group received 20 min of foot reflexology massage for three consecutive days (10 min for each foot) beginning from the third day of their hospitalization [16], [32]. In this group, the researcher switched off all lamps inside the room and provided a quiet and peaceful environment using a gentle light and separating the patient from others with a hospital curtain. Now, the patient lay on his/her back on the bed and two pillows were placed under his/her feet (as his/her heels and Achilles tendons were not in contact with the pillow). Sitting on a chair beside the patient's feet, the researcher used 5 drops of baby massage oil and completely rubbed the patient's feet with his palms...[detailed descriptions of the massage]...It should be noted, that the researcher had a foot reflexology certificate...Five zones on each sole related to the brain, pituitary gland, kidney, adrenal gland, and solar plexus that effect on anxiety and sleep were massaged (Fig. 1)...The researcher used his left thumb to do the same movements and rub the patient's big toe, an area which is related to the brain. Then he put 3–5 kg of pressure (based on previous practices using a weighing scale) on the parts related to the brain and pituitary gland...He rubbed his right thumb with a circular movement (3–5 kg of pressure) on patient's solar plexus area (located at the center of his/her sole) and maintained the pressure for 5 s, and repeated the same movements for the area related to the kidney and adrenal gland...Foot reflexology massage was performed (from 8 a.m. to 9 a.m.) immediately before each dressing change on the third, fourth, and fifth days [34]."

[Note: there is no description of the control group in the Methods section; however, from the Abstract we learn that "Patients in the control group merely received routine care."]

"At the end of the fifth day, the comparisons of the mean of pain anxiety scores of the intervention and control groups a significant difference between the two groups. Therefore, the results confirm the positive effect of foot reflexology massage on burn-specific pain anxiety of patients hospitalized in burn ICUs. In a study, the effect of Shiatsu massage on anxiety in burn patients Showed that anxiety levels were significantly lower in the intervention group than the control group after the intervention. This is consistent with the results of the present study [35]."

"Study limitations: The presence of a massage therapist beside patients can affect their pain anxiety levels as well as their quality of sleep. This variable was not included in the present study; hence, it can be investigated in future studies. It is recommended that researcher stay in bedside with the patients in the control group and talk to the patient to remove the psychological confounders."



Comments: since there were no proper controls in this study, any benefit can be attributed to a combination of placebo effects (receiving considerable attention and care that the usual care group did not receive) plus nonspecific effects of massage. Reflexology holds that stimulation of specific reflex points on the feet or hands gives health benefits to supposed corresponding locations elsewhere in the body. Although the authors referred to stimulation of zones corresponding to various organs, there is no evidence that the effects had anything to do with the choice of these particular locations. So this is really a study of massage, not reflexology.

While the authors appear to recognize that there was a placebo effect that was not controlled for ("The presence of a massage therapist beside patients ..."), they do not seem to be aware of the likely nonspecific effects of massage and the need to control for them.

They also do not mention that the principles of reflexology are contrary to scientific knowledge of human anatomy and physiology.

One might not be surprised to see such a paper published in an alternative medicine journal, but Burns appears to be a mainstream journal. Its editors should have rejected this paper.