Is foot reflexology effective in reducing anxiety, pain and improving outcomes of labor among primigravida women?
Date of publication of the randomized controlled trial: August 2015
Design
Randomized controlled trial (RCT).
Participants
80 primigravida women who displayed cephalic being in active phase of labor (dilatation 3 to 4 cm) with no medical or obstetric complications and did not use any anesthesia methods and induction labor. Participants should not have any active psychological and anxiety diseases based on Beck and Spielberger State-Trait Anxiety Inventory (mean age = 25.56 years).
Intervention
Reflexology with sunflower oil was performed by mild massage of all feet sole and the fixed or rotating pressure was applied on pituitary gland, Solar plexus and uterine for 40 minutes.
Comparator
Comparison: Foot reflexology versus routine care.
Major Outcomes
Outcome 1: Pain intensity as measured by McGill Questionnaire for Pain Rating Index (PRI) at the end of intervention;
Outcome 2: Duration of labor;
Outcome 3: Anxiety as measured by Spielberger State-Trait Anxiety Inventory (STAI) at the end of intervention. Higher scores indicated higher level of anxiety;
Outcome 4: Apgar scores of infants in the fifth minute.
Settings
This trial was performed in an inpatient setting.
Comparison    Foot reflexology versus routine care
Main Results
Compared to routine care, foot reflexology showed significant effect in decreasing pain intensity (p<0.001) as measured by PRI, duration of labour (p<0.001) and anxiety level (p<0.001) among primigravida women. Besides, foot reflexology significantly increased Apgar scores of infants in the fifth minute (p<0.001).
Comparison: Foot reflexology versus routine care among primigravida women
Outcomes No. of studies (Total number of participants) Mean score (SD)/No. of participants Heterogeneity test ( I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 1 (80) Not reported Not reported Not applicable as there is only 1 study. Not reported <0.001 Moderate
2 1 (80) Not reported Not reported Not applicable as there is only 1 study. Not reported <0.001 Moderate
3 1 (80) Not reported Not reported Not applicable as there is only 1 study. Not reported <0.001 Moderate
4 1 (80) 9.6 (0.49)/40 9.07 (0.85)/40 Not applicable as there is only 1 study. Not reported <0.001 Moderate
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval.
Comparison    Foot reflexology versus routine care
Main Results
Compared to routine care, foot reflexology showed significant effect in decreasing pain intensity (p<0.001) as measured by PRI, duration of labour (p<0.001) and anxiety level (p<0.001) among primigravida women. Besides, foot reflexology significantly increased Apgar scores of infants in the fifth minute (p<0.001).
Comparison: Foot reflexology versus routine care among primigravida women
Outcomes 1 2 3 4
No. of studies (Total number of participants) 1 (80) 1 (80) 1 (80) 1 (80)
Mean score (SD)/No. of participants Intervention Not reported Not reported Not reported 9.6 (0.49)/40
Comparator Not reported Not reported Not reported 9.07 (0.85)/40
MD (95% CI) Not reported Not reported Not reported Not reported
p value <0.001 <0.001 <0.001 <0.001
Overall quality of evidence* Moderate Moderate Moderate Moderate
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to routine care, foot reflexology significantly reduced labour pain intensity, duration of labour, anxiety and increases Apgar scores. For all outcomes, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
The authors did not mention details of adverse events.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26545996
The synopsis is based on the following article:
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 Aug;53(8):507-11.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.