Is hand reflexology effective in reducing pain, anxiety and improving satisfaction during minimally invasive surgery for varicose veins under local anaesthetic?
Date of publication of the randomized controlled trial: December 2015
Design
Randomized controlled trial (RCT).
Participants
100 patients who received endovenous thermal ablation and/or phlebectomy for the treatment of varicose veins under local anaesthetic (mean age: 47.8 years, male %: 17%).
Intervention
Reflexology was administered to participants’ hands by a qualified reflexologist before the start of the anaesthetic injections. Each session entailed systematically working over different parts of hands and arms. The authors did not mention duration of the intervention.
Comparator
Comparison: Intra-operative hand reflexology versus usual care. Usual care referred to treatment as usual from the surgeons and medical staff.
Major Outcomes
Outcome 1: Anxiety as measured by Numeric Rating Scale (NRS) immediately after surgery. Higher rating indicated higher level of anxiety;
Outcome 2: Pain intensity as measured by NRS immediately after surgery. Higher rating indicated higher intensity of pain;
Outcome 3: Satisfaction with treatment as measured by NRS immediately after surgery. Higher rating indicated higher level of satisfaction with treatment.
Settings
This study was performed in an inpatient setting.
Comparison    Intra-operative hand reflexology versus usual care
Main Results
Compared to usual care, intra-operative hand reflexology showed significant reduction in anxiety (p<0.001). However, hand reflexology did not show significant reduction in pain intensity (p=0.056) and satisfaction with treatment (p=0.27).
Comparison: Intra-operative hand reflexology versus usual care
Outcomes No. of studies (Total number of participants) Mean score (SD)/No. of participants Heterogeneity test (I2) Cohen’s d (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 1 (100) 3.24 (2.22)/50 5.00 (2.31)/50 Not applicable as there is only 1 study. 0.78 (0.86 to 2.66) <0.001 Moderate
2 1 (100) 3.44 (2.06)/50 4.22 (1.97)/50 Not applicable as there is only 1 study. 0.38 (-0.02 to 1.58) 0.056 Low
3 1 (100) 4.56 (0.54)/50 4.44 (0.54)/50 Not applicable as there is only 1 study. -0.20 (-0.34 to 0.09) 0.27 Low
Keys: SD = standard deviation; CI = confidence interval.
Comparison    Intra-operative hand reflexology versus usual care
Main Results
Compared to usual care, intra-operative hand reflexology showed significant reduction in anxiety (p<0.001). However, hand reflexology did not show significant reduction in pain intensity (p=0.056) and satisfaction with treatment (p=0.27).
Comparison: Intra-operative hand reflexology versus usual care
Outcomes 1 2 3
No. of studies (Total number of participants) 1 (100) 1 (100) 1 (100)
Mean score (SD)/No. of participants Intervention 3.24 (2.22)/50 3.44 (2.06)/50 4.56 (0.54)/50
Comparator 5.00 (2.31)/50 4.22 (1.97)/50 4.44 (0.54)/50
Cohen’s d (95% CI) 0.78 (0.86 to 2.66) 0.38 (-0.02 to 1.58) -0.20 (-0.34 to 0.09)
p value <0.001 0.056 0.27
Overall quality of evidence* Moderate Low Low
Keys: SD = standard deviation; CI = confidence interval.
Conclusion
Benefits
Compared to usual care, patients received intra-operative hand reflexology showed significantly lower level of anxiety. However, no significant difference was found on pain intensity and satisfaction between the two groups. For outcome 1, 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. For outcomes 2 and 3, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
The authors did not mention adverse events of the intervention.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26294281
The synopsis is based on the following article:
Hudson BF, Davidson J, Whiteley MS. The impact of hand reflexology on pain, anxiety and satisfaction during minimally invasive surgery under local anaesthetic: a randomised controlled trial. Int J Nurs Stud. 2015 Dec;52(12):1789-97.


* 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.