Is foot reflexology or back massage effective in alleviating fatigue and improving sleep quality among hemodialysis patients?
Date of publication of the randomized controlled trial: August 2016
Design
Randomized controlled trial (RCT).
Participants
105 patients (mean age: 54.3 years, male %: 52.4%) who received hemodialysis therapy twice a week.
Intervention
30 minutes foot reflexology twice a week for 4 weeks, or 30 minutes back massage twice a week for 4 weeks.
Comparator
Comparison 1: Foot reflexology versus no treatment;
Comparison 2: Back massage versus no treatment.
Major Outcomes
Outcome 1: Fatigue level measured by Visual Analogue Scale (VAS). Higher score indicates greater fatigue;
Outcome 2: Sleep quality measured by Pittsburg Sleep Quality Index. Higher score indicates worse sleep quality.
Settings
This trial was performed in an outpatient setting.
Comparison    Foot reflexology versus no treatment
Main Results
Compared to no treatment, foot reflexology was significantly more effective in alleviating fatigue (p<0.001) and in improving sleep quality (p<0.001) among hemodialysis patients.
Comparison 1: Foot reflexology versus no treatment among hemodialysis patients
Outcomes No. of studies (Total number of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) MD p value Overall quality of evidence*
Intervention Comparator
1 1 (70) 58.51 (18.8)/ 35 80.74 (21.1)/ 35 Not applicable as there is only 1 study. Not reported <0.001 High
2 1 (70) 5.54 (2.15)/ 35 11.88 (2.47)/ 35 Not applicable as there is only 1 study. Not reported <0.001 Very High
Keys: SD = standard deviation; MD = mean difference.
Comparison    Back massage versus no treatment
Main Results
Compared to no treatment, back massage was significantly more effective in alleviating fatigue (p=0.029) and in improving sleep quality (p<0.001) among hemodialysis patients.
Comparison 2: Back massage versus no treatment among hemodialysis patients
Outcomes No. of studies (Total number of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) MD p value Overall quality of evidence*
Intervention Comparator
1 1 (70) 70.77 (16.0)/ 35 80.74 (21.1)/ 35 Not applicable as there is only 1 study. Not reported 0.029 High
2 1 (70) 8.34 (2.39)/ 35 11.88 (2.47)/ 35 Not applicable as there is only 1 study. Not reported <0.001 Very High
Keys: SD = standard deviation; MD = mean difference.
Comparison    Foot reflexology versus no treatment
Main Results
Compared to no treatment, foot reflexology was significantly more effective in alleviating fatigue (p<0.001) and in improving sleep quality (p<0.001) among hemodialysis patients.
Comparison 1: Foot reflexology versus no treatment among hemodialysis patients
Outcomes 1 2
No. of studies (Total number of participants) 1 (70) 1 (70)
Mean score (SD)/ No. of participants Intervention 58.51 (18.8)/ 35 5.54 (2.15)/ 35
Comparator 80.74 (21.1)/ 35 11.88 (2.47)/ 35
MD Not reported Not reported
p value <0.001 <0.001
Overall quality of evidence* High Very High
Keys: SD = standard deviation; MD = mean difference.
Comparison    Back massage versus no treatment
Main Results
Compared to no treatment, back massage was significantly more effective in alleviating fatigue (p=0.029) and in improving sleep quality (p<0.001) among hemodialysis patients.
Comparison 2: Back massage versus no treatment among hemodialysis patients
Outcomes 1 2
No. of studies (Total number of participants) 1 (70) 1 (70)
Mean score (SD)/ No. of participants Intervention 70.77 (16.0)/ 35 8.34 (2.39)/ 35
Comparator 80.74 (21.1)/ 35 11.88 (2.47)/ 35
MD Not reported Not reported
p value 0.029 <0.001
Overall quality of evidence* High Very High
Keys: SD = standard deviation; MD = mean difference.
Conclusion
Benefits
Compared to no treatment, foot reflexology or back massage are significantly more effective in alleviating fatigue and improving sleep quality among hemodialysis patients. Comparison 1: For Outcome 1, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect. For Outcome 2, the overall quality of evidence is very high. Further research is most unlikely to have an important impact on our confidence in this estimate of effect. Comparison 2: For Outcome 1, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect. For Outcome 2, the overall quality of evidence is very high. Further research is most unlikely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/27502815
The synopsis is based on the following article:
Unal KS, Balci Akpinar R. The effect of foot reflexology and back massage on hemodialysis patients' fatigue and sleep quality. Complementary Therapies in Clinical Practice. 2016 Aug;24:139-44.


* 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.