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Review: reflexology improved urinary symptoms in multiple sclerosis but was not effective for other outcomes in various conditions

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P-S Tsai

Dr P-S Tsai, Taipei Medical University, Taipei, Taiwan; ptsai{at}


What is the efficacy and safety of reflexology in patients with any condition?


Studies selected compared reflexology with control or other interventions in patients with any condition; reported outcomes of symptom relief, psychological wellbeing, quality of life, or perception of reflexology; and had quality assessment ratings of fair or above according to US Preventive Services Task Force criteria. Excluded studies evaluated combination therapies of reflexology with other interventions, a young age group {ie, <18 y},* <10 participants/group, or provided insufficient information about the principal measures of effect. Outcomes were urinary symptoms, paraesthesia, muscle strength, spasticity, lung function, menopausal symptoms, anxiety, depression, quality of life, improvement of symptoms of irritable bowel syndrome, leg circumference, and adverse events.


Medline, Cochrane Library, ProQuest Medical Bundle, Evidence-based Medicine reviews, SCOPUS, Chinese electronic periodical services, and Wangfane were searched from 1996 to 2007 for controlled clinical trials published in English or Chinese. 5 randomised controlled trials (RCTs) (n = 251) met the selection criteria; they compared reflexology with calf-area massage, non-specific foot massage, relaxing reflexology, or rest.


A single study (n = 39) found that reflexology improved urinary symptoms more than calf-area massage in patients with multiple sclerosis (effect size −0.9, 95% CI −1.6 to −0.2). Individual studies found no differences between groups for paraesthesia, muscle strength, or spasticity in patients with multiple sclerosis; lung function in patients with bronchial asthma; hot flushes, night sweats, anxiety, depression, or quality of life in menopausal women; improvement of symptoms in patients with irritable bowel syndrome; or leg circumference in pregnant women with foot oedema. No studies reported adverse events.


Reflexology improved urinary symptoms in patients with multiple sclerosis but was not effective for other outcomes in various conditions.

*Information provided by author.


Wang MY, Tsai PS, Lee PH, et al. The efficacy of reflexology: systematic review. J Adv Nurs 2008;62:512–20.

Clinical impact ratings: Complementary care 4/7; Family/General practice 6/7


The results of the review by Wang et al will be disappointing for nurses who are already using reflexology in their clinical practice, particularly in light of the need to provide evidence-based care. However, further analysis of the conclusions provides the impetus to critically consider limited clinical use. Although routine treatment is not recommended, administration on an individual patient basis, taking into account level of clinical need and patient preferences, is not necessarily contraindicated. Nurses need to ensure that integration of reflexology complies with the policies and protocols of their organisations. These will set out whether reflexology is provided as a treatment or as part of nursing care. Use of reflexology can be justified as part of nursing care if it addresses a nursing need, particularly one that has been difficult to address effectively.

The review by Wang et al found that reflexology was not effective for wellbeing or emotional distress, but others have found it to be effective for treatment of stress (supported by physiological changes).1 Even though reflexology interventions have limited clinical effectiveness, they provide an opportunity for nurses to spend specific, calm time with patients. Such “quality time” can only enhance communication, an important aspect of the therapeutic relationship.

Sceptics will rightly question whether reflexology has similar treatment effects to caring touch in the context of foot massage. Although the review by Wang et al suggests that there is something different about reflexology, nurses should remain cautious.


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  • Source of funding: Department of Health, Executive Yuan, Taiwan.

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