Stephenson, N.L., Swanson, M., Dalton, J., Keefe, F.J., & Engelke, M. (2007). Partner-delivered reflexology: Effects on cancer pain and anxiety. Oncology Nursing Forum, 34, 127–132.

To test the effectiveness of reflexology delivered by partners in patients with cancer 
 

An initial reflexology session of 30 minutes was provided in the hospital setting. The session included relaxing techniques, 15 minutes of reflexing areas of the feet corresponding to areas of the patient’s reported pain and body parts where cancer or pain was located. The final five minutes were used to reflex the entire area of the feet. Partners were taught how to perform a reflexing protocol and provided with associated written materials. Partners practiced the technique on the investigator or the patient and were given feedback on the technique. Signs and symptoms of deep vein thrombosis were reviewed to alert partners to avoid foot reflexology in that situation. Patients in the control group received usual care plus special attention for 30 minutes, consisting of reading a selection of the patient’s choice to the patient. Study data were obtained pre- and postintervention.

• The study reported on a sample of 86 patients.
• Mean patient age was 60 years (SD = 12.1 years) in the experimental group and 56 years (SD = 24.4 years) in the control group.
• The sample was 51% female and 49% male.
• The most prevalent types of cancer were lung, breast, colorectal, head and neck, and lymphoma.
• Of the total sample, 66% had a high school education or less, and 50% had an income less than $20,000.
• Baseline pain was 3.2 in the experimental patients and 4.5 in the control patients. Baseline anxiety was 5.0–5.6 (10-point scales).

• Multisite
• Inpatient setting
• North Carolina

• Patients were undergoing multiple phases of care.
• The study has clinical applicability for end-of-life and palliative care.

A randomized controlled trial design was used.

• Visual Analog Scale for Anxiety
• Brief Pain Inventory
• Short-Form McGill Pain Questionnaire

In the total sample, there were no significant differences between groups in pain outcome measures. In patients with higher baseline pain levels (≥ 5), significant differences were found in favor of the reflexology group in analysis of variance (p = 0.001, eta² for effect size = 0.12). Patients in the reflexology group had significant reduction in anxiety, with a 62% reduction from baseline to postintervention in those receiving reflexology versus 23% reduction in controls. Among those with higher levels of anxiety (≥ 5), significant differences were found in favor of reflexology (p = 0.001, eta² = 0.13).

Partner-delivered reflexology was associated with reduction in pain and anxiety compared to controls. The intervention appeared to be most effective in patients with higher levels of pain and anxiety.

• The study had a small sample, with less than 100 participants.
• The attentional control used was reading, rather than some use of touch. It is unclear if the specific technique of reflexology or touch was responsible for results observed.
• Limited demographic information was provided, so generalizability is not clear.
• The intervention was a single time point with pre- and post-measures. Longer term results or repeated use effects were not explored. The study was initially designed to include long-term follow-up after hospital discharge; however, attrition was so severe that this aspect of the research was dropped.
• There was no blinding, so there are associated risks of bias.
• No information was provided about medication use or any changes or differences between groups in overall pain management interventions.

Findings suggest that foot reflexology can be helpful for patients with cancer in reducing anxiety and perception of pain in the short term. Study findings suggest that partners can be taught to provide this type of intervention. Addition of partner-delivered reflexology might be a useful adjunct for anxiety and pain control; however, trained individuals need to be available to provide the teaching or the actual intervention.  Involvement of caretakers in patient care with this type of approach might be a useful way to empower patients and caregivers.