May 2014
J. E. M. McCullough, S. D. Liddle, M. Sinclair,1 C. Close, and C. M. Hughes
Abstract
Background. Reflexology is one of the top forms of complementary and alternative medicine in the UK and is used for healthcare by a diverse range of people. However, it is offered by few healthcare providers as little scientific evidence is available explaining how it works or any health benefits it may confer. The aim of this review was to assess the current evidence available from reflexology randomised controlled trials (RCTs) that have investigated changes in physiological or biochemical outcomes.
Methods. Guidelines from the Cochrane Handbook of Systematic Reviews of Interventions were followed: the following databases were searched from inception to December 2013: AMED, CAM Quest, CINAHL Plus, Cochrane Central Register of Controlled Trials, Embase, Medline Ovid, Proquest, and Pubmed. Risk of bias was assessed independently by two members of the review team and overall strength of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation guidelines.
Results. Seventeen eligible RCTs met all inclusion criteria. A total of 34 objective outcome measures were analysed. Although twelve studies showed significant changes within the reflexology group, only three studies investigating blood pressure, cardiac index, and salivary amylase resulted in significant between group changes in favour of reflexology. The overall quality of the studies was low.
Conclusions
This systematic literature review is the first, to our combined knowledge, to specifically analyse the existing data available from RCTs investigating the physiological and biochemical changes associated with reflexology, and it has demonstrated that a range of positive effects can be attributed to the treatment, specifically a reduction in stress parameters.
This will inform health care professionals of the evidence base for known benefits and will enhance evidence based decision making at clinical level. It is important to note that, in all of the studies included in this review, where psychological parameters were assessed, a significant improvement in health and well-being was determined and this factor alone had a positive effect on disease outcomes, prognosis, and rehabilitation.
None of the studies in this review investigated any long-term effects through follow-up with participants. Therefore, this is an aspect of CAM study design that must be addressed in the future.
It is still unclear from this review precisely how reflexology impacts physiological and biochemical parameters. It illustrates the need for further research into the use, efficacy, and mode of action of reflexology with well designed, high quality RCTs, if indeed RCTs are a suitable mode of investigation.
Also, this review highlights the need for further research into the measurable physiological and biochemical effects of reflexology in order to address the concerns of healthcare professionals and thus allowing all patients to benefit from any positive outcomes afforded by this inexpensive, noninvasive, and nonpharmacological therapy.
It is more than likely, however, that a number of factors are at work, both of a physiological and psychological nature and that reflexology is what it attests to be, a treatment that seeks to enhance and harmonise the mind, body, and spirit.
