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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 23
| Issue : 2 | Page : 190-195 |
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Effectiveness of foot reflexology on blood pressure among patients with hypertension in a Selected Hospital, Mangaluru
Joseph Ann1, D'Almeida Victoria2, Rashmi Shwetha3, Fernandes Preethi3
1 M.Sc. Nursing Student, Department of Medical Surgical Nursing, Father Muller College of Nursing, Mangaluru, Karnataka, India
2 Professor & HOD, Department of Medical Surgical Nursing, Father Muller College of Nursing, Mangaluru, Karnataka, India
3 Assistant Professor, Department of Medical Surgical Nursing, Father Muller College of Nursing, Mangaluru, Karnataka, India
| Date of Submission | 01-Jan-2022 |
| Date of Decision | 11-Nov-2022 |
| Date of Acceptance | 14-Nov-2022 |
| Date of Web Publication | 24-Jan-2023 |
Correspondence Address:
Prof. D'Almeida Victoria
Department of Medical Surgical Nursing, Father Muller College of Nursing, Mangaluru, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijcn.ijcn_1_22
Hypertension has emerged as a major health problem in developing countries. Reflexology can lower a high blood pressure through effects on relaxation, through blood vessel dilation and through a diuretic effect. The aim of the study was to find the effectiveness of foot reflexology on blood pressure among patients with hypertension. An experimental study design was adopted. Thirty-six in-patients with hypertension were selected from a selected hospital at Mangaluru by purposive sampling technique and were assigned to the intervention and control group by random allocation using closed envelope method (n = 18 + 18). Foot reflexology was administered to the subjects in the intervention group, whereas the control group received the routine care. The blood pressure was checked before and after the intervention or standard care using a digital sphygmomanometer in both the groups. Data collection was continued for three consecutive days. The one-way repeated measures analysis of variance showed that there was a significant difference between mean pre-test and the mean post-test level of systolic (F (5,13) = 77.30, P = 0.001) and diastolic blood pressure (F (5,13) = 40.98, P = 0.001) of the intervention group at various time intervals. The unpaired t-test showed that there was a significant difference in the mean post-test level of systolic (t (34) = 6.55, P = 0.001) and diastolic (t (34) = 8.46, P = 0.001) blood pressure between the intervention and control groups. Foot reflexology as a complementary therapy is effective in reducing hypertension, which also is cost-effective and safe.
Keywords: Blood pressure, effectiveness, foot reflexology, patients with hypertension
How to cite this article:
Ann J, Victoria D, Shwetha R, Preethi F. Effectiveness of foot reflexology on blood pressure among patients with hypertension in a Selected Hospital, Mangaluru. Indian J Cont Nsg Edn 2022;23:190-5 |
How to cite this URL:
Ann J, Victoria D, Shwetha R, Preethi F. Effectiveness of foot reflexology on blood pressure among patients with hypertension in a Selected Hospital, Mangaluru. Indian J Cont Nsg Edn [serial online] 2022 [cited 2023 May 31];23:190-5. Available from: https://www.ijcne.org/text.asp?2022/23/2/190/368419 |
| Introduction | |  |
The present generation has experienced a speedy heath revolution caused by quick urbanisation and also the globalisation of unhealthy lifestyles. The most striking shift of these changes that can be seen is the increasing range of non-communicable diseases.[1] Hypertension is a worldwide burden.[2] Raised blood pressure is attributable to 10.8% of all deaths in India.[3] The prevalence of hypertension in Indian urban population has increased from 2% to 4% in mid-1950s to 10%–15% at the end of 20th century.[4] Proper management of hypertension may require both pharmacological and non-pharmacological interventions. One of the non-pharmacological and life-style-based treatments is the complementary therapies.[5] Reflexology is one of such therapies in which pressure is applied to specific points and areas on the feet, hands or ears.[6] It is a systematic practice in which applying some pressure to any particular point on the feet has an impact on the functions of related parts of the body.[6] Each point of the pressure acts as the sensor on the feet and links with different parts of body specifically. These sensors will be stimulated by applying the reflexology technique to improve the blood and energy circulation that gives a sense of relaxation and maintains homoeostasis of functioning in the connected part. A study conducted in Korea, on the effect of self-foot reflexology (SRM) program on level of hypertension, using a non-equivalent control group pre-test–post-test design showed a significant decrease in systolic, diastolic blood pressure (DBP) and difference in pre-test and post-test between the experimental group and control group.[7] The investigator's clinical experience of taking care of hypertensive patients with complications and on multiple antihypertensive medications made to undertake the present study with the aim to find out whether hypertension can be controlled with non-pharmacological measures with a possible reduction in use of antihypertensive medications.
The objectives of the study were
- To assess the pre- and post-test level of blood pressure among patients with hypertension in the intervention and control groups
- To determine the effectiveness of foot reflexology on level of blood pressure among patients with hypertension in the intervention group
- To compare the post-test level of blood pressure among patients with hypertension in the intervention group and control groups.
Hypotheses
H1: There will be a significant difference in the mean pre-test and post-test level of blood pressure in intervention group.
H2: There will be a significant difference in the mean post-test level of blood pressure between the intervention and control group.
Conceptual framework
The conceptual framework for the study was developed based on Ernestine Wiedenbach's Helping Art of Clinical Nursing Theory (1964). The theory consists of three factors: central purpose, prescription and realities. A nurse while focusing on the central purpose develops a prescription and implements it according to the realities of situation [Figure 1]. | Figure 1: Conceptual framework based on Ernestine Wiedenbach's Helping Art of Clinical Nursing Theory (1964)
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| Methods | | |
An experimental design was adopted to conduct the study at inpatient medical department of a selected hospital at Mangaluru. The sample size was calculated using alpha error probability of 0.05 and power of test of 0.8. Based on these, a total of 36 subjects would be required. Purposive sampling technique was used to select 36 subjects who were randomly assigned to intervention and control group by closed envelope method (n = 18 in each group). In-patients who were diagnosed with hypertension for more than 3 months, between the age group of 41 and 70 years and are on antihypertensive drug of calcium channel blocker and/or beta-adrenergic blocker classes were included in the study. Patients using one group of antihypertensive medication were included to control effect of medication on blood pressure changes. Inpatients with hypertension who were unconscious, pregnant, having lower extremity fracture, impaired skin, foot ulcer, diabetic foot, peripheral insufficiencies, admitted for surgery or any skin allergy, who were on tricyclic antidepressants, sedatives hypnotics or under the treatment for Parkinson's disease, who were on antihypertensive drug other than calcium channel blocker and/or beta-adrenergic blocker classes were excluded. Baseline proforma, blood pressure record chart and new calibrated digital sphygmomanometer were used to collect the data.
Subjects were placed in supine position with privacy and blood pressure was assessed and marked in blood pressure record chart. Intervention group received foot reflexology for 20 min, once (10 min for each leg) between 8 AM and 12 PM for 3 days along with the routine hospital treatment, while control group received routine hospital treatment. Post-interventional blood pressure was recorded 5 min after each intervention for 3 days in the intervention group. Whereas the control group after pre-measurement of blood pressure continued any routine treatment and blood pressure was recorded at about 25 min after pre-test. A 20 min rest time in bed or chair was assured for control group as well to mimic the time that the intervention group rested for foot bath in the pre and post-test measurement. The pre and post-measurement was done on all 3 days. The data was compiled for analysis using SPSS software version 16. The data were expressed in frequency, percentage, mean, standard deviation, skewness, kurtosis, Levene's test, one-way repeated measures analysis of variance and unpaired t-test. P < 0.05 was considered statistically significant.
Ethical consideration
The study was approved by the Institution Ethics Committee (FMIEC/CCM/16/2019). Written informed consent was obtained from the subjects and confidentiality was assured.
| Results | | |
Out of 36 subjects, 12 (67%) in the intervention and 13 (72%) in the control group were in the age group of 51–60 years. Thirteen (72%) subjects in the intervention group and 11 (61%) in the control group had a family history of hypertension. Ten (56%) subjects in the intervention group and 12 (67%) in the control group had no habit of consuming alcohol. Ten (55%) subjects in the intervention group and 9 (50%) in the control group never exercised [Table 1].
Both the groups were homogeneous with regard to all demographic variables and pre-test blood pressure as analysed by Chi-square and Levene's test. The level of pre-test blood pressure in both the groups was normally distributed as analysed by skewness and kurtosis; hence, parametric test was opted for statistical analysis.
The mean pre-test and mean post-test level of systolic blood pressure (SBP) over all 3 days at various time points showed a highly significant difference (F (5,13) = 77.30, P = 0.001) in the intervention group. The eta square (ɳ2) value of 0.96 indicated that foot reflexology had a larger effect on SBP among patients with hypertension and the effect was not by chance [Table 2]. Post hoc Bonferroni correction test [Table 3] identified a significant difference at various time points. | Table 2: Comparison of mean pre-intervention and post-intervention level of systolic blood pressure at various time intervals in the intervention group
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The mean pre-test and mean post-test level of DBP at various time points also showed a highly significant difference (F(5,13) = 40.98, P = 0.001) in the intervention group. The eta square (ɳ2) value of 0.94 indicated that foot reflexology had a larger effect in reducing the DBP among patients with hypertension and the effect was not by chance [Table 4]. Post hoc Bonferroni correction test [Table 5] identified a significant difference at various time points. | Table 3: Comparison of effectiveness of intervention on systolic blood pressure at various time points in the intervention group using post hoc Bonferroni correction test
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 | Table 4: Comparison of mean pre-intervention and mean post-intervention level of diastolic blood pressure in the intervention group at various time points
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In the control group, the mean pre-test and post-test level of SBP as well as the difference between the mean DBP in the pre and post-test did not significantly vary [Figure 2] and [Figure 3]. | Figure 2: The mean pre-test and post-test level of systolic blood pressure of intervention and control groups on day 1, day 2 and day 3
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 | Figure 3: Line diagram showing the mean pre-test and post-test level of diastolic blood pressure of intervention and control groups on day 1, day 2 and day 3
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There was a significant difference in the mean post-test level of SBP between the intervention and control groups on day 2 and day 3 (P = 0.001) [Table 6] and in the mean post-test level of DBP in the intervention and control groups on day 2 (P = 0.03) and day 3 (P = 0.001) [Table 7]. | Table 5: Comparison of effectiveness of intervention on diastolic blood pressure at various time points in the intervention group using post hoc Bonferroni correction test
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 | Table 6: Comparison of mean post-test level of systolic blood pressure between the intervention and control group
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 | Table 7: Comparison of mean post-test level of diastolic blood pressure between the intervention and control group
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| Discussion | | |
The present study revealed that there was a highly significant difference between mean pre-test and mean post-test level of SBP (F (5,13) = 77.30, P = 0.001) and DBP at various time intervals (F (5,13) = 40.98 (P = 0.001) in the intervention group, showing that foot reflexology is an intervention that could be used in control of hypertension.
The present study findings are supported by the findings of an experimental study conducted by Lee in Korea, to assess the effect of self-foot reflexology massage on depression, stress responses and immune functions of middle-aged women. The results showed that there was a significant difference between mean pre-test and mean post-test level of SBP at various time intervals (F = 5.68, P = 0.002).[8],[9]
The findings are also congruent with the findings of the study conducted by Khalili et al., in Iran, which aimed to investigate the effects of foot reflexology on physiological parameters of patients before coronary angiography, which showed significant difference between mean pre-test and mean post-test level of SBP (P = 0.01) and between mean pre-test and mean post-test level of DBP (P = 0.02).[10],[11]
The current study has revealed that there was no significant difference in post-test SBP (t (34) = 1.62, P = 0.11) and DBP (t (34) = 0.06, P = 0.94) on day 1. However, on day 2, SBP (t (34) = 4.54, P = 0.001) and DBP (t (34) = 2.25, P = 0.03) and on day 3, SBP (t (34) = 6.55, P = 0.001) and DBP (t (34) = 8.46, P = 0.001) showed a significant difference between the intervention and control groups. Similar observations were found in another study.[12] However, contradictory results were found in another study where there was a significant decrease in the SBP after intervention (t (58) = 2.60, P < 0.05) on day 1, but showed no significant decrease (t (58) = 1.41, P < 0.16) on day 2 and highly significant increase in DBP (t (58) = 2.79, P < 0.01) on day 1 and no significant effect was recorded in the other observations of DBP.[13] The discrepancy in the above study might be explained by slight differences in reflexology technique across studies (e.g., location of the acupressure point, intensity applied and duration of the procedure).
Foot reflexology can be easily performed by anyone who is properly trained. In addition, if performed regularly at home by the patient, it may result in long-term improvements in BP and cardiovascular outcomes.
Limitations of the study
- A small sample size limits the generalisation of the study findings
- A short duration of intervention period limited the generalisation of findings.
| Conclusion | | |
Foot reflexology is a simple, cost-effective, non-pharmacological method of managing high blood pressure. It could be implemented in the hospital among the in-patients and can be taught to patients to practice in their home settings. Further rigorous studies are needed probably with larger sample size to explore the effect of reflexology on immediate as well as prolonged effect of this method on regulating blood pressure.[7],[14]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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| 7. | Wang MJ, Cha NH. An analysis of the effect of self-foot reflexology on level of hypertension. J Korean Acad Community Health Nurs 2003;14:5. |
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| 10. | Khalili A, Mardani D, Pour NB, Paymard A, Daraei M, Yaripoor S, et al. The effect of foot reflexology on physiological parameters. Int J Med Res Health Sci 2016;5:50-4. |
| 11. | Hodgson NA, Andersen S. The clinical efficacy of reflexology in nursing home residents with dementia. J Altern Complement Med 2008;14:269-75. |
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| 13. | Kaur J, Kaur S, Bhardwaj N. Effect of 'foot massage and reflexology'on physiological parameters of critically ill patients. Nurs Midwifery Res J 2012;8:223-33. |
| 14. | Hasan M, Sutradhar I, Akter T, Das Gupta R, Joshi H, Haider MR, et al. Prevalence and determinants of hypertension among adult population in Nepal: Data from Nepal demographic and health survey 2016. PLoS One 2018;13:e0198028. |
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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