MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Reflexology (originally called ‘zone therapy’ by its inventor) is a manual technique where pressure is applied to the sole of the patient’s foot. Reflexology is said to have its roots in ancient cultures. Its current popularity goes back to the US doctor William Fitzgerald (1872-1942) who did some research in the early 1900s and thought to have discovered that the human body is divided into 10 zones each of which is represented on the sole of the foot. Reflexologists thus drew maps of the sole of the foot where all the body’s organs are depicted. Numerous such maps have been published and, embarrassingly, they do not all agree with each other as to the location of our organs on the sole of our feet. By massaging specific zones which are assumed to be connected to specific organs, reflexologists believe to positively influence the function of these organs.

So, does reflexology do more good than harm?

The aim of this review was to conduct a systematic review, meta-analysis, and metaregression to determine the current best available evidence of the efficacy and safety of foot reflexology for adult depression, anxiety, and sleep quality.

Twenty-six studies could be included. The meta-analyses showed that foot reflexology intervention significantly improved adult depression, anxiety, and sleep quality. Metaregression revealed that an increase in total foot reflexology time and duration can significantly improve sleep quality.

The authors concluded that foot reflexology may provide additional nonpharmacotherapy intervention for adults suffering from depression, anxiety, or sleep disturbance. However, high quality and rigorous design RCTs in specific population, along with an increase in participants, and a long-term follow-up are recommended in the future.

Sounds good!

Finally a so-called alternative medicine (SCAM) that is backed by soild evidence!

Or perhaps not?

Here are a few concerns that lead me to doubt these conclusions:

  • Most of the primary studies were of poor methodological quality.
  • Most studies failed to mention adverse effects.
  • Very few studies controlled for placebo effects.
  • There was evidence of publication bias (negative studies tended to remain unpublished).
  • Studies published in languages other than English were not considered.
  • The authors fail to point out that a foot massage is, of course, agreeable (and thus may relieve a range of symptoms), but reflexology with all its weird assumptions is less than plausible.
  • Many of the studies located by the authors were excluded for reasons that are less than clear.

The last point seems particularly puzzling. Our own trial, for instance, was excluded because, according to the review authors, it did not include relevant outcomes. However, our method secion makes it clear that the primary focus for this study was the subscores for anxiety and depression, which comprise four and seven items, respectively. As it happens, our study was negative.

Also cuirous is the fact that the authors did not mention our own 2011 systematic review of reflexology:

Reflexology is a popular form of complementary and alternative medicine (CAM). The aim of this update is to critically evaluate the evidence for or against the effectiveness of reflexology in patients with any type of medical condition. Six electronic databases were searched to identify all relevant randomised clinical trials (RCTs). Their methodological quality was assessed independently by the two reviewers using the Jadad score. Overall, 23 studies met all inclusion criteria. They related to a wide range of medical conditions. The methodological quality of the RCTs was often poor. Nine high quality RCTs generated negative findings; and five generated positive findings. Eight RCTs suggested that reflexology is effective for the following conditions: diabetes, premenstrual syndrome, cancer patients, multiple sclerosis, symptomatic idiopathic detrusor over-activity and dementia yet important caveats remain. It is concluded that the best clinical evidence does not demonstrate convincingly reflexology to be an effective treatment for any medical condition.

I wonder why!

7 Responses to Reflexology: a new systematic review claims it is effective, but is it true?

  • Does anyone know how to search this blog for specific topics?

  • My favourite example of rubbish research happens to be on reflexology.

    https://www.sciencedirect.com/science/article/pii/S174438811000006X

    The subject of this remarkable study is reflexology for fibromyalgia. It was financed by a public grant. The first author is an assistant professor of nursing with a passion for reflexology, the second author a full professor at the national university. This study is only remarkable because it demonstrates in all aspects how not to do research. I find the conclusion to be particularly preposterous.

    • Thanks for the tip. That journal, Complementary Therapies in Clinical Practice, looks to be a great source of entertainment. I’m trying to make sense of “Bathing in a bathtub and health status: A cross-sectional study”, but unfortunately the full text seems to be paywalled.

  • So a nice foot rub makes people happy and relaxed? Not something we need an RCT to tell us.

    TBH I struggling to imagine how an RCT could implement effective double-blinding in order to determine if the beneficial effects are due to the pleasing human-on-human contact (which we’d expect), or the hocus-pocus woo-woo nonsense they slap on top to justify their prices.

    • you can simply massage the ‘wrong’ points in the control group and make sure patients and investigators are blinded

      • Exactly. Even just rubbing the dorsal aspect of te foot in the control group.

        But, then they might just say: Halleluja!! We disovered an equally effective method, and start selling dorsal reflexotherapy. ?

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