Effect of Foot Reflexology on Pain, Anxiety, and Physiological Indices in Leukemia Patients Undergoing Bone Marrow Aspiration: A Randomized Clinical Trial Study

Overview

Journal Contemp Clin Trials Commun

Date 2025 Jan 30

PMID 39881886

Authors

Marjan Mehri

Mohamad Golitaleb

Ali Safdari

Sabah Madadi

Fatemeh Rafiei

Hossein Shahbazi

Razieh Mokhtari

Nazi Nejat

Affiliations

Soon will be listed here.

Abstract

Introduction: Patients with leukemia undergoing bone marrow aspiration (BMA) frequently experience considerable pain and anxiety, which may negatively impact physiological outcomes. Reflexology, a complementary therapeutic approach, has demonstrated effectiveness in reducing pain and anxiety across various medical procedures. This randomized clinical trial aimed to evaluate the impact of foot reflexology on pain, anxiety, and physiological indices in leukemia patients undergoing BMA.

Methods: This randomized clinical trial was conducted at Ayatollah Khansari Hospital in Arak between August 2021 and January 2023. Patients were randomly assigned to either a reflexology intervention group or a control group receiving routine care. The intervention group underwent a 30-min foot reflexology session. Pain was assessed using the Numeric Rating Scale (NRS), and anxiety levels were measured via the Spielberger State-Trait Anxiety Inventory (STAI). Physiological indices, including systolic and diastolic blood pressure, heart rate, and arterial oxygen saturation, were measured before and after the intervention.

Results: Of the 72 patients, 68 completed the study (intervention: n = 35, control: n = 33). Post-intervention, the intervention group showed a significant reduction in systolic (p = 0.017) and diastolic blood pressure (p = 0.028), while the control group experienced no significant changes. Heart rate significantly increased in the control group (p = 0.030), but no significant change was observed in the intervention group (p = 0.977). Anxiety levels significantly decreased in the intervention group (p < 0.001), with a notable between-group difference (p = 0.006). Pain intensity was also significantly lower in the intervention group compared to the control group (p = 0.034).

Conclusion: Foot reflexology is an effective intervention for reducing pain and anxiety in leukemia patients undergoing BMA. Reflexology may be considered a valuable, non-invasive supportive therapy for managing procedural pain and anxiety in oncology settings.

Citing Articles

Comparing the impact of foot and hand reflexology on anxiety and physiological indices in colonoscopy candidates: A randomized clinical trial.

Golitaleb M, Safdari A, Rafiei F, Yaghoobzadeh A, Mohamadi N, Mokhtari R Contemp Clin Trials Commun. 2025; 44:101449.

PMID: 40034721 PMC: 11874527. DOI: 10.1016/j.conctc.2025.101449.

References

Rahmani Vasokolaei Z, Rejeh N, Heravi-Karimooi M, Tadrisi S, Saatchi K, Poshtchaman Z . Comparison of the Effects of Hand Reflexology versus Acupressure on Anxiety and Vital Signs in Female Patients with Coronary Artery Diseases. Healthcare (Basel). 2019; 7(1). PMC: 6473738. DOI: 10.3390/healthcare7010026. View

Duzel B, Cam Yanik T, Kanat C, Altun Ugras G . The effect of acupressure on pain level and hemodynamic parameters after coronary angiography: a randomized controlled study. Front Cardiovasc Med. 2023; 10:1173363. PMC: 10374945. DOI: 10.3389/fcvm.2023.1173363. View

Ozturk R, Sevil U, Sargin A, Yucebilgin M . The effects of reflexology on anxiety and pain in patients after abdominal hysterectomy: A randomised controlled trial. Complement Ther Med. 2018; 36:107-112. DOI: 10.1016/j.ctim.2017.12.005. View

Whatley J, Perkins J, Samuel C . 'Reflexology: Exploring the mechanism of action'. Complement Ther Clin Pract. 2022; 48:101606. DOI: 10.1016/j.ctcp.2022.101606. View

Rizi M, Shamsalinia A, Ghaffari F, Keyhanian S, Nabi B . The effect of acupressure on pain, anxiety, and the physiological indexes of patients with cancer undergoing bone marrow biopsy. Complement Ther Clin Pract. 2017; 29:136-141. DOI: 10.1016/j.ctcp.2017.09.002. View

Abedian Z, Soltani N, Mokhber N, Esmaily H . Depression and anxiety in pregnancy and postpartum in women with mild and severe preeclampsia. Iran J Nurs Midwifery Res. 2015; 20(4):454-9. PMC: 4525343. DOI: 10.4103/1735-9066.161013. View

Mobini-Bidgoli M, Taghadosi M, Gilasi H, Farokhian A . The effect of hand reflexology on anxiety in patients undergoing coronary angiography: A single-blind randomized controlled trial. Complement Ther Clin Pract. 2017; 27:31-36. DOI: 10.1016/j.ctcp.2017.01.002. View

Goktuna G, Dagcan N, Arslan G . The Effect of Hand Reflexology Massage on Pain and Anxiety After Coronary Artery Bypass Graft Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial. J Cardiovasc Nurs. 2023; 40(2):E57-E64. DOI: 10.1097/JCN.0000000000001033. View

McGrath P, Rawson-Huff N, Holewa H . Procedural care for adult bone marrow aspiration and biopsy: qualitative research findings from Australia. Cancer Nurs. 2012; 36(4):309-16. DOI: 10.1097/NCC.0b013e31826f3bac. View

10.

Zhang Y, Wang S, Ma X, Yuan Y, Cheng H, Lin L . Massage therapy can effectively relieve cancer pain: A meta-analysis. Medicine (Baltimore). 2023; 102(27):e33939. PMC: 10328622. DOI: 10.1097/MD.0000000000033939. View

11.

Gunnarsdottir T, Jonsdottir H . Does the experimental design capture the effects of complementary therapy? A study using reflexology for patients undergoing coronary artery bypass graft surgery. J Clin Nurs. 2007; 16(4):777-85. DOI: 10.1111/j.1365-2702.2006.01634.x. View

12.

Abbaszadeh R, Tabari F, Asadpour A . The Effect of Lavender Aroma on Anxiety of Patients Having Bone Marrow Biopsy. Asian Pac J Cancer Prev. 2020; 21(3):771-775. PMC: 7437323. DOI: 10.31557/APJCP.2020.21.3.771. View

13.

Goral Turkcu S, Ozkan S . The effects of reflexology on anxiety, depression and quality of life in patients with gynecological cancers with reference to Watson's theory of human caring. Complement Ther Clin Pract. 2021; 44:101428. DOI: 10.1016/j.ctcp.2021.101428. View

14.

Gendron N, Zia Chahabi S, Poenou G, Rivet N, Belleville-Rolland T, Lemaire P . Pain assessment and factors influencing pain during bone marrow aspiration: A prospective study. PLoS One. 2019; 14(8):e0221534. PMC: 6715342. DOI: 10.1371/journal.pone.0221534. View

15.

Sajadi M, Goudarzi K, Khosravi S, Farmahini-Farahani M, Mohammadbeig A . Benson's Relaxation Effect in Comparing to Systematic Desensitization on Anxiety of Female Nurses: A Randomized Clinical Trial. Indian J Med Paediatr Oncol. 2017; 38(2):111-115. PMC: 5582545. DOI: 10.4103/ijmpo.ijmpo_183_16. View

16.

Abbaszadeh Y, Allahbakhshian A, Seyyedrasooli A, Sarbakhsh P, Goljarian S, Safaei N . Effects of foot reflexology on anxiety and physiological parameters in patients undergoing coronary artery bypass graft surgery: A clinical trial. Complement Ther Clin Pract. 2018; 31:220-228. DOI: 10.1016/j.ctcp.2018.02.018. View

17.

Blodt S, Pach D, Eisenhart-Rothe S, Lotz F, Roll S, Icke K . Effectiveness of app-based self-acupressure for women with menstrual pain compared to usual care: a randomized pragmatic trial. Am J Obstet Gynecol. 2017; 218(2):227.e1-227.e9. DOI: 10.1016/j.ajog.2017.11.570. View

18.

Safdari A, Khazaei S, Biglarkhani M, Mousavibahar S, Borzou S . Effect of acupressure on pain intensity and physiological indices in patients undergoing extracorporeal shock wave lithotripsy: a randomized double-blind sham-controlled clinical trial. BMC Complement Med Ther. 2024; 24(1):55. PMC: 10809617. DOI: 10.1186/s12906-024-04360-1. View

19.

Dehghan-Nayeri N, Adib-Hajbaghery M . Effects of progressive relaxation on anxiety and quality of life in female students: a non-randomized controlled trial. Complement Ther Med. 2011; 19(4):194-200. DOI: 10.1016/j.ctim.2011.06.002. View

20.

Ali E, Awad W, Khedr M, Rabie E . Effect of hand reflexology in ameliorating anxiety, pain, and fatigue among patients undergoing coronary angiography. BMC Complement Med Ther. 2023; 23(1):425. PMC: 10668458. DOI: 10.1186/s12906-023-04256-6. View