Is reflexology (a form of complementary therapy) proven to be clinically effective for individuals with various medical conditions?

Clinical Effectiveness of Reflexology

Reflexology has limited proven clinical effectiveness, with the strongest evidence supporting its use only for pain management and anxiety reduction in cancer patients undergoing active treatment, though benefits are generally small and inconsistent across conditions. 1

Evidence-Based Recommendations by Clinical Context

Cancer-Related Symptoms (Strongest Evidence)

Pain Management During Active Cancer Treatment

• Reflexology can be incorporated into systemic cancer treatment for pain management, with 6 of 7 randomized trials showing significantly less pain in reflexology groups compared to controls during chemotherapy, chemoradiotherapy, targeted, and/or hormonal therapy. 1, 2
• Three larger trials (>90 patients per arm) demonstrated benefit, though methodological quality varied. 2
• The Society for Integrative Oncology-ASCO guidelines support this use based on moderate-quality evidence. 1, 2

Anxiety During Active Cancer Treatment

• Four studies demonstrated at least small benefits of foot reflexology with short-term interventions for anxiety reduction. 1
• Effect sizes were small: 1.1-point difference on HADS (may not be clinically meaningful), 2.46-point difference on HADS (small effect), and 11.03-point difference on BAI (medium effect) in gynecologic cancer patients. 1
• Two well-conducted trials in breast cancer patients showed no benefit, highlighting inconsistency in effectiveness. 1
• No significant adverse events were reported across studies. 1

Chemotherapy-Induced Peripheral Neuropathy (CIPN)

• Aromatherapy self-foot reflexology (three times weekly, 15 minutes per foot, 18 sessions over 6 weeks) showed lower peripheral neuropathy symptoms and less interference with daily activities. 1, 2
• Despite low evidence levels, aromatherapy self-foot-reflexology may be considered as part of self-care for CIPN pain to improve patient self-efficacy. 2
• No side effects were reported in CIPN studies. 2

Post-Treatment Cancer Patients

Anxiety in Post-Treatment Phase

• Three RCTs in patients with metastatic cancer or in palliative care programs showed decreased anxiety, but effect sizes were small (1.8-point difference on 11-point VAS, 4.5-point difference on STAI, 0.8-point difference on HADS-A). 1
• These differences may be below clinically meaningful thresholds in two of three trials. 1
• All three trials had high risk of bias including unclear randomization, lack of masking, and unclear intervention protocols. 1

Non-Cancer Conditions (Weakest Evidence)

General Medical Conditions

• The best clinical evidence does not demonstrate convincingly that reflexology is an effective treatment for any medical condition outside of cancer-related symptoms. 3, 4
• Systematic reviews examining reflexology for diabetes, premenstrual syndrome, multiple sclerosis, dementia, asthma, back pain, headache, irritable bowel syndrome, and menopause found that most higher-quality trials did not generate positive findings. 3, 4
• A single-blind trial for irritable bowel syndrome found no statistically or clinically significant difference between reflexology and control groups on abdominal pain, constipation/diarrhea, or abdominal distention. 5

Methodological Quality Concerns

Critical Limitations Across Studies

• Methodological quality was often poor across reflexology trials, with low Jadad scores. 3, 4
• Common methodological flaws include: unclear randomization, lack of masking of participants and outcome assessors, unclear allocation concealment, inadequate analysis plans, and small sample sizes. 1
• Reflexology interventions varied widely regarding number and length of sessions, qualifications of providers (professional reflexologists versus trained caregivers versus self-administered), and control procedures. 1, 2
• Nine high-quality RCTs generated negative findings, while only five generated positive findings in a comprehensive systematic review. 3

Physiological Evidence

Objective Outcome Measures

• A systematic review of 17 RCTs examining physiological or biochemical outcomes found that although 12 studies showed significant changes within the reflexology group, only 3 studies (investigating blood pressure, cardiac index, and salivary amylase) resulted in significant between-group changes in favor of reflexology. 6
• The overall quality of these studies was low. 6

Clinical Implementation Considerations

When Reflexology May Be Considered

• For cancer patients during active treatment experiencing pain or anxiety, reflexology may be offered given the favorable risk-benefit ratio and absence of significant adverse events. 1, 2
• Treatment frequency typically ranges from twice daily for 20 minutes to three times weekly for 15 minutes per foot, with duration of 4-6 weeks. 2
• Reflexology should not be recommended as a primary treatment for any medical condition, but may be considered as an adjunct therapy for patients with specific interest in this modality, particularly in cancer care settings. 1

Common Pitfalls to Avoid

• Do not recommend reflexology as an effective standalone treatment for non-cancer conditions, as evidence does not support this use. 3, 4
• Do not expect consistent benefits across all cancer types; breast cancer patients in well-conducted trials showed no benefit. 1
• Do not assume clinically meaningful improvements even when statistically significant differences are found, as effect sizes are often small. 1
• Recognize that anecdotal evidence of positive effects does not constitute scientific proof of effectiveness. 7