Effects of reflexology on nursing home residents withdementia.

Hodgson NA, Andersen S. The clinical efficacy of reflexology innursing home residents withdementia. The Journal of Alternative andComplementary Medicine 2008;14(3):269-275.

Aim Of This Study

This study's aim was to examine whether reflexology could have a positive effect on physiologicaldistress, pain and dementia symptoms in nursing home patients suffering mild to moderatedementia.

Method

Twenty-one nursing home patients (17 females, 4 males) over the age of 75 participated in thisstudy. All participants had been diagnosed with dementia for three to seven years prior toenrolment. Their diagnosis was determined by criteria set out in the Functional Assessment Stagingscale. None of the participants had a history of deep vein thrombosis, epilepsy, bile or kidneystones, had a pacemaker, had a fever or had foot wounds or fractures.

Participants were randomised into two groups of 11 and 10. The first group received weeklyreflexology treatments for the first four weeks of the study and then four weeks of weekly friendlyvisits. The second group received weekly friendly visits for the first four weeks and then weeklyreflexology treatments for four weeks.

The same reflexology therapist conducted all of the reflexology treatments and all of the friendlyvisits to all participants. Treatments and visits occurred mid morning on the same day eachweek. The reflexology sessions lasted for 30 minutes and usually began with five minutes ofprogressive relaxation exercises.

After the relaxation exercises, the therapist applied finger andthumb pressure to specific areas ofboth feet. During treatments, thetherapist talked generally about reflexology and answered anyspecificquestions. If participants wanted to relax and close their eyes, thetherapist would encouragethem to do so.

The friendly visits also began with five minutes of progressive relaxation after which 25 minutes ofcompanionship and conversation ensued. All visits took place in the participants' private rooms and,as part of the visits, the therapist would offer to water their plants. During the conversation, thetherapist talked generally about the weather or current events.

Measurements

Prior to study commencement, the Folstein Mini-Mental State Examination (MMSE) was completed.This 30-point questionnaire measures the participants' cognitive function in arithmetic, memoryand orientation.

Four types of data were collected on the day of the visit at four times across the day: 7-7.30 am, 11-11.30 am, 1-1.30 pm, 3.30-4 pm. Salivary [alpha]-amylase was taken from salivary samples tomeasure physiologic distress; an observational scale, the Apparent Affect Rating Scale (AARS) was

used to measure anger, depression and anxiety; and a checklist of non-verbal pain indicators (CNPI)measured pain. Other physiological measures included blood pressure, pulse and cognitive status.Data were collected by registered nurses at the nursing home.

Results

While receiving reflexology treatments, participants showed significantly lower pain andphysiological distress levels than the control condition. Borderline improvements were found in thereflexology condition for sadness.

There were no differences between conditions for diastolic or systolic blood pressure, pulse rates orobserved emotional ratings for anger, anxiety, alertness or pleasure.

Conclusion

The researchers concluded that:

These findings support preliminary evidence that reflexology treatment may be beneficial in themanagement of distress in nursing home residents with mild to moderate stage dementia.

Limitations Of This Study

The researchers acknowledged that due to the small sample size, it was not possible to analyse theinteraction between cognitive affects and salivary [alpha]-amylase samples.

It is unclear if the nurses were blinded as to which group the participants belonged. Even if theywere not made aware, it may have become apparent during conversations with participants and thiscould have had an impact on results.