The effects of reflexology on pain and sleep deprivation in patients with rheumatoid arthritis: A randomized controlled trial
Introduction
Rheumatoid arthritis (RA) is a chronic, idiopathic, systemic, inflammatory, autoimmune disease characterized by pain in the joints and swelling, loss of function in the joints, morning stiffness and sleep deprivation as well as fatigue accompanying these states [1]. The loss of function due to the disease also leads to poor quality of life [2]. Depending on the prognosis, physical deformities and unbearable pain may become prominent over time [3]. Pain causes poor quality sleep; furthermore, patients complain about fatigue not only because of their disease but also because of sleep deprivation [4]. The incidence of sleep disorders in individuals with RA was reported to range between 54% and 70% Therefore, these individuals' productivity at work and skills for conducting daily practices decrease [3].
The dissatisfaction with medical treatment methods, invasive procedures and the necessity of using daily analgesics as well as the toxic and harmful effects of drugs push patients to different quests for symptom management. Non-pharmacological methods such as reflexology, massage, hydrotherapy, therapeutic touch, acupuncture, music therapy have been used for symptom control and functional improvement in these patients [5,6].
Reflexology is the stimulation of reflex points through massage on some body parts. Foot reflexology is the practice of applying pressure to specific areas of the feet. Reflexes in the feet match to organs, glands, and systems of the body. There are some theories on the mechanism of action of reflexology [7,8]. According to the haemodynamic theory, reflexology stimulation increases blood flow to the related organ or body part. The nerve impulse theory argues that reflexology stimulation enhances nervous connection to the corresponding body parts. According to the energy theory; organs and body parts are linked through electromagnetic fields and that these pathways are blocked in states of disease. Lactic acid theory defends that lactic acid accumulates on the soles of the feet in the form of crystals and reduces regular flow. Reflexology shows that the fusion of crystals promotes free circulation [7,8]. With these features, reflexology becomes an appropriate alternative method for RA patients.
Although the effect of foot reflexology on pain symptom has been evaluated in RA patients, no study has been conducted on sleep quality. The aim of this randomized controlled trial is to analyze the effects of foot reflexology on pain and sleep quality in RA patients. Two hypotheses were explored in this study. One of the hypotheses is that foot reflexology practice reduces pain and the other is that foot reflexology improves sleep quality in RA patients.
Section snippets
Ethics
The Institutional Ethics Committee of Gaziantep University Medical Faculty (No: 2014/344) approved this study before implementation. Informed consent was obtained from all the participants included in the study.
Design and sample
This study was planned as a randomized controlled trial to evaluate the effect of foot reflexology on pain and sleep quality in RA patients. The study was held at the “Rheumatology Follow-up Polyclinic” of a university hospital located in a big city in Turkey between January–July 2015. A
Socio-demographic and disease characteristics of subjects
The socio-demographic and disease characteristics of the subjects are given in Table 1. The mean age of the patients is 50.16 ± 14.32 (22–74 years). Most of the patients were female (76.6%). The majority of the patients were not well-educated (70.0%). Most of the patients were married (93.3%). Almost all of the patients had health insurance (96.7%). Some of the patients were cigarette (25%) and alcohol (6.6%) consumers. The mean duration of RA diagnosis of the patients was 12.25 ± 7.65 years.
Discussion
This study shows that foot reflexology applied to RA patients reduces the symptoms of pain related to the disease and improves sleep quality. In the meta-analysis study conducted by Lee et al., [2011], it was concluded that foot reflexology was a useful nursing practice that had a more positive effect on fatigue and sleep than pain [14]. In another study, it was stated that foot reflexology had a mitigating effect on the symptoms of fatigue in RA patients [15].
A limited number of previous
Conclusions
The results of this study show that foot reflexology applied to RA patients is effective in increasing sleep quality, as well as reducing pain symptoms. This study shows that foot reflexology has an effect that improves sleep quality while also supporting the results of the previous studies conducted on the effects of reflexology on pain relief.
In this study, it was shown that pain and sleep symptoms of RA patients could be reduced by foot reflexology in a short time. Furthermore, this study
Funding statement
This study was supported by the Gaziantep University's Scientific Research Project (BAP/SBF.15.01).
Conflicts of interest
Gaziantep University's Scientific Research Project were responsible for the analysis and documentation of the study.
Acknowledgements
We thank all patients who participated in this study.
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