Comparison of Single and Combined Effects of Nature Sounds and Foot Sole Reflexology Massage on the Level of Consciousness in Traumatic Comatose Patients: A Randomized Controlled Clinical Trial
Strong EvidenceIn Plain Language: reflexology, explained
Consciousness disturbances are the most common posttraumatic complications. The purpose of this study was to compare the single and combined effects of nature sounds and foot sole reflexology massage on level of consciousness in traumatic comatose patients. This randomized controlled clinical trial was conducted in 2 teaching hospitals in an urban area of Iran. Samples were 120 traumatic comatose patients who were randomly assigned into control, nature sounds, foot reflexology massage, and nature sounds plus foot sole reflexology massage groups. Patients in all groups received routine care. Interventions were performed twice a day for 2 weeks, each time for 30 minutes. The patients' level of consciousness was assessed using the Glasgow Coma Scale before, 1 week, and 2 weeks after the intervention. The groups had no significant differences in the mean scores of the consciousness level before, 1 week after, and the last day of the intervention. Also, there was a significant difference in the number of patients who regained full consciousness (P = .001) in the intervention groups compared with the control group. Significant differences in the number of days of consciousness were reported in at least one of the groups compared with other groups (P = .001). This difference was significant in the control group compared with the foot reflexology massage group (P = .032), as well as the nature sounds plus foot sole reflexology massage group (P = .001). Single or combined interventions can increase the level of consciousness in comatose patients and reduce the duration of coma.
Key Findings: what this randomised trial found
- ✓Neither nature sounds alone, foot reflexology massage alone, nor their combination produced statistically significant improvements in consciousness levels among traumatic comatose patients over the 2-week intervention period.
- ✓The study found no significant differences in Glasgow Coma Scale scores between the control group and any of the three intervention groups (nature sounds, foot reflexology massage, or combined treatment) at any measurement timepoint.
What This Means for You
While this study shows promise for reflexology as a complementary therapy for coma patients, it's a specialized medical setting—discuss with your healthcare team whether reflexology might support recovery alongside standard medical treatment.
What This Means for Practitioners
This RCT provides evidence that foot sole reflexology massage may accelerate consciousness recovery in traumatic coma patients when combined with or used separately from sensory stimulation, supporting its use as an adjunctive therapy in clinical settings.
Study Design: how this randomised trial was run
Common questions about this study
What does this study mean in practice?
While this study shows promise for reflexology as a complementary therapy for coma patients, it's a specialized medical setting—discuss with your healthcare team whether reflexology might support recovery alongside standard medical treatment.
What did this study find?
Neither nature sounds alone, foot reflexology massage alone, nor their combination produced statistically significant improvements in consciousness levels among traumatic comatose patients over the 2-week intervention period. The study found no significant differences in Glasgow Coma Scale scores between the control group and any of the three intervention groups (nature sounds, foot reflexology massage, or combined treatment) at any measurement timepoint.
How strong is this evidence?
This is a randomised trial and we rate its evidence strong. It covers 120 participants. It was published in Holistic nursing practice, a Q2 journal. Reflexology is a complementary therapy, not a replacement for medical treatment.
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