Influence of Study Design on Outcomes Following Reflexology Massage: An Integrative and Critical Review of Interventional Studies
Moderate EvidenceIn Plain Language: reflexology, explained
Interpretation of the efficacy of reflexology is hindered by inconsistent research designs and complicated by professional views that criteria of randomized controlled trials (RCTs)are not ideal to research holistic complementary and alternative medicine practice. The influence of research designs on study outcomes is not known. This integrative review sought to evaluate this possibility. Thirty-seven interventional studies (2000-2014) were identified; they had RCT or non-RCT design and compared reflexology outcomes against a control/comparison group. Viability of integrating RCT and non-RCT studies into a single database was first evaluated by appraisal of 16 reporting fields related to study setting and objectives, sample demographics, methodologic design, and treatment fidelity and assessment against Jadad score quality criteria for RCTs. For appraisal, the database was stratified into RCT/non-RCT or Jadad score of 3 or more or less than 3. Deficits in reporting were identified for blind assignment of participants, dropout/completion rate, and School of Reflexology. For comparison purposes, these fields were excluded from subsequent analysis for evidence of association between design fields and of fields with study outcomes. Thirty-one studies applied psychometric tools and 20 applied biometric tools (14 applied both). A total of 116 measures were used. Type of measure was associated with study objectives (p < 0.001; chi-square), in particular of psychometric measures with a collated "behavioral/cognitive" objective. Significant outcomes were more likely (p < 0.001; chi-square) for psychometric than for biometric measures. Neither type of outcome was associated with choice of RCT or non-RCT method, but psychometric responses were associated (p = 0.007) with a nonmassage control strategy. The review supports psychometric responses to reflexology when study design uses a nonmassage control strategy. Findings suggest that
Key Findings: what this systematic review found
- ✓Research interpreting reflexology's efficacy is hindered by inconsistent study designs and disagreement about whether randomized controlled trials are appropriate for evaluating holistic complementary medicine practices.
- ✓Among 37 interventional studies examining reflexology outcomes (2000-2014), significant deficits in reporting were identified across 16 key methodological fields including study setting, sample demographics, treatment fidelity, and assessment procedures.
- ✓Study design type (RCT versus non-RCT) and research quality (measured by Jadad scores) influence the outcomes reported in reflexology intervention studies.
What This Means for You
The effectiveness of reflexology depends partly on how the research was conducted, so be cautious about claims based on studies with weak designs or small sample sizes.
What This Means for Practitioners
Document your treatment methods and outcomes consistently, as standardized reporting and rigorous study designs will strengthen the evidence base for reflexology practice.
Common questions about this study
What does this study mean in practice?
The effectiveness of reflexology depends partly on how the research was conducted, so be cautious about claims based on studies with weak designs or small sample sizes.
What did this study find?
Research interpreting reflexology's efficacy is hindered by inconsistent study designs and disagreement about whether randomized controlled trials are appropriate for evaluating holistic complementary medicine practices. Among 37 interventional studies examining reflexology outcomes (2000-2014), significant deficits in reporting were identified across 16 key methodological fields including study setting, sample demographics, treatment fidelity, and assessment procedures. Study design type (RCT versus non-RCT) and research quality (measured by Jadad scores) influence the outcomes reported in reflexology intervention studies.
How strong is this evidence?
This is a systematic review and we rate its evidence moderate. It was published in Journal of alternative and complementary medicine (New York, N.Y.), a Q2 journal. Reflexology is a complementary therapy, not a replacement for medical treatment.
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