Comparing the Effect of Foot Reflexology Massage, Foot Bath and Their Combination on Quality of Sleep in Patients with Acute Coronary Syndrome

Effects of Temperature, Duration, and Heating Height of Foot Thermal Therapy on Sleep Quality of Older Adults: A Systematic Review and Meta-Analysis

Background: Sleep disturbances, which are common problems in older adults, often lead to cognitive decline and depression and may even increase mortality risk. Foot thermal therapy is a simple and safe approach for improving sleep and is associated with relatively few side effects. However, the effect of different operations of foot thermal therapy on sleep quality in older adults is inconclusive. This study aimed to access the effects of temperature, duration, and heating height of foot thermal therapy (administered through a footbath) on the subjective and objective sleep quality of older adults. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, eight databases were searched for all relevant articles published up to July 2023, and a rigorous systematic review and meta-analysis was conducted. This study was registered in the PROSPERO database (CRD42022383460). Inclusion criteria were: (1) participants with a mean age ≥60 years; (2) interventions that included foot thermal therapy; (3) a control group that received routine care but no thermal therapy; (4) outcome measurements that assessed sleep quality; and (5) the studies that utilized randomized controlled trials or quasi-experimental studies. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. The meta-analysis was performed using RevMan version 5.4. Results: A total of 11 studies were included. Foot thermal therapy before bedtime improved subjective sleep quality in older adults, with optimal parameters of 40°C temperature (standardized mean difference [SMD] = 0.66, 95% confidence interval [CI]: 0.33 to 0.99), ≤20-min duration (SMD = 0.66, 95% CI: 0.39 to 0.93), and 10 cm heating height (SMD = 0.78, 95% CI: 0.45 to 1.11). Subgroup analyses revealed that a temperature of 41°C-42°C can improve objective sleep latency (SMD = 0.54, 95% CI: 0.09 to 0.99). Conclusions: It is recommended to administer foot thermal therapy (40°C; ≤20 min; 10 cm above the ankle) to older adults 1 h before their bedtime. If they have trouble falling asleep, the temperature can be increased to 41°C-42°C.

The effect of classical foot massage on insomnia and anxiety in preeclamptic pregnant women: a randomized controlled study

OBJECTIVE

Preeclampsia is one of the most common complaints during pregnancy. Preeclamptic pregnant women may experience insomnia and anxiety.

METHODS

This study was a randomized controlled trial with 71 preeclamptic women. In the experimental group, a foot massage was done for 3 days in a week. In the control group, any applications were not done. These groups were assessed for insomnia and anxiety levels.

RESULTS

In this study, it was found that classical foot massage significantly reduced (12.45±5.74 vs. 33.4±6.41) insomnia and anxiety compared with the control group (18.8±6.44 vs. 39.19±8.31, respectively, p<0.05).

CONCLUSION

The classical foot massage can effectively decrease insomnia and anxiety symptoms.

The effect of foot bath on sleep quality in the elderly: a systematic review

INTRODUCTION

Population aging is a problem that has affected most countries in the world. Poor-quality sleep is a common complaint among the elderly. Foot baths are a method of heat therapy and are performed as an independent nursing care in different departments. The present study was conducted with the aim of investigating the effects of foot baths with spa on improving the sleep quality of the elderly.

METHODS

This research is a systematic review. We systematically searched six databases, including Google Scholar, PubMed, Web of Science, Scopus, Embase, and the World Health Organization databases, to retrieve the related articles based on the keywords used in our search strategy from 2010 to March 2023.

RESULT

Finally, 10 articles were included in this study. All studies were randomized controlled trial (RCTs) and semi-experimental. In all 9 studies, the positive effects of the foot bath were reported. In 9 studies, the effect of foot baths with water above 40 degrees Celsius was reported. The PSQR questionnaire was used in most of the studies.

CONCLUSION

The total findings of this study showed that due to the high prevalence of sleep problems in the elderly, foot baths with warm water can be used as an easy, simple, and safe nursing intervention to improve sleep quality. Therefore, it can be used in nursing homes and hospitals. It is also a non-pharmacological and inexpensive nursing intervention that can be implemented by the elderly themselves after training by community health nurses.

The effect of audiobooks on sleep quality and vital signs in intensive care patients

OBJECTIVE

Improving sleep quality in the intensive care unit is significant for the recovery process. This study investigated the effect of listening to audiobooks on sleep quality and vital signs in intensive care patients.

METHODS

This quasi-experimental study utilized the pre-posttest design, involving control and intervention groups. The study was conducted in the internal medicine intensive care unit of a hospital in Turkey between January-June 2022. Standard nursing care was given to both groups on the first night, and the Sleep Evaluation Form and Richard Campbell Sleep Scale were used to measure sleep quality in the morning. On the second day, the intervention group listened to a recorded story, and the control group had standard care. Sleep quality and vital signs were measured again.

RESULTS

Data from 56 participants were analyzed. Noise (96.4%), light (69.6%), unfamiliar environment (64.8%), concerns about illness (33.9%), and care and treatments (58.9%) are the main causes of sleep disruption. The effect of these factors decreased in the intervention group after the Audiobook Listening Practice, which significantly improved the sleep quality of the ICU patients (p < 0.001). Among the vital signs, a significant difference was found in pulse and blood pressure (p < 0.001), while no changes were observed in temperature and respiratory rate in time group interaction (p > 0.05).

CONCLUSIONS

The Audiobook Listening Practice improved sleep quality and life parameters in the ICU. Nurses can use the practice to improve sleep quality in intensive care units.

IMPLICATIONS FOR CLINICAL PRACTICE

Evidence-based studies are needed to improve the sleep quality of patients in intensive care units, to ensure clinical improvement, and to reduce the length of stay at hospital. The practice is effective in manipulating environmental stressors. This low-cost method significantly improves patient care activities. It is recommended to integrate such complementary activities into intensive care units, to train nurses about the practice, and to support the practice with new studies.

Non-pharmacological interventions for improving sleep outcomes among patients with a diagnosis of coronary artery disease: a systematic review and meta-analysis

AIMS

To determine the effectiveness of non-pharmacological interventions on sleep outcomes among patients with coronary artery disease and recognize pertinent characteristics that potentially affect the effectiveness of such interventions.

METHODS AND RESULTS

Relevant studies conducted before 27 April 2022 were identified through four core electronic databases using terms related to coronary artery disease, sleep outcomes, and randomized controlled trials. Two authors independently conducted study selection, data extraction, and risk-of-bias assessment. Meta-analysis, sub-group analysis, publication bias analysis, and sensitivity analysis were conducted using R version 4.2.2. Of the 4755 retrieved articles, 42 studies were selected for systematic review and 30 studies were included in the meta-analysis. The findings of this study revealed that non-pharmacological interventions significantly improved self-reported sleep quality (standardized mean difference = -0.85, 95% confidence interval -1.08, -0.63), but had no effects on objectively measured sleep efficiency and duration. Regarding the types of interventions involved, environmental control was the most effective in improving self-reported sleep quality, followed by relaxation, self-care behaviour management, and relaxation and cognitive/psychological complex interventions. Through subgroup analysis, we did not find any covariates that were significantly related to self-reported sleep quality.

CONCLUSION

Non-pharmacological interventions have been shown to play beneficial roles in improving self-reported sleep quality among patients with coronary artery disease. Additional studies are required to elucidate the effect of non-pharmacological interventions on objectively measured sleep outcomes and to characterize their optimal frequencies and durations.

REGISTRATION

PROSPERO CRD42022366851.

Effect of massage therapy on sleep quality in critically ill patients: A systematic review and meta-analysis

AIM

The aim of the study was to compare the effects of massage interventions on sleep quality among patients in the adult critical care unit.

BACKGROUND

Massage interventions have positive effects when applied to manage sleep quality in critical care units. However, research identifying the effect of massage intervention is limited.

DESIGN

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

METHODS

Five databases were searched from their inception to 15 April 2022 (the last search was conducted on 15 November 2022, but it yielded no additional eligible studies). The literature search was conducted using Embase, MEDLINE, the Cochrane Library, CINAHL, PsycINFO and additional sources such as Google Scholar. The Cochrane risk of bias tool for randomised trials (RoB 2.0) was used to assess the risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system assessed the certainty of evidence and recommendations.

RESULTS

In total, ten randomised controlled trials comprising 569 participants were used in the systematic review, and eight trials were included in the meta-analysis. Subgroup analysis revealed significant effects of foot reflexology massage on subjective sleep quality. Massage therapy for a two-night duration in cardiac care unit patients exhibited a significant effect on subjective sleep quality. The overall GRADE certainty of evidence was low.

CONCLUSION

Massage intervention, particularly foot reflexology massage, with a two-night duration showed improvement in subjective sleep quality among critically ill patients. Although evidence quality was low, the results suggest that massage interventions provide a non-invasive, low-cost and effective way to promote sleep quality in critically ill adult patients.

RELEVANCE TO CLINICAL PRACTICE

Massage interventions can enable nurses to recommend and implement strategies promoting and improving sleep quality among critically ill patients.

STUDY REGISTRATION

The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.York.ac.uk/Prospero with the registration number # CRD42022332371).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution if such details are not necessary or do not apply to your work and state why.

Physical and Mental Effects of Foot Baths Among Women in Labor: Protocol for a Pre-Post Test Experimental Design

BACKGROUND

Foot baths are used in complementary and alternative therapy to improve the duration and quality of sleep and reduce tension, anxiety, fatigue, and confusion. They are also known to improve the frequency of labor contractions and to increase their duration in women; thus, they are commonly used by midwives in clinical settings in Japan. However, the physical and mental effects of foot baths during labor are unknown.

OBJECTIVE

This study aims to assess the physical and mental effects of foot baths based on biomarker levels and self-administered questionnaires.

METHODS

A single-arm pre-post test trial design is being used in this study, and the study is being conducted at a general hospital in Tochigi Prefecture, Japan. The target study population is women in the first stage of labor, the phase when the uterus starts to contract and when the cervix dilates to 10 cm, or those undergoing labor induction. Participants who meet the eligibility criteria are recruited, and written informed consent is obtained from them. They are asked to answer the questionnaire and to collect 1.5 mL of saliva in 2 microtubes each, before and after the intervention. The intervention is foot baths for 15-20 minutes using a foot bath device. Data on delivery, such as gestational age, gravidity, parity, diagnosis following the last vaginal examination, and presence or absence of membrane rupture, are retrieved from the medical records. The primary outcomes are salivary cortisol levels before and after the foot baths. The secondary outcomes are levels of relaxation and comfort, labor pain, body warmth, vital signs, and interval of labor pain before and after the foot baths, which are assessed using a numerical rating scale. A paired t test or Wilcoxon signed-rank test will be performed to compare the data for salivary cortisol levels and numerical rating scale scores.

RESULTS

Data collection started on April 1, 2022. As of October 2022, we had enrolled 10 participants. Because of the COVID-19 pandemic in Japan, it is difficult for medical personnel to freely interact with women in labor until the results of the COVID-19 polymerase chain reaction test are available in the research facility, complicating the recruitment process.

CONCLUSIONS

This is the first prospective study to assess the effects of foot baths using a biomarker during the first stage of labor. The findings on the effects of foot baths on women in labor will provide novel insights that may improve the outcomes of delivery. A randomized controlled trial to investigate the effects of foot baths to obtain robust evidence should be conducted in the future.

TRIAL REGISTRATION

University Hospital Medical Information Network-Clinical Trial Registry UMIN000046539; https://tinyurl.com/2wwj7dns.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39985.

Do ginger footbaths improve symptoms of insomnia more than footbaths with warm water only? - A randomized controlled study

OBJECTIVES

To compare the effects between warm water (WW) and ginger footbaths (WW+ginger) on sleep quality and warmth regulation in adults with self-reported insomnia symptoms.

METHODS

A prospective randomized-controlled study in which 28 participants (mean age 50.9 years, 64.3% women, insomnia symptom duration 11.4 years) were randomized to receive WW (n = 13) or WW+ginger (n = 15) daily for 2 weeks. Treatment involved nightly footbaths (12 liters of 38-42 °C warm tap water, maximum duration 20 min) with and without topical ginger (80 g of powdered ginger rhizomes).

MAIN OUTCOME MEASURES

The primary outcome measure was self-reported sleep quality (global score from Pittsburgh Sleep Quality Index, PSQI) at 2 weeks. Secondary outcomes included measures of insomnia severity (Insomnia Severity Index, ISI) and warmth regulation (Herdecke Warmth Perception Questionnaire, HWPQ and 24-hour distal-proximal skin temperature gradient, DPG).

RESULTS

WW+ginger had no greater effect on PSQI (mean between-difference 0.0 [95% CI -3.0 to 2.9], Cohen's d=0.0) or ISI (-0.2 [-3.9 to 3.4], 0.0) than WW. Nor were there any significant differences in HWPQ perceived warmth (0.1 ≥d≥0.5) or DPG (0.1 ≥d≥0.4) between WW and WW+ginger. Both groups improved over time in PSQI (WW+ginger: d=0.7, WW: d=1.3) and ISI (WW+ginger: d=0.8, WW: d=1.0). Perceived warmth of the feet increased only in WW+ginger over time (d=0.6, WW: d=0.0).

CONCLUSIONS

This dose of ginger (6.67 g/liter) did not have greater effects on sleep quality, insomnia severity or warmth regulation than WW. Considering effect sizes, costs and risks, the use of WW would be recommended over WW+ginger in this patient population.

Effects of Aroma Foot Massage on Sleep Quality and Constipation Relief among the Older Adults Living in Residential Nursing Facilities

This study focused on the effects of aroma foot massage on sleep quality and constipation relief among older adult residents in nursing facilities. This research used a non-equivalent control group and a quasi-experimental design. The participants included 40 older adults aged ≥70 years residing in two nursing facilities in Seoul City. The aroma foot massage nursing intervention consisted of a preparation stage using jojoba carrier (aroma recipe) oil and lavender oil, an aroma foot massage stage, and a finishing stage. Sleep quality scores after the experiment increased by 3.72 at post-test (M = 38.44) compared to pre-test (M = 34.72), which confirmed that sleep quality improved significantly following intervention in the experimental group as compared to the control group (F = 14.45, p = 0.001). Furthermore, the frequency of defecation in the experimental group was significantly higher than that in the control group (Z = −3.93, p < 0.001). Similarly, the constipation assessment scores decreased at post-test significantly by 2.39 in the experimental group as compared to the control group (F = 17.87, p < 0.001). These results confirm that aroma foot massage is an effective nursing intervention for alleviating constipation symptoms and improving sleep quality. Therefore, we recommend that aroma foot massage be used as a complementary intervention in combination with drug-based treatment to improve sleep quality and relieve the constipation symptoms experienced by older adults living in nursing facilities.

Effect of Foot Massage on Decreasing Blood Pressure and Anxiety in Older People with Hypertension in Indonesia

Background:

Globally, the prevalence of hypertension, especially in older people, is relatively high and increasing annually. In addition to hypertension, many older people also experience anxiety. Interventions are needed to reduce blood pressure and overcome anxiety, one of which is foot massage.

Objective:

To determine the effect of foot massage on reducing blood pressure and anxiety in older people with hypertension.

Method:

This study was a one-group pre-test–post-test design with a time-series design for measuring blood pressure and assessing the degree of anxiety after foot massage intervention for 12 sessions. Thirty older people with hypertension and anxiety participated in this study.

Results:

A significant decrease in anxiety was observed after the 6th and 12th sessions of foot massage intervention ( P < 0.05). A significant decrease was observed in systolic blood pressure after the 12th intervention compared to baseline and 8th intervention ( P < 0.05).

Conclusion:

Foot massage intervention is effective in reducing blood pressure and anxiety in older people with hypertension.

The effect of footbath on the quality of sleep in older adults: A pilot study

This pilot study was a randomized controlled trial that aimed to investigate the effect of the warm footbath on the sleep quality of Iranian older adults. Males and females aged over 60 were randomly divided into three groups (footbath group with water at 40°C, footbath group with water at 37°C, and one control group) using the permutation block method. Repeated measures design was used to compare the groups after week two and week four to study the effects of footbath on sleep quality. Footbath with water at 40°C and 37°C caused significant improvement in the participants' sleep quality. No significant difference was found between the participants' sleep quality treated with water at 40°C and 37°C. Future studies with larger samples are recommended for assessing the effectiveness of warm footbath in enhancing sleep quality in older adults.

The effect of massage therapy on fatigue after chemotherapy in gastrointestinal cancer patients

INTRODUCTION

Gastrointestinal cancer patients undergoing chemotherapy usually suffer from fatigue, which may affect different aspects of their lives.

OBJECTIVE

The current study aimed to investigate the effect of massage therapy on fatigue after chemotherapy in gastrointestinal cancer patients.

METHOD

In this quasi-experimental study, 88 gastrointestinal cancer patients were randomly allocated into two groups of intervention and control. Patients received the chemotherapy for 3 h. The intervention group received four sessions of foot massage with an interval of 40 min during the chemotherapy. The massage duration was 7 min for each foot. Fatigue was measured using the visual analogue scale to evaluate fatigue severity just after and 24 h after the chemotherapy. Friedman and Mann-Whitney U tests were used to analyze the data.

RESULTS

The mean age of patients was 59/18 ± 9/35, and the most common type of cancer was gastric cancer (40%). There was a significant difference in the mean score of fatigue between the two groups immediately after (P > 0.001) and 24 h after chemotherapy (P < 0.001). In the intervention group, fatigue score decreased gradually (P = 0.031), while it increased in the control group (P = 0.001).

CONCLUSION

This study demonstrated that foot massage, as a simple method, could reduce chemotherapy-induced fatigue.

The effect of warm salt water foot bath on the management of chemotherapy-induced fatigue

PURPOSE

Several studies have shown that the warm water bath can be a beneficial approach in the management of fatigue. This experimental study was conducted to evaluate the effect of warm salt water foot bath in the management of chemotherapy-induced fatigue.

METHODS

This randomized controlled trial was perfomed between November 2017-February 2018. Seventy five patients who experienced moderate or higher level chemotherapy related fatigue were randomly assigned to the intervention or control group. A training booklet about chemotherapy-induced fatigue was given to all patients. In addition, the experimental group performed 20 min warm salt water footbath for a week. The primary outcome was the change in fatigue level over 7 days after chemotherapy. The secondary outcome was the difference in physical, affective, emotional, and cognitive fatigue scores of patients.

RESULTS

The level of fatigue was grade 2 and grade 3 for 65.3% and 33.3% of patients, respectively. There was no statistically significant difference between groups regarding the mean of total fatigue score before and after bath (p > 0.05). However, the amount of decrease observed in the experimental group was found to be statistically significantly higher than the control group (p = 0.012; p < 0.05). In addition; the score in behavioral/severity, sensory, affective and cognitive dimensions related to fatigue decreased in the experimental group but did not decrease in the control group.

CONCLUSION

This study shown that warm salt water footbath can be an effective approach in enhancing fatigue related quality of life cancer patients. More studies should be conducted to assess the effectiveness of this intervention.

Effects of Nurse and Care Worker-led Foot-Care Program on Older People's Foot Conditions: Before and After Intervention Study

Introduction

An increasing number of older people with frailty in Japan use geriatric day care centers. Older people who have been certified as requiring long-term care attend centers during the day and receive nursing care help with bathing, excretion, meals, and functional training services. Many older people have foot problems with need foot care by nurses and care workers (NCWs) at geriatric day care centers.

Objective

This study explored the effects of NCWs’ foot-care programs on the foot conditions of older people attending daytime services.

Methods

A before-after intervention study was conducted at geriatric day care centers for older people, where the foot-care program was presented by NCWs for two months. The foot conditions of 23 clients (8 men, 15 women, mean age = 78.6 years, standard deviation = 9.2) were assessed before and after the program. Changes in foot condition and clients’ perceptions after the study were analyzed through descriptive statistics, McNemar, and paired t-tests.

Results

Although dramatic changes in foot conditions were not observed, some conditions were improved or maintained. Changes were observed in mean dry skin scores (p < .01; right foot: 1.6→1.1, left foot: 1.6→1.1), skin lesions and long nails (skin lesions R: 0.2→0.1; long nail R: 1.4→1.0, L: 1.1→0.8), and edema (R: 43.5%→39.1%, L: 52.2%→47.8%). Further, clients started perceiving that foot health is important and discussed their feet with staff more often.

Conclusion

The NCWs’ foot-care program was effective in maintaining and improving foot health in older people and positively affected their perception of foot care.

Effect of Guided Imagery Along With Breathing Relaxation on Sleep Quality of the Elderly Patients Under Abdominal Surgery: A Randomized Clinical Trial

Elderly patients undergoing surgery often suffer from sleep disorder. Holistic therapies might help them sleep better. The aim of this research was to determine the effect of guided imagery along with breathing relaxation on sleep quality in elderly patients undergoing abdominal surgery. A double-blind randomized clinical trial was conducted on 90 elderly patients undergoing abdominal surgery in 2 educational hospitals in 2018, Mashhad, Iran. The elderly patients with different abdominal surgical procedures were distributed to the wardrooms and then the rooms were randomly assigned into 2 groups. In the intervention group, the patients learned breathing relaxation the day before surgery and then an audiotape was provided to perform the guided imagery from the day before surgery for 5 days (twice) along with breathing relaxation. St Mary's Hospital Sleep Inventory was completed the night before, 48 hours and 96 hours after the surgery. Data analysis was done using SPSS 21 through analytical tests. Results of the test indicated that the score of sleep quality was significantly higher in the intervention group the night before surgery (P = .001). The total scores of sleep quality in the intervention group 48 and 96 hours after the surgery were significantly higher (P < .001). Based on results of generalized estimating equation model, the score of sleep quality for patients was 8.76 units higher in the intervention group than in the control group by controlling for the effects of time. Guided imagery along with breathing relaxation improved the sleep quality of the elderly patients undergoing abdominal surgery.Trial registration: IRCT20180731040652N1.

Effect of Foot Reflexology Intervention on Depression, Anxiety, and Sleep Quality in Adults: A Meta-Analysis and Metaregression of Randomized Controlled Trials

Objectives

The aim of this study was to conduct a systematic review, meta-analysis, and metaregression to determine the current best available evidence of the efficacy and safety of foot reflexology for adult depression, anxiety, and sleep quality.

Methods

Electronic databases (PubMed, ClinicalKey, ScienceDirect, EMBASE, PsycINFO, and the Cochrane Library) were searched till August, 10, 2020, and the validity of the eligible studies was critically appraised. Randomized controlled trials comparing foot reflexology groups with control groups for adult depression, anxiety, and sleep quality were included. Twenty-six eligible studies were included to assess the effect of foot reflexology intervention on the reducing symptoms of depression and anxiety and improving quality of sleep, respectively, as the primary outcome.

Results

Twenty-six randomized controlled trials involving 2,366 participants met the inclusion criteria. The meta-analyses showed that foot reflexology intervention significantly improved adult depression (Hedges' g = −0.921; 95% CI: −1.246 to −0.595; P < 0.001), anxiety (Hedges' g = −1.237; 95% CI −1.682 to −0.791; P < 0.001), and sleep quality (Hedges' g = −1.665; 95% CI −2.361 to −0.970; P < 0.001). Metaregression reveals that an increase in total foot reflexology time (P = 0.002) and duration (P = 0.01) can significantly improve sleep quality.

Conclusions

Foot reflexology may provide additional nonpharmacotherapy intervention for adults suffering from depression, anxiety, or sleep disturbance. However, high quality and rigorous design RCTs in specific population, along with an increase in participants, and a long-term follow-up are recommended in the future.

The effects of foot reflexology on back pain after coronary angiography: A randomized controlled trial

BACKGROUND AND AIMS

Back pain is among the most common complaints of patients during the first hours after coronary angiography (CA), i.e. when they are restricted to complete bed rest. This study aimed to evaluate the effects of foot reflexology on back pain after CA.

METHODS

This randomized controlled trial was conducted in 2018-2019 on patients hospitalized in the post-angiography unit of Razi hospital, Birjand, Iran. Through convenience sampling, 120 patients were recruited and their demographic characteristics and baseline back pain intensity were assessed immediately after angiography using a demographic questionnaire and a visual analogue scale, respectively. Then, patients were randomly allocated to a control (n = 60) and a reflexology (n = 60) group through block randomization. Patients in the reflexology group received 8-min foot reflexology for each foot (16 min for both feet) while their counterparts in the control group solely received routine post-angiography care services. Back pain assessment was repeated for all participants immediately, two, four, and 6 h after the intervention. Data were analyzed using the SPSS software (v. 16.0).

FINDINGS

Back pain intensity significantly increased after angiography in both groups (P < 0.05). Yet, pain intensity in the reflexology group at all post-intervention measurement time points was significantly less than the control group (P < 0.001).

CONCLUSION

Foot reflexology is effective in significantly reducing back pain after CA.

Before-bedtime passive body heating by warm shower or bath to improve sleep: A systematic review and meta-analysis

Water-based passive body heating (PBH_WB) as a warm shower or bath before bedtime is often recommended as a simple means of improving sleep. We searched PubMed, CINAHL, Cochran, Medline, PsycInfo, and Web of Science databases and extracted pertinent information from publications meeting predefined inclusion and exclusion criteria to explore the effects of PBH_WB on sleep onset latency (SOL), wake after sleep onset, total sleep time, sleep efficiency (SE), slow wave sleep, and subjective sleep quality. The search yielded 5322 candidate articles of which 17 satisfied inclusion criteria after removing duplicates, with 13 providing comparable quantitative data for meta-analyses. PBH_WB of 40-42.5 °C was associated with both improved self-rated sleep quality and SE, and when scheduled 1-2 h before bedtime for little as 10 min significant shortening of SOL. These findings are consistent with the mechanism of PBH_WB effects being the extent of core body temperature decline achieved by increased blood perfusion to the palms and soles that augments the distal-to-proximal skin temperature gradient to enhance body heat dissipation. Nonetheless, additional investigation is required because the findings regarding PBH_WB are limited by the relative scarcity of reported research, especially its optimal timing and duration plus exact mechanisms of effects.