American Journal of Nursing Research
ISSN (Print): 2378-5594 ISSN (Online): 2378-5586 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Nursing Research. 2019, 7(4), 412-419
DOI: 10.12691/ajnr-7-4-2
Open AccessArticle

The Effect of Foot Reflexology on Physiological Indicators and Mechanical Ventilation Weaning Time among Open-Heart Surgery Patients

Amira Elsayed Elsayed1, Nahed Attia Kandeel1, and Wafaa Wahdan Abd El-Aziz1

1Critical Care and Emergency Nursing Department, Faculty of Nursing, Mansoura University, Egypt

Pub. Date: May 05, 2019

Cite this paper:
Amira Elsayed Elsayed, Nahed Attia Kandeel and Wafaa Wahdan Abd El-Aziz. The Effect of Foot Reflexology on Physiological Indicators and Mechanical Ventilation Weaning Time among Open-Heart Surgery Patients. American Journal of Nursing Research. 2019; 7(4):412-419. doi: 10.12691/ajnr-7-4-2


Shortening the length of mechanical ventilation (MV) and lowering dose of sedatives among critically ill patients can decrease complications, intensive care length of stay and mortality rate. Therefore, introducing non-pharmacologic interventions such as reflexology became an issue of concern for critical care nurses. The purpose of this study was to investigate the effect of foot reflexology on physiological indicators and mechanical ventilation weaning time in open-heart surgery (OHS) patients. Methods: Quasi-experimental study with a convenience sampling technique was used to recruit 80 patients who underwent open heart operation and admitted to cardiothoracic intensive care unit (ICU) of Mansoura University Hospital. Random assignment was allocated to the intervention group (foot reflexology) and the control group (routine care). Data were collected using participants' physiological indicators and MV weaning time assessment tool. Results: There were statistical significant differences between the foot reflexology group and the control group concerning all physiological indicators (p < 0.05). Statistical significant differences were also noted on shortening the length of weaning time between both groups (p < 0.05). Conclusion: Foot reflexology is an effective method for stabilizing physiological indicators and decreasing ventilator dependence among patients undergoing OHS. Therefore, it can be introduced as an adjunct to daily care of OHS patients in ICU.

foot reflexology physiological indicators mechanical ventilation weaning time open heart surgery

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  World Health Organization. (2017). Cardiovascular diseases fact sheets. Available at [Accessed May. 17, 2017].
[2]  American Heart Association. (2015). Heart Disease and Stroke Statistics 2015: a report from American Heart Association. Available at
[3]  Urden, L., Stacy, K., & Lough, M. Critical Care Nursing: Diagnosis and Management. St. Louis: Mosby. 2014.
[4]  Shrestha, U., & Adhikary, G. P. Problems faced by clients and factors affecting post-operative recovery after open-heart surgery in selected hospitals in Kathmandu, Journal of Institute of Medicine, 39(3).‏ 73-77. 2019.
[5]  French, J. Medical-surgical Nursing Made Incredibly Easy, Lippincott Williams & Wilkins, Philadelphia, 2012.
[6]  Liu, H., Ji, F., Peng, K., Applegate, R.L., & Fleming, N. Sedation after cardiac surgery: Is one drug better than another? Anesthesia & Analgesia, 124(4). 1061-1070. 2017.
[7]  Vincent, J. L. Optimizing sedation in the ICU: the eCASH concept, Signa Vitae, 13(3), 10-13.‏ 2017.
[8]  Gumus, F., Polat, A., Yektas, A., Totoz, T., Bagci, M., Erentug, V., & Alagol, A. Prolonged mechanical ventilation after CABG: risk factor analysis. Journal of Cardiothoracic and Vascular anesthesia, 29(1), 52-58.‏ 2015.
[9]  Trouillet, J. L., Combes, A., Vaissier, E., Luyt, C. E., Ouattara, A., Pavie, A., & Chastre, J. Prolonged mechanical ventilation after cardiac surgery: outcome and predictors. The Journal of Thoracic and Cardiovascular Surgery, 138(4), 948-953.‏ 2009.
[10]  Wong, W. T., Lai, V. K., Chee, Y. E., & Lee, A. Fast‐track cardiac care for adult cardiac surgical patients. Cochrane Database of Systematic Reviews, (9), 2016.
[11]  Gelinas, C., Arbour, C., Michaud, C., Robar, L., & Côté, J. Patients and ICU nurses' perspectives of non‐pharmacological interventions for pain management. Nursing in critical care, 18(6), 307-318.‏ 2013.
[12]  Tracy, M. F., & Chlan, L. Non-pharmacological interventions to manage common symptoms in patients receiving mechanical ventilation. Critical Care Nurse, 31(3), 19-28.‏ 2011.
[13]  Shahdadi, H., Mansouri, A., & Bandani, E. The effect of foot reflexology massage on the anxiety of candidates for cataract surgery. Journal of Fundamental and Applied Sciences, 9(75), 1517-1525.‏ 2017.
[14]  Tarrasch, R., Carmel-Neiderman, N. N., Ben-Ami, S., Kaufman, B., Pfeffer, R., Ben-David, M., &Gamus, D. The effect of reflexology on the pain-insomnia-fatigue disturbance cluster of breast cancer patients during adjuvant radiation therapy. The Journal of Alternative and Complementary Medicine, 1-7.‏ 2017.
[15]  The British Reflexology Association Ltd. (2013). About Reflexology. Available at:
[16]  Abbaszadeh, Y., Allahbakhshian, A., Seyyedrasooli, A., Sarbakhsh, P., Goljarian, S., & Safaei, N. Effects of foot reflexology on anxiety and physiological parameters in patients undergoing coronary artery bypass graft surgery: A clinical trial. Complementary Therapies in Clinical Practice, 31(2018), 220-228.‏ 2018.
[17]  Shahsavari, H., Abad, M. E. E., &Yekaninejad, M. S. The effects of foot reflexology on anxiety and physiological parameters among candidates for bronchoscopy: A randomized controlled trial. European Journal of Integrative Medicine, 12(2017), 177-181.‏ 2017.
[18]  Sheikh, S., Yaghoubinia, F., &Navidian, A. Impact of Foot Reflexology Massage on the Patients’ Physiological Indicators without Trauma with Loss of Consciousness in the Intensive Care Unit. Indian Journal of Public Health Research & Development, 8(2), 201-206. 2017.
[19]  Koraş, K., &Karabulut, N. The Effect of Foot Massage on Postoperative Pain and Anxiety Levels in Laparoscopic Cholecystectomy Surgery: A Randomized Controlled Experimental Study. Journal of PeriAnesthesia Nursing, 1-8. 2018.
[20]  Sadeghi Shermeh, M., Bozorgzad, P., Ghafourian, A., Ebadi, A., Razmjoei, N., Afzali, M., & Azizi, A. Effect of foot reflexology on sternotomy pain after coronary artery bypass graft surgery. Iranian Journal of Critical Care Nursing Summer, 2, 51-4.‏ 2009.
[21]  Ray, B. S., Natha, H., & Nageshwar, V. Foot reflexology: effect on pain and anxiety in post-operative patient. International Education and Research Journal, 3(5), 49-51. 2017.
[22]  Embong, N. H., Soh, Y. C., Ming, L. C., & Wong, T. W. Revisiting reflexology: Concept, evidence, current practice, and practitioner training. Journal of Traditional and Complementary Medicine, 5(4), 197-206.‏ 2015.
[23]  Chandrababu, R., Rathinasamy, E. L., Suresh, C., & Ramesh, J. Effectiveness of reflexology on anxiety of patients undergoing cardiovascular interventional procedures: A systematic review and metaanalysis of randomized controlled trials. Journal of Advanced Nursing, 75(1), 43-53. 2019.
[24]  Kaur, J., Kaur, S., & Bhardwaj, N. Effect of foot massage and reflexology on physiological parameters of critically ill patients. Nursing and Midwifery Research, 8(3), 223-33.‏ 2012.
[25]  Mahmoudirad, G., GhaediMosolo, M., &Bahrami, H. Effect of foot reflexology on anxiety of patients undergoing coronary angiography. Iran J Crit Care Nurs, 6(4), 235-242. 2014.
[26]  Peacock, J. & Peacock, P. Oxford handbook of medical statistics, Oxford University Press Inc, New York, 2011.
[27]  Asadizaker, M., Fathizadeh, A., Haidari, A., Goharpai, S., &Fayzi, S. The effect of foot and hand massage on postoperative cardiac surgery pain. International Journal of Nursing and Midwifery, 3(10), 165-169. 2011.
[28]  Ebadi, A., Kavei, P., Moradian, S. T., & Saeid, Y. The effect of foot reflexology on physiologic parameters and mechanical ventilation weaning time in patients undergoing open-heart surgery: A clinical trial study. Complementary Therapies in Clinical Practice, 21(3), 188-192.‏ 2015.
[29]  Rahmani, Z., Rejeh, N., Heravi-Karimooi, M., Tadrisi, S. D., & Vaismoradi, M. Effect of hand reflexology on anxiety and physiological variables among patients hospitalized in the cardiac care unit: A randomized placebo controlled clinical trial. Journal of Nursing Education and Practice, 8(4), 35-42. 2017.
[30]  El-Refaye, G. E., & Elsisi, H. F. E. M. The blood pressure response to foot reflexology adjunct to transcendental meditation training on postmenopausal hypertension. Physical Therapy and Rehabilitation, 4(4), 1-8.‏ 2017.
[31]  Kunz, B., & Kunz, K. Complete reflexology for life, Dorling Kindersley Limited publishing, United States, 2007.
[32]  Mansouri, A., Shadadi, H., Poudineh-Moghadam, M., Vahed, A. S., &Dehghanmehr, S. Evaluation of the effect of foot reflexology massage on vital signs and anxiety after blood transfusions in children with thalassemia. Bali Medical Journal, 6(3), 623-629.‏ 2017.
[33]  Dalal, K., Maran, V. B., Pandey, R. M., & Tripathi, M. Determination of efficacy of reflexology in managing patients with diabetic neuropathy: A randomized controlled clinical trial. Evidence-Based Complementary and Alternative Medicine, 2014, 1-11. 2014.
[34]  Stillerman, E. Modalities for Massage and Bodywork, Elsevier Health Sciences, St. Louis, Missouri, 2016.
[35]  Korhan, E. A., Khorshid, L., &Uyar, M. Reflexology: its effects on physiological anxiety signs and sedation needs. Holistic nursing practice, 28(1), 6-23. 2014.
[36]  Ghazavi, A., Pouraboli, B., Sabzevari, S., &Mirzaei, M. Evaluation of the effects of foot reflexology massage on vital signs and chemotherapy-induced anxiety in children with leukemia. Medical-Surgical Nursing Journal, 4(4), 41-48.‏ 2016.
[37]  Khaledifar, A., Nasiri, M., Khaledifar, B., Khaledifar, A., &Mokhtari, A. The effect of reflexotherapy and massage therapy on vital signs and stress before coronary angiography: An open-label clinical trial. ARYA Atherosclerosis, 13(2), 50-55. 2017.
[38]  Elshamy, K., & Elsafety, E. Effect of nursing interventions using foot reflexology on blood pressure and quality of life of hypertensive patients at mansoura university hospitals: preliminary results. The Medical Journal of Cairo University, 79(2), 193-202. 2011.
[39]  Khalili, A., MasoudiAlavi, N., Mardani, D., Pour, N. B., Paymard, A., Daraei, M.,... & Vardanjani, M. M. The effect of foot reflexology on physiological parameters. International Journal of Medical Research & Health Sciences, 5 (9), 50-54. 2016.
[40]  Azami, H., Paveh, B. K., Rezaei, M., & Samadzadeh, S. The impacts of short-term foot massage on mean arterial pressure of neurosurgical patients hospitalized in intensive care units. Iranian Journal of Critical Care Nursing, 8(3), 133-142.‏ 2015.
[41]  Rollinson, K., Jones, J., Scott, N., Megson, I. L., & Leslie, S. J. The acute (immediate) effects of reflexology on arterial compliance in healthy volunteers: A randomised study. Complementary Therapies in Clinical Practice, 22(2016), 16-20.‏ 2016.
[42]  Jones, J., Thomson, P., Lauder, W., Howie, K., & Leslie, S. J. Reflexology has no immediate haemodynamic effect in patients with chronic heart failure: a double blind randomised controlled trial. Complementary Therapies in Clinical Practice, 19(3), 133-138.‏ 2013.
[43]  Ruiz-Padial, E, López, N. T., Bujaldón, J. L., Villanueva, I. E., & del Paso, G. R. Cardiovascular effects of reflexology in healthy individuals: evidence for a specific increase in blood pressure. Alternative Medicine Studies, 2(4), 10-17. 2012.
[44]  Chen, H. B., Liu, J., Chen, L. Q., & Wang, G. C. Effectiveness of daily interruption of sedation in sedated patients with mechanical ventilation in ICU: A systematic review. International Journal of Nursing Sciences, 1(4), 346-351. 2014.
[45]  Ismail, M. (2017). Effect of reflexology treatment on physiological outcomes among mechanically ventilated patients. (Master Dissertation, Cairo University).