Foot reflexology in the management of functional constipation: A systematic review and meta-analysis

https://doi.org/10.1016/j.ctcp.2020.101198Get rights and content

Highlights

  • Foot reflexology could significantly increase the cure rate of FC with a pooled RR 1.27 (95%CI: 1.16, 1.40, p< 0.00001).

  • Based on this systematic review and meta-analysis, foot reflexology is considered as an effective complementary therapy for treating functional constipation.

  • Randomized controlled trials with long-term follow-up are needed for further investigation.

Abstract

Background

Foot reflexology has been considered an important complementary therapy for many health-related symptoms, especially for some chronic conditions such as anxiety, stress, pain and fatigue. Some studies also showed that foot reflexology had a significant effect on functional constipation, whereas some studies did not. The effect of foot reflexology on functional constipation remains controversial. Therefore, an evidence-based systematic review and meta-analysis of randomised controlled trials were conducted to investigate the effect of foot reflexology on functional constipation.

Methods

Randomised controlled trials were identified by searching five electronic databases and hand-searching eligible reference lists. Studies that reported the effect of foot reflexology on functional constipation were included. Two reviewers performed the study screening, quality assessment and data extraction. Any discrepancy was discussed with a third reviewer. Quantitative synthesis was conducted for the same outcome measurements by calculating weighted risk ratios.

Results

A total of 203 records were identified, of which seven were eligible. Overall, foot reflexology significantly increased the curative ratio, with a pooled risk ratio of 1.27 (95% CI: 1.16, 1.40, p < 0.00001). Three trials compared the improvement of constipation-related symptoms after intervention in both the experimental and control groups by evaluating the constipation-related symptom scores. The results all showed that foot reflexology can effectively improve constipation-related symptoms. However, one trial reported that foot reflexology had no significant effect on stool frequency and stool consistency. Two studies indicated that foot reflexology significantly reduced the recurrence rate of functional constipation. One study reported the effect of foot reflexology on compliance with the toilet training, diet and motivation. Nevertheless, no significant improvement was detected.

Conclusion

Foot reflexology is an effective complementary therapy for treating functional constipation. However, because of the small number of included studies and their small sample sizes, the current evidence was insufficient to support the effectiveness of foot reflexology in reducing the recurrence rate, improving the constipation-related symptom, and compliance with toilet training, diet and motivation. Randomised controlled trials with long-term follow-up are needed for further investigation.

Section snippets

Background

Functional constipation (FC) is defined as a bowel symptom–based gastrointestinal disorder without an organic cause, which is a very common condition with varied prevalence among populations at different ages and in different geographic regions. Especially in children, the prevalence of FC worldwide ranges between 0.5% and 32.2%, with a pooled prevalence of 9.5% (95% CI 7.5–12.1) [1]. In the United States, FC accounts for 3%–25% of visits to a paediatric gastroenterologist [2]. In adults,

Methodology

This is a quantitative meta-analysis to determine the effectiveness of foot reflexology on patients with FC. The study followed a pre-specified study protocol registered in PROSPERO (CRD42018106589). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was adopted to guide the report of final results [28].

Included studies

The primary search detected 203 studies in total. After screening the titles and abstracts, 96 records that were not related to the topic and three duplicated articles were excluded. Sixteen articles on abdominal massage were also excluded. We removed 31 records for unqualified types of study design, such as review, case report, non-experimental research and RCT protocol. Through a full-text review, 24 articles that did not meet the inclusion and exclusion criteria were deleted because

Discussion

This systematic review and meta-analysis sought to explore the efficacy of foot reflexology in the management of FC. The meta-analysis of five randomised controlled trials indicated that foot reflexology would significantly increase the cure rate by improving stool frequency, stool consistency, difficult defaecation, incomplete evacuation, abdominal pain and bloating, with a pooled RR 1.27 (95% CI: 1.16, 1.40, p < 0.00001), which suggested that foot reflexology was an effective alternative

Conclusion

This study reviewed the efficacy of foot reflexology for the management of FC. A significant increase of the curative rate was found in meta-analysis, which indicated that foot reflexology is an effective complementary therapy for FC. However, the current evidence was insufficient to support the use of foot reflexology for decreasing constipation severity of its recurrence rate and improving the compliance with toilet training, diet and motivation, because of the small number of studies and

Authors’ contributions

Y.Z. and Y.Q.H. designed the research; Y.Q.H. and N.J. designed the search strategies and conducted the literature search; S.Q.W., S.X.C. and L.J.Z. evaluated the quality of included studies and extracted the data; Y.Q.H., Y.C. and X.J.Z. conducted the statistical analysis; Y.Q.H., N.J. and Y.L.W. were involved in the interpretation of the results. Y.Z. was responsible for the writing and critical revision of the manuscript. All authors read and approved the final manuscript.

Funding

The study was supported by the National Natural Science Foundation of China (General No. 71974142).

Declaration of competing interest

The authors declare no conflicts of interests.

Acknowledgment

Not applicable.

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