Objectives: Reflexology claims that the feet are representative of the body and that massage to specific points of the feet increases blood supply to ''mapped'' organs in the body. This review provides the first systematic evaluation of existing reflexology randomized controlled trials (RCTs) to determine whether there is any evidence to suggest the existence of a reflexology treatment-related hemodynamic effect; to examine whether reflexology researchers used study designs that systematically controlled for nonspecific effects in order to isolate this specific component; and to highlight some of the methodological challenges that need to be overcome to demonstrate specific and beneficial hemodynamic effects. Design: Fifty-two RCTs of reflexology published from 1990 to September 2011 were initially retrieved. Setting/Location: Cardiorespiratory Department, Highland Heartbeat Centre, Raigmore Hospital, Inverness. Subjects: Adult subjects. Interventions: Studies using reflexology foot massage techniques as the intervention versus sham reflexology treatment, simple foot massage, conventional treatment, or no treatment as the control were then selected. Outcome measures: Outcome measures included any hemodynamic parameter potentially involved in the regulation of circulating blood volume and flow, including heart rate and systolic and diastolic arterial blood pressure. Results: Seven RCTs suggested that reflexology has an effect on selected cardiovascular parameters; however, five of these delivered the reflexology intervention as a whole complex treatment, with the data collector often delivering the intervention themselves. Conclusions: This systematic review found that although reflexology has been shown to have an effect on selected hemodynamic variables, the lack of methodological control for nonspecific general massage effects means that there is little convincing evidence at this time to suggest the existence of a specific treatment-related hemodynamic effect. Furthermore, the review found that few studies of reflexology controlled for nonspecific effects in order to isolate any specific active component, despite the hemodynamic claim being a key part of the therapeutic value of reflexology. Therefore, further research approaches using more innovative designs and robust methods that can allow a treatment-induced, therapeutically beneficial hemodynamic effect to reveal itself are needed to help reflexology purchasers make a more informed decision about the safety and product quality of the reflexology hemodynamic claim and for reflexologists to be able to guarantee minimum product quality, validity, and safety standards in their practice.

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