Reflexology Might Help Treat Detrusor Overactivity
Reflexology Might Help Treat Detrusor Overactivity
Abstract & Commentary
By Frank W. Ling, MD, Clinical Professor, Dept. of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville. This abstract originally appeared in April 2008 OB/GYN Clinical Alert. Dr. Ling reports no financial relationship to this field of study.
Synopsis: Foot reflexology was more effective than non-specific foot massage in reducing daytime urinary frequency.
Source: Mak HL, et al. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:653-658.
One hundred and twenty subjects with symptoms of idiopathic detrusor overactivity (OAB) were recruited to evaluate the efficacy of reflexology compared to nonspecific foot massage. Ten therapists were trained in a standardized fashion, and each treated the same number of patients in each group. Patients kept voiding diaries for 3 days before and after the therapy. They were randomized to one group or the other and were also asked whether they thought they were in the reflexology group or the control group. Ninety-seven of the 120 patients completed the study. Reduction in daytime micturition frequency was seen in both groups with the reflexology group showing a greater decrease (1.9 vs 0.55 episodes, p = 0.029). Urge incontinence episodes was also decreased in both groups, but did not reach statistical significance (2.18 vs 1.04, p = 0.055). Nocturnal micturition frequency, urgency episodes, and pad utilization were not changed in either group. Quality-of-life measures were similar in the two groups. Interestingly, significantly fewer patients in the foot massage group believed that they had true reflexology.
Commentary
So how far "out there" is foot reflexology in your practice? Without question, it is not utilized to the same extent in different parts of the country, or world for that matter. This study was done in Hong Kong. Some readers with a good memory may recall that a very nice randomized, placebo-controlled trial demonstrating the potential efficacy of reflexology for premenstrual syndrome was published in Obstetrics and Gynecology by Oleson in December of 1993. In that case, their control group received "sham reflexology," not dissimilar to what was done here. The study was done in California. I can assure you, however, that alternative therapies are everywhere (including where I practice in Memphis, Tennessee). They just aren't discussed and/or utilized so openly in some regions.
In this study, the authors went to great lengths to make this a scientifically sound endeavor. They excluded patients appropriately, and went to great lengths to standardize the therapy, be it true reflexology or nonspecific foot massage. This included using the same creams and controlling the topics of conversation during the therapy. Despite their best efforts, a significantly greater proportion of the control group felt that they had not received the true treatment. This demonstrates that true blinding was not achieved in this study and how difficult this can be.
Theoretically, reflexology's benefit stems from areas of the foot and hand corresponding to other glands, organs or areas of the body. It is unclear what the true mechanism is that creates the benefits that patients report. Certainly the short follow-up time might limit this study's significance (or lack thereof). The authors correctly point out that larger studies with longer follow-up and better blinding may be needed in order to determine the ultimate role of this treatment modality in the treatment of OAB. The slight improvement in the one measure may not be enough to make a convert out of very many traditional providers, but the door remains open for patients and/or their providers to walk through.
So why would I include this article in this publication, which is designed to bring you evidence-based science? Because this IS evidence-based and it does help us practice. "How?" you might ask. That's a fair question. First, we must acknowledge that the study was well-designed and completed. Second, remember that good science doesn't mean that only positive results are important. A lack of statistical significance helps us advance our practice also, by putting certain treatments in proper perspective. The fact that some benefit was seen in daytime micturition frequency was not a big change in sum, but for an individual patient, there is the possibility that they might be. Similarly, the lack of significant improvement in the other measures in this relatively small study is not very encouraging, but the possibility of benefit has not been eliminated.
So do I recommend this technique? I must admit that I have not; however, the practitioners in this region are limited. I certainly have not dissuaded patients who have asked about other alternative treatments as many of them have not been systematically studied for various maladies. To me, acupuncture is far more "mainstream" these days. Massage therapy is definitely widely used. How far "out there" you want to encourage your patients to seek alternative treatments must be an individualized decision, based on your comfort, the patient's willingness, as well as the specific medical condition. My key word for the day in this regard is to be "open-minded." You may well be surprised.
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