The Effect of Reflexology on the Anxiety of Pregnant Women During Labor: A Systematic Review and Meta-Analysis

Background: Reflexology is a non-invasive, inexpensive, and simple technique that can be employed for pregnant women. Objective: This study aimed to determine the effects of reflexology on anxiety during labor (primary outcome) and its side effects (secondary outcome). Methods: In this systematic review, the Cochrane Library, PubMed, Google Scholar, Scopus, Web of Science, SID, Science Direct, and ProQuest databases were searched systematically and without time constraints until 20 April 2021. The quality of the selected articles was assessed using Cochrane Handbook and the meta-analysis was performed utilizing RevMan 5.3. Heterogeneity was evaluated by the I2 statistic and as there was heterogeneity between the studies, subgroup analysis was carried out based on the control group. Since the anxiety assessment tools in the included studies were identical, the mean difference (MD) was reported. The quality of the evidence was assessed using the GRADE approach. Results: Six studies that included 643 pregnant women were investigated in this systematic review. The results of the meta-analysis using five of the studies revealed that reflexology significantly lowered the mean scores for maternal anxiety compared to routine care or simple massage (MD: -11.34; 95% CI: -16.28 to -6.40). None of the studies reported any specific side effects after reflexology treatment. Conclusion: Reflexology can decrease maternal anxiety during labor. However, given the small number of studies and the high or unclear bias risk in most of them, no definitive conclusions can be drawn, and it is recommended that further research with stronger methodologies be conducted on this subject.