Effects of Reflexology on Post-Operative Pain Severity after Laparoscopic Appendectomy for Patients at Surgical Units
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Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
Effects of Reflexology on Post-Operative Pain
Severity after Laparoscopic Appendectomy for
Patients at Surgical Units
Nehal M.Abo El-Fadl *
* Lecturer of Medical Surgical Nursing, Faculty of Nursing, Benha University, Egypt.
Abstract
Background: Reflexology is a type of massage that involves applying different
amounts of pressure to the feet, hands, and ears. It is based on a theory that, these
body parts are connected to certain organs and body systems. Aim: The study was
aimed to evaluate the effect of reflexology on post-operative pain severity after
laparoscopic appendectomy for patients at surgical units. Methods: A quasi-
experimental research design was utilized to conduct this study in the general
surgery department at Benha University Hospital. A purposive sample of (60) adult
patients post laparoscopic appedectomy were included in this study. Three tools
were used; (Tool I) patients’ knowledge assessment questionnaire, (Tool II)
patients’ practice observational checklist and (Tool III) visual pain analogue scale
to assess pain severity. Results: This study showed that most patients (study group)
had an unsatisfactory level of total knowledge and inadequate total practice
regarding reflexology technique after laparoscopic appendectomy pre intervention
(22% and 2%). This result improved significantly regarding all knowledge and
practice elements post intervention, where the majority of patients (study group)
had satisfactory level of total knowledge and adequate total practice (82% and
95%). Also, there was marked improvement in pain severity among the study
group pre and post intervention.While, there was no improvement noticed in the
control group regarding their total knowledge, practice, and pain severity pre and
post intervention.Conclusion: The current study concluded that, performance of
the study group post intervention concerning pain severity has been greatly
improved after application of reflexology technique that supports the first and
second research hypotheses. Also, there was a significant negative correlation
between patients’ performance and pain severity immediate post intervention for
the study group that supports the third research hypothesis. The study
recommended continuous in-service training programs and repeating the study on
a high probability sample to achieve generalization of the findings.
Keywords: Reflexology, laparoscopic appendectomy, patients, postoperative
pain severity.
E-mail: dr_nehal12@yahoo.com
587Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
Introduction cancer treatment and even decreases the
pain of pregnancy, even the one
Reflexology is considered to be a occurring after delivery (Staughton,
form of Complementary and Alternative 2020).
Medicine (CAM). CAM refers to
treatments used to, or instead of Contraindications of reflexology
conventional medical care. The House of include Internal bleeding, either recently
Lords Select Committee for Science and or currently, being under the influence of
Technology has placed reflexology in alcohol or banned substances, varicose
group two, categorized as therapies used veins or a history of similar conditions,
mostly to complement conventional contagious skin conditions, athletes foot
medicine. Its popularity has increased in or other fungal conditions, viral
recent years as the public seek more infections causing vomiting or diarrhea,
holistic ways to maintain good health severe bruising, bone fractures of bone
and well-being. In fact CAM is bruises, gout, or swelling and
increasingly being considered as a safe inflammation in and around joints, any
and effective way of reducing the causes cuts, open wounds or sores, excessive
and impacts of pain and disease (Lee, et scar tissue, sunburn, internal implants
al., 2011). and haematomas (Fuller, 2016).
Reflexology is a treatment based on The roles and responsibilities of
the principle that there are areas and nurses had changed regarding
points on the feet, hands, and ears that technological advances and scientific
are connected through the nervous knowledge. As a result, there is a need
system to corresponding parts of the for inclusion and proper use of
body. When pressure is applied to these complementary therapies in nursing
areas and points, it stimulates the interventions. At this point, nurses need
movement of energy along the nerve to learn about therapies with
channels and helps to restore multidimensional benefits such as
homeostasis balance in the body reflexology. Reflexology is thought to
(Zarifian, 2017). have a powerful therapeutic effect
between nurse and patient, because
The benefits of reflexology include touching creates a safe and unbiased
its ability to stimulate nerve function, environment and has strong therapeutic
increase energy, boost circulation, aspect through a sincere nurse-patient
induce a deep state of relaxation, and relationship (küçükkelepçe & Karaca,
eliminate toxins from the body. 2017).
Moreover, it helps to stimulate the
central nervous system, prevent Significance of the study:
migraines, and treat urinary tract
conditions. This type of massage speeds Appendicitis is one of the most
up recovery after an injury or surgery, common surgical emergencies, and it is
reduces sleep disorders, and relieves one of the most common causes of
depression and pain. It also helps in abdominal pain. Globally, the incidence
relieving side effects associated with of appendicitis or appendectomy is
around 100 per 100,000 person years
588Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
(Ferris et al., 2017). Appendicitis occurs rooms, a nursing station and physician
in 7% of the US population, with an office, and each room includes 5 beds.
incidence of 1.1 cases per 1000 people
Sample:
per year. (Craig and Brenner, 2020).
A purposive sample of 60 adult
Aim of the study patients post laparoscopic
The study was aimed to evaluate the appendectomy were included in this
effect of reflexology on post-operative study, and divided randomly into two
pain severity after laparoscopic equal groups (30 study & 30 control
appendectomy for patients at surgical groups). Group I (study group):
units. consisted of (30) patients who received
the intervention along with the routine
Operational definition hospital care. And Group II (control
group): consisted of (30) patients who
Patients’ performance means received the routine hospital care only.
patients’ knowledge and practice. According to the following criteria:
Research Hypotheses Inclusion criteria:
The following research hypotheses 1- Patients between the ages of 30–60
were formulated to fulfill the aim of the years, of both sexes.
study:
2- Patients who agreed to participate in
H1: Performance of the study group the study and able to communicate
will be improved post intervention effectively.
than the control group.
Exclusion criteria:
H2: The study group will be able to
manage pain post intervention than 1- Patients who had hands and feet
the control group. amputations, diseases (arthritis),
inflammation, phlebitis, or edema,
H3: There will be significant negative burn wound, lesion or fractures in
correlation between patients’ hands and feet; had any problems
performance and pain sverity post related to vessels and blood,
intervention for the study group. diabetes, visual disorders, hearing
Subjects and Methods disorders and also hypersensitivity to
hands and feet massage.
Research design
2- Patients with appendicular mass,
A quasi-experimental (pre/posttest) appendicular abscess, or localized
design was utilized to achieve the study's peritonitis also were excluded from
aim. this study.
Research Setting According to statistical office of
The study was conducted in general Benha University Hospital, the total
surgery department affiliated to Benha annual admissions of patients with
University Hospital, Benha Egypt. The laparoscopic appendectomy surgery who
general surgery department contains 10 met the previously mentioned criteria
589Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
were 80 patients (Statistical Office in Part (2): aimed to assess patients’
Benha University Hospital, 2019). knowledge about reflexology. It was
Sample size was calculated according to adapted from El-Abd, (2018). It included
the following equation that adopted from (6) items related to the definition, types,
Taylor, (2014): benifits, effects, principles and
precautions of reflexology.
n= N
The questionnaire tool contained
1+N (e) 2
(12) questions about reflexology. All
Where: n = sample size, N= total knowledge items were multiple-choice
population size, e = margin error (0.05). questions. The patients were asked to
After doing the equation, the sample reply to these questions with only one
was (66) patients divided randomly into correct response for each question pre
two equal groups, (30) patients for study and post intervention.
group and (30) patients for control group
and (6) patients were chosen for pilot Scoring system:
study and were excluded later from the Two scoring levels for questions
main study. were used. The correct answer was
scored (1), the incorrect answer, and not
Data Collection Tools
known was scored (0). The total score
Three tools were used to collect data was (12) resulting from adding the total
for this study; patients' knowledge number of questions. Then the results
assessment questionnaire, Observational were converted into a percentage. Total
checklist to assess patients’ practice knowledge score was categorized as:
regarding reflexology & Visual
- ≥70% was considered a satisfactory
Analogue Pain Scale. The first and
level of knowledge (8 degrees or
second tools were developed by the
more).
researcher after reviewing recent related
literature. -Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
Scoring system: participate in this study after explaining
the study’s aim.
Two scoring levels were used: done
was scored (1), and not done was scored Patients were informed about
(0). The total score was (21), resulting confidentiality of the obtained
from multiplying the total number of information and the nature of the study.
scores, and then the results were They were reassured that the obtained
converted into a percentage. Total information was used only for the
practice score was categorized as: purpose of the study. They have the right
at any time to withdraw from the
- ≥70% was considered an adequate
research without giving any reason.
level of practice (14 scores or more).
A pilot study was conducted on six
-Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
been checked using the method of - The researcher divided the studied
internal consistency. The Cronbach patients (study group) into five groups,
alpha reliability coefficient was (0.976) and each group consisted of six
for the knowledge questionnaire and patients.
(0.807) for the observational checklist - The intervention was carried out for
which proved high. each group from study group
The researcher developed the separately through the conduction of
intervetion program after reviewing the sessions according to the studied
related literature. It covered the patients' actual needs assessment.
following information: definition, types, - The intervention was conducted in 5
benefits, effects, principles, technique sessions, two sessions per week. Each
and precautions of reflexology. session lasted about 30 minutes,
The study was conducted through including periods of discussion
three phases: according to the patients' progress and
feedback.
Assessment Phase: It was carried
out for all studied subjects by the - Different teaching tools and media
researcher to collect baseline data were used, including seminars, group
regarding patients' knowledge & practice discussions, and presentations.
about laparoscopic appendectomy. The - Sampling and data collection were
researcher attended the clinical setting
started and completed during the
two days per week during morning period from July 2020 till the end of
shifts. The researcher interviewed each December 2020.
patient after his/her admission to the
hospital to collect baseline data about - Each group attended the following
socio- demographic data, medical data sessions:
and knowledge assessment sheet using The first session covered the
(Tool I). All the studied patients were definition, types, and benifits of
observed after laparoscopic reflexology. The Second session started
appendectomy using (Tool II) before with a review of the previously presented
applying the intervention. Then, both principles and advancement to the next
groups were assessed for pain severity step, which centered on reflexology
using (Tool III). effects on health. The third session
The implementation phase concentrated on precautions and
included the following steps: principles of reflexology.
- Setting general and specific objectives. The fourth session began with
reviewing the points that were
- Preparation of materials needed for previously instructed. It focused on the
session's implementation.
preparations and precautions for
- The researcher dialed with control reflexology and demonstrating about
group firstly to avoid contamination of proper position during procedure. The
data then study group. fifth session focused on demonestration
of postoperative reflexology technique.
592Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
Evaluation Phase: The evaluation 38.9±12.23respectively. As well, 66.7%
had been made immediately after and 46.7% of both groups were males
intervention by using the same tools of respectively. Also, 90% and 93.3% of
the pretest. The researcher reassessed both groups were married respectively.
knowledge, practice and pain level to the Moreover, 46.7% and 36.7% of both
control group and, evaluating the effect groups were illiterate respectively. As
of intervention on knowledge, practice well, 56.7% of study group and 63.3%
and pain management of the study group of control had family history of
by comparing the results pre and post appendicitis respectively.
intervention. Table (2): shows that, there was
A comparison between both groups high statistically significant difference
(study group and control group) was between study and control groups post
done for two times: the first before intervention regarding all items of
intervention and the second was done knowledge as observed (P-value
after intervention to determine the effect =0.001). As well, 93.3, and 90% of the
of reflexology on post-operative pain study group had incorrect answers
severity after laparoscopic about benefits, definition, and
appendectomy for patients at surgical precautions of reflexology respectively
units. pre intervention which improved to be
correct post intervention as observed:
Data Analysis
70%, and 86.6% compared to the
The data collected were structured, control group which had no
tabulated, and statistically analyzed improvement noticed post intervention
using SPSS (Version 20 of the statistical for the same items as observed: 13.3,
computer software package). Average and 6.6% pre intervention, and 16.6%,
and standard deviations were determined and 10% post intervention respectively.
for the spectrum of quantitative
Figure (1) illustrates that, there
variables. The number and percentage
was marked improvement in study group
distribution were computed for
regarding satisfactory level of
qualitative variables. A Chi-square test
knowledge from 22% pre intervention to
was used to analyze the relationship
82% post intervention compared to
between qualitative variables. Paired t-
test was used to determine the mean control group which had no
improvement noticed pre and post
difference between two sets of
intervention.
observations. For interpretation of
outcomes of significance, significance Table (3): shows that, there was
was adopted at p ≤0.05, and high high statistically significant difference
statistically significant at p ≤0.001. between study and control groups post
intervention regarding all items of
Results: practice as observed (P-value =0.001).
Table (1): shows that, 66.6% and As well, 90% of the study group didn’t
63.3% of the study and control groups perform the procedure perfectly pre
aged between 30- < 40 years with mean intervention which improved to be
age of 39.9±11.75 and 86.6% post intervention compared to the
593Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
control group which had no group pre and post intervention.While,
improvement noticed for the same items there was no statistically significant
as observed: 6.6% pre intervention, and correlation between total pain score and
16.6% post intervention respectively. physiologic parameters among control
group pre and post intervention.
Figure (2) illustrates that, there was
marked improvement in study group Table (7): shows that, there was
regarding adequate level of practice from statistically significant negative
2% pre intervention to 95% post correlation between total pain score and
intervention compared to control group total performance scores among study
which had no improvement noticed pre group pre and post intervention which
and post intervention. means that when patients’ knowledge
and practice levels increase, the severity
Table (4): shows that, there was no
of pain will decrease. While, there was
statistically significant difference
no statistically significant correlation
between study and control groups pre
between total pain score and total
intervention regarding pain severity.
performance scores among control group
While, there was high statistically
pre and post intervention.
significant difference between them post
intervention. As well, 73.3% of the study
group complained of severe pain pre
intervention with mean pain level 5.4 ±
1.3 compared by none of them post
intervention, while, there was no
improvement in pain severity among the
control group pre and post intervention.
Table (5): shows that, there was no
statistically significant difference
between study and control groups pre
intervention regarding their physiologic
parameters. While, there was high
statistically significant difference
between them post intervention. As well,
there was marked improvement in the
study group physiologic parameters pre
intervention compared to post
intervention. While, there was no
improvement in physiologic parameters
among the control group pre and post
intervention.
Table (6): shows that, there was
statistically significant positive
correlation between total pain score and
physiologic parameters among study
594Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
Table (1): Distribution of patients (both groups) regarding their demographic characteristics (n=60).
Study group n=30 Control group n=30
Items Patient data
N % N %
30- < 40 20 66.66 19 63.33
41- < 50 5 16.6 6 20.0
Age 51- < 60 5 16.6 5 16.6
Mean ±SD 39.9±11.75 38.9±12.23
Sex Female 10 33.3 16 53.3
Male 20 66.7 14 46.7
Marital status Married 27 90.0 28 93.3
Not Married 3 10.0 2 6.7
Illiterate 14 46.7 11 36.7
Educational level
Primary education 9 30.0 10 33.3
Secondary education 6 20.0 5 16.7
University education 1 3.33 4 13.3
Family history Yes 17 56.7 19 63.3
No 13 43.3 11 36.6
595Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
Table (2): Comparison of patients’ total knowledge (both groups) pre and post program intervention (n=60)
Pre- Intervention Post- Intervention
Knowledge Study group n=30 Control group n=30 Study group n=30 Control group n=30 p- P-
X21 X22
items Correct Incorrect Correct Incorrect Correct Incorrect Correct Incorrect value value
N % N % N % N % N % N % N % N %
Definition of
reflexology 3 10 27 90 2 6.6 28 93.3 26 86.6 4 13.3 3 10 27 90 0.213 0.644 22.79 .000**
Types of
5 16.6 25 83.3 3 10 27 90 24 80 6 20 7 23.3 23 76.6 0.39 0.531 24.75 .000**
reflexology
Benefits of
2 6.6 28 93.3 4 13.3 26 86.6 21 70 9 30 5 16.6 25 83.3 5.00 0.525 14.58 .000**
reflexology
Effects of
reflexology on 5 16.6 25 83.3 3 10 27 90 24 80 6 20 7 23.3 23 76.6 0.00 1.000 17.28 .000**
pain
Principles of
reflexology on 4 13.3 26 86.6 3 10 27 90 21 70 9 30 5.00 0.525 14.58 .000**
5 16.6 25 83.3
pain
Precautions
during 3 10 27 90 2 6.6 28 93.3 26 86.6 4 13.3 3 10 27 90 0.213 0.644 22.79 .000**
reflexology
X21 between study and control group pre-program. X22 between study and control group post- program.
High statistically significant at (p≤0.001) ** x2=chi-square test
596Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
Fig (1): Distribution of patients (both groups) regarding their total knowledge score pre and post intervention (n=60)
597Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
Table (3): Comparison of patients’ total practice (both groups) pre and post program implementation (n=60)
Pre- preprogram Post- preprogram
Study group n=30 Control group n=30 Study group n=30 Control group n=30
Practice items X21 p-value X22 P- value
Done Not done Done Not done Done Not done Done Not done
N % N % N % N % N % N % N % N %
Preparation 5 16.6 25 83.3 3 10 27 90 24 80 6 20 7 23.3 23 76.6 0.00 1.000 17.28 .000**
Precautions before
4 13.3 26 86.6 3 10 27 90 21 70 9 30 5 16.6 25 83.3 5.00 0.525 14.58 .000**
procedure
Performing
3 10 27 90 2 6.6 28 93.3 26 86.6 4 13.3 5 16.6 25 83.3 0.213 0.644 22.79 .000**
procedure
Finishing procedure 4 13.3 26 86.6 3 10 27 90 21 70 9 30 7 23.3 23 76.6 5.00 0.525 14.58 .000**
X21 between study and control group pre-program. X22 between study and control group post- program.
High statistically significant at (p≤0.001)** x2=chi-square test
598Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
98% 98% 98%
95%
100%
90%
80%
70%
60%
50% Adequate
40% Inadequate
30%
20%
10% 2% 2% 5% 2%
0%
Study group Control Study group Control
pre group pre post group post
intervention intervention intervention intervention
Fig (2): Distribution of patients (both groups) regarding their total Practice score pre and post intervention (n=60)
599Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
Table (4): Comparison between patients (both groups) regarding their pain severity pre and post program (n=60)
Pre- preprogram Post- preprogram
Study group Control group Study group Control group p- P-
Pain severity X21 X22
n=30 n=30 n=30 n=30 value value
N % N % N % N %
Mild 0 4.0 0 0.0 23 76.6 0 0.0
Moderate 8 26.6 9 30.0 7 23.3 26 33.3
0.821 .663 0.070 .000*
Severe 22 73.3 21 70.0 0 0.0 20 66.6
Mean ±SD 5.4 ± 1.3 5.9 ± 1.4 3.96 ± 1.6 5.7 ± 1.8
X21 between study and control group pre-program. X22 between study and control group post- program.
High statistically significant at (p≤0.001) ** x2=chi-square test
Table (5): Comparison between patients (both groups) regarding their physiologic parameters pre and post intervention (n=60)
Pre- preprogram Post- preprogram
Study group Control Study Control Paired Paired
Physiologic parameters P1 P2
n=30 group n=30 group n=30 group n=30 t-test t-test
Mean±SD Mean±SD Mean±SD Mean±SD
90.70 ± 93.0±9.01 81.20±8.69 .000**
Pulse rate 73.57±6.97 0.079 0.001 0.124
10.86
22.05±5.01 21.04±6.02 20.06±7.03 .000**
Respiratory rate 18.03±5.04 0.248 0.263
0.129
Systolic blood pressure 152.1±15.01 148.0±14.07 124.8±6.76 144.4±13.30 1.56 0.210 13.09 .000**
Diastolic blood pressure 98.67±9.42 97.27±10.52 70.67±4.69 89.87±8.80 0.213 0.644 22.79 .000**
P1 between study and control group pre-program P2 between study and control group post- program
High statistically significant at (p≤0.001) **
600Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
Table (6): Correlation between total pain score and physiologic parameters among study and control groups pre and post intervention (n=60).
Physiologic Parameters Total Pain
Study Control
Pre Post Pre Post
r P-value r P-value r P-value r P-value
Pulse rate 0.019 0.001** 0.360 0.001** 0.004 0.985 0.059 0.757
Respiratory rate 0.006 0.001** 0.494 0.001** 0.127 0.504 0.153 0.530
Systolic blood pressure 0.195 0.001** 0.352 0.001** 0.139 0.504 0.240 0.688
Diastolic blood pressure 0.301 0.001** 0.443 0.001** 0.150 0.593 0.036 0.850
Statistically in-significant at (p>0.05) statistically significant at (p≤ 0.05*) high statistically significant at (p0.05) statistically significant at (p≤ 0.05*) high statistically significant at (pOriginal Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
DISCUSSION The present study revealed that, the
The present study aimed to majority of both groups were married.
evaluate the effect of reflexology on This result was incongruent with
post-operative pain severity after Alosayfir, et al., (2018), who reported
in their study entitled “The Prevalence
laparoscopic appendectomy for patients
of People Underwent Appendectomy
at surgical units. Procedure in Saudi Arabia” that more
The study hypothesized that than half of participants were single .
Performance of the study group will be The present study revealed that,
improved post intervention than the more than half of both groups had
control group; the study group will be family history of appendicitis. This
able to manage pain post intervention result was in accordance with Lioyd,
than the control group. Also, there will (2019), who reported that family
be significant negative correlation history is one of the risk factors of
between patients’ performance and having appendicitis .
pain sverity post intervention for the Regarding total knowledge score
study group. pre and post intervention, the current
The current study revealed that study illustrated that, there was marked
more than half of study and control improvement in study group regarding
groups aged between 30- < 40 years satisfactory level of knowledge post
with mean age of 39.9±11.75 and intervention compared to pre
38.9±12.23 respectively. This result intervention. This emphasizes the
was in the same line with Yelon, et effectiveness of the intervention in
al., (2014), who reported that peak improving patients’ knowledge about
incidence of appendicitis, occurs reflexology.
between the second and third decades This result was in the same line
of life. with Afifi, et al., (2017), who revealed
The current study revealed that, in their study entitled “Impact of An
more than half of patients were males. Educational Session about Foot
This result was in agreement with De Reflexology on Nursing Students’
Wijkerslooth, et al., (2020), who Knowledge and Attitude: A Quasi
reported the same results in their study Experimental Study” that, knowledge
entitiled “Disease burden of level in the post-session was higher and
appendectomy for appendicitis: a better than in pre-session.
population-based cohort study.” Regarding total practice score pre
Also, this result was supported by and post intervention, the current study
Wang, et al., (2019), who mentioned in revealed that, there was marked
their study entitled “Laparoscopy improvement in study group practice
versus open appendectomy for elderly post intervention compared to pre
patients, a meta-analysis and intervention. This emphasizes the
systematic review” that, The risks of effectiveness of the intervention in
developing appendicitis through improving patients’ practice regarding
lifetime is higher in males than in reflexology.
females.
602Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
This result was in agreement with that, there was a significant increase in
Embong, et al., (2015), who reported both hemodynamic variables (systolic
in their study entitled “Revisiting blood pressure and diastolic blood
reflexology: Concept, evidence, current pressure) during painful procedures
practice, and practitioner training” that, except for the heart rate during
reflexology was widely accepted, and positioning.
evidenced positive effect in a variety of This result was inconsistent with
health conditions. Also, recommended Meeuse, et al., (2013), who reported in
that adequate training for practitioners their study entitled “Heart Rate
is necessary to ensure the consistency Variability Parameters Do Not
of service provided. Correlate with Pain Intensity in
Regarding pain severity, the present Healthy Volunteers” that, heart rate
study showed that there was high variability parameters may detect
statistically significant difference responses to pain, but are not suitable
between study and control groups post to assess pain intensity.
intervention. This result was in Regarding correlation between total
agreement with Rejeh, et al., (2020), pain score and total performance scores
who reported in their study entitled among study and control groups pre
“The Effect of Hand Reflexology and post intervention, the current study
Massage on Pain and Fatigue in revealed that, there was statistically
Patients after Coronary Angiography: significant negative correlation
A Randomized Controlled Clinical between total pain score and total
Trial” that, Statistically significant knowledge & practice scores among
difference was observed in pain and study group pre and post intervention.
fatigue scores between both groups From the researcher point of view, this
after the intervention. The intervention may be due to the effect of reflexology
had medium to large effects on intervention on the study group. These
patients’ pain and fatigue levels. results were in the same line with
Regarding correlation between total Taheri, et al., (2019), who reported in
pain score and physiologic parameters their study entitled “Comparing the
among study and control groups pre Effect of Foot and Hand Reflexology
and post intervention. The current on Pain Severity after Appendectomy:
study revealed that, there was A Randomized Clinical Trial” that, the
statistically significant positive results showed that foot reflexology
correlation between total pain score was more effective than hand
and physiologic parameters among reflexology in pain alleviation.
study group post intervention. This
CONCLUSION
result was supported by Khanna, et al.,
(2018), who reported in their study The current study concluded that,
entitled “Comparison between critical- performance of the study group post
care pain observation tool and intervention concerning pain severity
physiologic indicators for pain has been greatly improved after
assessment in the critically ill, application of reflexology technique
mechanically ventilated adult patients” that supports the first and second
603Original Article Egyptian Journal of Health Care, 2021 EJH Vol.12 no.1
research hypotheses. Also, there was 514426/what-is-the-incidence-of-
statistically significant negative appendicitis-in-the-us, Accessed on
correlation between patients’ 20/6/2020.
performance and pain severity post
De Wijkerslooth, E.M., van den Boom,
intervention for the study group that
A.L., & Wijnhoven, B.P., (2020).
supports the third research hypothesis. Disease burden of appendectomy for
RECOMMENDATIONS appendicitis: a population-based
cohort study. Surgical Endoscopy,
The present study recommended
volume 34, Pp.116–125.
conducting in-service training
programs periodically and regularly to El-Abd, A.A., (2018). Effect of foot
teach patients self-care skills after reflexology on blood pressure and
laparoscopic appendectomy surgery. In quality of life among patients with
addition, Innovative educational essential hypertension. Published
programs are needed to improve master thesis. Medical surgical
patients’ knowledge and practices. nursing, faculty of nursing , Benha
Also, repeating the study on a high university.
probability sample to achieve
Embong, N.H., Soh, Y.C., & Wong,
generalization of the findings. T.W., (2015). Revisiting
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