Introduction and Aim:
The use of Complementary and Alternative Medicine (CAM) is increasing and is popular with parents. There is currently little evidence to support its use in general, and no RCTs specifically investigating the use of Reflexology in children. We compared the way in which children with chronic idiopathic constipation (CIC) respond to reflexology treatment or foot massage when these are taught to their parents and carers, and used as part of their standard medical treatment.
From 08/03 to 08/05, 184 children of age 1-12 years with a diagnosis of CIC referred to the Gastroenterology Department of a paediatric teaching hospital were recruited and randomised into a 3 arm RCT- receiving standard treatment and Reflexology or standard treatment and foot massage or standard treatment alone for 12 weeks. Standard treatment followed regional constipation management guidelines for primary and secondary care. Follow up was for 12 months. The primary outcome was the increase in the mean number of bowel movements and improvements in constipation symptoms at 12 weeks: soiling, pain, medication use, general health status and behaviour per 4 week period. Outcomes were measured using a validated self-reporting constipation questionnaire (Clayden 2000) and the Child Health Questionnaire (Landgraff 1996). The primary analysis was intention to treat (n = 176) and statistical analysis, predefined in the analysis protocol, included independent t-tests, analysis of variance (ANOVA) and analysis of co-variance (ANCOVA).
There was no statistical difference between the groups at baseline in demography or constipation severity. Two group analysis adjusted for baseline (ANCOVA) showed significant differences between Reflexology and Control groups in bowel frequency (p = <0.05) and total constipation symptom score at 12 weeks (p < 0.05); there was a significant difference between Reflexology and Massage for total constipation symptom score (p < 0.05) only. There were no adverse effects reported during the study, suggesting Reflexology was well tolerated and safe.
Summary and Conclusion:
In the largest ever well-designed RCT of an intervention in paediatric CIC, reflexology as practised by parents is effective in improving outcomes, when used as an adjunct to standard treatment. To date, this is the only RCT of reflexology in paediatric practice, and further studies are needed.