EFFECTIVENESS OF FOOT REFLEXOLOGY ON PAIN AMONG HEMODIALYSIS PATIENTS

Background: Hemodialysis is the most important treatment for chronic kidney disease. The occurrence of the negative symptoms of dialysis therapy such as pain, sleep disorder, depression, fluctuations in blood pressure reduce the Quality of life and cause the illness to be perceived as burdensome. Foot reflexology serves to relax, improve circulation and promote a general feeling of wellness among hemodialysis patients. Aim: To assess the effectiveness of foot reflexology on pain among hemodialysis patients. Material& Methods:A quasi-experimental pretest posttest control group design was used. 302 patients underwent hemodialysis were selected from two hemodialysis center. Foot reflexology given for 2 weeks in an alternative day. Researcher used numerical pain rating scale for assessing the pain of hemodialysis patients.

The prevalence of chronic kidney disease in worldwide predicted to reach 8-16% of the populations. The incidence of chronic kidney disease rises every year, especially in developing countries cause of increasing life expectation age, so that people have a longer age. chronic kidney disease therapy needs special treatment such as dialysis or renal transplantation. Many people use dialysis to treat chronic kidney disease. Chronic kidney disease is a global threat to health in general and in developing countries in particular because the treatment is lifelong and expensive. Nearly 90% of patients in India cannot afford the cost. (Choudhari K, 2017) The global prevalence of chronic renal failure (CRF) is significantly elevated. Reports indicate that about 10% of the people had this problem from all over the world. Hemodialysis is the most important treatment for chronic kidney disease as of the 3 million people undergoing replacement renal treatment, 2.5 million (80%) use hemodialysis. (Habibzadeh H, 2020).
The occurrence of the negative symptoms of dialysis therapy such as pain, sleep disorder, depression, fluctuations in blood pressure, and stomachache reduce the quality of life and cause the illness to be perceived as burdensome. (Dąbrowska M, 2018) The theory of reflexology is based on the principle that energy flows through vertical zones throughout body from organs toward the head. Therefore, massage and stimulation of nerves cause relaxation, reduce tension and as a result returns balance in the body. Studies have shown that reflexology reduces anxiety, nausea and vomiting, pain, sleeplessness and fatigue. (Rahmani Z, 2017).

Methods & Materials:-
Researcher adopted a quasi-experimental pretest posttest control group design. Formal permission was obtained from Institutional Ethical Committee of Mahatma Gandhi Medical College & Research Institute, Puducherry. The formal setting permission was obtained from the Directors of two Dialysis Centers from Puducherry.302 hemodialysis patients (Experimental -155, Control -155) undergoing hemodialysis were selected for the study.
A brief introduction about the self and study were given and data was collected from the patients. Written informed consent was obtained from the patients and confidentiality of the responses was assured. After selection of samples, the investigator assessed the pretest level of pain in both the experimental and control groups using a Numerical Pain Intensity Scale. Foot reflexology is administered for 6 cycles in duration of 40 minutes by the investigator for the experimental group and the control group were received no intervention. The posttest level of pain was assessed by the investigator for the experimental and control groups after two weeks of intervention.
In regard to duration of renal failure, in the study group 27(17.88%) had below 1 year, 30(19.87%) had 1-4 years, 94(62.25%) had 5-8 years and none of them had more than 8 years. In the control group 32(21.19%) had below 1 year, 38(25.17%) had 1-4 years, 81(53.60%) had 5-8 years and none of them had more than 8 years.Regarding the duration of hemodialysis, in the study group 16(10.60%) of them were subjected to hemodialysis less than 1 year, 74(49.01%) had 1-2 years and 61(40.40%) had more than 2 years. In the control group 25(15.26%) of them were subjected to hemodialysis less than 1 year, 73(48.34%) had 1-2 years and 53(35.10%) had more than 2 years. In 497 regard to frequency of hemodialysis, in the study group 13(8.61%) had undergone one time per week, 33(21.85%) had undergone two time per week and 105(69.54%) had undergone three time per week. In the control group 13(8.61%) had undergone one time per week, 24(15.89 %) had undergone two time per week and 110(72.85%) had undergone three time per week. The study result coincided with studies by Bassat, Brill, Sharon (2019) conducted a retrospective study on incidence and treatment of pain in the dialysis unit of tertiary referral center. The cohort included 147 patients. Over 66% reported significant (VAS >40) chronic pain during the preceding 3 months, most often characterized as stabbing (38%) and with concurrent itching (44%). Only 33% of patients received chronic pain medications, while 55.6% of patients with severe pain and 45.9% with pain characterized as the worst imaginable did not receive any analgesics. Pregabalin or weak opioids were the most frequently used. The study concluded that chronic pain is highly prevalent and markedly undertreated in dialysis patients, despite its significant adverse impact.
Brkovic, Burilovic, Puljak (2016) conducted a systematic review on prevalence and severity of pain in adult endstage renal disease patients on chronic intermittent hemodialysis. A total of 52 studies with 6,917 participants were included. The data were collected by using PsycINFO, MEDLINE, CINAHL and Scopus. Results revealed that the prevalence of acute and chronic pain in hemodialysis patients was up to 82% and 92%, respectively. The study concluded that prevalence of pain was higher in patients undergoing hemodialysis and appreciable gaps and restriction in the accessible evidence The chi square test revealed that there was no statistically significant difference between the study and control group in pretest. The chi square value of posttest 1(2=20.23, p=0.001), posttest 2(2=87.90, p=0.001) and posttest 3(2=113.65, p=0.001) revealed that there was high level statistically significant difference between the study and control group which showed that the foot reflexology had significantly reduced the pain among patients subjected to hemodialysis in study group. Results showed that reflexology decreased mean scores of the fatigue, cramp and pain in the intervention group. The study concluded that the seriousness of pain, fatigue and cramp reduced in patients undergoing hemodialysis receiving reflexology.

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There was a significant association of pain with age at p<0.001, residence at p<0.001 and dietary pattern at p<0.01 in the study group.

Conclusion:-
The present study reveals that foot reflexology intervention has a definite impact in reducing the pain among hemodialysis patients.Foot reflexo logy is a simple, safe, cheap and cost effect ive int ervent ion. Nurses play an important role to identifying the complications of hemodialysis among patients with chronic renal failure and practice of foot reflexology relieve pain and discomfort among patients s u b j e c t e d t o h e m o d i a l y s i s i n t h e d i a l y s i s c e n t e r s .