The Effect of Reflexology on Anxiety in Patients Undergoing Open Heart Surgery: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Journal of Nursing Research, vol.Publish Ahead of Print, 2026 (SCI-Expanded, SSCI, Scopus)
- Publication Type: Article / Article
- Volume: Publish Ahead of Print
- Publication Date: 2026
- Doi Number: 10.1097/jnr.0000000000000725
- Journal Name: Journal of Nursing Research
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, CINAHL, MEDLINE, Directory of Open Access Journals
- Keywords: anxiety, nursing, open-heart surgery, reflexology, systematic reviews
- Kütahya Health Sciences University Affiliated: Yes
Abstract
Background: – Open-heart surgery is effective but may involve significant postoperative complications and long recovery times that can be exacerbated by patient anxiety. Nonpharmacological approaches such as reflexology have gained attention in the field of medicine for their ability to alleviate anxiety without significant side effects. Purpose: – This systematic review and meta-analysis were designed to determine the effect of reflexology on anxiety in patients undergoing open-heart surgery. Methods: – The PubMed, EBSCO (including MEDLINE and CINAHL), OVID, Web of Science, and Cochrane databases were searched from May 15 to July 15, 2024. Randomized controlled trials that evaluated patients who had open-heart surgery were included in the analysis. Studies were appraised using the Critical Appraisal Checklists for Randomized Controlled Trials developed by the Joanna Briggs Institute (JBI). The meta-analysis was conducted using the Comprehensive Meta-Analysis Version 2, and heterogeneity between studies was assessed using the χ2 test and I 2 statistic. The results were reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: – Eight studies encompassing 485 patients were included in the meta-analysis. All of the included studies used common measurement times for anxiety and compared intervention groups with either standard care or a placebo. In the meta-analysis performed using a random-effects model, reflexology was found to significantly reduce anxiety (g=−1.49, 95% confidence interval (CI)=[−2.35, −0.63], with a statistically significant difference observed between the intervention and control groups (z=−3.41, p=.001). However, the findings of the meta-analysis should be interpreted with caution. Conclusions: – Reflexology may be effective in reducing anxiety in patients undergoing open-heart surgery. However, the significant heterogeneity identified among the included studies indicates variability among study conditions. Therefore, their outcomes should be evaluated carefully. Reflexology may be used as an adjunct to standard patient care. Additional studies with more homogeneous methodologies are required to strengthen the evidence base for the efficacy of reflexology in reducing anxiety in this vulnerable patient population.