Understanding more about Reflexology, Research and Evidence Based Practice. Presentation by Nancy Klein 1. There are more ways to do research. The definition shows that it is important to decide which way we choose. Whatever system is used, it is always about a systematic investigation and controlled studies. ✓ The systematic investigation of a situation or problem in order to generate new know ledge ✓ or validate existing knowledge. ✓ The systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions. ✓ The collection and evaluation of information about a particular subject. The main purpose of research is to answer questions and generate new knowledge. 2. Evidence Based Practice find its roots in the originally developed Evidence Based Medicine. This was developed to find the best possible evidence for choosing the best possible medical treatment. In those days there many different ways of treatment in health care and therefor there was a need for standardization in medical therapies. Medical Surgery followed this this concept and thereafter the paramedics started their Evidence based Practice. Definition that is used: "EBP is the combination of the ancient and trusted clinical (or therapeutic) skills, supplemented with and, if necessary, corrected by the results of the best available research and the preferences of the patient". In this context it makes sense that complementary therapist also follow. But there is still a big gap in knowledge about how to do research. Not all type of research designs are fit for complementary medicine. Reflexology indeed needs a special design if we want to obtain the right data. We can place Reflexology in the field of Evidenc Based Practice. ✓ EBM Evidence Based “Medicine” ✓ EBS Evidence Based “Surgery” ✓ EBP Evidence Based “Practice” ✓ EBCAM Evidence Based “Complementary and Alternative Medicine” ✓ IM Integrative Medicine – “interventions” 3. Scientific research: When we start to learn about scientific importance we can find information via the Scientific Pyramid. This shows that not every article also has an scientific value. The higher in the pyramid the more impact research has. We have to look at methods and designs, how to read articles and how to validate them.
4. Why is research important and what does EBP want from us; there are lots of questions to answer. Or answers to be questioned: 1. First of all EBP is about a contribution to our own professional skills, and to those of others, with the purpose of achieving, improving and maintaining the quality of our profession! To have an open, objective but critical mind and to be able to act professionally in our society. EBP helps us, among other things, to watch over the quality in our profession. 2. What about knowledge and science within Evidence Based Practice according to us as Health Practitioners in Reflexology? Why Research is necessary for us Reflexologist to do? Good research can provide: ✓ Recognition by allopathic medicine / the right to work ✓ Referral by medical health practitioners ✓ Participating in multidisciplinary care ✓ The upcoming importance of “Integrative Medicine” ✓ Backlog in the field of CAM In this we have to face a lot of challenges: ✓ Different type of clients ✓ Different levels of illness ✓ Many different therapists / not fully qualified therapists ✓ Difference in levels of education ✓ Different methods ✓ Different foot charts and location of zones ✓ Research model / design CAM ✓ Practitioners other than reflexologists do the research 5. Conclusion: It is all about: getting clear what reflexology is and how we can acquire a strong position within multidisciplinary medicine. Evidence Based Medicine is all about critical questioning, life-long learning, developing and following trends, applying existing evidence, developing new evidence and quality improvement. And it is all about us!!! Professional Reflexology practitioner in health care R Research - point of view E Education - levels and skills F Future - following trends L Life-long learning - ongoing process E Evaluation - check and control X xxxxx - extra value O Outcomes - up-to-date information L Linked to all countries - exchange O Overview - knowledge and understanding G General standards - for profiling and recognition
Y you (all of you) - you are in the lead - Identity Appendix: 6. Sources that are used during the presentation to understand more about how to look at articles: 1. Review article: Review Article The Physiological and Biochemical Outcomes Associated with a Reflexology Treatment: A Systematic Review. J.E.M.McCullough, S.D.Liddle, M.Sinclair, C.Close, and C.M.Hughes. Institute of Nursing and Health Research, University of Ulster, Jordans town Campus, Shore Road, Newtownabbey, County Antrim BT370QB,UK. Conclusion of this article: “ This systematic literature review is the first, tour combined knowledge, to specifically analyse the existing data available from RCTs investigating the physiological and biochemical changes associated with reflexology, and it has demonstrated that a range of positive effects can be attributed to the treatment, specifically a reduction in stress parameters. This will inform health care professionals of the evidence base for known benefits and will enhance evidence based decision making at clinical level. It is important to note that, in all of the studies included in this review, where psychological parameters were assessed, a significant improvement in health and well-being was determined and this factor alone had a positive effect on disease outcomes, prognosis, and rehabilitation. None of the studies in this review investigated any long-term effects through follow-up with participants. Therefore, this is an aspect of CAM study design that must be addressed in the future. It is still unclear from this review precisely how reflexology impacts physiological and biochemical parameters. Evidence-Based Complementary and Alternative Medicine 15 It illustrates the need for further research into the use, efficacy, and mode of action of reflexology with well designed, high quality RCTs, if indeed RCTs are a suitable mode of investigation. Also, this review high lights the need for further research into the measurable physiological and biochemical effects of reflexology in order to address the concerns of healthcare professionals and thus allowing all patients to benefit from any positive outcomes afforded by this inexpensive, non-invasive, and nonpharmacological therapy. It is more than likely, however, that a number of factors are at work, both of a physiological and psychological nature and that reflexology is what it attests to be, a treatment that seeks to enhance and harmonise the mind, body, and spirit ” . Source: PubMed. 2. Double blind randomised trial: Reflexology for the treatment of pain in people with multiple sclerosis: a double- blind randomised sham-controlled clinical trial. CM Hughes1, S Smyth2 and AS Lowe-Strong2
Conclusion of this article: “Results from the current study clearly demonstrate a statistically significant and clinically significant reduction in pain following precision reflexology and sham reflexology within the study population. In addition, the observed reduction in pain continued for a further 10 weeks beyond the intervention period. In the group receiving precision reflexology a clinically important reduction in pain was evident by the third session, which is in keeping with findings from a previous survey, which indi cated that approximately six treatments are required to achieve relief from back pain.26 Not only did both treatments provide relief from pain, but also resulted in a reduction in other symptoms related to MS including fatigue, depression, disability and m uscle spasm. This study has indicated that precision reflexology is not superior to sham reflexology. However, both treatments offer clinically significant improvements for symptoms associated with MS. The improvements observed following the sham reflexology may be explained by a possible placebo effect or the stimulation of reflex points in the feet using non- specific massage. Thus, the mechanism of action of reflexology requires further investigation”. Source: PubMed. 3. Cross-over research: Fasciatherapy and Reflexology compared to Hypnosis and Music Therapy in Daily Stress Management. Bernard Payrau, MD, MT,1* Nadine Quere, MSc, PT, MT,1,2 Elisabeth Breton, MSc,1,3 Christine Payrau, MD1,4 1Interdisciplinary Working Group for Nonpharmacological Stress Management (IWGNSM), Paris, France, 2Ecole Bien-Etre du dos, Gentilly, France, 3Elisabeth Breton Reflexology School, Guyancourt, France, 4Institut Français d’ Hypnose, Paris, France Conclusion of this article: “The data of this study suggests a de -stressing action of both Fs DBM and Rf. It contributes to support the idea of their capability in the everyday stress management throughout the population. These first results remain to be confirmed and also to widen the knowledge on their time scope. The research field is vast, but the subject is of a key importance because it relates to the issue of a healthy population seeking to alleviate the burden of daily stress and avoid the chronic stressrelated diseases by means of such a preventive action.” Source: PubMed. 4. Case studies Case studies by Ann Gillanders(more info) listed in reflexology, originally published in issue 20 - May 1997 Source: http://www.positivehealth.com/article/reflexology/case-study-20-in-reflexology
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