Document Type : Original Article

Authors

MedicalSurgical Nursing, Zahedan University of Medical Sciences, Zahedan, Iran

Abstract

BACKGROUND: Pruritus is a common skin manifestation in patients undergoing hemodialysis.
Pruritus has a negative impact on the quality of life of patients receiving hemodialysis. This study
was aimed to investigate the effect of foot reflexology massage on pruritus in hemodialysis patients.
MATERIALS AND METHODS: A quasi‑experimental study was conducted on 90 hemodialysis
patients referred to Khatam‑al‑Anbiya and Ali‑Ebne Abi‑Taleb hospitals affiliated to Zahedan
University of Medical Sciences in 2019. Patients with moderate‑to‑severe pruritus scores obtained
from the Pruritus Severity Scale (PSS) were included in the study. They were randomly divided into
intervention and control groups using shuffling cards or envelopes. The intervention group received
nine sessions of foot reflexology massage 3 days a week for 20 min (10 min on each foot) with an
emphasis on the solar plexus point. The participants in both groups again completed the PSS 48 h
after the intervention. Data were analyzed using the SPSS version 24, independent t‑test, Chi‑square
test, and paired t‑test.
RESULTS: The results of this study demonstrated that foot reflexology massage significantly reduced
itching or pruritus in hemodialysis patients (P < 0.001). Pruritus scores in the control group were
statistically significant (P < 0.001). There was no significant statistically difference between the two
groups in terms of the pruritus scores before the intervention (P = 0.59).
CONCLUSION: Our findings showed that the foot reflexology massage could relieve itching or
pruritus in hemodialysis patients. It is, therefore, recommended that it can be used as an effective
intervention technique to alleviate itching in hemodialysis patients.

Keywords

1. Asgari M, Soleimani M. Comprehensive Book Intensive Nursing
Care in ICU. CCU and Dialysis Wards. Tehran: Boshra Publication ‎
Center; 2019.
2. AkhyaniM, GanjiMR, Samadi N, KhamesanB, DaneshpazhoohM.
Pruritus in hemodialysis patients. BMC Dermatol 2005;7:2012
. [Doi: 10.1186/1471‑5945‑5‑7].
3. Sá Tinôco JD, De Paiva MD, Macedo BM, Cossi MS, Delgado MF,
Lira AL, et al. Pruritus in hemodialysis patients: Association with
phosphorus intake and serum calcium level. Rev Gaúcha Enferm
2018;39:e20170081.
4. Riahi Z, Esfarjani F, Marandi SM, Kalani N. The effect of
intradialytic exercise training on the quality of life and fatigue in
hemodialysis patients. J Res Rehabil Sci 2012;14:63-73
5. Andersson RG, Quirk C, Sullivan J, Anderson CD. Cutaneous
manifestations of internal disease. Drug Discov Today Dis Mech
2008;5:e113‑23.
6. Darsow U, Pfab F, Valet M, Huss‑Marp J, Behrendt H, Ring J,
et al. Pruritus and atopic dermatitis. Clin Rev Allergy Immunol
2011;41:237‑44.
7. Khalili H, Dashti S, Ahmad Poor P, Haji Babaei M, Abdollahi F.
Efficacy of antipruritus drugs in chronic renal failure:
A comparative study. Tehran Univ Med J 2006;64:36‑42.
8. Schwartz IF, Iaina A. Management of uremic pruritus. Semin Dial
2000;13:177‑80.
9. Narita I, Iguchi S, Omori K, Gejyo F. Uremic pruritus in chronic
haemodialysis patients. J Nephrol 2008;21:161‑5.
10. Lupi O, Rezende L, Zangrando M, Sessim M, Silveira CB,
Sepulcri MA, et al. Cutaneous manifestations in end‑stage renal
disease. An Bras Dermatol 2011;86:319‑26.
11. Ro YJ, Ha HC, Kim CG, Yeom HA. The effects of aromatherapy
on pruritus in patients undergoing hemodialysis. Dermatol Nurs
2002;14:231‑4, 237‑8, 256.
12. Makhlough A, Ala S, Haj‑Heydari Z, Kashi Z, Bari A. Topical
capsaicin therapy for uremic pruritus in patients on hemodialysis.
Iran J Kidney Dis 2010;4:137‑40.
13. Priscilla L, Karen B. Medical‑Surgical Nursing. Critical Thinking
in Client Care. Single Volume. 4th ed. The United States: Pearson
Education International, Prentice Hall; 2010.
14. Gil Y, Greaves Malcolm W, Fleischer AI, Francis M. Itch: Basic
Mechanisms and Therapy. 1st ed. New York: Marcel Dekker Inc.;
2004.
15. HallJE, Hall M. Guyton and Hall Textbook of Medical Physiology.
14th ed. Elsevier; 2020.
16. Schmelz M. Itch and pain. Neurosci Biobehav Rev 2010;34:171‑6.
17. Edzard E. Nurses Hand book of Alternative and Complementary
Focus on Alternative and Complementary Therapies. 2nd ed.,
Vol. 5. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 58.
18. Bobbee T. Renal Nursing. A Guided to practice, 1st edition, eBook
Published 8 October 2018. Pub. Location London.
19. Chan MF, Chan EA, Mok E. Effects of music on depression and
sleep quality in elderly people: A randomised controlled trial.
Complement Ther Med 2010;18:150‑9.
20. Farrokhian R, Soleimani R, Farrokhian M, Alipour MR. Effect
foot reflexology on sleep quality in hemodialysis patients:
A randomized control trial. Sci J Hamadan Nurs Midwifery Fac
2016;24:213‑20.
21. Duo LJ. Electrical needle therapy of uremic pruritus. Nephron
1987;47:179‑83.
22. Rayner HC, Larkina M, Wang M, Graham‑Brown M,
van der Veer SN, Ecder T, et al. International comparisons of
prevalence, awareness, and treatment of pruritus in people on
Hemodialysis. Clin J Am Soc Nephrol 2017;12:2000‑7.
23. Shahgholian N, Dehghan M, Mortazavi M, Gholami F, Valiani M.
Effect of massage with aromatic oils on pruritus relief in
hemodialysis patients. Complement Med J Fac Nurs Midwifery
2016;2:291‑302.
24. Khorsand A, Salari R, Noras MR, Saki A, Jamali J, Sharifipour F,
et al. The effect of massage and topical violet oil on the severity
of pruritus and dry skin in hemodialysis patients: A randomized
controlled trial. Complement Ther Med 2019;45:248‑53.
25. Nazemzadeh M, Jalalodini A, Rezvani Amin M, Yousefian N,
Poornamdar Z, Ghaljeh M. The effect of foot reflexology massage
on pain intensity in patients with chronic low back pain visited
to physical therapy unit in Baghiathallah Hospital in Tehran.
Complement Med J Fac Nurs Midwifery 2012;2:25‑31.