INTRODUCTION:

Pain, defined by the International Association for the Study of Pain (IASP) as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage,” is one of the most disabling symptoms of osteoarthritis (OA)¹. OA, particularly of the knee, is the most prevalent form of arthritis, affecting nearly 528 million people globally according to the Global Burden of Disease (GBD) 2021 report⁶. It is characterized by progressive cartilage degeneration, joint stiffness, inflammation, and chronic pain, resulting in substantial functional impairment and decreased quality of life^1,4,6.

In India, the prevalence of OA has been steadily increasing due to sedentary lifestyle, obesity, and increased life expectancy.

Studies indicate that nearly 39% of individuals above 60 years exhibit clinical features of knee OA⁷. The condition is also a leading cause of disability-adjusted life years (DALYs) among the elderly.

While pharmacological management (NSAIDs, intra-articular corticosteroids) provides symptomatic relief, long-term use is associated with gastrointestinal, renal, and cardiovascular side effects^4,8. Surgical options like total knee arthroplasty (TKA) are expensive and not always feasible for all patients due to economic or health constraints⁸.

In this context, complementary and alternative therapies have gained clinical significance. Foot reflexology, a traditional technique applying specific pressure to reflex points on the feet, is believed to stimulate corresponding body parts and restore physiological balance^2,5,9. The mechanism involves activation of peripheral nerve pathways, increased endorphin release, and improved blood circulation, leading to reduction in pain perception and muscle tension^2,5,10.

Hence, integrating reflexology into pain management for OA could offer a holistic, safe, and cost-effective approach for patients seeking relief beyond conventional medicine.

STATEMENT OF THE PROBLEM:

A study to evaluate the effectiveness of foot reflexology on pain among osteoarthritis patients in selected hospitals at erode district.

NEED FOR THE STUDY:

Osteoarthritis is not merely a joint disorder but a chronic, progressive condition with major public health implications.

According to the World Health Organization (WHO, 2020), over 250 million peoples suffer from OA worldwide, and the prevalence is projected to increase by 50% by 2050 due to population ageing^4,6.

In India, nearly 45% of women above 65 years-experience symptoms of knee OA, and 70% show radiological evidence of joint degeneration^3,7.

OA is the second most common rheumatologic disorder in India, following rheumatoid arthritis, and contributes to about 30% of physical disability among elderly women⁷.

The chronic pain and stiffness associated with OA lead to dependency in daily activities, psychological distress, and social isolation.

Limitations of Conventional Treatment:

· NSAIDs and analgesics often provide temporary relief but may lead to complications such as gastritis, nephropathy, or cardiovascular risk^4,8.

· Physiotherapy, though effective, may not always be accessible or affordable to rural populations.

· Surgical management (TKA) remains costly and is not suitable for all due to co morbidities or advanced age.

Emerging Role of Foot Reflexology:

Foot reflexology is gaining recognition as a complementary therapy that stimulates nerve endings, enhances circulation, and promotes relaxation^2,5,9.

Clinical trials have reported significant pain reduction, improved joint flexibility, and reduced anxiety among OA patients receiving reflexology^10,11.

Being non-invasive, low-cost, and patient-centered, it aligns well with the holistic nursing approach and can be implemented as a part of community-based rehabilitation programs.

Therefore, the present study aims to assess the effectiveness of foot reflexology in reducing pain among osteoarthritis patients, thereby providing evidence-based support for its integration into routine nursing practice.

Organizational Context:

The study was conducted in collaboration with:

· Dakshin Trauma Center, Gobichettipalayam: specialized in musculoskeletal rehabilitation and orthopedic care.

· Siva Sakthi Rehabilitation Centre and Hospital, Oricheri: focuses on physiotherapy and non-pharmacological interventions.

These institutions provided a robust patient base and infrastructure to evaluate the efficacy of complementary therapies like reflexology.

OBJECTIVES:

· Evaluate pretest and posttest pain levels in experimental and control groups.

· Assess the effectiveness of foot reflexology in reducing pain among OA patients.

· Compare posttest pain levels between experimental and control groups.

· Explore associations between pretest pain levels and demographic/clinical variables.

HYPOTHESES:

H₁: Pretest and posttest pain levels in the experimental group will differ significantly following foot reflexology.

H₂: Posttest pain levels will differ significantly between experimental and control groups.

H₃: Pretest pain levels will show significant associations with selected demographic and clinical variables.

METHODOLOGY:

Design:

Quasi-experimental, pretest-posttest control group.

Setting:

Dakshin Trauma Center and Siva Sakthi Rehabilitation Centre, Erode District.

Sample:

60 OA patients, purposively sampled (30 experimental, 30 control).

Intervention:

Experimental group received foot reflexology (20–30 min/session, 5 days/week for 2 weeks); control group received standard care².

Assessment Tools:

· VAS: 10-cm line measuring pain intensity

· Observation Checklist: OA symptoms

· Structured Questionnaire: Demographics & clinical variables

Data Analysis:

and inferential tests (paired/ unpaired t-tests, Chi-square)¹⁴.

RESULTS:

1. A. Assess the level of pain –Experimental group

S. No	Level of pain	Pretest		post test
S. No	Level of pain	Frequency	Percentage %	Frequency	Percentage %
1	No pain	0	0%	1	3%
2	Mild pain	7	23%	10	33%
3	Moderate pain	10	33%	19	64%
4	Severe pain	13	44%	0	0%
5	Worst pain	0	0%	0	0%

Fig.1 Level of pain –Experimental group

Interpretation:

The experimental group showed a substantial reduction in pain after the intervention, with severe pain eliminated and most participants reporting mild to moderate pain.

B. Assess the level of pain – control group

S. No	Level of pain	Pre test		Post test
S. No	Level of pain	Frequency	Percentage %	Frequency	Percentage %
1	No pain	0	0%	1	3%
2	Mild pain	7	23%	7	23%
3	Moderate pain	15	50%	12	40%
4	Severe pain	5	17%	8	27%
5	Worst pain	3	10%	2	7%

Fig.2 Level of pain –control group

Interpretation:

The control group showed only a modest reduction in pain after the intervention, with many participants still experiencing moderate to severe pain, indicating limited effectiveness of standard care without reflexology.

2. Effectiveness of Foot Reflexology

S No	Group	Post Test		Paired ‘T’	P Value
		Mean	SD
1	pre test	5.67	2.34	2.59 ww	P<0.001 Statistical Significant
2	post test	3.67	1.79

Fig. 3 Effectiveness of Foot Reflexology

Interpretation:

Pain significantly decreased in the experimental group, and posttest scores were significantly lower than the control group.

3. Comparison of post test level of pain between experimental and control group

Group	Mean Pain Score ± SD	t-value	p-value
Experimental	3.6 ± 1.75	34	<0.05
Control	5.3 ± 2.84	—	—

Fig. 4 Comparison of post test level of pain between experimental and control group

Interpretation:

Pain significantly decreased in the experimental group, and posttest scores were significantly lower than the control group.

4. Association with Demographic and Clinical Variables:

Variable	Group	χ²	p-value	Significance
Nature of Work	Experimental	0.087	1.003	Significant
Age	Control	2.3	0.0016	Significant
Body Weight	Experimental	9.53	0.005	Significant

DISCUSSION:

The study demonstrates that foot reflexology significantly reduces pain in OA patients²^,⁵^,⁹^,¹⁰. The findings are consistent with prior research by Kunz (2009)² and Hanjani et al. (2022)¹¹, who reported that reflexology activates neural pathways, increases blood flow, and decreases inflammatory responses, leading to pain reduction. It is a non-invasive, cost-effective, and safe complementary therapy, aligning with holistic nursing principles emphasizing comfort, mobility, and psychosocial well-being²^,³^,⁵. Tailoring interventions based on demographic and clinical characteristics may further improve outcomes.

CONCLUSION:

Foot reflexology is an effective complementary therapy for pain reduction in OA patients. Incorporating reflexology into routine care can enhance patient comfort, mobility, and overall quality of life⁵¹¹.

REFERENCES:

1. Ann B. Maher et al. Orthopaedic Nursing, 3rd Edition. W.B. Saunders, 2002.

2. Barbara Kunz. Complete Reflexology for Life, 1st Edition, 2009.

3. Mary Powell. Orthopaedic Nursing and Rehabilitation, 2nd Edition. Churchill Livingstone, 1986.

4. Miller, M.D. Review of Orthopaedics, 4th Edition. Mosby, 2004.

5. National Association of Orthopedic Nurses. Core Curriculum for Orthopaedic Nursing, 6th Edition, 2007.

6. Global Burden of Disease Study (GBD). Lancet Rheumatology, 2021.

7. Pal, C.P. et al. Prevalence of Osteoarthritis in India: A Systematic Review, Indian Journal of Orthopaedics, 2016.

8. Felson, D.T. et al. Osteoarthritis: New Insights. Part 1: The Disease and Its Risk Factors, Annals of Internal Medicine, 2020.

9. Song, R. et al. Effects of Reflexology on Pain and Anxiety in Patients with Chronic Illnesses, Journal of Advanced Nursing, 2018.

10. Hanjani, S.M. et al. Effect of Foot Reflexology on Pain and Fatigue in Patients with Osteoarthritis, Complementary Therapies in Clinical Practice, 2022.

11. Wyatt, G. et al. Clinical Efficacy of Reflexology: A Systematic Review, Journal of Alternative and Complementary Medicine, 2021.

Received on 26.09.2025 Revised on 27.10.2025

Accepted on 20.11.2025 Published on 26.02.2026

Available online from March 03, 2026

A and V Pub J. of Nursing and Medical Res. 2026;5(1):5-8.

DOI: 10.52711/jnmr.2026.02

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.