The Effects of Foot Reflexology Massage on Depression, Anxiety, Stress, and Serum Cortisol Levels in Hemodialysis Patients

Background: Depression, anxiety, and stress are common issues observed among patients undergoing hemodialysis. Objectives: The present study was conducted to determine the effect of foot reflexology massage on stress, anxiety, depression, and serum cortisol levels among hemodialysis patients. Methods: A double-blind randomized controlled trial was conducted on 57 patients undergoing hemodialysis. The patients were randomly assigned to either a control group or an experimental group. The Depression Anxiety Stress Scale (DASS-21) was used to measure stress, anxiety, and depression in the sessions before and after the intervention. Serum cortisol levels were also measured between 7:30 and 8:00 a.m. before and after the intervention. Foot reflexology and simple foot massage were performed three times per week for four weeks, with each session lasting 15 minutes for each foot rotationally in the intervention and control groups, respectively. Results: There was no significant difference between the intervention group and the control group in terms of the mean scores of cortisol, stress, anxiety, or depression before the intervention. However, the differences in the mean scores of stress (P < 0.0001), anxiety (P = 0.01), depression (P < 0.0001), and cortisol (P < 0.0001) in the intervention group significantly decreased compared to those in the control group. Conclusions: This study showed that foot reflexology can reduce cortisol levels, stress, anxiety, and depression among hemodialysis patients.