Effect of foot reflexology on anxiety and physiological indices in patients undergoing extracorporeal shock wave lithotripsy: A randomized clinical trial study

• Foot reflexology significantly reduces pre-procedural anxiety in patients undergoing ESWL. • Reflexology leads to meaningful reductions in both systolic and diastolic blood pressure compared to routine care. • Heart rate decreases within the reflexology group, although between-group differences are not statistically significant. Anxiety is a common concern in patients undergoing extracorporeal shock wave lithotripsy (ESWL). Reflexology, as a simple and safe complementary approach, may help reduce anxiety, though evidence in this setting remains limited. This randomized clinical trial was conducted at Sina Hospital, Arak, Iran, between December 2022 and July 2023. 74 eligible patients undergoing ESWL for the first time were randomized equally to reflexology (n = 37) or control (n = 37). Reflexology consisted of a 20-minute standardized foot massage (10 minutes per foot) administered 30 minutes before lithotripsy. Controls received routine care. The primary outcome was state anxiety measured by the Spielberger State Anxiety Inventory. Secondary outcomes were systolic and diastolic blood pressure, heart rate, and oxygen saturation. Assessments were conducted immediately before and after the intervention. Data were analyzed with paired and independent t-tests. The two groups were homogeneous with respect to baseline demographic and clinical variables. Reflexology significantly reduced anxiety (52.22 ± 5.18 to 46.62 ± 8.30; p < 0.001), whereas controls showed no meaningful change (53.03 ± 5.01 to 51.76 ± 6.54; p = 0.165). Post-intervention between-group difference was significant (p = 0.004; Cohen’s d = − 0.68). Systolic and diastolic blood pressures declined more in the intervention group (p = 0.032 and p = 0.045, respectively). Heart rate decreased significantly within the reflexology group (p = 0.001) but not between groups. Reflexology reduced pre-procedural anxiety and improved some hemodynamic indices in ESWL patients. As a low-cost, non-invasive adjunct, it can be included in routine care.