Reflexology and meditative practices for symptom management among people with cancer: Results from a sequential multiple assignment randomized trial.
Gwen Wyatt, Rebecca Lehto, Pratim Guha-Niyogi and 5 others
PMID 34515341WHAT IT FOUND
Home-based reflexology and meditative practices, with caregiver involvement, did not differ in fatigue severity over 12 weeks.
For patients whose fatigue did not improve, adding the other therapy after 4 weeks did not improve outcomes, so choice can guide symptom management.
Key findings
01Patients first assigned to reflexology or meditative practices showed no significant difference in fatigue or other symptom severity during weeks 1 to 4 or weeks 5 to 12.
02For patients who did not respond to the first therapy, continuing it or adding the other therapy did not produce significantly different primary or secondary outcomes.
03Among the four decision rules, reflexology for 8 weeks had lower summed MDASI non-fatigue symptom severity at week 8 than reflexology plus added meditative practices (mean difference 7.04 points, p = .04).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The control group was small, with 47 randomized participants, so comparisons with control were not powered for formal significance. Attrition was higher in meditative practices, with 44 of 150 participants providing no post-baseline data, compared with 24 of 150 in reflexology and 3 of 47 in control. The lower-than-expected non-response rate left fewer non-responders than planned for the second randomization. The one significant secondary difference was among many comparisons, and the authors said chance was the best explanation. The sample was mostly white women, limiting generalizability. Supportive care medication data and completion or premature stoppage of cancer treatment were not uniformly available.
Declared interests
The authors declared no conflict of interest. The article is listed as NIH extramural funded.
The easy way to misread this
Do not read the 7.04-point lower MDASI symptom score for reflexology-only versus reflexology plus meditation as evidence that reflexology is superior or that adding meditation worsens symptoms. It was one of many secondary comparisons, the primary fatigue outcome was null, and the authors said chance was the best explanation.