The Effect of Foot Reflexology on Sleep Quality in Patients With Chronic Lymphocytic Leukemia Under Chemotherapy: A Randomized Controlled Trial

Abstract

Background and Aims: Chronic lymphocytic leukemia (CLL) frequently causes a range of physical and psychological symptoms, including disrupted sleep. Foot reflexology is thought to promote relaxation and improve sleep quality. This study evaluated its effectiveness in patients with CLL undergoing chemotherapy. Methods: A single-blind randomized controlled trial was conducted with 68 participants (n = 68), who were assigned either to an intervention group or a control group. The intervention group received daily 10-min foot reflexology sessions for 4 weeks using sweet almond oil, while the control group received standard routine care, including monitoring of vital signs, symptom management, medication administration, psychological support, and general patient education according to oncology ward protocols. Sleep quality was assessed at baseline and after the intervention using the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed with SPSS version 25, using chi-square tests, Fisher's exact test, and t-tests. Results: At baseline, there was no significant difference in PSQI scores between groups (Reflexology: 16.30 ± 1.29 vs. Control: 16.78 ± 1.38; p = 0.143). After the intervention, the reflexology group showed a marked improvement in sleep quality compared to the control group (11.78 ± 1.47 vs. 16.21 ± 1.40; p < 0.001). The effect size was very large and clinically meaningful (Cohen's d = 3.08, 95% CI: 2.55–3.61). Within-group analysis confirmed significant improvement in the reflexology group (t = 6.161, p < 0.001; Cohen's d = 3.50), whereas no significant change was observed in the control group (t = −1.559, p = 0.136). Conclusions: Foot reflexology appears to be a safe and effective complementary intervention to improve sleep quality in patients with CLL. However, the study's limitations, including the lack of a sham control, short-term follow-up, and a relatively small sample size, should be considered. Healthcare providers may cautiously incorporate reflexology into supportive care, ensuring integration with standard treatments and professional guidance.