title: Reflexology and progressive muscle relaxation training for people with multiple sclerosis: a crossover trial.
abstract: OBJECTIVE
  To compare the effects of reflexology and progressive muscle relaxation training for people with multiple sclerosis, provided by nurse therapists, on psychological and physical outcomes.
  
  
  METHODS
  A crossover design was chosen with a 4-week break between treatment phases. The Short Form 36 and General Health Questionnaire 28 were completed by patients (n=50) pre and post each of the 6-week treatment phases. Salivary cortisol levels, State Anxiety Inventory, systolic and diastolic blood pressure and heart rate data were collected pre and post the weekly sessions.
  
  
  RESULTS
  All of the chosen measures except for three SF-36 scales recorded significant changes, however, despite the 4-week break (washout period), most outcome measures did not return to their pre-treatment baseline levels. This meant that the analysis of the data was complicated by significant effects involving ordering of treatment occurring for eight of the variables (one from SF-36, two from the GHQ, SAI, Salivary Cortisol, Systolic BP and HR). However, there was a difference in the State Anxiety Inventory values between the treatments of the order of 1.092 units (95%CI 0.211-1.976) (p=0.016, Wilks lambda=0.885, df=1, 48) in favour of reflexology. Changes in salivary cortisol comparing levels pre 1st to post 6th session favoured reflexology (95%CI 0.098-2.644) (p=0.037, Wilks lambda=0.912, df=1, 48). A significant difference was found in the way the treatments affected change in systolic blood pressure following sessions; this favoured progressive muscle relaxation training (p=0.002, Wilks lambda=0.812, df=1, 48).
  
  
  CONCLUSIONS
  Positive effects of both treatments following sessions and over the 6 weeks of treatment are reported, with limited evidence of difference between the two treatments, complicated by ordering effects.
authors.affiliation: Christie Hospital NHS Trust, University of Derby (Buxton campus), Rehabilitation Unit, Wilmslow Road, Manchester M20 4BX, UK. peter.mackereth@christie.nhs.uk
authors.forename: Peter A
authors.initials: PA
authors.lastname: Mackereth
authors.forename: Katie
authors.initials: K
authors.lastname: Booth
authors.forename: Valerie F
authors.initials: VF
authors.lastname: Hillier
authors.forename: Ann-Louise
authors.initials: AL
authors.lastname: Caress
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000628:therapy; D001794:Blood Pressure; D018592:Cross-Over Studies; D005260:Female; D006304:Health Status; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D008297:Male; D008405:Massage; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D009126:Muscle Relaxation; D012463:Saliva / Q000737:chemistry
chemical_list: D006854:Hydrocortisone