title: Comparing the effects of reflexology and relaxation on fatigue in women with multiple sclerosis.
abstract: BACKGROUND
  Fatigue is the most common and highly disabling symptom of multiple sclerosis (MS) that has negative effects on employment, the process of socialization, compliance with the disease, and other factors effective on activities of daily living. The usage of complementary and alternative medicine methods in MS patients is higher than in the general population. However, there is no scientific evidence to support their effectiveness. Therefore, this study aimed to compare the effects of reflexology and relaxation on fatigue in women with MS.
  
  
  METHODS
  This study is a single-blinded randomized clinical trial that was done on 75 patients with MS who referred to the MS Clinic of Ayatollah Kashani Hospital (Isfahan, Iran). After simple non-random sampling, participants were randomly assigned by minimization method to three groups: Reflexology, relaxation, and control groups (25 patients in each group). In the experimental groups, the interventions foot reflexology and relaxation (Jacobson and Benson) were performed for 4 weeks, twice a week for 40 min in each session, and the control group received care and routine medical treatment as directed by a physician. Data were collected through a questionnaire and the fatigue severity scale before, immediately after, and 2 months after interventions from all three groups. Data analysis was performed by SPSS version 18 using descriptive and inferential statistical methods.
  
  
  RESULTS
  Findings obtained from analysis of variance (ANOVA) showed that there was no significant difference in the mean fatigue severity scores in the pre-interventions between the three groups (P > 0.05), but there was significant difference immediately after and 2 months after interventions between the three groups (P < 0.05). Findings obtained from repeated measures (ANOVA) showed that there was significant difference in the mean fatigue severity scores during different times between the three groups (P < 0.05), while this difference was not significant in the control group (P > 0.05). Furthermore, least significant difference post-hoc test revealed that the mean scores of fatigue severity immediately after intervention was lower in the reflexology group than in the other two groups and were lower in the relaxation group than in the control group; 2 months after interventions, the mean scores of fatigue severity were lower in the reflexology group than in the other two groups, but there was no significant difference between the two groups of relaxation and control (P > 0.05).
  
  
  CONCLUSIONS
  It seems that both interventions were effective in reducing fatigue, but the effects of reflexology on reducing fatigue were more than those of relaxation. Hence, as these two methods are effective and affordable techniques, they can be recommended.
authors: Isfahan Neurosciences Research Center, Faculty Member, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Fatemeh
authors: F
authors: Nazari
authors: Department of Adult Health Nursing, School of Nursing and Midwifery, Alzahra Hospital, Isfahan, Iran.
authors: Mozhgan Soheili
authors: MS
authors: Shahreza
authors: Department of Neurology, School of Medicine, Research Center of Neurosciences, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Vahid
authors: V
authors: Shaygannejad
authors: Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mahboubeh
authors: M
authors: Valiani
keywords: Fatigue; multiple sclerosis; reflexology; relaxation