الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Menopause is characterized by a decline in ovarian follicular activity particularly in the production of estrogen. As a result, some women may experience vasomotor symptoms such as hot flushes, flashes or night sweats. Other symptoms including insomnia, headaches, irritability, depression, memory loss, declining libido and genitourinary changes have been described. At a psychological level, a wide range of emotions has been associated with menopause although their direct connection to declining hormones is uncertain. These emotions extend from a sense of freedom from worrying about contraception and menstrual periods to a feeling of loss over one’s fertility. While many women pass through this stage of their lives with few physical or emotional complaints, others become debilitated by them.
For many years the most conventional treatment for menopausal symptoms in the world has been the use of combined estrogen and progesterone hormone replacement therapy (HRT). However, because of the significant risks associated with HRT which included increased risk of breast cancer, coronary heart disease, stroke, and venous thrombo-embolism, more women are turning to the use of complementary and alternative therapies in the hope of relieving their menopausal symptoms. The use of reflexology massage by nurses is easy and practical; it can be performed at any location, is non-invasive, and does not interfere with patients’ privacy. Reflexology massage has been widely used in fields which include, orthopedics, neuroscience, palliative care and obstetric & gynecologic nursing.
This study aimed to evaluate the effect of reflex foot massage therapy on menopausal symptoms.
Materials and method:
Materials:
The present study is a non-randomized controlled clinical trial.
The study was conducted at the health clinics of four faculties affiliated to the University of Alexandria namely: Faculty of commerce, Faculty of law, Faculty of Arts and Faculty of Education. The study sample comprised a purposely selected 80 females aged from 45 - <60 yrs., divided equally into study and control groups.
Tools of the study
Two tools were used for data collection, these are:
Tool I: Basic data structured interview schedule: a specially designed structured interview schedule to collect the following data:
− Socio-demographic characteristics such as age, level of education, occupation and family income.
− Medical history (used during the initial survey only)
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− Gynecological history such as bleeding, any previous gynecological diseases or operations (used during the initial survey only)
− Reproductive history, which comprises: Gravidity, parity, and number of abortions.
− Menstrual history.
− Menopausal History (age of onset, type of onset, symptoms).
Tool II: Greene Climacteric Scale: this scale was developed by Greene (1990) to assess changes in different menopausal symptoms before and after intervention.
It is composed of 21 items in three main Sections:
1. Psychological (11 items from 1-11)
2. Physiological (7 items from 12-18)
3. Vasomotor (2 items 19 & 20)
4. Sexual function (1 item)
Method of the study
The researcher received a training course covered (30 credit hours) on using reflexology foot massage techniques in the Open Academy of Complementary Medicine Center present in Cairo and supported by Cairo University. The researcher got a certificate which has been certified from Cairo University and the Ministry of Foreign Affairs.
An official letter from the faculty of Nursing, University of Alexandria was submitted to the chosen settings for obtaining permission to carry out the study after complete explanation of the study aim.
Tool I was developed by the researcher after reviewing related literature
Tool II was adapted and translated into Arabic.
Tools content validity was tested by a jury of five experts in the related field. The required corrections and modifications were carried out accordingly.
Reliability of the tools was done using Cronbach’s Alpha coefficient test and the result was statistically acceptable (Alpha 0.846).
A pilot study was carried out on 8 women (excluded from the study sample) to assess clarity and applicability of the tools and to identify the difficulties that may be encountered during the application of the technique and data collection tools. Following this pilot study the necessary modifications for the tools were done and a plan to resolve the implementation obstacles was put and considered during the actual study process and data collection.
Tool II was used in order to choose the eligible subjects (moderate & severe menopausal symptoms) from all female employees.
The 80 eligible subjects were randomly assigned to 2 groups; an experimental and a control group. Forty women are included in each group.
The study group received complete reflexology foot massage therapy session for three weeks three times per week, (every other day), for a total of 9 times for every woman. Each session lasted nearly 40 minutes (outside working hours and agreement was obtained from the subjects) 20 min for each foot to all reflex points in the foot guided by reflexology foot massage map. Participants were not given any self-care advice relating to menopause.
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Results of the study revealed that:
The results of the present study revealed that there were no statistical significant differences in the basic data between the study and control groups in relation to age, marital status, level of education, menstrual history, obstetrical history, and menopause history.
The study showed that a significant difference (p= 0.001) exists between women of the study group before & after application of the intervention. The overall menopausal symptoms intensity was severe before the intervention in almost all (95.0%) the study subjects, after three sessions (one week) of reflexology foot massage it declined to 47.5% severe and 50.0% moderate. As for overall symptoms severity after six sessions, it is noticed that an equal percent (47.5%) of the study subjects had mild or moderate symptoms and only 5% of them still had severe symptoms.
The current study also revealed that there was no significant statistical difference in relation to the severity of menopausal symptoms among the control group before and after non-specific leg massage. (p=0.095) for the overall symptoms severity. The overall menopausal symptoms intensity was severe in all (100%) women in the control group before the intervention, after three sessions (one week) of non-specific leg massage no change had occurred. It declined to become 92.5% after six sessions. And only to 15% moderate after 9 sessions. In relation to vasomotor symptoms, it was found that non-specific leg massage has no effect, as all the control subjects had experienced severe symptoms before and after all massage sessions.
Also, there was statistical significant lowering of the mean scores of the overall menopausal symptoms severity in the study group than in the control group after receiving 3, 6 and 9 massage sessions. Mean scores are: (38.4, 49.1), (19.3, 48.5) and (9.1, 47.6) respectively.
It was concluded that
Menopausal women underwent a course of 40 minutes reflexology foot massage for all reflex points on both feet, 3 times per week, for 3 consecutive weeks with a total of 9 massage sessions; resulted in significant decrease of menopausal symptoms severity in relation to psychological, physiological and sexual symptoms and a slow cumulative effect on vasomotor symptoms.
Recommendations:
The findings of this study lead to the following recommendations:
1. Nursing education institutions − Incorporate the technique in clinical nursing curricula, so that students will be trained to use it as an integral component of care provided to menopausal women in different health care settings. Subsequently, menopausal women can apply self-foot reflexology massage to benefit its cumulative effects at home. 2. Clinical obstetric settings − Approach the administrative personnel of health care settings, in order to raise their awareness about the benefits of reflexology to women suffering from menopausal symptoms so that they incorporate with pre service and in service
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training of nurses to enable them to use it as a non-pharmacological method for menopausal symptoms. − Providing audiovisual materials and patient’s guides so they can learn the technique easily. 4. Mass Media − Mass Media Sector could integrate the issue in TV medical programs to raise public awareness about the effectiveness of reflexology on menopausal symptoms
Recommendation for further research:
• Replication of the current study on a lager sample size and different settings for the purpose of better generalization. • Compare reflexology foot massage with other complementary medicine methods in decreasing menopausal symptoms. • As we live in a diverse society, additional researches on symptom Perception and management of menopausal symptoms in diverse groups of women are needed to provide holistic health care to all women.