The effect of self-foot massage on anxiety and sleep quality in nursing students: A single-blind randomized controlled study
Main Article Content
Abstract
Background
Anxiety and poor sleep quality have always caused problems for nursing students. Today, self-foot massage is considered adjunctive therapy for reducing anxiety and improving sleep quality. This study aimed to evaluate the effects of self-foot massage on anxiety levels and sleep quality among nursing students with high anxiety.
Methods
An experimental study with pre-test and post-test control groups, included 40 first-year nursing students who met the inclusion criteria (intervention= 20, control= 20). The students were randomized into intervention and control groups using block randomization. A block size of four was employed to maintain equal group sizes. State Anxiety Inventory (SAI) and Pittsburgh Sleep Quality Index (PSQI) were used to collect the data. In the self-foot massage group, subjects attended foot massage sessions at the same time every day for 10 days. Independent t-test and Chi-square method was used to analyze the data.
Results
The intervention group performing self-foot massage demonstrated significantly lower mean scores for PSQI (7.70 ± 1.5) and SAI (34.10 ± 4.82) compared to the control group, whose mean scores were 8.00 ± 2.65 and 38.80 ± 3.04, respectively (p=0.03; p=0.021). These differences indicate improved sleep quality and reduced anxiety in the intervention group. Subjective sleep quality was also found to be better among participants in the intervention group. However, no significant differences were observed between the groups in the PSQI subcomponents (p>0.05).
Conclusion
Self-foot massage can be considered as a potential therapeutic intervention that improves sleep quality and reduces anxiety among nursing students with high level anxiety.
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References
1. Sözen KK. Ayak masajının ameliyat sonrası ağrı düzeyine etkisi. [The effect of foot massage on postoperative pain level]. Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi 2020;15:110-15. doi: 10.17517/ksutfd.673351. Turkish.
2. Tokur Kesgin M, Çıtak Bilgin N, Ayhan F. Opinions of nursing students about clinical practice: general practice course. Soc Sci Studies J 2018;4:3805-16. doi: 10.26449/sssj.818.
3. Sözen KK, Karabulut N. Determining the relation between critical thinking tendencies and clinical decision- making skills of nursing students. ADYÜ Sağlık Bilimleri Derg 2021;7:71-9. doi: 10.30569/adiyamansaglik.814122.
4. Özbudak E, Koç Z. Hemşirelik uygulamalarında eleştirel düşünmenin önemi. [The importance of critical thinking in nursing practices]. Sağlık ve Toplum 2021;31:38-48. Turkish.
5. Cho GY, Kim HO. Effect of self-foot reflexotherapy on the fatigue, mood and vital signs of the nursing students. J Korean Biol Nurs Sci 2010;12:24-30. Korean.
6. Genç Köse B, Öztürk H. The effects of foot reflexology treatment on work stress and anxiety levels of nursing managers. Cyprus J Med Sci 2024;9:145-50. doi: 10.4274/cjms.2023.2023-7.
7. Mert A. Üniversite öğrencilerinin sosyal kaygi, mükemmelliyetçilik ve değerler arasindaki ilişkinin açiklanmasina yönelik bir model çalismaşi. [A model study for the explanation of the relationship between social anxiety, perfectionism and values of university students]. Mehmet Akif Ersoy Üniversitesi Eğitim Fakültesi Dergisi 2019;49:276-301. doi: 10.21764/maeuefd.428886. Turkish,
8. Aşantuğrul N. Üniversite öğrencilerinin gelecek kaygıları üzerine nitel bir araştırma: üniversite öğrencilerinde gelecek kaygısı. [The future anxiety of university students: a qualitative study.] Ases Ulusal Sosyal Bilimler Dergisi 2024;4:62-8. doi: 10.5281/zenodo.12532649. Turkish.
9. Huang HC, Chen KH, Kuo SF, Chen IH. Can foot reflexology be a complementary therapy for sleep disturbances? Evidence appraisal through a meta-analysis of randomized controlled trials. J Adv Nurs 2021;77:1683–97. doi: 10.1111/jan.14699.
10. Ağargün MY, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi İndeksinin Geçerliği ve Güvenirliği. [The validity and reliability of the Pittsburgh Sleep Quality Index]. Türk Psikiyatri Derg 1996;7:107-11. Turkish.
11. Vargas I, Perlis ML. Insomnia and depression: Clinical associations and possible mechanistic links. Curr Opin Psychol 2020;34:95-9. doi: 10.1016/j.copsyc.2019.11.004.
12. Köse Tosunöz İ, Güngör S, Öztunç G. İlk klinik uygulama öncesi yaşanan kaygı: hemşirelik öğrencileri örneği. [The anxiety before first clinical experience: the case of nursing students]. YOBU Sağlık Bilimleri Fakültesi Dergisi 2021;2: 54-61. Turkish.
13. Köse S, Yılmaz ŞK, Göktaş S. The relationship between exam anxiety levels and sleep quality of senior high school students. J Psychiatric Nurs 2018;9:105-11. doi: 10.14744/phd.2018.05025.
14. Aibar-Almazán A, Hita-Contreras F, Cruz-Díaz D, de la Torre-Cruz M, Jiménez-García JD, Martínez-Amat A. Effects of Pilates training on sleep quality, anxiety, depression and fatigue in postmenopausal women: randomized controlled trial. Maturitas 2019;124:62-7. doi: 10.1016/j.maturitas.2019.03.019.
15. Rafii F, Ameri F, Haghani H, Ghobadi A. The effect of aromatherapy massage with lavender and chamomile oil on anxiety and sleep quality of patients with burns. Burns 2020;46:164-71. doi: 10.1016/j.burns.2019.02.017.
16. Koraş Sözen K, Karabulut N. Efficacy of hand and foot massage in anxiety and pain management following laparoscopic cholecystectomy: a controlled randomized study. Surg Laparosc Endosc Percutan Tech 2020;30:111-6. doi: 10.1097/SLE.0000000000000738.
17. Özyurt Kaptanoglu R, Tosun N. Türkiye ve dünyada alternatif-tamamlayıcı tıp kullanımı. [Use of alternative-complementary medicine in Turkey and the world]. Atlas Sosyal Bilimler Dergisi 2022;1:1-9. Turkish.
18. Saltan A, Mert S, Topbaş Ö, Aksu B. The investigation of effect on foot plantar massage on functional recovery in older adults with general surgery, randomized clinical trial. Aging Clin Exp Res 2024:36:118. doi: 10.1007/s40520-024-02770-2.
19. Çetin Ö, Bülbül T. Kanıta Dayalı Rehberleriyle Tamamlayıcı ve Destekleyici Uygulamalar. Editörs: Başer, M., Taşcı, S. Ankara, Akademisyen Tıp Kitabevi, 2015;89-95. Turkish.
20. Çankaya A, Saritaş S. Effect of classic foot massage on vital signs, pain, and nausea/vomiting symptoms after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2018;28:359-65. doi: 10.1097/SLE.0000000000000586.
21. Koraş K, Karabulut N. The effect of foot massage on postoperative pain and anxiety levels in laparoscopic cholecystectomy surgery: a randomized controlled experimental study. J Perianesth Nurs 2019;34:551-8. doi: 10.1016/j.jopan.2018.07.006.
22. Samarehfekri A, Dehghan M, Arab M, Ebadzadeh MR. Effect of foot reflexology on pain, fatigue, and quality of sleep after kidney transplantation surgery: a parallel randomized controlled trial. Evid Based Complement Alternat Med 2020; 2020:5095071. doi: 10.1155/2020/5095071.
23. Pasyar N, Rambod M, Najafian Z, Nikoo MH, Yoosefinejad AK, Salmanpour M. The effect of foot reflexology on fatigue, sleep quality, physiological indices, and electrocardiogram changes in patients with acute myocardial infarction: a randomized clinical trial. Iran J Nurs Midwifery Res 2024;29:608–16. doi: 10.4103/ijnmr.ijnmr_310_23.
24. Cai DC, Chen CY, Lo TY. Foot reflexology: recent research trends and prospects. Healthcare 2023; 11:9. doi: 10.3390/healthcare11010009.
25. Kim NG, Park HR. Foot health status and associated characteristics of nursing students: a cross-sectional study. BMC Nurs 2025;24:742. doi: 10.1186/s12912-025-03327-y.
26. Parlak AG, Akkuş Y, Araz Ö. The effect of foot reflexology on stress, fatigue, and low back pain in intensive care unit nurses: a randomized controlled trial. Pain Manag Nurs 2024;25:494-500. doi: 10.1016/j.pmn.2024.05.013.
27. Kotruchin P, Imoun S, Mitsungnern T, Aountrai P, Domthaisong M, Kario K. The effects of foot reflexology on blood pressure and heart rate: a randomized clinical trial in stage-2 hypertensive patients. J Clin Hypertens (Greenwich) 2021;23:680-6. doi: 10.1111/jch.14103.
28. Liu C, Chen X, Wu S. The effect of massage therapy on pain after surgery: a comprehensive meta-analysis. Complement Ther Med 2022; 71:102892. doi: 10.1016/j.ctim.2022.102892
29. Fazlollah A, Babatabar Darzi H, Heidaranlu E, Moradian ST. The effect of foot reflexology massage on delirium and sleep quality following cardiac surgery: A randomized clinical trial. Complement Ther Med 2021;60:102738. doi: 10.1016/j.ctim.2021.102738.
30. Buysse DJ, Reynolds CF, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28:193-213.
31. Spielberger CD. Manual for The State-Trait Anxiety Inventory. Palo Alto, CA : Consulting Psychologists Press;1983.
32. Öner N, Le Compte A. Süreksiz Durumluk/Sürekli Kaygı Envanteri El Kitabı [Transient state-trait anxiety inventory manual]. 1st edition. İstanbul: Boğaziçi Üniversitesi Yayınları; 1983. Turkish.
33. Wang WL, Hung HY, Chen YR, et al. Effect of foot reflexology ıntervention on depression, anxiety, and sleep quality in adults: a meta-analysis and metaregression of randomized controlled trials. Evid Based Complement Alternat Med 2020:2654353. doi: 10.1155/2020/2654353.
34. Alinia-Najjar R, Bagheri-Nesami M, Shorofi SA, Mousavinasab SN, Saatchi K. The effect of foot reflexology massage on burn-specific pain anxiety and sleep quality and quantity of patients hospitalized in the burn intensive care unit (ICU). Burns 2020;46:1942-51. doi: 10.1016/j.burns.2020.04.035.
35. Gholitabar Omrani M, Ghasemi M, Gholizadeh Gerdrodbari M, Javan R, Mahdavifar N. The effects of foot reflexology massage on the sleep quality of nurses working in the selected hospitals of Sabzevar University of Medical Sciences. Trad Integr Med 2024;9:371-8. doi: 10.18502/tim.v9i4.17472.
36. Wang Y, Dai X, Zhu J, Xu Z, Lou J, Chen K. What complex factors influence sleep quality in college students? PLS-SEM vs. fsQCA. Front Psychol 2023;14:1185896. doi: 10.3389/fpsyg.2023.1185896.
37. Yigitalp G, Aydın LZ. Determination of sleep quality, fatigue and related factors in nursing students. J Nurs Midwifery Sci 2021;8:212-8. doi: 10.4103/JNMS.JNMS_69_20.
38. Arslan G, Ceyhan Ö, Mollaoğlu M. The influence of foot and back massage on blood pressure and sleep quality in females with essential hypertension: A randomized controlled study. J Hum Hypertens 2021;35:627-37. doi: 10.1038/s41371-020-0371-z.
39. Solmaz G. The effect of foot massage applied to patients with congestive heart failure on peripheral edema and sleep quality: a randomized controlled study. Holist Nurs Pract 2023;37: 143-52. doi: 10.1097/HNP.0000000000000581.
40. Kırca AŞ, Çetin NŞ. The effect of classical foot massage on insomnia and anxiety in preeclamptic pregnant women: a randomized controlled study. Revista da Associação Médica Brasileira 2024;70:e20230744. doi: 10.1590/1806-9282.20230744.
41. Li H, Zhao M, Shi Y, et al. The effectiveness of aromatherapy and massage on stress management in nurses: a systematic review. J Clin Nurs 2019;28:372-85. doi: 10.1111/jocn.14596.