Reflexology for pain and anxiety in patients undergoing coronary angiography: a systematic review and meta-analysis

AIM: To evaluate the effects of reflexology, a non-pharmacological nursing intervention, on pain and anxiety in patients undergoing coronary angiography. METHODS AND RESULTS: This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42024607829). A comprehensive literature search was performed in PubMed, Web of Science, Cochrane, Clinical Key, and Google Scholar between 15 October 2024 and 15 January 2025, covering studies published from 2000 to 2025. Eight randomized controlled trials and two quasi-experimental studies investigating the effects of reflexology on pain and anxiety in patients undergoing coronary angiography were included. Methodological quality was independently assessed by two reviewers using the Cochrane Risk of Bias 2 (ROB2) and the ROBINS-I tools. Effect sizes were calculated using standardized mean difference (Hedges' g) with 95% confidence intervals for eligible outcomes. A total of 10 studies involving 913 participants were included. Reflexology significantly reduced anxiety levels immediately after the intervention (Hedges' g = -1.78; 95% CI -2.94 to -0.63) and 30 minutes post-intervention (Hedges' g = -1.16; 95% CI -2.10 to -0.22). Due to heterogeneous pain measurement scales, pooled meta-analysis for pain was not performed. Narrative synthesis indicated reduced pain intensity in the early post-procedural period. CONCLUSION: Reflexology may be a beneficial and feasible non-pharmacological nurse-led intervention for reducing anxiety and early post-procedural pain in patients undergoing coronary angiography. Integrating reflexology into cardiovascular nursing practice may support symptom management, patient comfort, and psychological well-being as an adjunct to standard cardiac care.