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  1. 1. Archives Des Sciences Vol 65, No. 11;Nov 2012 The effect of foot reflexology on premenstrual syndrome Sareh Abdollahi Fard M.Sc. International Branch, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mahrokh Dolatian(Corresponding Author) a : Faculty of Nursing and Midwifery ,Dept. of Midwifery Shahid Beheshti University of Medical Sciences, Tehran, Iran b : Phd.by research Student , Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences Tehran, Iran E-mail: mhdolatian@gmail.com Dr. Reza Heshmat Acupuncture and Reflexology Specialist, Tehran – Iran. Dr. Hamid Alavi Majd Associate Professor. Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Abstract: Background and aim: Premenstrual syndrome is a set of physical, mental and behavioral symptoms with different severity that causes disorders in individual and social relationships. This syndrome occurs during luteal phase of menstrual cycle with complicated reasons. It is one of the most common disorders of childbearing ages. Because of unclear and complicated causes of this syndrome, different treatment methods have been presented. Reflexology is as a non-drug methods of prevention and treatment of premenstrual syndrome. It is an old, mild and non-invasive method that, there is not enough researches about it’s effect on symptoms of premenstrual syndrome. This research was carried out in order to determine the effect of foot reflexology on symptoms of premenstrual syndrome in students of dormitories of Jahrom university in 2011. Method: This study was a single–blind controlled clinical trial of two groups in which, 90 students with premenstrual syndrome (who were resident in dormitory of Jahrom university) were include in two groups of foot reflexology and control. Intensity of premenstrual syndrome was recorded by subjects in two cycles: pre – intervention cycle and intervention cycle. The tools of data gathering consisted of data gathering form. Temporary diagnosis form of PMS, dialog record from and Beck depression test. Descriptive and inferential statistics were used in order to analyze data. Results: There was no significant statistical difference between under research variables in the respect of interventional variables. In comparison of pre and post intervention in reflexology significantly led to decrease of average of mental symptoms (25.12 %) and physical symptoms (19.34 % ) (p<0.0001). In comparison with control group, there was signification difference between the average of physical and mental symptoms in reflexology group was signification less than control group (p<0.0001). Conclusion: It seems that, foot reflexology is effective in improvement of physical and mental symptoms of premenstrual syndrome. Therefore, it is possible to achieve a main midwifery aim which is to decrease the symptoms intensity of premenstrual syndrome by training of this simple technique which doesn’t need specialists in order to be done. Keywords: premenstrual syndrome, foot reflexology, complementary medicine. 140 ISSN 1661-464X
  2. 2. Archives Des Sciences Vol 65, No. 11;Nov 2012 Introduction: Premenstrual syndrome is one of the most common disorders of childbearing ages that occurs in 85–90 percent of women who are at childbearing ages. These disorders is a group of physical – temperamental and behavioral changes that occurs regularly and periodic any in most of cycles. The symptoms of this syndrome includes the following: Fatigue, irritability, edema, anxiety, stress, breast pain, mood change, depression, acne, increase of appetite, unwarranted cries, headache, forget fullness, Gastrointestinal symptoms, difficulty in concentration, hot flashes, flatulence, Limb edema and vertigo. This disorder can cause disorders in material relation, material problems, social isolation, reduction of attention, the increase of complaints of Psychosomatic disease and even suicide and legal problems. Although premenstrual syndrome has known as a most common diseases of the world, but it’s real prevalence is achieved hardly, and it’s main cause is the larg difference which is in diagnostic definitions and criteria’s. The prevalence of premenstrual syndrome was been reported between 54-90 percent in different researches. The real cause of premenstrual syndrome is nearly unknown. Scientist believes that many factors are involved in this syndrome. Many Attempts has been made in order to treat this syndrome. Overall aim of the treatment of premenstrual syndrome is to control symptoms adequately, so that patient can act appropriately in all stages of menstrual cycle. There is no single treatment which be under consideration of everyone. Treatment approach is that, first, all patients with premenstrual syndrome should be followed by non-drug and fewer complication treatments, and drug treatments should be used for patients who have resistant and permanent symptoms despite non-drug treatments. In this direction, treatments methods has recommended as following: During therapy, surgery, and non-drug treatments and alternative and complementary medicine. With due attention to side effects of drug treatments and surgery, use of non-drug treatments and complementary medicine has been mostly considered. By researchers in women with premenstrual syndrome. Today, complementary medicine is one of the most common treatment methods of many type of disease. Because in addition to being economical, they have less side effects than chemical drugs. One of the non- drug methods of premenstrual syndrome prevention and treatment is to use reflexology. Reflexology is a branch of complementary medicine. It is a wholes tic, old, mild, cheap and noninvasive method, and includes massaging the reflex points on the hands and feet. The basis of reflexology is that, there are reflex points on palms and soles that conform to each part of body including muscle, nerve, gland and bone. In the other words, feet represent a map of the entire body. It means that, all organs and different parts of the body have been reflected of the body parts on soles is exactly similar to their placement arrangement in the body. These reflections can be found on the soles, toes and along the inner and outer sides of the feet. Reflexology has been led to treat a variety of physiologic problems such as nausea and vomiting, increase of life quality, reduction of the depression, fatigue, and also reduction of anxiety intensity in middle aged women and women of childbearing age. Also reflexology has been caused to reduce labor intensity and primiparous women’s anxiety during childbirth. Moreover, it has been caused to reduce pain severity after cesarean and the severity of constipation in pregnant women. The circumstance of reflexology’s function is still unknown. But there are some discussed theories about the mechanism of reflexology. The theories include following: The gate control theory of pain, theory of nerve impulse, increased secretion of endrophins and enkephalins and consequently pain control, improvement of lymphatic flow and immune system, improvement of nerve flow and blood flow and excreting poisons from body as a result of the improvement of blood flow. Some studies carried out with the aim of determining the effect of reflexology on childbearing age women’s problems have had positive results. But, considering the lack of enough researches about the effectiveness of reflexology on intensity of symptoms of premenstrual syndrome 141 ISSN 1661-464X
  3. 3. Archives Des Sciences Vol 65, No. 11;Nov 2012 and high rate of PMS prevalence, side effects and high cost of pharmaceutical methods, and on the other hand, the increasing tendency to complementary and alternative medicine and also lack of research in this field in our country, the researcher decided to study the effect of foot reflexology on intensity of premenstrual syndrome as a practical approach in order to control the intensity of premenstrual syndrome by using of non-drug method in students of dormitory of Jahrom university in 2011. Materials & Methods of study: The present research was a clinical trial of two group that was carried out after getting approval with 88/‫ 831/م/ع‬and confirming by ethics committee of Shahid Beheshti medical science university with number 116/3470 and registering in clinical trials center of health ministry with registration code of IRCT138811103226N1. In this research, the effect of foot reflexology on symptoms of premenstrual syndrome was studies in the students of dormitories of Jahrom university in 2011. Data were gathered from November 2011 to April 2012 for six months in all of the blocks of girl’s dormitory of Jahrom university. The number of sample was estimated 45 person in each group, considering 10% elimination of sample. The inclusion criteria consisted of: Iranian race, age group between 18 to 35 years old, normal body mass index (BMI)(19.8 - 26), regular menstruation (menstrual periods with duration of 21 – 35 days), non smoking and alcohol, not using oral contraceptives, Anticonvulsant drugs, antidepressant drugs, vitamins during last 3 months, not having history of underlying mental and physical illnesses, lack of occurrence of event during last 6 months, getting score of 0 – 9 in Beck depression Test and diagnosing form of the syndrome. Not using the sedatives, herbal drugs, lack of regular exercise and lack of surgery during last 6 months and during the study were also considered. Exclusion criteria from the study consisted of: Lack of patient cooperation, using of vitamins, occurrence of shock and traumatic event such as surgery, death of one of the first degree relatives (mother, father). In this study, the method of sampling first was purposive sampling and then, the selection of individuals was randomly done by using of Random Allocation software. The sampling method was that, first, the researcher gave students a questionnaire consisted of inclusion criteria after referring to girls dormitories of Jahrom university. If the students had inclusion conditions, temporary diagnosis form of premenstrual syndrome was being given them and was being collected. With existence of at least 5 symptoms of existing symptoms, Beck depression Test was being given them. If the individuals were normal and non-depressed on the basis of received score, were being selected as research unit and a written consent was being received in order to participate in the study. Then, the questionnaire of demographic information was being completed by samples. Then daily record form of symptoms was being completed by samples for two consecutive cycles. The samples were being excluding from the study in case of self – Therapy. Daily record form consists of 20 symptoms of the symptoms of premenstrual syndrome which is derived from DSM IV criteria: Stress, Pliancy, Irritability, anxiety, depression, fatigue, headache, forgetfulness, heart beating, increase of appetite, decrease of libido, willingness to suicide, limb edema, breast pain, sleep disorders, willingness to eat sweets, flatulence. Lack of concentration, unwarranted cries and incompatibility. The individuals who have at least 5 symptoms from 7 days before the beginning of menstruation and up to first four days of the menstruation and be without symptom at the rest of the cycle, are diagnosed with the disease. Research units were marking daily symptoms severity with degree of severity from “ 1 don’t have “ to “severe “ ( 0 to 3 ) in mentioned form. Data gathering tools in this research were questionnaire, standard analog scale and metal meter. Content validity was used in order to determine validity of the questionnaires. In this 142 ISSN 1661-464X
  4. 4. Archives Des Sciences Vol 65, No. 11;Nov 2012 manner that, after arrangement based on the other researcher’s books, articles and studies, corrective comments of the obstetrics, gynecologists, psychologists, psychiatrists, reflexologists, and acupuncturists and five person of the research community was received and applied. Concurrent validity was used in order to achieve the validity of correct determination of the reflexology points and method of the exertion of pressure. In this manner that, the procedure was confirmed by an acupuncturist and a reflexology expert. Also, Seca balance (made in Germany) and an inflexible metal meter (Leica, made in Italy) were used in this study. The method of cronbach’s Alpha was used in order to survey reliability of the questionnaires. In this manner that, the questionnaires were given to 10 persons of the researcher community and then, cronbach’s Alpha coefficient was calculated and 80% was achieved. Re – test was used in order to determine reliability of daily record form. So that, the researcher gave this form to 15 persons of the researcher community to mark it. After a while, the forms were gave them again and spearman correlation coefficient was calculated for each 20 symptoms of premenstrual syndrome. In order to determine reliability of the balance first, two – kg control weight was weighted by it and according to producer factory’s recommendation, it was calibrated by the same standard weight. A standard inflexible meter was used in order to measure the Length that, various weather conditions didn’t influence it. Equivalent reliability was also used in order to determine reliability of the procedure of foot reflexology. In this manner that, the procedure was conformed by an acupuncturist and a reflexology export. The necessary training was provided to samples in both groups before beginning the work about circumstance of completion of the forms and questionnaires. The thumb (pollex) and index finger was used in order to work on feet. For beginning the massage, the feet were anteriority and posteriorly (back of leg) massage by both hands from knee to ankle (from up to down). In women, the beginning of feet reflexology first is from left foot reflexology first is from left foot. First, whole of the sole was mildly massaged and then, the pressure was exerted on related and specified zones with special concentration these areas consists of: Pituitary gland: Exactly in the center of hallux (big toe) of both feet, solar network (Kidney): Almost in width of four fingers, under fingers base of both feet and in the center of the foot. Spleen: in exterior edge of left foot. Liver: opposite of the spleen at right foot, alone with kidney point (solar network), Adrenal gland: or solar network, genital zone (uterus and ovary): in both feet, under the malleolus and in both side (interior and exterior edge of the malleolus). Breasts: on the foot, from ankle joint ,i.e. width wise line (wrinkle) to the junction of the toes. These cones are on the basis of sole division in the center of diaphragm line. Foot reflexology was done by researcher on each foot (totally so minutes) once a day for 15 minutes and within 5 – 10 days before the start of period (monthly bleeding cycle), and before the onset of symptoms of premenstrual syndrome or from the onset of symptoms of the premenstrual syndrome and continued until period time (totally 5 – 10 days). Then, the researcher considered samples until the end of menstrual cycle and after it. Also, in control group, foot has been mildly and in effectively massaged. The study was a single – blind study, i.e. the lack of sample’s awareness of the treatment group by reflexology and control. After the treatment cycle, daily record form of the symptoms was gathered and then, Mann – Whitney test was used for determining the difference of severity of the symptoms between two groups. The significance level for all tests was considered p<005. Results:: The results showed that, most of the samples were almost 21 years old and less. The average age in reflexology group was 20.8 ± 2.7 and in control group was 20.5 ± 1.4 . 143 ISSN 1661-464X
  5. 5. Archives Des Sciences Vol 65, No. 11;Nov 2012 BMI in 50% of the individuals was 19.8 to 21, duration of premenstrual cycle was 21 – 28 days in 52% of the cases 28 – 38 days in others, and the menarche age in 55% of the people was 12 – 13 years. All students were in non – medical and paramedical fields and didn’t have any education and information about this syndrome most of the people had premenstrual history in the family (52 percent) and most of them were single (75 percent ). The father of most researcher units had high school education and the mother of most researcher units had primary education. Interfering factors in severity of premenstrual syndrome such as regular exercise during a week, use of drug (herbal drugs or vitamin) which influence PMS, were controlled. The other effective factors on PMS were studied and evaluated. These factors include the following: economic – social status, duration of marriage, the history of physical and mental disease, regular menstruations, interval between menstruations, bleeding duration of each cycle, spotting between menstrual cycles. There was no statistically significant difference between two groups after caring out statistical test. As it has been shown in tables 1,2,3, first, the average of PMS severity in both group was calculated before intervention. Mann – Whitney out statistical test didn’t show significant difference regarding symptoms severity of the PMS after intervention in the group of reflexology and control. Physical and mental symptoms was calculated in both areas. The average of general severity of the symptoms of PMS after intervention in reflexology group an control group was 9.63 ± 10.46 and 43.08 ± 29.19 respectively. There was statistically significant difference between two groups regarding the average of symptoms severity reduction after inter venting in general symptoms of the syndrome (p<0.001) (table 1). The average of severity of physical symptoms of premenstrual syndrome in reflexology group and control group was 14.85 ± 16.85 and 44.40 ± 28.76 respectively. Wilcoxon statistical test showed significant statistical difference in this respect between two groups (p<0.0001) and in order to compare the groups (two by two), Mann – Whitney test showed significant difference between two groups with (p<0.0001), (Table 2). The average of severity of mental symptoms of premenstrual syndrome in reflexology group and control group was 7.40 ± 8.65 and 42.51 ± 31.94 respectively. Wilcoxon statistical test showed significant statistical difference in this respect between two groups (p<0.0001) and in order to compare the groups (two by two), Mann – Whitney test showed significant statistical difference between two groups with (p<0.0001), (Table 3). It was observed that, in all mentioned cases, the seventy of symptoms in reflexology group was less than the control group. The most reduction of the severity was in severity of the symptoms such as: Sleep disorders (13.24 percent), fatigue (12.88 percent), lack of concentration (12.51 percent) , depression (11.4 percent), anxiety (11.3 percent), stress (9.2 percent), headache (8.38 percent), flatulence (7.98 percent), incompatibility (7.93 percent), and breast pain (painful breasts, 7.33 percent). The least reduction of the severity was in severity of the symptoms such as: Willingness to suicide (0.23 percent), Libido (0.94 percent), willingness to eat sweets (2.42 percent), Limb edema (2.6 percent), forgetfulness (3.44 percent) and heart beating (3.71 percent). Reflexology didn’t influence duration of the menstruation and amount of bleeding, and most of the research units (73.3 percent in reflexology group and 65.5 percent in control group) didn’t report any side effect. The average of physical symptoms severity of premenstrual syndrome has been reduced in reflexology group after treatment. 144 ISSN 1661-464X
  6. 6. Archives Des Sciences Vol 65, No. 11;Nov 2012 The average of mental symptoms severity of premenstrual syndrome has been reduced in reflexology group after treatment. Discussion: The finding of this research showed that, in all mentioned cases, symptoms severity of premenstrual syndrome in reflexology group was less than the control group. Although certain cause of premenstrual syndrome has not been known yet, but it is discussed about sexual hormones and central neurotransmitter. Often, the symptoms of this syndrome is similar to the conditions that the neurotransmitter of serotonin is reduced and for that reason, nowadays, the first treatment line for treating this syndrome is to use the methods with the mechanism of inhibitors of serotonin re-absorption. It is necessary to mention that, according to survey of the literatures by present researchers, so far, there is no any study about the effect of reflexology on PMS. Also, few number of the articles related to research subject was achieved in abroad, and this case limits the possibility of comparison with the results of the other studies. Ernest et al , in their study (the survey of useful effects of the reflexology) stated that, reflexology is very helpful in treatment of the symptoms of PMS. In Terry aleoson and Viliam Flocko’s study a by the title of the effect of foot (sole), hand and back of ear on PMS, the individuals were included in two groups of intervention and control for 2 months. After 4 months follow up study, all individuals of treatment group stated that, reflexology has been helpful in reduction of the severity of 38 symptoms of PMS. Moreover, there are some studies which show that, the reflexology leads to reduction of depression, stress, anxiety, pain, fatigue, sleep disorders in the other disease. It also leads to increase of life quality and improvement of blood circulation. Since these symptoms are of PMS symptoms, thus we mention some cases of mentioned studies: Asl-Toghiri and Ghodsi, in their study, by the aim of the survey of reflexology effect on menopaused women’s sleep disorders showed that, reflexology is useful in treatment of sleep disorders. Jang Su Hiyoon and him Kai Ha carried out a study by the aim of the survey of foot reflexology effect on stress and fatigue and blood circulation. The results of this study showed that, foot reflexology is very helpful in reduction of stress and fatigue and improvement of middle – aged women’s blood circulation. These findings show that, there is the possibility of reflexology use in treatment of the symptoms of PMS. Also, the results of present research confirms the results of Ernest, oleoson and Flocko’s research. As we observed, reflexology could significantly reduce all symptoms of PMS. Also, in Ernest etal and sun choo Jiong’s study, significant difference was observed between two groups in all symptoms of PMS. There is no sufficient information about the basis of reflexology and circumstances of it’s circumstance. Some propounded theories about the circumstances of reflexology’s function consist of: Theory of gate control of pain. Theory of nerve impulse, increase of endorphin and enkephalin discharge and the improvement of Lymphatic flow and immunity system, the improvement of nerve current and blood circulation as the result of pain control and excretion of poisons from body as the result of improvement of blood flow. Current knowledge shows that, the effectiveness of treatment of reflexology may be explained in some scientific contexts such as vasodilatation of peripheral vessels in order to remove local toxin accumulation and reduce pain sense which is related to neural pathways in theory of gate control of pain. Gate theory states that, pain impulse can be inhibited in spinal cord by inhibitor signals which comes from touching nerve fibers. Tiran and Mack state that, complementary medicines such as acupuncture, massage, reflexology and Aromatherapy that cause relaxation and sleep stimulation, increase the discharge of endorphin. Reflexology has anti-inflammatory and anti- spasmodic effects. It is also stimulant of blood circulation. Reflexology balances blood 145 ISSN 1661-464X
  7. 7. Archives Des Sciences Vol 65, No. 11;Nov 2012 pressure, slows breathing and makes it to be deep, regulates the function of hormones, excretes the poisons from body, and relieves pain through muscle relaxation. As we know, blood stasis and imbalance of the hormones are of propounded etiologies of premenstrual syndrome (PMS). Therefore, the reduction of physical symptoms such as flatulence, headache, breasts pain and heart palpitation is justifiable by using of reflexology. Reflexology stimulates central nervous system and increases temperament. It causes deep relaxation and reduces stress. Thus the reduction of symptoms PMS, particularly mental symptoms is justifiable. Our study like the results of Ernest’s et al studies showed that, foot reflexology doesn’t have any side effect. In the other words, reflexology is effective in treatment of PMS without special side effect. Thus considering this strength of the research and also prospective control of symptoms record for 2 months, the results of this research is reliable. Conclusion: This study which was carried out for the first time in Iran, showed that foot reflexology is effective and useful in reduction of the average of PMS symptoms. Also, it has not had any notable side effect. Therefore, it is recommended that, foot reflexology be used in treatment of PMS. This method is simple and doesn’t need specialists for caring out. It is possible to learn the method of pressure exertion on mentioned areas by using of a few training sessions effectively. The turning point of this method is that, no tools are needed to reduce PMS symptoms and it is possible to reduce the severity of mental physical symptoms of PMS only with fingers of hand. Also, it is possible to include this method in education program of midwifery students and teach it to clients and the women with PMS symptoms. Acknowledgment: This research is the result of thesis of master midwifery (MSC in midwifery), international branch of Shahid Beheshti university of medical science. The honorable director and research assistant of that university and also international branch and officials of nursing of university and midwifery faculty and honorable director and student assistant of Jahrom university who cooperated in caring out this research and also all of the students who cooperated in this project are hereby thanked. References: 1-Bakhshani N, Hasanzade Z, Raghibi M (2011). Prevalance of premenstrual symptoms and premenstrual dysphoric disorder among adolescents students of zahedan. Zahedan J Res Med Sci (ZJRMS). 13(7): 29-34. 2-Gehlert s, Song I.H, Chang C-H, Hartlage S.A (2009). The Prevalence of premenstrual dysphoric in a randomly selected group of urban and rural women. Pychological Medicine 39: 129-136. 3-Pourmohsen M, Zoneamat Kermani A, Taavoni S and Hosseini AF (2010). Effect of combined calcium and vitamin E consumption on premenstrual syndrome. Iran Journal of Nursing (IJN). 23(65): 8-14. 4-Speroff L, Fritz MA (2011). Clinical Gynecology Endocrinology and Infertility. 8th ed. Philadelphia: Lippincott Williams & Wilkins. 531-546. 5-Berek J S (2007). Novak s Gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins. 6-Braverman P K (2007). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. J Pediatr Adolesc Gynecol 20: 3-12. 146 ISSN 1661-464X
  8. 8. Archives Des Sciences Vol 65, No. 11;Nov 2012 7-Kim S-Y, Park H-J, Lee H (2011). Acupuncture for premenstrual syndrome: a systematic review and meta-analysis of randomized controlled trials. BJOG: An International Journal of Obstetrics & Gynecology. 118(8): 899-915. 8-Kashani L, Saedi N, Akhondzadeh Sh (2010). Femicomfort in the Treatment of Premenstrual Syndrome: A Double-Blind, Randomized and Placebo Controlled Trial. Iranian J Psychiatry. 5(2): 47-50. 9-Baker FC,Colarian IM, Trinder J (2008). Reduced parasympathic activity during in the symptomatic phase of sever premenstrual syndrome. J Psychosom Res. 65(1): 13-22. 10-Ernest E, Posadzki P, Lee M.S (2011). Reflexology: An update of a systematic review of randomized clinical trials. Maturitas. February 2011, 68(2): 116-120. 11-Kim D R, Freeman E W (2010). Premenstrual Dysphoric Disorder and Psychiatric Comorbidity Diagnostic Dilemmas-Effective Treatment Approaches. Psychiatric Times. 43: 1-5. 12-Ozgoli G, Shahveh M, Esmaielli S, Nassiri N (2011). Essential oil of citrus sinesis for the treatment of premenstrual syndrome; a randomized double-blind placebo-controlled trial. J Reprod Infertil. 12(2): 174. 13-Ozgoli G, Selselei E, Alavi Majd H (2010). Severity of Premenstrual Syndrome(PMS) and its related factors in students of shahid beheshti university of medical sciences. Journal of Nursing and Midwifery. 20(68). 14-Dolatian M, Hasanpour Z, Montazeri Sh, Heshmat R, Alavi Majd H (2011). The Effect of Reflexology on Pain Intensity and Duration of Labor on Primiparas. Iranian Red Crescent Medical Journal. 13(7): 475-479. 15-Ernst E, Pittler M H., Wider B. “The Desktop Guide to Complementary and Alternative Medicine An evidence-based approach”.Second Edition. MOSBY Elsivier. 2009: 250-257. 16-Ernst E (2009). Is Reflexology an Effective Intervention? A systematic review of randomized controlled trials. MJA: The Medical Journal of Australia. 191(5): 263-266. 17-Tiran D, Chummun H (2005). The physiological basis of reflexology and its use as a potential diagnosis tool. Complementary Therapies in Clinical Practice. 11(4): 58-64. 18-Asltoghiri M, Ghodsi Z (2011). The effect of reflexology on sleep disorder in menopausal women. Procedia-Social and Behavioral Sciences. 31(2012): 242-246. 19-Soo Hyun Jang, Kye Ha Kim(2009). Effects of Self-Foot Reflexology on Stress, Fatigue and Blood Circulation in Premenopausal Middle-Aged Women. Journal Korean Academic Nursing. 39(5): 662-672. 20-Mokhtari Noori J, Sirati Nir M, Sadeghi Shermeh M, Ghanbari Z, Haji Amini Z, Tayyebi A, Javadinasab M (2009). Effect of foot reflexology massage and Benson relaxation on anxiety. Journal of Behavioral Sciences. 3(2): 159-165. 21- Mollart L(2008). Women s Cycle & Reflexology. Canadian Journal of Reflexology 2(5): 1-12. 22.Murakami K, Ssaki S, Takahashi Y,Uenish K, Watanabe T, Kohri T (2008). Dietary glycemic index is associated with decreased premenstrual symptoms in young Japanese women. Nutrition. 24(6): 554-61. 147 ISSN 1661-464X
  9. 9. Archives Des Sciences Vol 65, No. 11;Nov 2012 23-Oleson T, Flocco W(1993). Randomised Controlled Study of Pre-menstrual Symptoms Treated With Ear, Hand and Foot Reflexology. American Journal of Obstetrics and Gynecology 82(6): 906-911. 24-Kreydin A (2008). Reflexology for PMS, Natural relief for monthly premenstrual syndrome. PubMed: ID 18395582. APR 2008. [Online]. <http://www.suite 101.com/content/reflexology-for-pms.html > Table 1- The comparison of the average of general (overall) severity of the symptoms of premenstrual syndrome before and after treatment in students of the dormitories of Jahrom university in 2011. reflexology group Control group Result of test Treatment Average of score + average of score + (Mann- stage standard deviation standard deviation Whitney) Before 33.02 ± 27.34 33.40 ± 27.54 NS treatment After treatment 9.63 ± 10.46 43.08 ± 29.19 P<0.0001 The average of reduction of general severity 23.39 ± 19.77 -9.68 ± 14.33 P<0.023 of the symptoms after treatment Intra – group difference P<0.0001 P<0.0001 (Wilcoxon test) The average general severity of the symptoms of premenstrual syndrome has been reduced in reflexology group after treatment. 148 ISSN 1661-464X
  10. 10. Archives Des Sciences Vol 65, No. 11;Nov 2012 Table 2- The comparison of the average of physical symptoms severity of premenstrual syndrome before and after treatment in students of the dormitories of Jahrom university in 2011. Control group Result of reflexology group average of score + test Treatment stage Average of score + standard (Mann- standard deviation deviation Whitney) Before treatment 34.19 ± 30.72 35.27 ± 30.98 NS After treatment 14.85 ± 16.83 44.40 ± 28.76 P<0.0001 The average of reduction of physical symptoms 19.34 ± 20.73 -9.13 ± 11.49 P<0.0001 severity after treatment Intra – group difference P<0.0001 P<0.0001 (Wilcoxon test) Table 3- The comparison of the average of mental symptoms severity of premenstrual syndrome before and after treatment in students of the dormitories of Jahrom university in 2011. Control group reflexology group Result of test average of score + Treatment stage Average of score + (Mann- standard standard deviation Whitney) deviation Before treatment 32.52 ± 28.02 32.59 ± 28.07 NS After treatment 7.40 ± 8.63 42.51 ± 31.94 P<0.0001 The average of reduction of mental symptoms 25.12 ± 21.50 -9.91 ± 17.46 P<0.0001 severity after treatment Intra – group difference P<0.0001 P<0.0001 (Wilcoxon test) 149 ISSN 1661-464X

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